Board supports sewer bond, discusses residency program

SEELEY LAKE – At their Jan. 12 meeting, the Seeley-Swan Hospital District Board voted unanimously to designate Chair Twyla Johnson as the special district agent to vote in favor of the sewer bond that is being voted on Feb. 23. They also learned more about the possibility of the Seeley-Swan Medical Center being included in the residency program through Partnership Health Center.

Board member Walt Hill provided background information on the letter the Hospital District received from the Sewer District. Hill also serves as a director on the Sewer District.

Hill said, as it is currently designed, the sewer district treatment plant will cost $10-12 million and the collection system for Phase One will add around $5 million. The Sewer District has around $10.5 million in grants. The proposed bond would cover the rest of the cost as a 40-year loan with an interest rate between two and two and half percent.

“There has been a continual fight on this between the ones that would like to have a sewer system and those that don’t,” said Hill. “The ploy at this time from those that don’t was to go ahead and show them that the assessment system, which was outlined in the original effort [in 2017], wasn’t sufficient to pay the debt and so we had to go to another source or another way around it.”

Hill added that the assessment method was sufficient when the resolution was made in 2017. However due to various problems, including a lawsuit by those opposing the sewer, the project has become more costly and slowed the process.

Hill said the voters are being asked whether or not to authorize the general obligation bond. February was the earliest time the election could be held to meet all the legal requirements. To further clarify why there is an election at all, Hill said as of the May 2020 election, there are now three directors that oppose the sewer and two that would like to have a sewer “making it difficult to move ahead in any direction.”

“If the general obligation bond fails, there is no money and the feds will pull out their $10 million,” Hill said. “We will have no financial footing for the sewer system.”

Hill added that it has been made very clear by the Department of Environmental Quality and Missoula County that doing nothing is not an option with the implied statement that Seeley Lake will have a sewer system.

“We have to because we are breaking state standards and I think common sense tells us that we are not doing the drainage system in this valley any good. The tests show that we are polluting the ground water,” Hill said.

To add to the complexity, Hill said three weeks ago landowners in favor of the sewer filed a lawsuit against the Sewer District. The lawsuit is asking a judge to force the District to follow the resolutions that were made in favor of building the system and pursue them.

Hill said the bond attorney made it very clear that he could not certify the selling of bonds until the time that there is no legal objection on either side. Hill said the District is working hard to resolve this before the bond election. However, even if the bond election passes, the bonds cannot be sold because there is still some question.

Hill further explained that if the bond passes and a judge rules in favor of the landowners’ lawsuit, the Sewer District will have to maintain resolutions passed by the previous board to move the project forward.

“In simple terms if the GO Bond goes, the sewer will be built,” said Hill. “If the GO Bond doesn’t go, the sewer will be built.”

The difference, Hill explained, would be the grant funding offsetting the cost to the residents within the Sewer District. With the bond, Hill estimated residents would pay $60-70 plus operation and maintenance. However, if the bond doesn’t pass and they lose the grant funding, the cost of the sewer will be about $250 per month per property.

Following the board’s unanimous vote to designate a special district agent and vote in support of the bond, Johnson said, “I appreciate the fact that obviously we all see a need for this. We would be super crazy as a town to not get this thing passed.”

Faculty physician for the Family Medicine Residency of Western Montana Darin Bell, MD presented information to the board about the potential of bringing the residency program to Seeley Lake.

Bell provided a history of the Residency Program which started in 2013. The residency program is designed to be clinic-based training with a licensed physician supervising. The resident would visit with and examine the patient and come up with a plan of care that would then be reviewed by the supervising physician.

“For all practical purposes from a patient perspective, they do everything any physician would do,” said Bell. “The added caveat is they are reviewing all those patient encounters with an attending physician. The attending physician also has to certify the documentation and that the notes that they are writing in the patient chart are accurate.”

Bell added the residents coming to work at the Seeley-Swan Medical Center would be in their second or third year and would come on a regular basis to see patients.

Hill said he strongly endorses the residency program. However, he asked if there was enough space in the clinic for the resident to have their own office space and not overcrowd exam rooms.

“It is something that we do want to address and we will be thinking about before coming up with any kind of recurrent schedule. It is a very real issue,” said Bell who added that the current providers have already raised that concern.

District Clerk Marty Kux asked if patients have any say in their provider.

Bell said the vast majority of the patients that work with the residents come away with a positive experience. First, working with a resident for one or two years is enough time to build a relationship and trust. Second, often the patient sees this as an opportunity to help Montana have more doctors by giving someone experience so they can then take that experience and be successful in a setting where they are needed.

“In medical education and training, the emphasis is consistently put on patient-centeredness. If the patient does not want to work with a resident physician then we don’t force them to,” Bell said. “They have the ability to pick and choose who they want to be their provider … and to change whenever they want to.”

Bell added that the residency program is a great recruitment tool for rural communities. Not only does it provide a large pool of applicants for open positions, it also affords the opportunity for residents to get to know an area before making a long-term commitment.

Due to limited housing and other required educational rotations residents are involved in simultaneously, Bell said the resident would most likely commute to Seeley Lake for the clinic rotation. He said they would work with the schedule, possibly integrating tele-health visits and in-person visits, to account for travel conditions. This balance still needs a lot of work so they can maintain patient access.

PHC Chief Medical Officer Dr. James Quirk said he is very supportive of the program and the medical providers in Seeley Lake are excited about the opportunity to integrate the program in Seeley Lake. He said depending on COVID, he would like to see residents start rotations in the spring and then do a trial through the summer.

“I think this would really be a great opportunity for Seeley,” said Quirk. “I think it is on the right track right now and I don’t think there is anything that is insurmountable.”

With the exceptions of the few concerns to address, all the Board members were verbally supportive of the program coming to Seeley-Swan Medical Center. Bell will continue discussions and keep moving the program forward.

The next meeting will be Feb. 9 at 5 p.m. via conference call. The agenda will be posted at the Medical Center and Post Office at least 48 hours prior to the meeting. To call in dial 1-346-248-7799, meeting ID, 953 2960 8482 #.