The Enterprise - White Salmon, Washington

Local medical professionals featured in Sundance documentary

About healthcare

Ben Mitchell

October 30, 2012

Starting tomorrow, Skylight Theater in Hood River will be showing the documentary, Escape Fire: The Fight to Rescue American Healthcare -- a film that includes some scenes and settings that should look pretty familiar to Gorge residents.

The documentary, which has received awards at the Sundance Film Festival as well as nationwide critical acclaim, was filmed, in part, right here in the Columbia River Gorge.

Broad in scope but narrow in message, Escape Fire examines several of the many issues our healthcare system currently faces -- and doesn't exactly paint it in the most flattering light.

The Gorge is a fairly prominent feature in the film, which includes shots of Mt. Hood, the Hood River Bridge, and a beautiful time-lapse sequence of clouds swirling over Mt. Defiance and the Columbia River. But the scenic geography of the Gorge is far from being the main focus of the film. In addition to the local settings, Escape Fire also features interviews with local medical professionals who express frustration at the current state of rural healthcare.

Hood River physician Dr. Erin Martin is one of several people interviewed for the documentary and could arguably be considered its protagonist (certainly one of them) as the film is bookended by her story. Escape Fire opens with Martin's last day of work in the summer 2010 at La Clinica Del Carino in The Dalles as a primary care physician -- a time when Martin said her life was at a crossroads due to her disillusionment with her profession.

"I was very frustrated," she explains. "I was really about to leave medicine for good."

At the heart of Martin's frustration is what she characterizes -- and what the film also portrays -- as a healthcare system that does not reward primary care providers for spending time with their patients. At one point in the film, Martin states that "the way the system is set up, I can't effectively help people."

Rural nonprofit health clinics like La Clinica rely heavily on Medicare and Medicaid reimbursements and other federal funding to survive. The problem, Martin says, is insurance companies, Medicare and Medicaid reimburse at significantly higher percentages for medical procedures (such as invasive surgery) than they do for office visits. Coupled with budget cuts, primary care physicians are forced to see more patients in the same amount of time, which means less time for each patient visit.

Martin feels this is detrimental to the health of patients as she has less time to ask about their diets, their emotional and mental well-being and any other factors that may be contributing to whatever affliction compelled them to seek care. As Martin puts it in the film: "I'm not interested in increasing productivity; I'm interested in helping patients."

In a move that was documented by the film crew, Martin joins the NorthShore Medical Group in White Salmon (called Mid-Columbia Family Practice at the time of filming in January 2011) with the promise that she will be able to spend more time with her patients. Eventually though, state budget cuts end up creating similar issues for Martin at NorthShore as they did at La Clinica.

Cindy Robertson, administrator of NorthShore Medical Group as well as Vice President of the Rural Health Clinic Association of Washington, is featured in a scene in Escape Fire talking about the budget cuts with Martin. She agrees with Martin that the more time patients can spend with their physicians, the better.

"The best things for many patients would be to spend an hour with their physicians," Robertson says.

In the film, Robertson fears that NorthShore will be closed within a couple years. Almost two years later, the practice is still open, but administrators have been forced to change the default appointment time from 20 minutes to 15 minutes in order to see more patients, which means more reimbursement money.

In addition to physicians, patients are also featured in Escape Fire. Despite the invasiveness of having their medical issues filmed, Robertson said patients were onboard with the exposure as they hoped the film would serve as vehicle for healthcare reform.

"Our front desk asked if they would be interested in participating, and most did," Robertson notes.

"When you tell them what the film was about," Martin explains, "and why they were doing it, they wanted to be a part of it."

Robertson remembers the experience of working with the documentary crew as a rewarding one, even though employees at NorthShore had to work around the crew that was there following Martin around eight hours a day.

"They were very respectful," Robertson says. "They were very sensitive, very down-to-earth."

Martin was initially less than thrilled about being included in the film and was unsure about it even after shooting had wrapped.

"It really is pretty invasive," she says. "They were at my house every morning, driving with me to work with a camera in my face."

Like her patients though, Martin realized the greater good the film could serve.

"After I saw the film in its entirety, I was so glad I participated," she notes.

Eventually, a fed-up Martin left NorthShore for the same reasons that she left La Clinica. Today, she has a recently opened practice in Hood River called the TrueMed Institute, where she operates as an out-of-network provider. The practice takes a more holistic approach to medicine and allows Martin to spend 60-90 minutes with each patient.

Although she is happier now, Martin says she is brought to tears when she watches the scene in Escape Fire where she walks out the door and leaves La Clinica and her patients behind.

"I get upset every time I see that scene," she says. "I get choked up. These were my patients."

"You don't sign up to work in a rural health clinic," she adds, "unless you feel compelled to help people."