At their last meeting, the Kitsap Public Health District went over a report by John Hopkins that was very critical of health care in Kitsap County.

Six board members talked about the report at their meeting April 2.

Board member Drayton Jackson said St. Michael Medical Center’s response showed many of the criticisms brought up in the report are already being worked on. St. Michael’s clarifying response says the “missing pieces the report showed…We’re doing that good work already.” Board member Stephen Kutz said St. Michael’s addendum shows it’s already “closed some of the gaps.” He said private and public healthcare providers need to come up with the answers together. “It boggles my mind all of the things going on.”

Board member Becky Erickson called the report “a tool. It’s exactly what we wanted it to be.” She said it gives them a list of things to work on. “We’re good at creating policy, but not implementing it.” Board member Ashley Mathews said she sees the report as opportunities. “We can work on many of the things in the report,” she said, specifically mentioning more charity work.

Board member Michael Watson said he felt the public chastised the board for accepting the report. But he said it’s all community action that will move the process along. “The board has little to do with the recommendations within the report.” Board member Greg Wheeler said he’s interested in checking out one of the Hopkins recommendations—forming a public hospital district—but he needs to know more about it.

Hospital response

Presentations were then given to the board from some of the areas that were criticized.

Chad Melton, chief executive officer of St. Michael, said he doesn’t take offense to the Hopkins report; he just wants it to be factual. For example, the hospital is more involved in the community than it was 2 1/2 years ago when he took over. He said the hospital benefitted the community by $54.6 million, which is more than what the state and nation ask for.

Melton said the hospital plays an important role in the county’s economy. It is its largest private employer with 2,500 workers and an annual payroll of $252 million. He said the Emergency Department has 80,000 visits a year, the most in the state. And it loses money as Medicare only pays 75% of the actual cost and Apple Health pays just 48%. He said they have $37.5 million in uncompensated care.

There is lower staff turnover, better ratings from patients and 96% retention in nurses the past year. In the past 10 years, the hospital has brought 200 doctors to the county. A $105 million tower with 74 acute beds is expected to be done in fall of 2025, which should ease some pressure in the ED, Melton said. The hospital has 336 beds total, and takes 1,300 transfers from other parts of the state, so it doesn’t serve just local patients.

Health care will need more staffing with the aging population. “Later in life we all need additional services,” he said.

Mental health

Monica Bernhard, CEO of Kitsap Mental Health Services, said it serves moderate to severe clients 24/7 in Kitsap, ranging from 39% of its clients in Bremerton to 2% on Bainbridge Island. She said her agency increased staff 29% in the last three years, but they are still often criticized for not having enough help. She said public health is a training ground for many so there are lots of vacancies. Employees open their own clinic or change to private practice. But retention is improving with 69% last year compared with 91% this year.

Bernhard also said they are criticized for lack of diversity, but they are more diverse than the general population, which is 82% white in Kitsap. For example, there are 9% black clients and 9% black staff, but the general population is 3% black. ”We make efforts to make sure that happens,” she said of diversity. Bernhard said they are historically underfunded so they rely a lot on volunteers. “Early intervention is critical” as mental health issues increase over time.

Erickson, who is Poulsbo’s mayor, said, “We have a severe mental health problem on our streets. People are in crisis. Police try to handle it,” but it really should not be up to them. Kitsap Mental Health needs to respond when called, she said.

Kutz said Medicare and insurance companies need to be part of the discussion. “They need to be here,” he said, adding mental health agencies need responsible funding. “But mental health is not on the table.”

Nonprofit input

Bonnie Obremski of Olympic Community of Health said goals of the nonprofit include improving experience and outcomes, reducing costs and preserving emergency services. Its job is to connect the community to care. Other goals are to reduce the stigma of substance use disorder, form strategies from data and to meet people where they are.

Obremski gave the example of a Port Angeles woman who prior to intervention made 23 visits to the ED costing $17,250. Afterward, there was one visit costing $750. She had another slide in her presentation about the Poulsbo Fire CARES program. It serves people facing behavioral health issues and chronic medical conditions. It says 257 people were assisted in the first half of this year, and 88 were connected to care. Also, 74 people avoided 9-1-1 calls because of on-scene activity/home visits. Obremski said next step is to encourage elected officials to support more funding.

Wheeler said too many people are falling through the cracks. “First responders like police and fire face a tremendous challenge,” he said, adding if they are the only help “the mental health system is failing.”

Health officer

Dr. Gib Morrow, KPHD health officer, shared some goals for 2024-28.

He said Kitsap needs to improve access to health care and recruit and retain its workforce. He said it needs to expand care for substance use disorders, along with mental and behavioral health. Morrow said KPHD can’t do it alone. “We are all public health…It’s all of society,” not one agency, he said. To improve there needs to be collaboration and partnerships. Decisions need to be data-driven and flexible for maximum funding. Health equity and the trust that goes with it also are key. “We have a long way to go, but there is progress.”

One area of importance is the number of ED visits is going down, although it’s still worse than the state and neighboring counties. “It’s the most expensive place to receive care,” he said of the ED, but it’s the place where people go “when there are no other options.” He said programs that are helping people before they go to the hospital are working. By catching problems earlier, it keeps it “from getting out of control. Case management is so important,” he said, adding some people go to the ED monthly, weekly and even daily, while “a lot of people never go to the ED.”