Dr. Jordann Loehr, an OB/GYN and Toppenish resident, sits inside a basement conference room in Yakima on Friday, Jan. 27, 2023. Loehr, along with other members of the Toppenish Maternity Workgroup, attended a commissioners work session meeting to talk about establishing a public hospital district in the Lower Valley.
For Dr. Jordann Loehr, the benefits of a public hospital district in the Lower Yakima Valley are clear.
"Once it's formed, the community itself -- the Lower Valley -- will have a health a care entity that is accountable to the community, is owned by the community," Loehr said. Public hospital districts have the authority to own and operate hospitals and other health care facilities. They can also provide hospital and other health care services.
"It has no impact on our taxes," she added, referring to the ballot initiative. "If so, taxes would be on a separate vote."
A vote on whether to establish the Yakima County Lower Valley Public Hospital District is one of three local initiatives on the Nov. 5 ballot. The others are a proposed Metropolitan Park District in Toppenish and a Union Gap School District construction bond.
The proposed public hospital district needs a simple majority of 50% approval plus one favorable vote to pass. Turnout needs to exceed 40% of the total votes cast in the district during the last general election.
If it passes, the hospital district would be the first of its kind in the county and the 57th public hospital district in the state of Washington.
This is supporters' second attempt to get the proposition passed. It failed to meet its total vote requirement due to a low voter turnout in August 2023. It passed with 66% of votes in favor, but did not meet the number of total votes needed. With turnout so low in the last election and more voters because of the presidential election, supporters don't expect to have an issue meeting the threshold this time.
Concerned about care
Concerned physicians, nurses and residents proposed the Yakima County Lower Valley Public Hospital District in response to the closing of Astria Toppenish Hospital's Family Maternity Center in January 2023.
Hospital officials cited financial losses, fewer deliveries and reduced Medicaid funding as reasons for the decision. They said options where they could have their babies include Astria Sunnyside Hospital or Yakima Valley Memorial Hospital.
"We were given no warning and a 30-day notice," Loehr said when presenting the measure to county commissioners in June for inclusion on the ballot. The center abruptly closed nine days after the announcement, right before Christmas. "This triggered us to say, 'What can we do? How can we fix this?' "
In advocating for solutions, supporters mentioned some of the challenges that women within and around the Yakama Reservation face, distance and transportation primary among them. Indigenous women and their babies face health challenges and mortality rates at higher percentages than other populations.
A public hospital district is a special purpose district similar to a school, fire or library district. Hospital districts were introduced by the Legislature in 1945 to fill the health care gaps in areas where private hospitals cannot operate.
The process began with a petition submitted to the Yakima County Commissioners requesting that voters consider a proposition to establish a hospital district in the Lower Valley.
The district's proposed boundaries didn't change from the first ballot initiative, Loehr said. They encompass all of the Yakama Reservation inside Yakima County including Toppenish, Wapato, Zillah and White Swan. Sunnyside, Grandview, West Granger and Mabton weren't included in the district because of their proximity to Astria Sunnyside Hospital and Prosser Memorial Hospital.
In one change from last year, the number of elected commissioners would drop from five to three. Residents will also vote on those three commissioners, who will oversee the start of the new district and operations. The candidates are Loehr for Position 3; Charlene Tillequots, a member of the Yakama Nation Tribal Council, for Position 1; and Gabriela Guel for Position 2.
"In order to be a public hospital district commissioner, you have to live in the Lower Valley in the hospital district," Loehr said. "So all of us are invested in this."
What will it do?
This year's voters guide doesn't have a statement opposing the new hospital district. Last year's voter guide included an opposing statement written by Yakima businessman Bruce Smith that said there weren't enough specifics about what was planned and it could lead to a new tax.
Loehr has said a new hospital district will need to survey community members to determine what they want, and supporters want to let that process happen. While the idea first started because of a concern about maternity care services, other efforts might improve services before the lengthy process to form a hospital district takes hold.
She mentioned the Ttáwaxt Birth Justice Center in Wapato is working to open a birth center to serve Lower Valley residents. And Loehr and another physician have worked to provide emergency, crisis maternity care on call in Toppenish.
"Once commissioners are elected, we will need to do a survey of the community" on residents' needs and wants, Loehr said. "It may be a birth center, though (the planned) birth justice center will likely meet that need. I have a clinic for women's health care. ... If we need mental health counselors for our teenagers, they could employ them.
"Out here, access to ambulance care is limited," she added, so that could be a possibility.
Other hospital districts in the state, such as the one in Upper Kittitas County, are involved in providing ambulance services
Commissioner LaDon Linde also noted there have been efforts over the past year focused on health care services in the Lower Valley, and commissioners have worked to improve ambulance response times in the Lower Valley.
What's next?
If the district is approved, district commissioners will adopt a budget which includes sources of revenue and expenses. Some sources of revenue may require public hearings and/or voter approval before an assessment is made.
Though solutions wouldn't be immediate, a public hospital district, once established, could use taxpayer money, grants and loans to establish additional health care services, depending on what the community wants to focus on.
Loehr said she's as tax resistant as other residents. The benefit of a hospital district is it allows local decision making and problem solving.
"Before we can figure out what funding is needed we need to determine what the priorities of the community are ... then is the community willing to pay that cost? And can we get funding from elsewhere?" she told commissioners.
By definition this would be a rural public hospital district, Loehr said. That means it could negotiate and collaborate with other rural public hospital districts. They could share group purchasing options, she said.
"I'm just excited to see what the community comes up with. People in the Lower Valley are problem solvers," she added. "I'm stoked."