Below is information regarding Public Hospital District issues that have been discussed in the media, or that may have come up in conversations with colleagues, family or friends.

What is the issue between the hospital districts?
The upcoming merger of Skagit Valley Hospital and Skagit Valley Medical Center will result in more than 100 healthcare providers becoming employees of Skagit Valley Hospital beginning in July. Because some of those providers are located in our hospital district (Public Hospital District 304), this would place at least one clinic owned by Skagit Valley Hospital (Public Hospital District 1) in United General Hospital's service area, and could potentially lead to others being established here.

Who is affected?
The merger affects some of the physicians located in The Pavilion at United, if they choose to become Skagit Valley Hospital employees. This includes four Internal Medicine physicians: Dr. Peggy Bissell, Dr. Mary Ann Hink, Dr. T.W. Martin, and Dr. Rico Romano; and two General Surgeons: Dr. Mike Erie and Dr. Karen Hunter. The pharmacy and optometry businesses located in The Pavilion at United would also change hands and become part of Skagit Valley Hospital.

This does not affect Physicians Care Family Medicine, located on the first floor in The Pavilion at United. Those physicians are in private practice, including Dr. Jonathan Fish, Dr. Edwin Stickle and Dr. Vanoy Smith.

Is it legal for Skagit Valley Hospital to locate their services here?
Not without the permission of District 304, United General Hospital. The state’s hospital districts were formed to prevent one district from encroaching on another’s primary service area. The intent is to protect taxpayers from supporting more than one district.

Here is an excerpt from the Association of Washington Public Hospital Districts’ Legal Guide. "If the district does not obtain the consent of another district, then, according to case law and a Washington State Attorney General Opinion, an extraterritorial operation within the boundaries of another district may be viewed as an invasion of that district and not authorized under RCW 70.44 or any other statute."

Did Skagit Valley Hospital ask permission?
In October 2009, Skagit Valley Hospital and Skagit Valley Medical Center made a presentation to United General Hospital’s administration, requesting that they be allowed to keep the physicians and clinic located on our campus. However, according to the Memorandum of Understanding they presented, if the clinic did not “achieve an economic break-even or better basis,” United General Hospital would be required to subsidize the operation of the clinic.  The request also asked for the right to operate District 1 services in Sedro-Woolley and Burlington.

In February 2010, Skagit Valley Hospital and Skagit Valley Medical Center made a presentation to District 304 Commissioners, again indicating their desire to keep the clinic and its employees located on the United General Hospital campus.

What was the response from District 304/United General Hospital?
After almost 8 months of workshops, discussions and deliberations, including input from administrators, physicians and key personnel, the District 304 Commissioners decided to deny Skagit Valley Hospital’s request to keep the clinic on our campus or provide services elsewhere in District 304.

What is the rationale for that decision?
A number of factors played into the decision: (1) If the proposal from Skagit Valley Hospital had been accepted, United General Hospital would have been required to pay for any financial losses the Skagit Valley Hospital clinic sustained; (2) The clinic in question is already decreasing their referrals of patients to United General Hospital. Once it becomes a Skagit Valley Hospital-owned clinic, that trend would most likely become exacerbated; (3) Allowing Skagit Valley Hospital to provide services in our area would eventually erode the services we have worked to implement over the last six years, including surgery, lab and diagnostic imaging; (4) Prior attempts at joint ventures, and collaborations with Skagit Valley Hospital -- including a difficult 12-year affiliation -- were unsuccessful. Based on those experiences, we believe that while our organizations share a mission to care for our communities, and both offer excellent healthcare services, we are on very different paths, with conflicting goals and objectives. We stand firm in our desire to operate independently, collaborating only with organizations who share our vision.

What is the downside of this decision?
Unfortunately, the physicians who choose to work for Skagit Valley Hospital will no longer be providing services in our community or on our campus.  As their clinic relocates, this will result in at least a temporary inconvenience to patients who want to continue receiving services from them.

We have the utmost respect for physicians, especially those we have worked alongside for years. We will be sorry to see them go and will do everything we can to help make the transition a smooth one for them and their patients.


Couldn’t those physicians be employed by United General?
Yes, and the employment opportunity was extended to them. We even offered to cover any penalty included in their contract with Skagit Valley Hospital for breaching the non-compete clause. The offer will remain open; we are fully prepared to employ them should they change their mind.


When will these six physicians be relocating?
The details of their relocation have not been worked out. Our intent is to do what we can to minimize disruption in patient care.

What will happen to the space that clinic currently occupies?
The Pavilion at United is a “condo” style building: District 304 owns the land, the space inside was purchased by Skagit Valley Medical Center (all of the second floor and the first floor pharmacy and optometry) and Physicians Care Family Medicine (first floor). Skagit Valley Medical Center cannot sell or lease their space without giving us the first right of refusal, but the space may be purchased by anyone who meets our approval.

How can United endure the loss of six physicians? 

While we don’t like losing any providers, there are a number of other excellent physicians in our community. And because we have been aware for some time that we needed more doctors in our district, we had already been working on new collaborative efforts with other organizations, namely PeaceHealth St. Joseph Medical Center in Bellingham. Those negotiations began more than 18 months ago, before we were aware of the merger between Skagit Valley Hospital and Skagit Valley Medical Center.

Why did United begin collaborating with PeaceHealth instead of Skagit Valley Hospital?
United has had need for specialty physicians since the disaffiliation from Skagit Valley Hospital in 2004, including Orthopedic Surgery, General Surgery, Cardiology, Gastrointerology, and Pulmonology.  For the past 5 years, United has sought the services of specialists in Mount Vernon, but to no avail. Recruiting these physicians from around the country is very difficult for a small organization like United, so turning to a larger organization was the logical solution. PeaceHealth St. Joseph Medical Center is very successful at recruiting specialists, and they responded quickly and positively to our needs.

What’s the difference between bringing in PeaceHealth and allowing Skagit Valley Hospital to have a clinic on United’s campus?

The collaboration with PeaceHealth St. Joseph Medical Center makes sense because our organizations both place high value on trust, respect and compassion. We both focus on quality and safety, with each organization receiving high marks in quality measures. Most importantly, PeaceHealth is dedicated to helping United General remain viable and to providing services locally. Rather than competing with our services, PeaceHealth is only here to complement them.

Did PeaceHealth need permission to have a clinic in Sedro-Woolley?
No, because PeaceHealth is a private non-profit organization, not a public hospital district.

Does that mean patients will be transferred to Bellingham?
Patients of PeaceHealth physicians will be treated in Sedro-Woolley, unless they need care that cannot be provided here. In that case, patients will be referred or transferred to a facility that provides the service they need.

Don’t patients always have the choice of where they receive hospital services?
Yes, patients have a choice where they receive their healthcare services. When a physician says you need a diagnostic test, lab test, physical therapy, etc., you are free to acquire those services wherever you wish, just as you can fill a prescription at the pharmacy of your choice.

How will our partnership with PeaceHealth affect United General’s policies on abortion and assisted suicide, given that PeaceHealth is a Catholic organization?
There will be no change in United General’s policies. As a public hospital, our policies are not based on any religious belief.

Is PeaceHealth preparing to buy United General?
No, they are only collaborating with us. Public Hospital District 304 is not for sale. To make that kind of change would require a public vote.

Other questions? Comments or suggestions? We welcome your feedback. Please send a message, or call Administration at  (360) 856-7112.