Panhandle Health chair proposes May workshop to reassess clinical services amid low clinic use

Panhandle Health District board Chair Dr. Thomas Fletcher proposed holding a strategy workshop on clinical services on Saturday, May 10, at 9 a.m., to examine why district clinics appear underused and to plan responses to recent legislative changes affecting Medicaid and federal public-health programs.

Fletcher told the Kootenai County-hosted meeting on April 9 that he had done informal “secret shopping” visits to several Panhandle Health clinics and found them largely empty. "If we are to believe that public health actually has a purpose in human civilization ... then it is incumbent upon us, those who are in public health, to do something to restore the trust in public health and the efficacy of public health," Fletcher said. He described the May 10 session as a workshop for scenario planning rather than a meeting intended to produce immediate actions.

The workshop, as Fletcher described it, would bring together the 15 county commissioners who participate in Panhandle Health, Panhandle Health board members and members of the public. Fletcher said the session would begin with three short presentations: an analysis of clinic activity over the past 10 years from Eric Katner, an update on recent Medicaid-related legislation from facilitator Seth Grigg, and a review by Fletcher of how public health differs from private clinical care. "I was actually doing some secret shopping ... and what I noticed is that the Panhandle health clinics are empty," Fletcher said.

Commissioner Duncan supported a data-driven approach and said decisions should be based on what the analysis shows rather than on anecdote. "If we're to make a decision, this is how I would like to make a decision ... it seems it would be more productive to try to understand what the problems are, identify the causes, and then present options," Duncan said. Commissioners present at the meeting were identified as Eberlein, Duncan and Metari.

Fletcher listed possible hypotheses for low clinic use — lack of public awareness of services, loss of public trust after COVID-era policies, clinic hours that do not match community need, or people with expanded Medicaid choosing private clinics. He also noted state-level and federal changes that could affect district funding and programs, and he asked Grigg to brief the group on the legislative outcomes. Fletcher said, "Maybe with the Medicaid expansion 2 years ago and in the effusion of $800,000,000, people can now take their Medicaid card and go get boutique medicine wherever they want."

Fletcher said the district's statutory independence from the Idaho Department of Health and Welfare gives local boards latitude to act, but he acknowledged most local boards are cautious: "Are we prohibited? No. As a practical matter, do you have board members who are willing to execute on some of the measures that you might imagine? No." He cited that another health district (referred to in the meeting as District 2) has closed all its clinics and that at least one board member in District 4, Vicky Purdy, favors closing clinics in that district.

On workshop logistics, Fletcher proposed arranging tables so commissioners and their board members sit together, starting at 9 a.m., and limiting the meeting to a morning session with a "hard" start and a "soft" end. He said the meeting would open with the three presentations, then accept written public questions that staff would collate before moving into facilitated discussion of the Panhandle Health mission and clinical programs. He proposed reserving a portion at the end for in-person public comments.

The meeting participants discussed remote access. Kootenai County staff said the session could be streamed on YouTube so people could watch but that two-way participation via Zoom was not planned; the county representative also noted there is a call-in number and the technical setup could permit callers to ask questions. Fletcher said his preference was that callers who wanted to ask questions attend in person, but he left the final decision to facilitator Seth Grigg.

Fletcher emphasized the exercise is intended as scenario planning rather than to create immediate policy or closures. "I would not have an action item," he said. The Panhandle Health board must still decide whether to proceed; Fletcher told attendees he expected to know the board's decision by a board meeting the following Thursday (he referenced "the eighteenth").

No formal motions or votes were recorded on April 9; the proposal for the May workshop remains contingent on Panhandle Health board approval. If the workshop proceeds, Fletcher and Grigg would lead the session and the county would help with room layout and logistics.

If the workshop occurs as described, it will provide the board with historical clinic-utilization data, a legislative funding update and a facilitated discussion of possible futures for the district's clinical services. Fletcher said the goal is to give commissioners a basis for funding and program decisions in the coming year rather than to mandate immediate changes.

Meeting adjourned after the discussion; public comment period that followed produced no speakers.

(Reporting note: all direct quotations in this article are from participants identified in the April 9 Panhandle Health District meeting transcript.)