An Open Letter

An Open Letter to my friends, neighbors and constituents who are members of Save Our Sequim, and to our entire community.


It is an honor and a privilege to represent you as your County Commissioner. I am truly saddened by the way the announcement of the Jamestown Healing Campus has so quickly and so deeply divided our community, and I write this with hope that we can find it within ourselves – whatever “side” we think we might be on – to work through the feelings that divide us in a way that brings us back together.

Because this announcement has been so troubling to many, I have listened carefully to your questions, objections, opinions and fears surrounding the issue, both at the forum held by the Sequim City Council and at the forum held by the Jamestown S’Klallam Tribe as well as in numerous email and phone conversations.  

Many have expressed belief that this work has taken place in private, without informing the public.

One core belief I have as an elected official it is that local government only works when citizens participate. It troubles me greatly to think that so many feel they have been left out of the process.

I know that the first time some heard of this project was in the local newspaper and it is not hard to imagine how upsetting that must have been. The reality is that the local press – despite a much more robust effort than in many rural communities – can’t and doesn’t cover everything, and local elected officials and governments don’t always know how a given issue or project might be perceived.

For instance – it surprises me that a collaborative project between our most trusted local health care providers that directly addresses two of the top three priorities identified in our most recent County Health Assessment, in an area that has been disproportionately impacted by the opioid epidemic and which is the result of much effort at the local and state level is being perceived negatively.

In this case, the public has been invited to learn about the plans for the Healing Campus from the Jamestown S’Klallam Tribe and local health officials in a forum provided for the dissemination of information and for taking public testimony before any plans have been submitted. Although the City of Sequim has not yet received an application for this project, they held a separate forum purely to accept public testimony.

I have no doubt that the input which has been received so far will be taken into account by the Jamestown Tribe as more detailed plans are developed – especially since it has been encouraged and accepted before the permitting and application process has begun.

Our regional behavioral health care system is complex. There are multiple ways for the public to stay informed or participate in the process.

Building and supporting the local and regional behavioral health system, of which treatment for substance use disorder is a part, is among the most complex of issues that we deal with as local policymakers. When I took office in 2016 I had no idea that I would have any involvement in this system. It has turned out to be the subject on which I have spent the most time and energy, experienced the highest level of stress and concern, worked the hardest to understand and, I believe, is among the most important of the County Commissioners’ responsibilities.

I am your local elected official who most often sits at the table where our public health officials and the leaders and administrators of our health care providers – Olympic Medical Center, Peninsula Behavioral Health, the North Olympic Healthcare Network, the Jamestown S’Klallam Tribe and others – struggle to make decisions that will result in residents of this county having access to the health care services they need, want and deserve.  

It is a privilege of the elected office I hold to work with these leaders and I consider them to be heroes. I simply cannot adequately describe how challenging it is to build and maintain a robust comprehensive rural health care system in America.

The fact that Sequim has access to hospital services, our own cancer center, an increasing variety of medical specialists, behavioral health providers and substance use disorder treatment centers with partners like the Jamestown S’Klallam Tribe who are deeply committed to working together is a testament to bold, brave, intelligent, persistent and effective leadership.  

I suspect that the reason some of this work came as a surprise is due to its complexity.  These conversations don’t lend themselves to a sound bite or a standard newspaper article.  To this day I struggle to communicate even the basics of what we are trying to accomplish in a concise and understandable fashion. As engaged citizens we need to reach beyond media if we want to stay informed and if we want our voices to be heard.

I want to be sure that you know how and when your voice may be heard if you are interested in the development of our local behavioral health care system. One of the most direct ways to stay informed is to attend meetings of the Clallam County Behavioral Health Advisory Committee. This is a volunteer advisory board to the County Commissioners that holds a public meeting every month to discuss our local and regional behavioral health care system, set priorities for allocating funding, and make annual funding recommendations to the Commissioners. You can learn more on the Health and Human Services page of the Clallam County website, clallam.net. If you wish to be more deeply involved, you may apply to sit on the Committee when an appropriate opening exists.

http://www.clallam.net/HHS/HumanServices/bhabmeetings.html

Another public forum – at which the Jamestown’s Healing Campus project was previewed in 2018 – is the Executive Board and/or the Advisory Committee of the Salish Behavioral Health Organization (SBHO). The SBHO is a tri-county partnership between Clallam, Jefferson and Kitsap Counties that is responsible for the administration of all of the medicaid-funded behavioral health services, substance use disorder services, and mental health crisis services in all three counties. It is overseen by Commissioners from each of the three counties and the administrative offices are housed within Kitsap County government.

While the SBHO is about to sunset as a formal organization and evolve into something new as the state transitions to Integrated Managed Care, this organization has held open and public Board meetings on a regular basis for many years. The Executive Board is provided advice by a volunteer committee of experts and citizen representatives from all three counties.  Citizens are welcome to attend any meeting of the Executive Board and/or the Advisory Committee, listen to what is going on, and make a comment.

https://www.kitsapgov.com/hs/Pages/SBHO-LANDING-HOME.aspx

The Clallam County Board of Health is yet another forum to track if you are interested in keeping tabs on community health and health system-related issues. The Board of Health meets every month to discuss a wide range of public health and environmental health subjects.

http://www.clallam.net/HHS/PublicHealth/boh.html

The regional organization that is responsible for helping us manage health care transition is called the Olympic Community of Health. This organization also holds open and public meetings on a regular basis and is the forum for all “big picture” regional health care conversations. It is the lead entity behind the Three County Opioid Response Project or 3CORP which is a multi-sector (behavioral health care providers, physical health care providers, law enforcement officials and first responders, local government officials and public health experts) collaborative effort to address opioid addiction in our region.

https://www.olympicch.org/

Every single one of these forums is open to the public. While it takes just a bit more work to track on what is planned for discussion, I truly appreciate it when citizens participate. Many of you actually do! If you want to know what is happening in an arena you care about, or if you want to play an active role in making decisions, all you need to do is to show up. Attend a meeting. Make a comment. Ask a question. Apply for a citizen-at-large position. Others do, and you can too. Your engagement would be more than welcomed.

Many say they don’t necessarily question the need for the type of service that the Jamestown Healing Campus will provide, but simply question the location.

Some have asked “Why Sequim?” or “Why do we need to think regionally?” while others are more focused on “Why that particular location?”

While as individuals we may or may not like the concept of a regional approach to health care, that is how Washington State is organized. Every city and county in the entire state is part of what is known as an “Accountable Community of Health” or ACH. Our “ACH” includes Clallam, Jefferson and Kitsap Counties. We are inexorably tied together as a region and our task as public officials is to work together to develop and implement a regional system.

In the case of developing this specific resource, currently not available in our region – namely observed daily dosing of MAT including methadone for patients with opiate use disorder – it is our obligation to take a regional view.

Our first step, initiated by the Salish Behavioral Health Organization Executive Board in 2017, was to actively try to recruit a provider to our area. This provider is a company called Baymark and they will be opening clinics in Port Angeles and Bremerton this year.

The Jamestown S’Klallam Tribe and Baymark are aware of each other’s plans and both agree there is sufficient need to support their collective programming. This belief is reinforced by the Public Health Officers from each county, by the hospital and health care providers from each county, and by those who are working most actively in this arena.

While we as individuals may or may not like it, a regional system is being crafted. In our region, for this resource, Sequim makes great sense due to its central location, ease of access, appropriate zoning, availability of necessary services and critical mass of health care resource. As property rights advocates understand, it is the right of any individual or business entity to purchase land that has been put up for sale, and to build an allowed facility on appropriately zoned land.

I have found objections to the specific location particularly interesting as many have described it as being in or near “the center of town.” While some may view the space between Costco and Highway 101 as in or near the center of town, this opinion is certainly not shared by all who live here.

Personally, I have always viewed the center of town as the intersection of Sequim Avenue and Washington Street. I have always viewed the west end of town where the big box stores are as “the outskirts” or the edge of town. My point is to acknowledge that we all have different impressions about the pluses and minuses of this particular location and not everybody views this location negatively.  

It is our job as citizens to participate in public processes that help to define what is “the center of town” and what is “the outskirts” so that our impressions can be turned into reality. The City of Sequim has hosted numerous public forums and planning sessions throughout the past decade that have resulted in the definition of neighborhood boundaries, the naming of each neighborhood, the identification of key assets within each neighborhood, the goals for the future of each of these neighborhoods, and all of that public process ultimately created the zoning that ensures this collective vision be preserved and achieved.

Many have expressed a belief that MAT is a farce; that it is simply substituting one drug for another or that abstinence is the best or only way to beat opiate addiction.

These attitudes are representative of a deep rift within the recovery community that has existed since the dawn of MAT and which has been exacerbated by the scale of the opioid epidemic.

As public health officials who are responsible for setting policy and developing systems, it is our obligation to follow the science. While each individual is different, the data is clear about MAT: It works. It works because of the unique physiology of opiate addiction. It works most effectively when paired with robust wraparound services. It is the nationally and internationally accepted standard of care for opiate use disorder and it is our job to do what we can to make this medical service available to our citizens who need it.

The CDC, Washington Department of Health, AMA, American Psychiatric Association, American Society for Addiction Medicine, and the Federal Department of Health and Human Services support MAT as the standard of care for treating opiate use disorder. Locally it is supported by Clallam County HHS, first responders and law enforcement officials including the Sheriff.

Many have expressed skepticism about the “profit” to be made by the Jamestown S’Klallam Tribe.

This is one of the most frustrating objections of all. The fact is that our national health care system requires that providers make a profit in order to function. My observations these past few years underscore that this is the primary factor which makes implementing and maintaining this system so complex, especially in economically-stressed rural counties like ours.  

The Jamestown S’Klallam Tribe is in a unique position to take the lead on this due to the reimbursement rate they are eligible to receive, and we are fortunate they are willing to step into this key leadership role to help address one of our most important community health needs.

Unless one favors a single payer or medicare-for-all national system that doesn’t require profit to be made, an objection to a “profit” is really just an objection to who is making the profit and I call that for what it is: Discrimination.

Furthermore, “profit” isn’t the correct concept here as the law requires that any excess revenue the Jamestown Tribe might realize from this facility be ploughed back into the provision of additional health care services. Any “profit” will benefit the tens of thousands of local citizens who make use of the other medical services offered by the Jamestown S’Klallam Tribe.

Many have expressed fear about what might happen if a facility like the Jamestown Healing Campus is built.  

Will it attract drug dealers? Will crime increase? Will citizens be in danger? Will it increase homelessness or attract homeless people to our area?

The fact is no one can predict with certainty what will happen. We can look at the many national studies that indicate the presence of this type of facility in a community tends to reduce both property and personal crime by rates approaching 80%, but some feel those studies aren’t relevant. We can look at our neighboring town of Anacortes and try to learn from their experience – which has been wholly positive – but some believe there is no comparison.

We can’t say for certain what will happen, so instead let’s focus on being prepared for what might happen. Those who are supportive of this type of programming will be working hard to understand how to ensure it is functioning as intended and on developing and supporting the entire suite of services that will help program participants be most successful.  

Those who oppose it can work to understand how their voices can be a part of the development of any strategies that might be necessary to address whatever problems may arise.

And that brings me back to where this open letter began – the divide that is causing our community so much pain.  

I believe the tactics and approach being promulgated by Save Our Sequim – specifically the intentional effort to name and call out businesses that are “for” or “against” this resource, the exploitative imagery, incendiary rhetoric and false information printed on the S.O.S. mailer, the effort to bully and intimidate public officials through angry and aggressive threats, and the strategy of voicing objections and making accusations before asking questions and engaging in dialogue – are what is creating the divide.

We are better than this. Rather than working to organize business owners into “for” or “against” camps that sow division between owners, staff and customers, how about asking what questions or concerns they might have.

Rather than providing an online forum that is being used to express anger and levy threats, how about providing a forum for people to share their concerns, and then invite elected officials to come and address those concerns.  

Rather than attempting to scare and divide residents by sending out an inflammatory and provocative mailer, how about finding ways to work collaboratively with public health and civic officials to ensure that concerns are discussed in a meaningful fashion.

Rather than focusing on fears, how about focusing on developing solutions to address those fears. If Save Our Sequim was to enumerate the concerns of its members and commit to working in a collaborative fashion with the Tribe and other local leaders and professionals, I am confident they would be welcomed.

As most seem to be concerned with security and safety issues, especially what might happen “off-campus,” how about designating one or several representatives and asking to meet with the Tribe and local law enforcement officials to be a partner in helping to craft a plan to ensure those concerns will be addressed. 

The Tribe has described a slow-and-steady approach to building clientele; why not ask how SOS can be present when the conversation regarding “how things are going and what problems might we be experiencing” takes place?

It is this type of approach that can actually have meaning and impact. It is this type of approach that can ensure SOS is a part of the solution to any problems that might arise. It is this type of approach that builds understanding and trust. And it is this type of approach that can bring us back together as a community.

The Jamestown S’Klallam Tribe is clear in its intent to build this Healing Campus. It is supported by local leaders, public health officials and health care administrators throughout our county and our region. Sequim has a real opportunity to show community leadership by embracing the Healing Campus, rather than opposing it. 

I am truly afraid that if the tactics and strategies of division being utilized by organizers and supported by participants of Save Our Sequim continue, instead of saving Sequim they will destroy what makes us special.

Mark Ozias
Clallam County Commissioner, Dist. 1