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Having been the only physician who has worked in the South Routt Medical Center in Oak Creek during the past 12 years, I think I have some valuable perspective on the "current" crisis.

First of all, the crisis is not current. The problems faced by the South Routt Medical Center Board and the Yampa Valley Medical Associates at this time are just sequels in a recurring story. The clinic was built and equipped with a grant and bake sale funds in the early 1960s, but unfortunately, there was never an endowment set up, or a continued-funding mechanism established to maintain the building, upgrade equipment and support administrative costs. Most of the infrastructure equipment has been replaced through small grants, good will or no longer works. The X-ray equipment was shut down during the early years of my tenure and has not been upgraded or fixed.

In the '80s, the clinic had the unfortunate experience of hiring a doctor with some problems. In 1987-88, after pleading guilty to embezzlement, theft, drug use and fraud, his employment at South Routt ended, and the clinic closed for a time.

A young physician worked in the clinic for a few years and then moved on for some additional training, which, once again, left the clinic empty. I think that the first medical group/doctor who provided administrative services and medical care at the SRMC was Mountain Medical Associates and Dr. McCauley. This lasted from about 1990 to 1992, at which time, MMA decided that the financial loss was not acceptable and moved on. Next, Steamboat Medical and Dr. Smilkstein began serving the medical center. Steamboat Medical provided staff, materials, supplies and administrative services, and I provided the medical care, along with a physician assistant. At no time was SMG making money, but they were willing to provide the service at what amounted to a break-even level.

At the end of 1994, because of a changing medical environment and increased financial stresses, leaving Oak Creek became part of a reorganization strategy for SMG. South Routt Medical Center again was faced with closing its doors and looked for one more good Samaritan. This time, Yampa Valley Medical Associates stepped up, which brings us to the crisis. During the past eight months, YVMC has absorbed a small loss each month, and in spite of trying to improve overall business and collections, it has made little progress.

I stayed on because I enjoyed taking care of the people of South Routt, I had been there for more than 12 years, and my wife (who came out of retirement) was willing to work for the past eight months for free. Well, not exactly free because a nurse is an expense, and her volunteerism reduced the overhead. She was forced to re-retire recently, and the clinic and myself were faced with an added $800 per month expense on top of an ongoing loss.

A financial adviser I once knew had a saying that people don't plan to fail, they fail to plan. The Oak Creek Board is a good example of this adage. For as long as I have been involved with the clinic, the board has been made up of hard-working, good-hearted people who had neither the training, skills nor desire to run a medical clinic. They also failed to understand this or seek out the help they needed to overcome the shortfalls. During this entire current crisis, I initiated communications with the president of the board on several occasions, but even as the senior medical provider for more than a decade, I was never formally asked to meet with the board to discuss what solutions I thought were needed or appropriate.

In the end, I decide that the only way the board and the town of Oak Creek would move forward on this is if a crisis was introduced, so I quit. This was not done with any anger or hurt feelings. I still very much like and respect the South Routt Board members I know and sincerely hope that the outcome of all this will be a secure free-standing clinic that serves the people of South Routt long into the future. It is clear that the crisis already has accomplished something positive. The South Routt Medical Center Board is being reorganized, the town of Oak Creek has voted to relieve the clinic of monthly utility costs, the town is considering a tax to support the clinic long term, and the Board is actively seeking out grants to upgrade the facility.

Considering the future of the Medical Center, it's not quite time to wear shades, but a little tint on the glasses is in order.

Daniel Smilkstein, MD