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Unalaska clinic faces funding crisis

October 20th, 2017 | Jim Paulin Print this article   Email this article  

An emergency request for funding to keep the island community's only health care facility from closing down is now before the Unalaska City Council, with an emergency grant application for $700,000, according to James Kaech, executive director of Iliuliuk Family and Health Services.

The request is specifically for "urgent health care," meaning after-hours visits and other emergencies including preparing severely ill patients for medevac flights, a service that loses about $800,000 annually. But a larger, $1.5 million, federal grant supporting routine daily services mandates 24-hour care, he said.

Without additional funds from the city, the federal grant could be lost, he said.

In less than two years, from Jan. 2016, through August, the clinic has seen 546 patients after regular hours, including 86 who were flown off the island to Anchorage hospitals 800 miles away, according to Kaech.

"Without support (from the city) there would be a significant increase in medevacs and create an increased hardship to the community," Kaech said. Each medevac flight costs about $75,000, he said, provided by private air carriers.

"The family practice is carrying the urgent care," Kaech said. Yet the clinic can't turn sick or injured people away if they're afflicted at midnight, on land or at sea.

"The target population of Iliuliuk Family and Health Services consists of anyone in need of medical, dental, or behavioral health care while visiting, working, or residing in the city of Unalaska, the port of Dutch Harbor, or the fishing fleet of the Bering Sea," according to the grant application.

Kaech said the clinic now has enough money to keep meeting payroll for the next two months. It's already cashed in a $200,000 Fidelity financial investment to keep things running, he said.

The clinic's total budget of $5.3 million includes $2.7 million in patient revenue including health insurance payments; $2.4 million in grants including the main federal grant and the proposed new city funding; and various smaller revenue sources, according to IFHS.

In an Oct. 10 memo to the city council, acting City Manager Erin Reinders said Kaech discussed the clinic's emergency funding request with city staff.

"The clinic certainly provides a necessary service for the community, and if support is requested annually, it would become part of the regular Community Support Program process and would need to meet the same requirements," Reinders said.

The support program annually funds various non-profits, including the arts council, community television, and the museum.

Kaech was hired just two months ago, coming from Olympia, Wash., where he was an administrator with the Washington Association of Community and Migrant Health Centers. His priorities include attracting patients back to the clinic by lowering fees for medical services. The clinic has lost about 25 percent of its patients in recent years, opting for out-of-town medical services, and he said high fees are a big reason. He said the clinic's fees are among the highest in the state, and he'd like to see them among the lowest.

Another big move was creating a new position, of chief financial officer. Darlene Dumois-Allen, who starts Oct. 25, and who he worked with in Washington, will fill the position. That's a move praised by Unalaska City Councilor David Gregory, who heard Kaech's presentation at last week's council meeting.

Kaech said he thought his presentation was well-received, even if his "dramatic ask" for major funding wasn't exactly good news. "They've seen it coming, so I don't think anyone was surprised," especially since he said the clinic's been losing money for about the last seven years. He noted that the council includes former clinic board members, familiar with the financial challenges.

Kaech is also taking an innovative approach to collecting $1.3 million in unpaid medical bills. Through the end of this month, the clinic is offering a 50 percent discount on bills older than 120 days. He said he may ask his board of directors to continue it through November.

So far, after two months in Unalaska, Kaech, 45, said he's loving his new home, especially sportsfishing, and volunteering as a basketball referee at the community center.

Jim Paulin can be reached at


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