Steamboat Pilot & Today

An article in the April 23rd issue of the Steamboat Today reported that the Steamboat Medical Group will soon "pull out of its partnership with the South Routt Medical Center." SMG has been providing clinical coverage and a receptionist through an informal agreement that has allowed them to use the building in exchange for part-time staffing of the clinic.

The chairperson of the board for the South Routt Medical Center gamely proclaimed that they are "seeking another partner" and that they are not closing the doors. Residents of South Routt County who are concerned about local medical care should take note.

For years, SRMC has been a tenuous entity, providing clinical services only a few hours a week, supported by a limited range of diagnostic technology. It has been able to do this in recent years only by the extraordinary support of SMG, which has agreed to put a clinician there with no financial support from the board, and has almost certainly subsidized the service. The board of SRMC has not had a formal agreement or a contract with SMG to define the parameters of the relationship, a degree of informality that is both unbusinesslike and irresponsible.

This kind of relationship has ensured that the SRMC Board had no control over the range and nature of services or been unable to provide the type of accountability that is typical in these kinds of organization-provider relationships.

This lack of a business orientation is noteworthy because it is symptomatic of much deeper problems with the performance of the board of SRMC. For years, the board has seen its role as primarily one of caring for the clinic building rather than sponsoring a true medical clinic. This has meant that SRMC has been dependent on whatever it could find from clinicians willing to use the space.

Further, this has resulted in a clinic open very part-time and unable to be a full-service clinic for people seeking care (limited diagnostic lab tests, no x-ray services, etc.). Consequently, most people in South Routt have gone elsewhere for medical care.

Because of my national work with rural health services, I was asked more than a year ago to join the board. There is an extensive body of experience that has shown that for rural ambulatory clinics to meet the needs of the public and to survive financially, they need to provide access to care full-time, they need to have a full range of diagnostic and treatment services, and the quality of care needs to be good.

Further, as in "Field of Dreams," if you build it, they will come. But first you have to step up to being a full-service, every-day clinic so people know you're there when they need you.

The SRMC Board has not stepped up. What has been needed is bold leadership to get a critical mass of services going, either through hiring a full-time clinician or contracting with an existing local medical group to provide it. But that also would require going out to raise the funds to carry the financial responsibility until the utilization increased so it will break even.

You can't do that simply by managing the building. It requires strong leadership and vision and informed steps that honor the established principles that have ensured the survival of small rural health facilities. It also requires being honest about how fragile, how tenuous, the situation with the SRMC has been for years, and how poorly it has met the needs of South Routt residents.

When the board decided last November to continue its approach and to take a "less aggressive and more conservative way of letting the clinic build slowly" (personal letter from Chairwoman Linda Long), I chose not to continue as a board member.

If the people of South Routt wish to salvage a local medical clinic, new leadership must emerge. Clinics nationally that have chosen the SRMC path typically have closed. The choice is up to the community.

Bruce Amundson

Oak Creek