Q&A: What’s at stake for employees as Spokane Regional Health District considers privatizing their opioid treatment services?

Spokane Regional Health District (SRHD) is amid a months-long process to determine if it should privatize its opioid treatment services. This week the Board of Health will consider whether to move forward into the next step: beginning to work through the financial and legal details of privatization.

We sat down for a Q&A with Suzie Saunders, the representative of Protec 17 , the union for SRHD’s Treatment Services Employees. We asked Saunders to weigh in on the potential privatization of the Division.

SRHD’s Administrative Officer Dr. Alicia Thompson has completed Phase One of the Feasibility Study , which analyzed feedback from stakeholders including patients, employees and service providers and identified the impacts privatization would have on them. The study also measured how much interest private providers had in acquiring the division. Thompson is set to present her findings and her recommendation on whether the study should continue on to Phase Two at the SRHD Board of Health meeting this Thursday .

The Board will then vote on Thompson’s recommendation, making the final decision as to whether she should continue down the path of privatization for the Treatment Services Division, which serves 1,000 patients, connecting them with methadone and mental health services to manage opioid addiction. At last month’s meeting, board members expressed a desire to move forward to phase two , without having seen Thompson’s phase one findings and recommendations, which set off alarm bells for community members .

Tell us a little bit about yourself.

My position is as a union representative, so I work for Protec 17, the union that represents around 10,000 public sector workers in Washington state and Oregon. We represent most of the health districts in Washington. I myself represent Spokane Regional Health District (SRHD), Benton Franklin Health District and Yakima County Health District. I’ve had this role for a little over four years now.

When did you first start hearing about the potential of privatization, and what were your first reactions to that?

For me, it was the beginning of this year, maybe around March or April when the Feasibility Study was announced. I’ve heard other people say that they’ve been talking about it for a really long time, but that was the first I’ve heard of it.

I was really alarmed. That kind of tack is very scary to me because who knows what will happen to the workers, if that were to come true. I immediately was concerned about their livelihoods. Are their jobs going to be guaranteed? Are they going to be able to continue their benefits? Are they going to have a union at whatever this new entity is going to be? Are they going to be able to have their pension follow them? As their union rep, that’s what comes to mind for me.

If you talked to any of the workers, their first concern would be their patients.

And that is a concern of mine as well. I live in this community and I really care about the most vulnerable among us as well. But again, my first concern was for the workers and the potential for them to lose their jobs.

What are the stakes for the employees that you represent if the ultimate decision is privatization?

Nobody knows what’s going to happen, so this is just my initial thoughts when I first heard about this, the worst thing that I could imagine would have been for them to all lose their jobs. For this new private entity to say, ‘Okay, SRHD, great job, you’ve done well until now, but we’re taking over from here and we’re going to just let all these people go, bring in our own people and go forward from there and start charging exorbitant amounts of money for people to get this treatment,’ and for this whole program to really go away.

I’m concerned about people losing their jobs or if there was a chance for them to keep their job, would they have to reapply for it? Would their union contract follow them and continue with them? You know, would their benefits follow them and be as good as they are at SRHD?

The biggest thing is their pension.The workers right now have a defined benefit pension through PERS, which is the Public Employment Retirement Service, which is a Washington State plan. It’s one of the healthiest pensions in the nation. It is a great benefit for people. When they get to retirement age, they’re guaranteed money to pay them back for all the time they spent in public service. So that would be a huge loss and that issue hasn’t gone away.

None of the private providers or even the Tribal providers in the community would be able to continue that pension. That is only available to public sector workers in Washington state.

What have conversations with Dr. Alicia Thompson or other members of her team looked like during this phase one of the Feasibility Study?

I have to give credit to Dr. Thompson. I think she really does care about the employees and about the patients and about the community, and I think she’s really done her best to try to bridge the gap and provide information. But she’s been given a really difficult job, which is to examine the feasibility of separation.

The question is not ‘How can we increase treatment services or how can we make it better?’ The question is ‘Can we separate? Can we get rid of it?’ in my eyes, those are my words.

I think Dr. Thompson has been given a really difficult job. She has tried to communicate, she has done a really good job of listening and gathering data and information. But, I just met with her yesterday to give our union’s perspective on this whole thing. And she’s still kind of repeating this phrase that I have heard from members of the board as well, which is that treatment services should be run like a business. And we don’t agree with that at Protec 17.

We represent public sector workers. I myself have worked in the public service for over half a decade, and I really feel strongly that these government services like this should not be run like a business. They are a public good. That is why they were started. That’s the role of government: to fill holes where private entities can’t can’t provide the same level of service. So, to hear someone at the top of the, uh, you know, a public agency say that part of their agency should be run like a business is alarming. I don’t agree with that, and I know that many of the employees don’t agree with that either.

What have conversations with employees been like in the last couple of months?

‘Fear’ here is the word.

They are terrified. They’re terrified of losing their jobs. We’ve talked about their benefits or pension, but more than that, they are really worried about the patients.

This is a very vulnerable population, and they don’t want these people to relapse or to stop coming to treatment or to go back to taking drugs on the street or to die.

Some of the feedback that I’ve seen that has been gathered from patients is that they’re thinking about stuff like that because this idea of privatization just brings so many unknowns.

And, some of it isn’t unknown to some of these patients and some of the workers at Treatment Services. They came to SRHD. From the private sector, they have seen the worst of the worst when treatment is run like a business. So, it’s scary.

They don’t know why we’re doing this. Treatment Services is a very successful program. It’s over 30 years old. It has run in the black, I think there’s only been two years where Treatment Services has ever been in the red and not made enough money to cover the expenses. There’s a fear and, I guess suspicion, like ‘Why are we doing this?”

This is a program that has worked very well for a very long time. So why now? Why at the height of the opioid crisis are we talking about something so disruptive?

One of the things that we’ve heard pretty repeatedly from the folks that are on the board and Thompson is that there is a flexibility issue or that, because this is public health, there are some things that just take a lot longer or there’s funds that the division doesn’t have access to because government moves slowly and has all of these checks and balances. What’s your perspective on that take?

As a union that represents public sector workers all over the state, that is something that I hear a lot, and it’s real. That is true.

There are a lot of checks and balances in government for a very good reason: It keeps it accountable to the public. We can file public records requests and just make sure that things are running in a way that is fair and representative of the people and what the public wants.

It may be a little bit more difficult in the public sector to expand services or to be nimble, but it is absolutely possible. And SRHD has created positions in this time that the Feasibility Study has been going on. They have been hiring, it’s not impossible.

So just because it is a little bit more difficult than the private sector doesn’t mean it is impossible. It is something that governments do every single day.

Have you had any conversations with board members, about this process and if so, what have those conversations looked like?

The only board member I have talked to is Patricia Kienholz, who has actually turned up to several different community events and made herself available to talk to folks about this, which I really appreciate. That’s not something I’ve seen out of board members previously. And she’s asking a lot of really good questions, like, “How can we make Treatment Services better?” and also sharing that some of the messaging that has come down to employees has maybe not been totally complete.

She brought to our attention that there are other options besides privatization such as Treatment Services potentially going under Spokane County. That’s something that hadn’t been brought forward before. That was news to me.

So I think she’s really doing her due diligence and getting out in the community, meeting people where they’re at, talking to folks and thinking outside the box. Like if privatization isn’t the best thing, then, then what are some other options to make Treatment Services better or to overcome the hurdles that they’re talking about like hiring might be slow or that they can’t get certain grants.

I think there are solutions to those problems and I think she’s trying to get out there and find out what those are.

But she’s the only board member that’s reached out or had conversations with you?

Yeah, I believe so.

What are some of your fears or concerns about this Feasibility Study process?

I think that it’s asking the wrong question. I think that the question “Is it feasible to separate?” is not a good question.

The question should be, “How can we make Treatment Services better?”

Finding solutions to those stated problems like the hiring, like the funding issue. And like I had mentioned before, I personally don’t see those as huge problems. Hiring happens all the time. They’ve got job postings almost every week. They’ve created new positions in Treatment Services just since the Feasibility Study has been going on. Treatment Services has run in the black, all of its 30+ years, except for two.

So Treatment Services is very financially successful. It is nimble enough to hire and expand when needed. So those problems are just not as big as I feel like they’ve been made out to be.

My concern with this Feasibility Study is that it might be more than meets the eye.

This, to me, looks more like an effort to make public health in our community as small as possible. It’s an effort to shrink the role of government and the size of government and to provide only the bare minimum services that are required by law. That’s what I think the real motivation behind this Feasibility Study is.

Do you have any hopes for this process or hopes for what comes out of it?

I hope that the question changes and turns into ‘How do we make Treatment Services better? How can we better provide these essential services in our community and fight the opioid crisis? End the opioid crisis?’

So I think it is bringing up some creative thinking and also showing the Board of Health and Dr. Thompson and the employees that the community cares about them and this work and these patients.

There’s been a lot of support. A lot of people have turned up to these listening sessions and the town halls and really shown that they care about this work.

And so I hope that that means something to the folks that are in charge, to the Board of Health and to the employees that do this work — that they’re not invisible. That they are providing an essential service that this community is proud of and wants to fight for.

What do you want the general public to know or understand in advance of the meeting this week?

I want them to know what’s at stake. This is the largest opioid treatment program in Washington state. It serves over a thousand patients who are struggling with opioid dependency. And in my eyes, it is like the single biggest tool we have to fight the opioid crisis in our community. It needs to be allowed to continue.

I want folks to understand that they can make a difference, soI would really encourage people to either turn up to the Health Board’s meeting on Thursday and let them know that our community is rallying behind this work and wants it to continue. They can email the BOH at public_comment@srhd.org and share the same message.

But I just want people to know what an amazing program that we’ve had working well in our community all this time.

It shouldn’t be shut down for trivial reasons, just because it’s a little bit challenging to get funding sometimes or it’s a little more complicated to expand it then a private business would be.

It is an essential public health service that really should continue in our community and is our best tool at fighting the opioid crisis here.

Is there anything that I haven’t asked you that you think is important to share?

I just want to expand a little bit on why the Treatment Services program under SRHD is so effective. For one thing, it is continuous. Those couple of years that it operated in the red, that lack of funding was covered by the general fund of SRHD, so there is a backup system in place. If anything goes awry — there’s a lack of funding or something goes wrong — there’s just a support system in place.

SRHD also has all these amazing other public health resources that are really accessible to folks when they come to SRHD: Treatment Services, mental health services, Women, Infants & Children (WIC) Nutrition Program, the Nurse-Family Partnership, things like that.

SRHD does a great job of treating the whole person and giving people access to resources in the same place, and they just can’t get elsewhere. It is just a complete package where they can get all the support that they need and that’s what really makes it so unique.

Also the employees that work there are public health heroes. They care about this work. They came to work at SRHD for a reason — because it’s the place to be, it’s the best program in our community. And they’re very proud of that.

It’s a top tier program that would be a huge, huge loss in our community if it were to go away.

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