May 30, 2006

My Dear Patients and Friends of the Rinehart Clinic,

These are exciting times. The Meyer Memorial Trust has awarded the Rinehart Clinic a Capacity Building Grant. At the on-site visit their representative was very impressed with the non-profit model of care we have developed here in Wheeler. We asked for, and received, $110,000 over three years from Meyer Memorial to partially fund the position of Executive Director, whose main job it will be to take our Federally Qualified Rural Health Clinic to the next Federal tier, a Community Health Center. (CHC) Why is this important?

As a CHC our reimbursement from Medicare per visit would increase substantially, at no increase in cost to local patients. In addition Medicare would give us a several hundred thousand dollar grant to bring about this transition. With these extra funds, we would be able to provide both Mental and Dental Health Care, two areas sorely lacking in north Tillamook County.

This is not going to be easy, but is an essential step if we are to preserve the rural health care delivery system you and I have worked so hard to resurrect over the past 14 years. The problem is, the Feds are chipping away at the reimbursement we receive as a Rural Health Clinic. All the while, they are beefing up the CHC’s. CHC’s are enthusiastically supported by our President. In fact, Mr. Bush sees the care delivered by CHC’s as a reason not to overhaul our fractured healthcare system. Whatever. In any event, as this area grows, our little Rural Health Clinic is just not going to be able to meet our needs, and is not meeting some of them now. We’ve just about outgrown our present facility.

An Executive Director will have multiple additional duties, not the least of which would be to supervise yours truly. (The ability to herd cats will be a necessary prerequisite for this job.) At this time our Board of Directors is doing many of the tasks that would be done by an E.D., such as research for grant applications, interacting with volunteers, doing grassroots fundraising, and developing financial and investment Policy. With the addition of an E.D. to do these tasks we will now be able to evolve as an organization. I want to thank to all of you, Contributors, Volunteers, Board of Directors, Staff, and the many Community Members who spoke on behalf of the Rinehart Clinic, and to Ann Blaker, our Grant writer. Whoopee!

Hear Ye, Hear Ye! Rinehart Appointed to the Governor’s Commission on Pain!

It’s true. On May 22nd, 2006, I was appointed to the Governor’s Commission on Pain, to represent Rural Oregon physicians and their patients. The commission meets every other month, in Salem, for an afternoon. The Web site can be found under Pain Management, Department of Human Services, State of Oregon. It is the purpose of the Pain Commission to advise the Governor and the Legislature regarding issues surrounding Pain Management in the state. My good friend Carl Peters encouraged me to serve…he said, “Harry, you’ve been a pain around here for some time,” and therefore “might as well go to Salem and be a pain over there.”

Do you recall the Winter of ’05 Letter of Appeal, in which I described being investigated by the Board of Medical Examiners (BME) for my care of eight patients who suffered from pain? Here’s an update on the trials and tribulations of attempting to care for these people. This summer we intend to sit down with representatives from Law Enforcement, Patients with Chronic Pain, Legislators, Physicians, Regulators, and Local Officials to have a Dialogue regarding this issue. This has not been done before. Surely we all have the same goals, to reduce the inappropriate use and diversion of pain medication. So why can’t we work together, instead of at cross-purposes, to deal with this problem in a manner that benefits all community members? I think we can. We’re going to give it our best shot. I’ll give you an update in the Fall.

There is a great deal of interest in this dialogue, and it will be attended by Kathleen Haley, JD. Executive Director of the Oregon BME, Philip Parshley, MD, Medical Director of the BME, Kathy Hahn, PharmD, Chair of the Governor’s Advocacy Commission on Pain, and Diana Norton, RN, Executive Director of the Pain Commission. It will be facilitated by Bryan Johnston, JD, past Dean, Willamette School of Law, as well as nationally recognized expert in dispute resolution. Furthermore, Dr. Johnston has expressed an interest in taking this issue to the state level. We’re going to get this issue aired, if not resolved, in Oregon, which is not surprising.

And the reason, I believe, we will solve this problem, is that six of my patients with severe chronic pain are willing to “come out”, reveal their identities, and discuss in a semi-public dialogue just how their lives would be seriously impaired were it not for the treatment of their pain. There are going to be some surprises, for if you were to meet these people, or even work with them day-to-day, neither you nor anyone else would have any idea they were taking pain medication. There are a lot of myths surrounding pain medication, the major one being that anyone ingesting opioids is impaired. In reality, most people who receive appropriate medication for pain become less impaired.

In the meantime, life in Wheeler goes on. As I mentioned in my Winter of ’05 Letter of Appeal, the cost of caring for the uninsured and impoverished in our midst has risen six fold, going from $2,000 per month in early 2004, to over $15,000 per month at the present time, due to the cut backs in the Oregon Health Plan. This community and your clinic have not flinched. We have yet to turn a single person away for lack of ability to pay for health care. I’m amazed. Had anyone shown me a crystal ball in 2004 I would not have believed it would be possible to continue this level of subsidy. Yet we do, day in and day out. Mainly thanks to generous donations from you, the community.

The clinic received a very generous gift consisting of a parcel of appreciated land recently, which the board gladly accepted. It consists of nearly 7 acres, just east of Hwy 101, a little north of Nehalem Road. It’s zoned Forest, but will make a great camp, or investment, for someone. This gift is from my little sister, Gail Pfenninger, and her husband Oz, who live in Denver. Thanks Gail and Oz!

The 2nd Annual Sand Dollar Auction is coming up September 9th. Sorry, dinner tickets are all sold out, but we can always use auction items. Please contact Joyce, 503-368-4284 if you have something to donate. No gift is too small, or too large, for that matter. If you would like to become a sponsor of the auction please call Patty, 503-368-6081. Sponsorships start at $100.

The Board of Directors has contracted with Smith Barney to manage Endowment funds. This means your contributions will no longer languish at low interest rates. In fact they earned over $5,000 the first quarter of this year. Good things happening today were well planned twenty years ago. Our plan is to increase the Endowment to 2 Million Dollars, at which time interest earnings will assure healthcare delivery in north Tillamook County in perpetuity. Please join us, in leaving this legacy for the future.

Contributions to the Rinehart Clinic are deductible to the full extent of the law. Donations may be directed to specific areas of interest, such as Medications, Women’s Health Care, Endowment, or the General Fund, etc. The biggest area of need right now is the General Fund due to the increase care provided to ex Oregon Health Plan patients.

I was driving north on 101 yesterday, returning from Tillamook. Near Lake Lytle the mountain range that turns the Nehalem River from its northerly course to westerly up around Elsie comes into view. First you see Neah-Kah-Nie, then Rock, and then Angora Peak towering majestically up behind them both. Once around Fisher’s Point there is Onion Peak, Sugarloaf and finally Saddle Mt., way up the valley. They’re so huge, laid out above the bay and valley floor. Sometimes, when the light is right, it appears one has entered an ancient enchanted valley, it is so beautiful. I’ve been looking at this spectacle for 60 years, yet the sheer mass and beauty of it still thrills me. But mostly I marvel at the generosity of the community of human souls who live here, swaddled by this great igneous ridge to the north, and the gentle rolling Coast Range on the east and south, shushed by the Pacific on the west. Though here for only moments in time, we’re like an ancient tribe, who takes care of its own. What an honor and a privilege it is to live amongst you, in this magnificent setting. Thank you for allowing me and the Rinehart Clinic to serve as the conduit for primary healthcare delivery for us all.

Good health to you. See You at the Crab Derby! June 10 and 11, Jetty Fishery!

Harry H. Rinehart, M.D.