A three-candidate Primary Elec-tion for a position on the Skyline Hospital Board of Commissioners, and for two spots on the November General Election ballot, is now underway. The election is open to all voters who reside in Klickitat County Hospital District No. 2.

The candidates are appointed in-cumbent Ricky Knowles and two former Skyline Hospital employees, Karleen Swarztrauber and Wil-liam (Bill) Hollander.

The 18-day Primary Election voting period began with the mailing of ballots last Friday by the County Elections Department.

Four Skyline commissioners ap-pointed Knowles, president of the non-profit Skyline Foundation, to a vacancy in Position 4 in May, following the resignation of longtime Commissioner Don Schaack. This is his first run for elective office.

The appointment will last until the General Election results are certified. The winner will serve out the remainder of an unexpired 6-year term, then start a full 6-year term in January 2020.

Swarztrauber, a physician, isn’t new to Skyline Board elections. She ran for and won election to Position 5 in 2016 in a contested race against a longtime incumbent. She did not take office. As she was running for election, Swarztrauber was em-ployed by Skyline; she declined to resign her employment after the election. Per State law, she could not both sit on the governing body of the Skyline Board and be an employee of the Hospital District.

Hollander, another first-time candidate for elective office, work-ed in Skyline’s laboratory for nine years as a medical technologist.

Following is our interview with the candidates. Our questions are in bold. Their answers follow.

Everybody wants to know, Why are you running for a seat on the Hospital Board, what’s motivating you toward this particular kind of elective public service?

Ricky Knowles: Public service has always been important to me and likely a result of growing up in such a strong community as White Salmon. I benefited a great deal from the service of others and I’ve always felt a need to pay it back as much as I can. From serving my country as an officer in the Navy to these last four years serving as President of the Skyline Foun-dation, I’ve always made sure to make public service a part of my life.

Karleen Swarztrauber: I have always been interested in public health. At Tulane Medical School, I pursued a Master of Public Health degree. After my Neurology Resi-dency, I was a fellow in the Robert Wood Johnson Clinical Scholars program at UCLA, which is an awarded fellowship for physicians who want a career in the public health sector. When I was employ-ed at Skyline Hospital as a neurologist, I became interested in running for the Board position. It was clear to me that the organization was not thriving. And that was unfortunate, because the people in this community deserve the best.

Bill Hollander: I spent the last nine years as a laboratory scientist in the lab at Skyline, I moved here in 2009 to make a home for myself and my family. I want to make sure that the hospital remains a vital resource for the people in this area.

What is your background, what do you do for a living, since voters want to know something personal or interesting about the people who are running for elective offices? I don’t want to invade your privacy, but I’m hoping you will use this as an opportunity to introduce yourself to voters.

Swarztrauber: I am trained as a neurologist and pain management physician. I am also trained as a health services provider. Currently I am consulting for the State of Washington Labor and Industries. I was the Health Officer last year for Klickitat County. More recently, I have started Tephra Farms and I am focusing on getting my pork products to the local farmer’s markets. I have a strong interest in how food impacts our health.

Hollander: I am now retired from medical technology, but I plan on living here for a long time to come. I enjoy the outdoors and the seasonal variations in weather that we get here, and I believe that the people in this small area are much more amiable than those I find in cities. I want to keep White Salmon a place that is pleasant to live in.

Knowles: I grew up in White Salmon and attended the Naval Academy in Annapolis, MD. After graduating I went through flight school in Pensacola, FL and began a 10-year career as a pilot in the Navy. It was during flight school that I started dating and eventually married my wife Amy, who is also from White Salmon and a classmate of mine at Columbia. We moved back to White Salmon in 2013 and now have two children, Owen and Marin. We are excited to live in the community once again and thankful for the long and winding road that brought us back.

Rural hospitals across the nation are struggling to stay open. The biggest concern for the public here is, how financially stable is our Hospital District? My question is, what should the Hospital Board be focusing as financial strategies for sustaining the Hospital District, which is an integral part of our local community and the other communities of western Klickitat County?

Hollander: I’m a pretty smart guy, but I don’t have a background in finance. If elected, I would depend on the other board members to help me get an understanding of the financial ins and outs of keeping the Hospital District viable. With their help, I could bring a fresh viewpoint to the planning table.

Knowles: Rural hospitals indeed are struggling across the nation as the costs of healthcare are outpacing the rate of reimbursements. It’s difficult for small hospitals to generate the volume needed to survive given such razor thin margins and as a result you do see many of them closing or being absorbed by larger health care systems. More important now than ever, rural hospitals must focus first on quality and second on those services that are sustainable from a business perspective. To remain financially sound Skyline must continue to provide high quality care and focus on controlling costs across its range of services.

Swarztrauber: In today’s health care market, finances are critical. The profit margins have become very thin and the regulations have become extensive. The good news is here are a lot of people and organizations who want to see a rural hospital survive. The Board should be consumed with determining which route to financial stability meets the strategic goal of the organization. Options could include large federal or private grants, partnerships, lucrative services, levied taxes and take-overs. The choice could have a huge impact on the community and should be weighed carefully.

We’ve heard stories that some of Skyline Hospital’s services are more expensive than what other medical facilities charge. What can the Hospital Board do to ensure that Skyline Hospital’s pricing for routine services is competitive with other facilities, so that health care consumers don’t have to go out of town to save money?

Knowles: As a current board member, I’m familiar with the process that Skyline uses to set pricing and the measures it takes to make sure they are as competitive as possible. Skyline regularly conducts independent pricing studies that compares its prices with those in the local and regional markets. Historically Skyline has been extremely competitive against these benchmarks and part of my role on the board is to monitor this closely and make sure it continues to offer high quality health care at fair prices.

Swarztrauber: Skyline Hospital needs a vision. Vision is not “surviving financially” or “renovating.” The vision is the reason for the existence of the hospital. In my humble opinion, for a rural hospital that vision should be: to serve the community. If expensive labs and imaging does not serve the community, then the price of these services needs to be changed. If a take-over results in the loss of many local jobs, then that is not serving the community. Everything that is done at Skyline Hospital should be done to meet that primary vision.

Hollander: The hospital administration is constantly evaluating and comparing prices within the scope of small, critical access hospitals. Continued oversight can keep charges from getting out of hand.

Are there other services the Hospital District could be offering beyond Skyline’s services, its medical clinic, and its physical therapy department to meet the community’s constant health care needs? Has anyone given consideration to establishing a dental clinic as a Hospital District service? What about a pharmacy? Conversely, is the Hospital District offering too many services? Is its medical clinic profitable? What about physical therapy? Do these services pay for themselves?

Hollander: Developing new services is an inherently risky proposition, almost all new services are going to run in the red during their beginning growth. Evaluating new services and reviewing present services for financial viability is a continuing responsibility of the board. Specific services such as the clinic, dental services, orthopedic surgery, ob-gyn services, etc., are constantly being discussed and looked into for us and by watching what works for other hospitals.

Swarztrauber: We know from the Columbia Gorge Regional Community Health Assessment that access to dental services, affordable housing and food security are big problems in our community. The needs of the community should always come first. Offering dental services is a great idea.

Knowles: Both the Skyline medical clinic and the physical therapy department are profitable especially when you factor in their effect on referrals and ancillary services. One of my goals is to expand the services available in the community and address the full range of its healthcare related needs. I believe the overall health of a person is much more than simply the clinical care they receive, and we should seek to treat the social and behavioral drivers of healthcare as well.

Revenue is the driving force in any business. Might the Hospital District need to try for a levy lid lift in the coming term to augment its revenue?

Knowles: I’ll being looking for ways to grow our revenue so that Skyline can expand services that otherwise wouldn’t be feasible. An increase to the tax levy was recently approved by the board and will be on the ballot this November. So much has changed in healthcare since the current levy was established over 20 years ago that we have a responsibility to make sure it is still in-line with our community expectations for healthcare. I hope voters who vote for me also vote for the levy increase, knowing that I have a strong vision for the Hospital and need the resources to see it through.

Hollander: As far as I know, the levy is for operation and maintenance of the facility, and is not included in toting up revenue. I may be wrong but this is my understanding.

Swarztrauber: Taxes are often levied because that can be an easy way for leaders to raise money. Competent leaders should explore other options for raising funds before they place that burden on the community. It gets back to the vision. If the vision is serving the community, then an increase in taxes must be balanced with an increase in valuable services.

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