Bolinas and Stinson Beach residents aired a host of common grievances about the Coastal Health Alliance—long wait times, short visits, shoddy record systems and difficulty with receptionists, among others—at a meeting with C.E.O. Steven Siegel, doctor Anna O’Malley and a few other staffers on Tuesday night at the Bolinas firehouse.
But the back-and-forth conversation, which lasted the better part of three hours and drew around 50 residents, was amicable and largely forgiving: there are real challenges to operating a community clinic in West Marin, including high turnover of medical practitioners and slackened local demand.
Through letters in local newspapers, the alliance had asked residents to submit comments ahead of time, alerting employees of their primary concerns, and many had done so.
Dr. O’Malley, who lives at Commonweal Garden down the road from the firehouse and spends just two days at C.H.A. in tandem with other less formal medicine practices in the community, jumpstarted Tuesday’s conversation. “In the spirit of taking radical responsibility for whatever we can take responsibility for,” she said, “I’d like to say that the theme that has been raised by many—that wait times are unacceptable—I am largely the problem.”
She continued, “There’s a style of medicine that is in-depth, relationship-oriented, respectful, deeply curious about meaning and based on listening to what is important in someone’s story. This is hard to do in 20 minutes.”
Mr. Siegel, who has run the alliance for the past seven years, agreed the 20-minute time slots were a problem, but broke down the reasoning behind the number. The alliance has a budget for 15.5 visits per doctor per day; with a 20-minute time slot, they can book 20 visits a day, which, with no-shows, turns out as an average of 14 visits a day.
The clinic has very strict regulations, in part because of the federal monies it receives from the Health Resources Services Administration for operating in an underserved area. Mr. Siegel said those funds account for over 25 percent of his revenue. (He also jokes that maintaining that income through regular reporting of finances and workflow accounts for 80 percent of staff hours.)
Mr. Siegel said he was considering the possibility of increasing appointment times to 30 minutes, though he noted that in the case of Dr. O’Malley, who is in extreme demand ever since she started at C.H.A. around 10 years ago, that would mean she could see fewer patients.
Dr. O’Malley also stressed that she was not going to sever conversations with people with real needs exactly at the 20-minute mark, as that wasn’t responsible, either.
Instead, she encouraged patients to think about their priorities—two, three, maybe even four topics—prior to their appointments so the time is manageable. “That’s such a gift to me,” she said. “It is honoring my time, my children’s time, your community’s time.”
Kim Hett, an Inverness resident who sits on the alliance’s board of directors, spoke up on Tuesday on behalf of other parents. Given the current wait times, she suggested that the alliance figure out a way to make waits easier: providing notifications when doctors are running behind and keeping patients in the lobby as opposed to small examination rooms “which can be hard with kids and hard with anxiety,” she said.
Ms. Hett added that she thought scheduling fewer visits per day while opening clinics more days could attract additional patients. (The Point Reyes location is open Monday through Friday and often on Saturdays, but the Bolinas clinic is open on Mondays, Wednesdays and Thursdays only.)
Many commenters agreed that the Bolinas facility, which was built in 2008 thanks a multi-year grassroots community fundraising effort, should be open more often. Others also protested the closing of a third clinic, in Stinson Beach, which the alliance shuttered in 2016 amid staff departures and dwindling patient numbers.
Indeed, staffing has been an ongoing challenge. To fill the roughly 50 positions, Mr. Siegel said he is constantly hiring, as he is unable to retain employees. The expensive housing market, rural setting and pay rates that are below competitors like Kaiser—though Mr. Siegel assured that pay is market-rate—are all factors, he said.
In 2017, the nonprofit alliance—which dates back to 1981—was set to merge with a larger health organization, West County Health Centers, which has eight clinics and over 235 employees.
A comprehensive needs assessment commissioned by C.H.A. in 2010 found that an increase in second homes was leading to a shrinking population and changes in demographics. The assessment recommended the merger to help keep patients. Mr. Siegel explained to the Light in 2017 that the alliance often has employees multitasking, while West County Health Centers has designated staff for every job.
In the end, the two groups were unable to reach a deal and the plans crumbled.
Since then, the alliance has redoubled efforts to hire a complete staff. Mr. Siegel announced good news that this week a new medical doctor, Steven Aussenberg, has joined the staff—finally bringing the alliance to full staffing capacity. (The position had been vacant for a year after Dr. Edwin Munich left.)
Patient demand is another factor. The last few years have seen a 10 percent drop in patients at the Bolinas site; the numbers are more stable in Point Reyes Station, stabilized in part by an influx of people seeking the three-year-old dental services, which will move into a permanent facility next month.
Mr. Siegel clarified that the decreases are in C.H.A. patients from outside the area; numbers of West Marin patients are fairly stable. Ten years ago, he said, the alliance had 1,000 patients with a Petaluma zip code, but now that’s down to 300, perhaps as a result of improved services in Petaluma.
Mr. Siegel encouraged residents to use the facility if they hoped for more hours.
Another widely held concern expressed on Tuesday pertained to clerical services. After the medical system digitized around 10 years ago, there has been chaos, said Dr. O’Malley. Entering records across multiple systems that “don’t talk with one another” takes up a lot of her time, especially for patients with Kaiser, which has its own data system. (When asked, the vast majority of meeting attendees confirmed they have health insurance through Kaiser.)
Commenters also reported prescription mess-ups, difficulty using their online portals, and even trouble with vaccinations given to their children, such as failures by staff to record the shots on medical records.
Concerning the last complaint, Dr. O’Malley said that one of the clinic’s unique offerings—the possibility of a slowed or selective immunization schedule—is the culprit. “What happens when we do that is that it takes checking, double checking and cross checking with the database, a high degree of diligence and a concerted effort.”
She added, “There’s no excuse, I won’t even try to make one, and any time this happens I am appalled and shocked. But I do think it is very important for parents to have their own records, so you have them no matter the system.”
Ms. Hett and several other mothers in the audience requested a follow-up meeting focused on prenatal and pediatric care—a suggestion to which Dr. O’Malley, Mr. Siegel and other staffers present were amenable.
Other recommendations from audience members included an alliance newsletter to keep customers informed and in good communication with staff, a suggestion that also received a warm welcome.
Creating an atmosphere in which there are easier and more human interactions between staff and patients was a vision held by all. The wall with sliding-glass windows at the reception desk is a requirement, Mr. Siegel said, but nevertheless, he said he’s working with employees to improve the attitude.
“The atmosphere for which healing happens starts when someone picks up the phone,” Dr. O’Malley agreed. “This is very important to me, to not have turnover there, and have a local person. And this is part of the exhaustion—is that I am that friendly face, after people pass through the gatekeepers.”
The Coastal Health Alliance is open Monday, Wednesday and Thursday in Bolinas from 9 a.m. to 5 p.m. (minus a lunch break between 12:30 and 1:30 p.m.), and between the same hours every week day in Point Reyes Station. Call the clinics to see if Saturdays are open at (415) 663.8666.