By Melinda Munson

April 18 is tax deadline, Skagway’s first ship day with an estimated 4,000 passengers — and the date the town votes in a special election for two clinic ballot questions.

The first question will read:

“The E.A. & Jenny Rasmuson Community Health Center building and the Dahl Memorial Clinic business shall not be leased or sold without ratification by public vote.”

This question was put on the ballot via an initiative petition, thus the language had to remain untouched. Voting “for” the ballot question will require voter approval on any sale or lease of the clinic/building. Voting “against” the measure means the Skagway Borough Assembly could vote to lease the clinic/building. 

Currently, the assembly has the authority to lease the clinic building at below market value without voter approval, according to Municipal Code 16.04.070.

The second question reads:

“Shall the Municipality of Skagway lease the E.A. & Jenny Rasmuson Community Health Center building and land for $1.00 to SEARHC and sell the Dahl Memorial Clinic business and assets for $1.00 to SEARHC?”

(For or Against)

Originally, talks with Southeast Alaska Regional Health Consortium (SEARHC) centered around purchasing the clinic. That changed to a lease of the clinic and its equipment, with the sale of the clinic business. 

The second question is an advisory question.

“It says what the community wants to do,” said Mayor Andrew Cremata. “The assembly is looking for a clear direction. Is​​ this someth​​​​ing we should pursue or should we scrap the whole thing and say we’re running a clinic?”

If the draft SEARHC Management Contract (July 28, 2022) is approved by the assembly as currently written, SEARHC would “acquire ownership and assume responsibility for the day-to-day operations of the clinic” with an anticipated purchase price of $1. The clinic building could be leased for 25 years at $1 per year. 

SEARHC would be required to keep all current clinic employees, “subject to SEARHC’s routine background check screening standards and procedures.” According to the discussion draft, “SEARHC will commit to continuing all current services offered by the clinic,” with eventual expansion of specifically named services such as dental and mental health.

Discussions first began with SEARHC around the summer of 2021. Dahl Memorial Clinic had lost 75% of its staff, struggled with what ex-employees described as a “toxic environment” and had complaints from patients ranging from breaches of privacy to inadequate medical care.

“They’d [SEARHC] always expressed interest,” said Borough Manager Brad Ryan. He invited them to give a presentation. According to Ryan, he never reached out to other companies about the lease of the clinic and no other parties have expressed interest.

In preparation for the April 18 vote, The Skagway News held a clinic forum

April 12 which can be viewed on The Skagway News Facebook page. The mood was tense as the audience grilled Heidi Aylsworth, SEARHC chief strategy and business development officer. At least one citizen stormed out of AB Hall during the forum.

Tim Cochran asked why SEARHC, which he stated reported $209 million total revenue for 2019, should get a $1 lease of the clinic building.

“Because it cost the municipality to run what I believe to not be sufficient health care,” answered Assembly Orion Hanson. “And while you say it would be for $1, it’s not for $1. It’s actually a negative balance to run the clinic … So I think the question is, at what cost do we continue to pay, and then that increases and continues to increase… And are we getting the kind of service that we expect from that? And while SEARHC makes profit, most private healthcare or nonprofit healthcare do.”

When asked by The Skagway News if the town has the resources to fill and run a nine member board, Dahl Memorial Clinic Board of Directors President Jeremy Simmons addressed what he felt were misconceptions.

“The clinic board isn’t responsible for the governance of the clinic,” he explained. They advise “the management of the clinic as to what sort of services are necessary for the community and act as a way for the community to address the clinic to whatever needs they might have.” 

“I absolutely think that everybody in this community has the skill and expertise to serve in that advisory and guidance capacity of this board and I would welcome even more people to come out to do that,” he said. 

Barb Broderson expressed concern that non-Alaska Natives would have less access to medication and doctors within the SEARHC system. Established in 1975, SEARHC, a non-profit, is one of the oldest and largest Native-run health organizations in the nation.

“SEARHC is committed to taking care of the communities we serve –  “every resident of every community that SEARHC is in,” Alysworth said. “I’m saying very clearly that SEARHC takes care of everyone who seeks care at our facilities, in each environment.”

Skagway resident Brooke Sturgis quoted the cost of getting a standard annual blood test for an uninsured patient who doesn’t qualify for the sliding scale fee, which she cited as about $500 more expensive with SEARHC than Dahl.

According to Alysworth, approximately 18 months ago, her team made a price comparison between Dahl and SEARHC for the top 10 reasons people “come to the clinic.” 

“They were very comparable,” she said. The cost of SEARHC services is consistent throughout the state, meaning a prescription of amoxicillin in the Haines SEARHC clinic costs the same as the Wrangell SEARHC clinic.

As voting draws closer, clinic finances are a point of much discussion. In general, the Municipality of Skagway (MOS) now expects to fund Dahl Memorial by approximately $1 million each year. According to the municipality, in 2022 the clinic made $854,367 in revenue, collected $1,444,275 in a Health Resources and Services Administration grant (HRSA) and received $45,277 in other grants. The MOS contributed $968,871 in American Rescue Plan Act funds (ARPA), which replaced traditional sales tax due to COVID-19 and the loss of cruise ship passenger spending.

The COVID-19 years were anomalies with Dahl receiving extra grants, for example 2021, where the clinic drew only $82,843 from an anticipated muni budget of $774,277.

In 2019, the last pre-pandemic year, the clinic was allotted $697,478 in municipal funds and spent $697,498.  

The 2023 budget sets aside $947,025 for the clinic.

For some people like former clinic board member Nicole Goodman, a clinic funded in part by the municipality makes sense.

“The utilization of Dahl Memorial Clinic is one of the top benefits for me personally, as a tax paying resident,” she said. “Each resident may not directly enjoy benefits from each and every department that our tax money funds. As such, it should be subsidized like other taxpayer funded departments.”

Katie Auer, a current clinic board member, hopes that SEARHC will assume operations of the clinic, but not necessarily to save the municipality money.

“I will be voting for SEARHC because I believe that the citizens of Skagway deserve consistently available, quality healthcare in a clinic managed by professionals,” she said.

Polls are open April 18 from 7 a.m. to 8 p.m. at City Hall. Absentee ballots should be time stamped at the post office no later than April 18 and arrive at the clerk’s office by 4 p.m. April 20. Absentee-in-person ballots are available at City Hall until 5 p.m., April 17.