Report: St. Michael lacks charity cases

They say charity begins at home, but that’s not the case for St. Michael Medical Center in Silverdale.

A report shows nonprofits like St. Michael should be giving almost 6% of what they make for charity health cases. Instead, it’s less than 1%.

During public comments, five people criticized the report. One compared it to the “Salem witch trials,” while St. Michael president Chad Melton said “misinformation” could be detrimental to people’s health, thinking they can’t get proper care locally. Doug Baxter Jenkins of Virginia Mason Franciscan Health even questioned the accuracy of the charity numbers.

The report was done by the John Hopkin’s Center for Health Security. It was presented to the Kitsap Public Health District March 5 by Sanjana Ravi, Tener Veenema and Diane Meyer of the center.

Veenema said tax-exempt hospitals give 5.9% to charity cases. But St. Michael made $451 million and gave $15 million to charity cases, which is less than 1%. She said while there are no federal or state requirements, that amount is “exceptionally low. It should significantly increase charity,” she said.

The report also says St. Michael is rated 60th out of 69 hospitals in the state. Veenema added that St. Michael has already taken steps to make improvements after consultation with the center.

The report was criticized by some during public comments at the start of the meeting, and Veenema and KPHD health officer Dr. Gib Morrow addressed that.

“I understand it’s uncomfortable,” Morrow said, but since the report he has seen “positive momentum” and an “incredible response” by St. Michael to step in and address some of the issues.

Veenema said rather than being defensive she hopes the community sees the report as an opportunity for targeted improvement. “It hasn’t been well-received, and I respect their feelings,” she said. “But I hope they see these as a springboard to moving forward.”

One of the key findings in the report says that many residents have reservations about St. Michael due to its religious affiliation, challenges accessing financial assistance, reports of poor patient experiences, diminished workforce morale and perceived monopolistic tendencies.

Other key findings in the report include: The county does not have sufficient workforce to meet community needs; health insurance reimbursement rates have resulted in critical gaps in care; new technology could bridge gaps in overburdened system; and underserved, senior and minority populations face barriers to access and quality.

Meyer said the COVID pandemic exposed problems in health care that already existed, such as workforce shortages, facility closures and inequities in care. Veenema said the goal of the 85-page report is to point out deficiencies to help systems grow stronger. She said consolidations are a major problem nationwide, as there has been a loss of 1,000 hospitals. She said expansion of Catholic facilities is creating monopolies, as 40% of the hospital beds in the state are of that religious affiliation.

During public comments, Melton said it was discouraging to read the report because so much has been done to improve care there. He said health care is an absolute priority, and he will continue to collaborate with others to provide outcomes everyone deserves.

Baxter-Jenkins said he would like to have an honest conversation with those who did the report because St. Michael does much more than it was given credit for in work that benefits the community. He said it was more like $36 million, not just $2.5 million.

Dr. Melissa Lowe said it’s false to say patients can’t get some reproductive care at St. Michael because of its Catholic affiliation. Legal procedures such as sterilizations are done there, and abortions have never been provided there.

Rosalie Apalisok, a nurse at St. Michael, said the report neglected to mention all the programs going on to bring more nurses to the hospital.

“Let us all be judged by our worst moments,” said Jennifer Corgis, who emphasized she has no connection to St. Michael, other than having been a patient. She said things that happened 10 years ago were getting “thrown in our faces.” She called on the KPHD board to “reject this report in its entirety.”

Study recommendations

•Mental and behavioral health: Access to resources to make emotional, psychological and social well-being.•Primary healthcare: Access, within the county, care that connects them to disease prevention, treatment, rehabilitation and palliative care services.

•Equity: Equal opportunity to high-level health, irrespective of age, gender, race, sexual orientation, religious beliefs, employment or income level.

•Housing: Access to safe, healthy, dignified and affordable shelter.

•Reproductive health: Resources for obstetric and gynecological health, family planning and maternal health.

Additional recommendations

Recruit new healthcare providers for mental and behavioral health, primary care and reproductive health.

KPHD should help county avoid redundancies and increase success rates in securing grants.

Recruit primary care nurses, midwives and mental health nurse practitioners.

County leaders explore forming public hospital district.

St. Michael increase spending on community investments 1% per year for five years to justify status as nonprofit.

St. Michael should clarify its status as a Catholic-affiliated hospital.

Lobby Defense Health Agency to reopen labor and delivery services at Naval Hospital Bremerton.

Increase public transit routes that connect to healthcare facilities.

Evaluate Comprehensive Emergency Management Plan.

Develop long-term strategy and legislation to improve behavioral healthcare access.

KPHD should resume providing infectious disease testing services and make needle exchange programs more accessible.

Healthcare providers should integrate hospital-at-home services.

Petition state lawmakers to increase Medicaid reimbursement rates.

Morrow’s report

Morrow said people over 65 should get a second COVID shot this spring, but in general respiratory illnesses are on the decline, and Center for Disease Control guidelines are being scaled back. People can return to their normal lives once symptoms have improved for 24 hours. He said the new reality reflects that 98% of people have developed immunity to it.

He said 16 states have 40-plus cases of measles, including Washington. Morrow said up to 40% of cases are hospitalized, and the patients are overwhelmingly unvaccinated. He said it’s highly contagious as the germs get airborne and can infect anyone who comes into the room any time that same day.

Regarding the opioid epidemic, Morrow said overdoses have tripled in the past three years in emergency medical services responses. Kitsap is below the state average, but it’s still a steep climb here. Bremerton and South Kitsap have the highest number, but per capita, North Kitsap is actually worse, he said. “No section is not affected by this issue,” he said, adding medications work and are safe, and the legislature is working to fund treatment, prevention and response.

Finally, Morrow talked about firearm safety. He said the death rate in Kitsap has been stable for about 14 years and is lower than most of the state. Deaths by firearms are overwhelming suicides. He urges gun owners to keep their weapons locked up and unloaded as many suicides are “compulsive events.”