Sean C. Morgan
Of The New Era
A proposal to open a school-based health clinic at Sweet Home High School drew a largely negative response during a community forum held on Thursday, June 22.
At issue is a health clinic accessible by students in the school setting. It would be open part-time and provide medical and mental health services.
Opponents criticized the district and its proposed partners in the venture for the late date for the forum and for not notifying the community sooner. A grant application must be submitted next month, and the School Board will need to decide whether to go forward with the application at its meeting on July 10.
Opponents also raised concerns that the clinic would be used for Planned Parenthood activities. While assuring the audience that reproductive services could and probably would be excluded by contract from the services provided by the clinic, opponents were concerned that the clinic would still be required by law to provide information on where such services could be obtained.
Dr. Rick Wopat of Samaritan Health Services, a partner in the clinic, conducted an informal poll by asking those who would be interested in a clinic to stand. Between seven and 10 individuals stood. When he asked those totally opposed to the clinic to stand, between 20 and 30 stood.
Overview
At the School Board’s February meeting, Anne Peltier and Pat Crozier of the Linn County Health Department introduced the possibility of establishing a clinic at the school and asked if the board was interested, Supt. Larry Horton said. Through consensus, the board agreed to take a look at the idea, using a $30,000 grant to the Health Department.
The clinic would be a partnership between District 55, Linn County Health and Samaritan Health Services.
Adolescents have a high rate of going without health care, said nurse practitioner and consultant Jackie Rose. She said she has worked at a high school clinic in Oregon City. Adolescents are in a complex development stage, and most of their health problems are linked to high-risk behavior, Rose said. A school-based clinic can provide the access they need, many of the adolescents coming from families where getting medical attention can be difficult. They also receive prevention messages during their visits to the clinic.
When a clinic is opened, its policies, purposes and procedures are spelled out in a contract, Rose said. That means services Sweet Home does not want, such as abortions or dispensing birth control, would not be provided at the clinic.
Last year, 24,000 students visited school-based clinics in Oregon 87,000 times. Of those, nearly half of had insurance coverage, Rose said. About 18 percent are on Oregon Health Plan, and about 29 percent have no insurance coverage.
Many of the students with coverage are not covered for “preventive services,” or they have high deductibles, discouraging prevention services.
Of those who visited Oregon school-based clinics, about 71 percent said they would have been unlikely to receive the care they received had it not been for the clinic, Rose said. When adolescents don’t receive early care for problems during the day, they often end up in the emergency room at night, pushing up insurance and health care costs in general.
Wopat is chief quality officer for Samaritan Health Services, which has a vision for building healthy communities, he said. This idea is an outgrowth of the Community Health Improvement Program that Samaritan ran a couple of years ago to help determine how to improve services in east Linn County.
In Sweet Home, participants were concerned about access to health care, teen health and prevention, he said, and Samaritan was challenged to “meet people on their own turf.”
Sweet Home has high asthma rates among its children, with 16 percent suffering from the condition compared to a 12 percent state average, he said. Also, 18.1 percent of Sweet Home adolescents reported thinking about suicide, compared to 12 percent statewide.
In other areas, Sweet Home youth were closer to the state average, Wopat said. Those statistics show where a clinic might help.
Of 717 emergency room visits from the Sweet Home area, 281 were not urgent, he said. Only 19 percent were true emergencies. A clinic could help diminish those numbers.
District Nurse Jane Bubak described students who were unable to get medical help. One had an abscessed tooth at the end of the school year and had no way to take care of it. She said she had no idea what happened to the student.
One boy and his sister had scabies, but their mother had no car or gas money to give a friend for a ride to urgent care, Bubak said. The adolescents this clinic will help don’t have the means to get help elsewhere, she said.
“I mainly know the children that have the most needs,” Bubak said, adding that these children’s parents aren’t those attending the forum. She said she would like for all of the children to be the kind of kids who have parents that care, have a car and gas.
One junior high student looked like she may have scarlet fever, but her mother had no car or insurance and is subject to panic attacks in public, Bubak said.
“That could have been nicely handled right here in town,” she said.
“I don’t know if there are other ways to meet the needs,” Bubak said This sounds like a wonderful way. This would be like having a doctor on site. I sure hope it gets your thoughtful attention.”
Objections
Highway 20 Church of Christ Pastor David Redick asked why the meeting had been set so early in the evening, while people were still returning from working out of town and unable to attend, and why the meeting had been set so late in the process.
“It really isn’t involving some of the people I think would like to be here,” Redick said.
Peltier explained that the meeting time was arbitrary, and Wopat explained that other meeting times have constraints as well. Wopat said he is available to take input from anyone at any time during this process.
The committee working on the clinic wanted to make sure it had gathered information and was prepared for the forum as well as getting the word out about the forum, a focal point in the process itself, Peltier said.
Data on these clinics has been available for five years, Redick said. It seems like “you’re waiting to the last second to try to slip it under.”
While not involved in the planning, Wopat said, “we really do have to get our ducks in a row. That doesn’t say waiting till June was the best strategy. There’s no attempt to slip this under the door.”
“If this is a project the community doesn’t want, any of them, these partners can say no and give the money back to the state,” said Linn County Health Director Frank Moore.
He suggested calling the county commissioners and talking to them, and they can pull it off the board. “No one is locked into this at this point.”
“We’re not going to take it personally if it doesn’t go in Sweet Home,” Peltier said. The partnership saw an opportunity to meet a need and thought it would explore the idea.
Rose outlined the formation of the clinic at Oregon City in 1988.
Regarding reproductive services, “many members of the community were understandably concerned and distrustful,” Rose said, but the final decision was to move forward. One pastor ended up joining the advisory board and worked closely with Rose on what the clinic would look like.
That clinic, by a memo of understanding, did not provide abortions or birth control, she said. It still does not.
Multnomah County clinics did add reproductive services later, a four-year process in the 1980s, according to partnership officials.
Oregon City still does not, and it’s spelled out in policies and procedures for her successor, Rose said. “In my role, I felt it was critically important to be sure we didn’t step over that line. I had kids tell me I really need you to bring me condoms.”
She responded that they needed to find another way, she said.
“If you can’t, you’re not ready to have sex.”
That Oregon City advisory board, with its parent members, was critical to the formation of the clinic, Rose said.
But, said local resident Jeani West, if those services are not available, the clinic still must refer adolescents to a place, such as the Health Department, which can refer teens to reproductive services.
“People in Keizer-Salem fought tooth and nail to get a school-based clinic-free area,” Sweet Home resident Lynne Sjoburg said. “For some reason, these people think you can’t take care of your kids yourself. The state is taking care of your kids. What else are they going to take care of for you? This is an insult, I think, to you as a community.”
Parent Tony Ward noted that the community already has these services available, all near the school. Linn County Health is just down the road along with a Samaritan clinic. Immunizations are available at the Boys and Girls Club. Health and wellness, along with prevention messages, are taught in school.
“When sick, they’re not going to come to school to go to the clinic,” Ward said.
He doesn’t believe anyone’s ramming the clinic down Sweet Home’s throat, and he’s neither for nor against the clinic, he said. “And there’s always paranoia about things like this. “I can tell you, they’re not going to do abortions at the high school, but we need to find out about referrals (mentioned by West).”
“I trust the people that have been working on this the last several months,” Susan Kinney, a parent, said. “I think we’re in a medical crisis right now in Sweet Home.”
She said her family has lost four family physicians over the last eight months, adding that any opportunity for more access for her children is welcome.
Former School Board member Milt Moran, a current member of the Samaritan Lebanon Community Hospital Board, told the audience “there’s a huge need out there,” and contraceptive services and abortion are “not going to happen here.”
This clinic will catch kids “falling through the cracks,” Moran said. “This program is really worth a hard look in our community. There’s lots of kids not represented in this room tonight, and these are the kids that need (to be) taken care of.”
School Board member Jason Redick said he wants to hear from the community.
“This is not a decision board members want to make without the support of the community behind them one way or the other,” Redick said. “I can’t get behind it if the community is against it. The feeling I get at this point is that the community doesn’t support this.”