By Joanna Markett
Morris News Service-Alaska

JUNEAU -- Bartlett Regional Hospital in Juneau is in discussions with Skagway officials about managing the town's medical clinic.

The clinic, which has faced financial and staffing difficulties, is run by the nonprofit Skagway Medical Corp. and serves Skagway's 862 residents.

"We would be there as long as they wanted us," Bartlett Administrator Bob Valliant said. "We would have a contract of some kind with them. What the duration of that will be hasn't been discussed."

The city of Skagway owns the clinic building and leases it to the locally, run Skagway Medical Corp. for $1 a year, Skagway City Manager Bob Ward said. The city pays for the utilities and often subsidizes clinic operations at a cost of $20,000 to $170,000 a year, he said.

Skagway Medical Corp. members elected a new seven-member board last year to oversee the clinic. The decision to ask Bartlett for help came from the city, the Skagway City Council and the old Skagway Medical Board, Ward said.

"The primary issue is a consistent lack of a dedicated professional management structure," Ward said. "The boards out there have focused on medical service delivery. And, we have very good medical service delivery, but management in the past has been a combined provider-administrator position, which means focus wasn't applied in either area. What's happening now isn't mismanagement, it's the result of no management."

The clinic now has a $170,000 deficit and $190,000 in uncollected bills, Ward said.

Under a draft proposal from Bartlett, Skagway would pay the Juneau hospital $30,000 a year to manage the clinic. Skagway also would pay for a clinic administrator selected by Bartlett. The clinic still would have a local board, Ward said.

"We're not coming into this thinking it would be self-supporting, but we want to make sure the difference between costs and revenues is as small as it can be," he said.

Jan Nelson, newly elected president of the Skagway Medical Board, said his board is analyzing Bartlett's proposal. Not everything is clear to board members right now, he said.

"I think the people should have a say in how the clinic is run and the personnel that are running it," he said. "To me, the main thing is to have the best health care available to the people here that we can possibly afford."

Valliant said officials from Bartlett and Skagway haven't sat down to discuss the draft proposal yet. Bartlett, too, is carefully reviewing the situation, he said.

"I want to make sure, first of all, we can do something to help them and that I'm not putting Bartlett at risk in any way," he said.

The Skagway clinic has two physician assistants on staff and is open year-round, Nelson said. A physician from Juneau visits monthly.

"We have such a boom-bust cycle. In the summer we're so busy, we don't have enough people. In winter, it's just locals," Nelson said. "But we still have overhead, like any other city entity, the police force, fire and rescue."

The SouthEast Alaska Regional Health Consortium also has expressed an interest in Skagway's clinic, but deferred to Bartlett, Ward said.