Ritzville looks to heal rift in medical community [The Spokesman-Review, Spokane, Wash.]

Dec. 30--RITZVILLE -- Main Street has been busier this year after the town's two doctors completed an ugly split from the local hospital and started their own clinic.

Drs. Charles "Marty" Sackmann and Valerie Eckley, along with 77 community volunteers and a handful of skilled craftsmen, remodeled an old building that had once housed the law office of Sackmann's father.

It took them just a matter of weeks to hire four staff and open Hometown Family Medicine.

Launching their own small-town clinic isn't what the doctors initially desired. In this era of complicated medical billing, high malpractice insurance, unfolding health reform laws, unemployment, economic unrest and looming cuts to the Medicare and Medicaid programs, the challenges of operating a new private medical practice were daunting.

"It's been quite a ride," Sackmann said.

But the risks trumped signing what the doctors considered an untenable contract with the East Adams Rural Hospital in Ritzville.

The 20-bed hospital is the centerpiece of a taxpayer-supported district, with an elected board of directors. It has struggled for years, and there have been six different administrators in the past decade.

The most recent administrative team, led by Mark Barglof, had been hired with the task of squeezing more work from the doctors to boost revenue and restore a balance of power in the hospital between doctors and the district.

Contract terms equated to a productivity requirement -- forcing them to see more patients and admit more to the lightly used hospital -- which the doctors labeled administrative meddling in their doctor-patient relationships.

The bitter negotiations unfolded against the backdrop of the hospital district's desire to build a multimillion-dollar facility to replace the aging East Adams hospital.

Hospital district board members abandoned the notion following a public meeting late last January that attracted as many residents as a high school basketball game. The vast majority of the crowd firmly supported the doctors and demanded the board renegotiate their contract. When the board refused, people responded with their loyalties and their votes.

When the clinic opened Feb. 14, the doctors charged patients a $30 flat fee per visit as a quick way to get their doors opened and meet payroll. Now billing through traditional methods, the clinic is open six days a week and either Sackmann or Eckley travels to nearby Lind twice a week to see patients.

While the new clinic is busy, the hospital's clinic, staffed by physician's assistants, has neared collapse, said Barglof, as patients followed Sackmann and Eckley to the private clinic downtown.

The hospital district had drawn up a $6 million budget that estimated the clinic would contribute $1.1 million. Instead, the exodus of patients following the contract row has cut the clinic's projected revenues in half and left the district with a $578,000 loss by the end of November.

"From the clinic perspective, we have suffered," Barglof said. "The patients followed their doctors."

The district is not giving up, however. It is advertising for a family practice doctor to staff its clinic in competition with Sackmann and Eckley, and is even trying to capture new patients from Adams County who currently use Spokane clinics and services.

It will be a difficult undertaking, especially following a mandate for change illustrated by hospital board elections in November. Voters there filled three of the five board seats up for election with candidates sympathetic to the doctors during the contract dispute. They campaigned on a platform to fire Barglof.

"I just hope they immerse themselves in the issues before making a decision," Barglof said. "I'm concerned."

Some in the community say it's time to heal the rift.

Ritzville Mayor Linda Kadlec, who a year ago criticized the board in the local newspaper, and a group of church ministers have encouraged the sides to meet and began working out their differences.

Having local doctors and a local hospital are too important to the community, they say.

"We need to look toward putting this town back together," Kadlec said. "We have a new board coming in so we'll see what happens."

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