A series of resolutions largely seeking assistance from the city and third-party entities for six “non-core” services such as drug rehabilitation and hospice care was approved Tuesday night by Bartlett Regional Hospital’s board of directors as the hospital continues “burning through our cash” at a heavy loss.
As a result, some decisions about keeping and paying for programs may be up to Juneau voters, possibly as soon as this fall.
The board’s action came after a month of evaluating proposed options, along with 85 public comments received in writing or during community meetings. As resolutions, the provisions in them don’t officially eliminate or otherwise immediately affect the programs under consideration, instead providing a road map for officials to follow with a priority on services deemed most important by feedback during the past month.
“We’re planning on sending this off to the Assembly to say ‘OK, this is what the board’s recommendations are’ because we are appointed by the Assembly,” Kenny Solomon-Gross, the board’s president, said after the meeting.
In addition to the Assembly indicating its willingness to subsidize programs, there will also be consideration of “either the state, the Assembly or private health care entities can come back and maybe even take over those programs. But in order for them to do that we want to make sure Bartlett is prepared to sustain that program, that it’s not just going to go away for a year or two,” Solomon-Gross said.
Kenny Solomon-Gross (right), president of Bartlett Regional Hospital’s board of directors, offers an assessment of resolutions intended to address the hospital’s financial crisis during a meeting Tuesday night as board Vice President Deborah Johnston listens. (Mark Sabbatini / Juneau Empire)
According to a statement issued by the hospital, the five resolutions seek to:
• Secure a dedicated financial subsidy or prepare a plan of closure Rainforest Recovery Center, a four-week, high-intensity residential addiction treatment program.
• Pursue similar action for crisis services.
• Prepare a five-year sustainability plan for home health and hospice services.
• Realign outpatient psychiatric services.
• Support the closure and transition of applied behavior analysis therapy, which works with people ages 2-21 diagnosed with autism.
A reminder of why the programs are being targeted was offered during a meeting of the hospital’s Finance Committee on Monday, where fine tuning of the wording of the resolutions also occurred. Board members and administrators have stated the hospital has been losing about $1 million a month since the summer of 2020 and will run out of cash within three years without significant changes.
“We had a $1.3 million loss in the month of April and we’re now sitting on an actual loss year-to-date of $10.4 million,” said Max Mertz, the finance committee’s chair, referring to the fiscal year that ends June 30. “We’re still digging holes.”
“We’re burning through our cash to date, agreed,” said Joe Wanner, Bartlett’s chief financial officer, when asked at the meeting for his assessment.
The possibility of reducing or eliminating the six targeted programs is seen as part of a larger effort to ensure the hospital can continue providing essential services such as surgery while achieving financial stability. Numerous people submitting public comments agreed that should be the priority.
“It strikes me that drastic action must be taken in order to keep the doors open, ” a written comment by Ray Preston declared. “Core services must be maintained. Everything else is expendable.”
But numerous pleas to keep the targeted programs were made by commenters saying they and/or people they knew had benefited from them, and that the existence of such services has communitywide implications for Juneau and Southeast Alaska. In particular, Rainforest Recovery Center, as well as hospice and home care services, received support from commenters.
Rainforest Recovery Center is the only high-intensity residential treatment program in Southeast Alaska due to the closure of a similar program in Ketchikan, wrote John Tarim, a Juneau psychiatrist and former medical director of the center.
“There are such programs in Anchorage but the waitlists can be months long,” he wrote. “During my career, I have had patients die while waiting to get into treatment. This will happen in Juneau and the rest of Southeast Alaska if RRC is to be closed. These are some of the most vulnerable and stigmatized people in our community and closing down such a program would be discriminatory and a disservice to the community.”
But there is ominous wording about possibly closing the facility in the near future in the resolution passed by the hospital board, which notes “the City and Borough of Juneau historically supported RRC since 2000. That funding was fully eliminated for fiscal years 2024 and 2025.”
“The hospital’s Board of Directors resolves to seek dedicated subsidy funding from public and private sources to defray direct and indirect operating costs of RRC,” the resolution adds. “The Board directs management to explore potential third-party operators for the program. If dedicated subsidization or a third-party operator cannot be secured within a reasonable period (by October 31, 2024), the Board reluctantly resolves to close RRC consistent with all applicable city, state, and federal guidelines and notices.”
Among the possibilities within that timeline is the Assembly, besides considering providing direct funding, could put a question on the Oct. 1 municipal election ballot asking residents if they want to fund the recovery center and/or other programs, Solomon-Gross said. Mayor Beth Weldon previously said putting the question to voters is among the possibilities worth considering.
“I always bear the mindset in anything that I’ve ever done in public service that if you have an opportunity to take something to the voters then I think the voters should get their say,” Solomon-Gross said. “We might not like it, but at least the voters will have an opportunity to decide.”
The deadline for the Assembly to approve ballot measures for the election is July 29, according to the municipal clerk’s office.
People submitting public comments also offered other funding suggestions to stabilize the hospital’s finances.
”I would strongly urge the City Assembly to use passenger fees to support the hospital,” wrote Linda Cryan. “It is a given the cruise industry will protest, but you need to provide numbers for how many passengers seek medical treatment here in Juneau.”
Hospice and home care services have also been cited as a critical local need ever since Catholic Community Service in Juneau halted its offering of those services in the fall of 2022 after about 20 years of doing so. Bartlett took over the programs a year ago, but operational and financial struggles have officials evaluating the possibility of an agreement with a third-party provider.
The resolution for the two programs adopted by the board takes a longer-view approach with its five-year plan that includes continuing evaluation of possible third-party providers, asking CBJ to subsidize any deficits incurred by the hospital and annual reevaluations of the programs’ status.
More definitive decisions have been made about the future of some of the other programs under scrutiny.
The Applied Behavior Analysis (ABA) Therapy involving autism patients, for example, is being discontinued by the hospital due to the two providers in the program resigning earlier this month to start their own company providing similar services. As a result, the resolution adopted by the board declares “its full support to the board-certified staff and their efforts to continue providing ABA therapy through independent practice and directs management to assist in the transition of services.”
Conversely, Bartlett Outpatient Psychiatric Services was declared in a board resolution to be “a core service within the purview of management.” The board is asking hospital officials to establish a realignment plan to make the program sustainable by Aug. 31 and provide monthly reports on the plan’s progress to the board through the end of the year.
Recent efforts to provide crisis services to adolescents and adults have proved difficult for the hospital. Two types of programs — Crisis Observation Services (COS), and Crisis Residential and Stabilization Services (CSS) — are seen as local needs, but due to what Wanner called “facility layout and staffing concerns” Bartlett has only been able to provide CSS services to adolescents at a facility that opened last year.
The board’s resolution of crisis services, noting “suicide prevention is a needed service within the community,” asks hospital management to “evaluate whether there are alternate service models that better meet the community need for crisis services.” Also, the possibility of collaborating with other agencies, subsidies from CBJ and/or other sources, and evaluating “the best and highest use” of the current crisis facility are mentioned.
Collaborating with other health organizations was mentioned in many of the public comments, with SEARHC frequently mentioned due to its expanding scope of programs. However, Bartlett officials have expressed concerns about that expansion encroaching on Bartlett’s most profitable services — and whether SEARHC as a Native nonprofit has funding and operational advantages not available to the city-owned hospital.
Solomon-Gross, when asked about the possibility of collaborating with SEARHC on programs while also worrying about them as a competitor, said “I’m always worried about what’s best for our community.”
“So if it’s best for our community and SEARHC wants to partner with us for Rainforest Recovery, or for any of these entities or programs that are possibly closed or eliminated, then if that’s best for our community I’m all for it,” he said.
• Contact Mark Sabbatini at mark.sabbatini@juneauempire.com or (907) 957-2306.
