Founding the West Olympia Clinic

The West Olympia Group Health Clinic

The origin story: I started working for Group Health Cooperative at the main Olympia clinic in January of 1984.  I very much appreciated working with teams in a system providing care across many specialties. It very much mirrored the system of Residency I had had and was better supported than my private practice in Salinas California. I still smarted from my private practice experience where my partner’s patient suffering from severe pre-ecclampsia on Christmas night presented very ill and with a dead baby needing to be delivered. My consultants across town told me, “Boy, that’s a really bad problem. She’s too sick to transport to San Francisco. Keep doing what you are doing and good luck!” She very nearly died. I aged five years in one night.

I developed rapport with my new team at Lilly Road on day one. From the staff bathroom, my next patient to be seen could be heard screaming that he needed help. The nurse assigned to my practice, Shannon Butters, made direct eye contact with me. It was a sort of challenge.

“I’ll get it,” I said.

The demented old man stood  in front of the toilet with his pants about his ankles. He needing to be wiped. I accommodated him and got his pants back on with soothing tones and soon, we were in an exam room taking care of the business at hand. Shannon later told me that it was clear I was going to be a credible partner. I had found a new clinical home.

I was was soon hitting my stride in this new practice; I had an OB call group of two people (Lisa Johnson and Gary Kelsberg) with whom I interacted every day in a relatively small “pod” of offices and exam rooms. An old time doc (Dr. Fitzpatrick) had an office kitty-corner in the pod and some days, at the end of work, I would visit him and he would pull a bottle of scotch out of a drawer. He smoked in his office! Shannon and I took it outdoors, on the steps out of sight. This was a very different environment from my private practice in so many wayss--where one partner wanted to give his services away for free, and the other wanted to be a millionaire within the decade. Neither drank Scotch nor smoked.  18 months in, there was a new development. The Lilly road clinic had growing pains and options were on the table for yet another change.

The "opportunity" presented itself when a private practitioner who had opened a “clinic” ie a double wide trailer on an undeveloped plot of land on the West Side of Olympia died unexpectedly. There was, in fact, scandal attached—he was under a cloud socially and with his medical practice.  He  had been found in the woods, dead with a bottler of Nitrous Oxide at his side. I presume there was a fire sale on his clinic and suddenly the primary care team was presented with a needed move—for two of us family docs—to strike out and start a new clinic on the West Side of Olympia—details on specifics to come later.

Kernie and I were in the midst of building a new house just ten minutes from the hospital, and some twenty minutes or more from this trailer. I was not especially interested given the isolation and lack of services I had come to take for granted. I rounded on my patients when they were in the hospital (just across the street from where I worked) so the timing and convenience for this potential change was not welcome.

The business meetings of the larger group of family physicians were quite trying as the leaders attempted to elicit  a commitment staffing the new clinic.  My new-found brothers and sisters in the mission of family practice now had a notable lack of eye-contact in these meetings. The normal friendly and cooperative spirit lagged—-notably lagged as contracts were reviewed and it was found that the more senior docs had a guarantee to not be moved; we newer hires had no such contract language. Trying to flesh out the possibilities out loud, I reflected at one point that this new clinic could be viewed as an opportunity given a commitment to improve the clinic over time and, “it would not be the worse thing in the world.”

Jan Vleck, our clinic chief and a former fellow-medical student with me at UCLA took this musing as a form of volunteering and let me know that I had been chosen to lead this new adventure: the Group Health Cooperative West Side Clinic.

“You have six weeks to find a partner from within our existing staff; otherwise, you will have the new hire, coming from the East Coast.”

And so it came to pass that John Porter, a new residency graduate would join me. All my teaming and relationships were for naught as I tried to find an experienced teammate to join me. I was once more, starting over and this was the backdrop of the most successful period of my career as a doctor.

The “Double Wide” and the origin of “The Far Side:”

In our rickety double wide trailer, we would have receptionists to manage the schedule. Shannon would support my work and Sally Jorgensen supported John Porter, the new hire.  There were two exam rooms for each doctor. We had a small closet that would serve as the pharmacy. The common area where the nurses had desks was where our bare-bones lab equipment stood.  I was young enough to remain proficient at doing urinalyses and hematocrits quickly. If more lab was needed, the patient would have to drive 15 minutes to get to the main clinic. The Cooperative agreed to develop a relationship with a nearby urgent care where we could get x rays done. Lastly, what in retrospect was probably in violation of many regulations regarding pharmacy, we had stocks of normally used drugs which included powdered amoxicillin which had to be reconstituted with sterile water by ourselves when prescribing this to children with ear infections.

John arrived; he had a great sense of humor and was open to adventure; we bonded nicely. We had lunch sitting on the back steps, looking out into the woods where occasionally, deer would forage. We supported each other with complicated patients; I taught him how to do vasectomies (in the woods, mind you). HIPPA was only a concept then and the walls were thin. The restrained laughter when my naked-but-draped deaf 80 year old female fell onto my lap “skootching down” for a pelvic exam (“I couldn’t hear you!”) Straddling me and  nearly knocking me over was evident when she and I regained our dignity and said our goodbyes in the hallway.  Shannon was still trying not to pee her pants with laughter while staying in the room pretending to clean it up. That same woman remarked on a poster of Roy Oberson, decorating our very professional clinic was, “Dr. Moeller, is that your wife?”

The reality about being unsupported turned out to be not so terrible. We needed an acute x ray maybe twice a week. The prescribing was not a problem and when more lab was needed, we developed a system of getting the results and conveying the answer by phone to the main clinic where the patient typically remained for the chance they needed an antibiotic or further evaluation in Urgent Care. We did our own urgent care in the double wide trailer when possible. This meant minor laerations, thormbosed hemorrhoids, and drainage of abcesses all were treated in clinic whereas over at the main clinic, they would be sent to Urgent Care.

A legend began. We were getting great service scores and our inability to access the usual testing found us using clinical judgment, saving money without a worsening of outcomes. We felt like we had a small mom and pop business with great camaraderie supported by a large integrated health plan.  At year one, we had a birthday celebration and invited all our fellow doctors and nurses from the main clinic. John and I put on tuxedos, I bought champagne which we drank out of the plastic (sterile) receptacles for collecting urine. We had a great time with just our few guests and our own little family.

When given my orders to the west side, I had negotiated a check-in with the staff at two years. Speaking for both John and myself, I had gotten agreement that after two years, if a larger and better supported clinic was not in the making, we would go back to the main clinic and two new doctors would come staff what was becoming known as the Far Side. It was clear by year two this would not be viable—-patients came to us for the locale and we now had relationships with them. You can’t change out doctors and nurses like car parts. And—don’t forget, we were in the woods…… I called the question, however, and no answer was forthcoming until about six months later when a deal was made with St Peter Hospital. Seeing our success and having a contract to hospitalize all our patients at St Peter (close to the East side clinic), they saw a way to draw more patients to their hospital who might otherwise go to the private local hospital near us. They helped finance a twelve thousand square foot facility that would house the “real” West Side Clinic. By then the famous Larkin comic strip, drawn by a graduate of Evergreen State College, also on the West side, became our inspiration for a new name. We were the Far Side Clinic

The adventure continued.