We will be live-tweeting at least part of the SRHD meeting (through the decision on whether or not to continue the Feasibility Study). Background info here: rangemedia.co/srhd-opioid-tr…
Other items on the agenda: rangemedia.co/srhd-opioid-tr…
a little wrinkle: Board member Charlie Duranona will not be in attendance because he was traveling. At the last meeting, he seemed to be a vote against advancing the Feasibility Study.
That leaves us with an even 6 member board.
First up providing citizen commentary is Dr. Luis Manriquez. He is speaking against advancing the Feasibility Study. (he also thanked CM Cathcart for his work raising the alarm on the opioid crisis).
Manriquez said he didn't have an issue with the question getting raised but he said if we ask people their opinion, we should listen to them. (An overwhelming majority of people did NOT want SRHD to continue the Feasibility Study.)
As a frontline service worker, Manriquez said SRHD should take a lot of pride in the quality of their Treatment Services, but also needs to take responsibility for the harm they've caused in making people question the stability services through this study.
Manriquez said he's heard an argument that private providers could serve people more effectively - "they are welcome to, in our current system, we have a market system." He said Treatment Services as a public provider does not impede private services ability to serve people.
hadley morrow is up now. They're dressed as a "cute little skunk," to say it "would really stink to lose Treatment Services as a public health program." morrow said the people who would be harmed are the most vulnerable.
they also said there's ways to expand without continuing the Feasibility Study. They said they have 5 voicemails from someone who is terrified she's losing her care if Treatment Services is privatized, because the client is subsidized.
morrow hopes they do not move forward, and asked them to deeply consider how the ripples of even asking this question has impacted community. "why am i fielding these calls?" morrow asked. If the study moves forward, they want SRHD to do a better job centering community.
"Moving forward to me really signals a lack of care and intentionality towards clients," morrow said, because the current Treatment Services clients made it very clear they wanted the Feasibility Study to end.
"This is not the time to be destabilizing care for these clients. Please don't make clients roadkill in this process. Thank you and Happy Halloween," morrow finished.
Caitlin Costanza is up now. She's a first year med student at WSU. She's coming here to oppose the privatization of these services. Costanza said one of her caregivers as a child accessed public, subsidized opioid treatment services she couldn't have gotten through a for-proft.
Costanza said, "I do not trust moving the services to a private provider would benefit our community," she said. She doesn't believe a for-profit company have an incentive to reinvest funds in community because they are, by design, for-profit.
Like Manriquez and morrow before her, Costanza finished by asking the board to actually consider the feedback from the surveys conducted in phase one that asked them to end the study.
a dr. whose name i missed is up now. She is also urging them to keep services as public. We're in the midst of an opioid crisis, and "we need to keep this as an in-house service," so SRHD stays responsible for keeping people safe and preserves client/provider relationships
Susie Saunders, union representative of the union for most of Treatment Services, is up now. She said since the Feasibility study began, 6 counselors have quit and "morale is at an all time low." A pod where we interviewed Suzie: rangemedia.co/podcast-srhd-e…
"We now know thanks to all of Dr. Thompson's research, that SRHD's Treatment Services is doing a fantastic model," Saunders said. She added that it's a statewide example of success in opioid treatment care.
"I urge you again to stop the Feasibility Study and let these folks get back to the great work they do for our community," saunders finished.
Donia Sanders, the clinic director for Treatment Services, is testifying now. She said she appreciated how Thompson approached the conversation, but said the findings in Stage One clearly revealed privatizing the division is not a good idea.
Sanders was bothered by a comment in the last meeting made by a board member "we should do the research and find out who can do it better." Sanders argued, "We're public health, we can do it better." She wants Treatment Services to get more resources, not be privatized.
Speeding right through some committee reports. Now we're on to action items. The Feasibility Study is the fourth item on the list, but unfortunately, they're going into a 20 min executive session first to discuss potential litigation.
Anddddd we're back. That was a v long executive session. Starting with action items. Up first, "Adopting the 2025 SRHD Fee Schedule
Commissioner Waldref said every year, they do diligent work to make sure the fee schedule is fair, isn't collecting more than is needed to keep the system afloat, and reinvests in the event extra funds are collected. Fee Schedule has been unanimously approved
On to Action Item B: Adopting the Proposed 2025 SRHD Budget. Commissioner Kuney says that as the Finance Committee Chair, she is in approval. Budget unanimously passed.
The third action item: requesting the BOCC for Spokane County to Provide Unrestricted Funding in the Amount of $2,053,960 to SRHD for the 2025 Budget Year. This isn't anything new, staff said, the county has provided supplementary funds in the past.
Kuney said this amount is the same amount requested last year. The item is just a *recommendation* the BOCC will still have to make a final decision at their meeting later.
That passed unanimously as well, which brings us to the item we've all been waiting for: The Feasibility Study decision. Thompson is back, presenting a business plan and additional financial information.
Thompson said this pro forma financial data was prepared by Julie Shiflett, NWCFO, based off of statements from SRHD's finance division, the target average enrolled client per week count of 1,400 as provided by the Treatment Services Division Director.
It's a very in depth set of historical data. I couldn't find *any* of this online available prior to the meeting but maybe I'm just dumb. 
Thompson highlighted a figure - at the end of September, Treatment Services had an excess of over $600k in their account.
Kuney wants to know, as we look at 2024 year to date, "knowing how funding and payments work - they don't all come at the same time- saying that we're at a $700k positive, I couldn't say that is true." She wants to know if this is cash basis or accrual basis.
In Treatment Services, they bill for services weekly, Thompson said. It's not like grant funded programs. So the nearly $700k excess revenue is pretty accurate. Another staff member said this figure takes into account all their monthly expenses.
"We don't have a lot of delayed billings," the staff member said. "So this is a pretty accurate billing." That means the division is doing really well financially.
Kienholz wants to know why the treatment costs per client jumped by almost $17 from 2022 to 2023. Thompson said she doesn't know this intimately because she's presenting on behalf of their CPA. Waldref thinks it might have been an increase in salary & benefits from 2022-23
Kuney said 2023 is also when they moved to the new building, which was additional costs and probably resulted in a higher cost per client.
Cathcart is confused about unduplicated clients vs clients served per week and wants to know if we're down clients. Thompson said this is reflective of a lot of people trying to get out of addiction, seeking services, and then quitting.
She said this is "a common process when you're trying to recover from opioid addiction." The unduplicated client count included everyone they provide services to and the average weekly count is indicative of unique repeat clients.
Cathcart said this assumes there are 400 or so individuals who attempt and fail treatment, which is a big jump. He wants to know if that's a trend, or if it's misreading data. Thompson said the big gap he's seeing is that this is 9 months of data he's comparing with 12 months
So of course there are less clients served in 9 months then there are in the 12 months of 2023. Kuney is trying to do quick math, Thompson isn't sure what Kuney is asking but said the next slides might answer her questions.
Here's what's on the next slide- it's detailing the different financial projections that have been created.
"The goal in all three models is to increase the amount of clients being served to 1400," Thompson said. Here's model 1:
Kuney acknowledged that they requested all of this info, but is saying that all this information is too much to process and to make a decision today. All this is coupled with the fact they just passed a budget, and these pro formas based on adding clients, would change budget.
"I apologize, but I will not be able to make a decision today," Kuney said. Cathcart said he agrees and he wants to hear from the CPA.
Kienholz said before coming in here today, she found the feedback to be meaningful but there's a conundrum with these budget projections being confusing. She wants to hear from Misty Challinor, the program director, too.
Thompson said she wants to highlight 2 things about this request that was given to her by the board. These were not requests for changing this years budget, these were guesses as to how much it would cost to increase our services to reach an additional 400 clients, she said.
"In no way were we coming in with an ask to change the budget, these were just guesses - that's what pro forma is, a forecast, figuring out what would it cost us if we went forward and tried to meet this goal," Thompson said.
the second thing she wants to say: The way Treatment Services makes money is based on the services it provides to clients, it's a fee for services program. So as clients served goes up, so does revenue. (It sounds like she's gentle parenting them a little bit.)
Waldref said she deeply appreciates Thompson's hard work and also thinks she will not be able to vote today, especially with Duranona gone.
Waldref thinks this was a good exercise to do to give everyone a better understanding of how treatment services works.
Cathcart wants to discuss the business end of increasing staff (which would be required to serve more clients). he wants to know the timeline of potentially hiring more staff and how the pieces would come together. He also wants to know how this would compare with private options
Cathcart has motioned to defer the decision to the December 5th BOH meeting. That was seconded. They want to ask questions of Challinor, but she's on leave. Thompson doesn't know when she is coming off leave, but knows it is not before Dec. 5.
Waldref said she's excited about getting more information and thinking creatively about Treatment Services, and she appreciates Thompson. The decision has been unanimously deferred.
I have to leave in a sec but, last action item is this: . Cathcart said the changes came from a request from constituents in his district who want to open a private cigar club. He wants to change SRHD code to make it easier to do that.rangemedia.co/srhd-opioid-tr…
Waldref thanked Cathcart for his work on this, she was wondering how this has been handled in jurisdictions across the state to make allowances for private clubs across the state. Cathcart doesn't know how it has been regulated, but says here it would be regulated by SRHD.
Thompson said all of SRHD's regulatory work is complaint-based - a complaint is filed and they investigate, there's no proactive investigating. Kuney said private clubs usually self regulate.
They're trying to define public place (no smoking allowed) as a place where three or more non member guests are allowed. A private place (where smoking could be allowed) would be where less than three non member guests are allowed.
I had to leave to get to an interview, but apparently that legislation passed, according to another journalist at the meeting.
@threadreaderapp unroll me
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