Then and Now
For everyone who has come to the Point in recent years and isn’t familiar with the history of the clinic, here’s some background. We're providing it because there are significant themes through this history that continue today, and because some of this history is now repeating itself in the current attempt to replace SuperTrack with the same physician assistant, Deb Shields. Because hospital district commissioner Stephen Falk and Shields took such pains to keep their activities hidden, we were unaware of how these themes were related until they were revealed through our recent records request, documented here.
While you may be used to having three doctors with available appointments and urgent care when needed, that’s a very recent development. Until 2019, there were no doctors (the only providers were nurse practitioners, Virginia Lester until 2012 and a replacement from then to 2018), urgent care was limited to established patients only, patients were required to designate the nurse practitioner here as their primary care provider in order to receive services even though their tax money supported the clinic, and it was only open three days a week. When the one nurse practitioner who staffed the clinic was absent, the clinic was often closed because the contractor, Unity Care, didn't always backfill her position, in violation of the contract.
The clinic was started by a local group called the Pioneers using federal grants in collaboration with a group called Interfaith, which later changed its name to Unity Care. In 2002, Virginia Lester, an Interfaith employee at the time, was the provider. She hired Deb Shields to be the receptionist and office manager. When the grants expired, the Hospital District was formed with the help of the Pioneer Group to continue funding the clinic through property taxes.
Virginia was replaced at the clinic in 2012. By 2017, patient numbers were dropping. Unity Care and the commissioners were concerned about the future viability of the clinic. But the board continued to support Unity Care because they believed there were no viable alternatives. For proof, they referred to their request for proposals issued in a prior year that generated no interest from other providers.
Here’s a table comparing SuperTrack with Unity Care, similar to the one we published last week comparing SuperTrack with Dr. Anwar:
| Specialty/Experience | SuperTrack | Unity Care |
|---|---|---|
| Family Practice | + | + |
| Urgent Care | + | |
| Emergency Care | + | |
| Internal Medicine | + | |
| Hematology | + | |
| Oncology | + | |
| Skin Care | + |
It is clear that SuperTrack provides superior services over Unity Care. But Unity Care had two major advantages over SuperTrack. First, Unity Care employees were loyal to their employer and to each other. In 2020, SuperTrack was betrayed by employees Lester and Shields when the two prepared a bid to take SuperTrack's contract with the help of board chair Stephen Falk, as we show here.
Second, the then-district commissioners supported Unity Care wholeheartedly, even though they knew that Unity Care wasn't fulfilling all of their contract obligations. While SuperTrack has far exceeded their own contract requirements, Falk is regularly hostile to them and Oggel appears to be aligned with him. Furthermore, while a community survey in 2018 revealed serious issues with quality of care under Unity Care, the previous board never aired those concerns in public. In contrast, Falk and Oggel have aired minor complaints about SuperTrack in public meetings in transparent attempts to damage their reputation. By law, such complaints are supposed to be handled by the superintendent in private, not by commissioners in public.
The themes running through the rest of this narrative are Falk's continued refusal to priorize the quality of services over his loyalty to Deb and Virginia, his refusal to listen to the community instead of just a single self-interested group, and his ongoing hostility to SuperTrack and Dr. Sean in particular.
Minutes from the August 18, 2020 meeting to consider replacing SuperTrack with Shields seem to foreshadow what could happen at the next meeting on June 12, 2024:
Stephen Falk: “I remain supportive of the Shields Company proposal…. I think there are some perceived advantages from the SuperTrack proposal that I actually don’t think are aspects that our community is particularly in need of. For example, having an MD present when we’ve been doing quite well for many years now with our clinic staffed with non-MD providers…. On the issues of the services provided under the current arrangement obviously the onsite providers have been doing an excellent job for the first 19-20 months. For 18 months of that time, it was Deb and Virginia so the people that we are praising, in my mind, when we’re praising SuperTrack, are actually Deb and Virginia.”
The statement that we don't need doctors denies the results of the Unity Care survey in 2018, which Falk was aware of, in which many patients said they needed and wanted doctors for various reasons. In many cases, their insurance and health conditions required that they have doctors as their primary providers. Others just wanted better care. It also overlooks the possibility that people supporting SuperTrack weren't doing it because they supported Deb and Virginia, but rather because they opposed Deb's and Virginia's betrayal of their employer, and because they were grateful that SuperTrack had stepped up when Unity Care stepped down.
This 2020 attempt to turn the clinic back over to Deb and Virginia failed by a vote of 2 to 1. Since then, SuperTrack has provided superlative services to the community that exceed the requirements of the contract in multiple ways.
And yet, here we are again. Stephen Falk is leading the charge and Sara Oggel apparently following to get Deb back into the clinic, now through the auspices of Dr. Anwar.
In 2022, SuperTrack asked the district to make their contract period two years instead of one, because the one-year period was constraining their ability to offer more attractive and secure contracts to potential employees. This restricted their ability to hire the best possible staff for Point Roberts. Unfortunately, the board voted to deny this request in the name of preserving "flexibility" on both sides.
(In our opinion, when we have three great doctors providing the best services Point Roberts has ever had, it's in our interest to lock them in rather than maintain "flexibility". When the fire commissioners recognized the value Christopher Carleton would have to the community, they locked him into a five year contract to be our Fire Chief. Imagine what would happen if that board hadn't continued to renew his contract.)
At the time, SuperTrack was running about a $90 K deficit at our clinic because they had replaced the planned physicians assistants and nurse practitioners with doctors, including Dr. Sean. In contrast to Unity Care, SuperTrack is staffing the clinic with three doctors, they do provide urgent care, they have greatly expanded the number of coverage hours, and they have subsidized the additional costs out of their own funds instead of asking for a contractual rate increase from Point Roberts taxpayers.
In that October 2022 meeting, Dr. Sean was recovering from Covid which he had come down with during a recent trip, and he was still visibly ill. Despite this, Falk was passive-aggressive with Dr. Sean throughout the meeting and overtly aggressive during the following exchange on the subject of SuperTrack’s request for two-year contract, continuing a behavior I (Vic) have seen in other meetings Falk has had with Dr. Sean.
The photos above are screenshots from this exchange. What follows is the transcript of the exchange between Dr. Sean and commissioner Falk. It's long, but we include it all for completeness, so we've highlighted key parts for those who don't want to read the whole thing:
Falk: "The last item we have was the previously tabled, twice tabled I guess, discussion on the proposal from SuperTrack to amend the agreement to have two year renewal terms rather than the one year period after the initial two year period. We had a brief discussion about it last month but we didn’t have Noel at that meeting so we weren’t going to proceed through. In any case, we have all three commissioners so we can have a discussion on the topic. The issue that Sean had described several months ago at this point was really a contracting issue from SuperTrack’s point of view when they try to make … calendar year contracts with physicians and other providers and it’s awkward if they would find that the agreement was being cancelled out of sync with the obligation that SuperTrack would have with the people they have contracted to provide services at the clinic, they’d have to find other work for them or otherwise to terminate the agreement outside of its contactual terms that they have with their providers.
"As I’ve expressed before, I think that going from one year to two would only slightly mitigate that problem, the issue would come up in the second year of that cycle that now would come up in the first year of the cycle. It might provide one year of breathing room but to my mind it doesn’t really solve that problem for SuperTrack completely, and I still think that it’s beneficial to both sides to have flexibility, not that we’re going to do anything with that flexibility… One could argue the opposite, that both sides would have benefit from being tied in together subject to some gross event that would cause a termination for cause. But anyway, my position remains the same and I would propose that we stick with the current arrangement."
Dr. Sean: "So, uh, whatever you guys decide we obviously will respect that, but I do want you to know that this decision that you make will have consequences. It kind of sends a message to us, first and foremost, about how you view this, is this a partnership, and do you respect, do you try to make things easier for us so we can do our work? Stephen, you’ve said several times that for you it doesn’t really matter. It’s us who’s asking for this because it makes a difference for us -"
Falk: "No, that’s not my point, but go ahead."
Dr. Sean: "Well, what is your reservation or objection? How would it hurt the commission if you were to make the contract two years?"
Falk: "I would answer with respect in two ways. One is the primary issue is that made sense the way the contract was originally negotiated, an initial period of two years to make sure the provider has time and commitment to get fully engrossed in the system and get set up and not having the worry about anything happening, and after that we keep this one year system that we’ve had for many years with the previous provider as well as the current one and that it provides flexibility for both sides, there’s absolutely no threat of trying to terminate or …"
Dr Sean: "My question is, what do you have against this term becoming two years?"
Falk: "But I also want to the other point, I haven’t heard an explanation that why a two year arrangement ultimately solves the problem that SuperTrack is concerned about because I think if you do it for two years, you have exactly the same issue in the second year of a two-year arrangement as you have currently in the one-year."
Dr. Sean: "Respectfully, let me say you didn’t answer my question. You answered my question with a question. Let me acknowledge that and then go ahead and answer you. We’re the provider of the service and you’re the receiver of the service. We have to put in capital budget, we have to go make sure we have staff, and we do have staffing shortages. As you know, it’s difficult to come by staff specially for Point Roberts, it’s challenging, we have to entice people, we have to make sure that they’re secure. If you tell them in the contract that if we lose the contract with Point Roberts you lose your job, they may choose another more attractive option. It has a significant effect on our ability to budget farther along and to be able to attract more people, and frankly to feel more secure in our relationship. Frankly, you didn’t know us. We had to come in and prove to you and to the community, and our opinion is there’s the right way to do medicine and every other way. We came in and we took the hits and we absorbed the costs of getting everything running, and with the help of everybody we’ve gone through a pandemic, we’ve pulled things together. And we feel like this is kind of sending a message back to us that we are still on the fence with you guys, that you don’t want to make a longer commitment. And frankly, we understand that you guys have other options, but so do we, I mean I can tell you is, if you choose this path, all I take from this is that OK, this is a business relationship for the commission, it’s not a partnership or a relationship that goes beyond that. And I feel that the commission could actually do better for the community because it’s hard out there. And we have over-delivered based on the agreements that we have, and if you guys say, OK, we just feel comfortable with the way it is then we’ll accept that, but that means we’ll be exploring other opportunities for us closer to home, especially with all this commute and going through two borders and such, perhaps. And would that be good for people there? I don’t think so. So I think it’s just a message that you’re sending, so I’m going to stop right there."
Falk (raising his voice): "I’m glad you are because the message that you’re sending is not one that I have any interest in hearing. I’m not threatening SuperTrack in any way but I feel like we were just threatened quite directly -"
Dr. Sean: "It’s not a threat, Stephen. If I’m telling you it makes our life easier and better to try to staff the clinic, and you say that that to me doesn’t really matter, and I want to just stick… it just defines the relationship, all it’s telling me is OK, well you guys are OK but -"
Somewhere in here, after growing increasingly upset at Stephen's disrespectful and bullying treatment of Dr. Sean, I (Vic) sent Stephen a private message through Zoom saying, “Stephen, please stop being such a dick to him.” I sent it privately to give him a chance to moderate his conduct without publicly embarrassing him. As it turned out, he took undue advantage of my discretion in the next meeting, as you'll see at the end below.
Falk: "No, the point I was making about staffing was the one you originally mentioned as rationale, as I understood it the rationale for the proposal for this change."
Dr. Sean: "I know, but all I hear back is that you don’t believe that that affects us, and I stop at that, I don’t need to convince you but -"
Falk: "You do need to convince me but you need to convince me in the way that I’ve tried to make this point over the last three meetings I believe. You described a situation in which the fact that we have this one year contract… what I took from your first comment about this, already several months ago, was that the reason why you were proposing this was because the current arrangement creates the problem, almost an automatic problem maybe, I’m not sure exactly how to characterize it, it creates the problem that you were describing, that you could be left with a stranded cost because of a contract you had entered into with a provider for the clinic -"
Dr. Sean: "Yes, yes, that is correct. You actually stated it correctly, but what you followed up with was, you don’t believe that’s a problem."
Falk: "No, no, I do believe it’s a problem, but I don’t believe this is a solution because if we do a two year, it’s a partial solution but it can’t -"
Dr. Sean: "It’s a partial solution, yes -"
Falk: "- in a two-year arrangement, basically a ten-year arrangement would be better, because you could freely do one year contract arrangements with your providers and it would only be a problem at the tenth year… so by changing it from one year to two year, it does diminish it somewhat but it actually only delays the problem for the next year. The same conceptual issue exists. And the reason I prefer the current arrangement is that it essentially keeps the pressure on both sides to provide good service, we need to pay our bills, you guys provide great medical service -"
Dr. Sean: "Well, see, that’s the thing - you said it - you want to maintain pressure on us to provide good service - wait a minute. You’re an attorney, Stephen, so you know there are three year leases, there are five year leases, you know, when you invest to improve a property to lease you want a longer term in order to get some of your investment back. So you’re right, if you give us a two year contract, it does help our situation, although, you know, in the second year, there might actually be some synchrony, but it still makes it better for us. But the truth came out when you said you’re trying to maintain pressure on us. You didn’t have to pressure us to bring three doctors to Point Roberts. Did our contract force us to do that? No. Why did we do that? Because we feel it’s the right thing. Because we wanted to give good service. So this, this, you’re sending a message that you want to maintain pressure for us to do good service. And I - that’s all I’m saying, I’m just acknowledging the truth in the message that you’re sending. So instead of saying, Sean, it doesn’t help you, because it does help us, doing a two year contract does help us, and that’s the end of the story. But instead of saying that, you could say, well, we are not sure, so we want to be basically applying pressure, and that’s closer to the truth. And I acknowledge that and I respect that, and all I’m saying is that that changes things a little bit because it’s a bit of a slap in our face, that we want to keep you on your toes. We don’t need to be kept on our toes. We’ve done better than you’ve expected or that you’ve contractually have asked us."
In the subsequent vote, Commissioners Falk and Sara Oggel voted to keep the one year contract term. Commissioner Noel Newbolt stated that she was initially opposed but changed her mind after hearing Dr. Sean's explanation and voted for the two-year term.
After the meeting, I sent the following email to the commissioners:
"At their recent October regular meeting, two of the Hospital District commissioners voted to retain the one-year renewal cycle for Supertrack’s contract instead of extending it to two years. Stephen Falk maintained that this decision was intended to preserve “flexibility” for both sides, but the effect was to deny Supertrack the flexibility they need in order to hire the best staff for the Point Roberts clinic. By restricting their ability to staff the clinic with the best available personnel, the District’s decision ultimately harms the interests of the community more than it harms Supertrack. With no better options for a clinic operator, and recognizing the superb job Supertrack has done in the past few years, this decision is like turning down a gift horse in case someone might offer you a unicorn later.
"On a personal note, I was appalled at how Stephen Falk treated Dr. Sean throughout the meeting. In the public comment period, I ended my comments by saying that Supertrack is treating us well, and I hoped we would treat them well in return. Stephen then proceeded to do the exact opposite. He was overtly hostile to Dr. Sean at times, passive aggressive the rest of the time, and disrespectful throughout, even though Dr. Sean was visibly ill. I believe that Stephen’s attitude and conduct, combined with his demonstrated poor judgment, are putting the future of quality health care in Point Roberts at risk, and potentially endangering the well-being of everyone who relies on the clinic."
The following month, at the end of the November meeting, Stephen Falk made the following statement:
"I would actually make one comment that I chose to ignore at the end of the last meeting, I treated it as if it was a personal matter but I think it was actually a commission matter. I had a brief, uh, vulgar and offensive message from a member of the public through the, uh, through the Zoom chat function and I chose to take it at the time as a personal attack and my general approach with bullies and intimidation is to ignore them, and I would do that for a personal matter, but this was actually while I was operating as a commissioner and chair of the meeting and so I thought I would rather bring it to the attention of the group because I don’t really think there’s any place for, uh, bullying and intimidation in a public matter like this, and just thought I’d put that on the record before we adjourn for this month. Hopefully it won’t recur."
