The WOL (West Olympia Clinic) II

Ramō=Randy Moeller
Jun 26
8 min read

I am not exactly a cagey negotiator. However, finding myself engaged with a small medical practice in a double-wide trailer and in the woods no less, was not something I saw as career building, much less the setting for an optimized practice. The relief that was palpable when I accepted the assignment was used to make a specific point: at the end of two years, if there were no plans to build and staff a more substantial clinic, my partner John and I would have the option to came back to the main clinic and two alternative doctors would be found. I called the question at two years knowing full well that doctors and nurses are not machine parts that can be traded or changed out. Doctor - patient relationships are just that and not easily changed. But calling the question worked; it catalyzed a negotiation between the Cooperative and Providence Health Care (Saint Peter Hospital specifically) and the financing was agree to, land bought, and plans drawn up for a 12,000 square foot facility (actually, it was a few square feet short of 12,000 which would have required an expensive ceiling sprinkler system for fire prevention) in West Olympia.

The Coop was responsive, proactive, and polite. I was invited to planning sessions involving architects and interior decorators but was quickly put in my place—and with good reason: I did not have a clue. The interior decorator who was quite good looking in her Nordstrom outfit let me know the colors were selected as were the chairs and art work. She then sniffed, looked around, gave a wan smile, and headed back to Seattle. No Roy Orbison posters in this clinic……

We moved into the facility, 84 days after construction was started, over the July 4 holiday weekend 1988. Our first patient is said to have been seen in the parking lot on July 3rd. This is in keeping with our attitude as clinicians, “You can throw anything at us and we will make it work,” and yet, the problem for that patient that day was vaginitis, so I cannot speak to the actual clinical interaction that day.

The negotiation for experienced staff was better this round. The building would be new and would include a pharmacy, lab, and x-ray. We would have an on-site optometrist. The staffing model for supporting nurses was changing throughout the COOP and our patient flow was to be managed by MA’s (medical assistants); the RN’s took on a managing role for chronic problems, problem solving, and, a lot of phone work. Mostly, the doctors who had had the opportunity to join originally remained steadfast anchored to the main clinic. One of my call partners, Lisa Johnson, was an exception who saw the opportunity and agreed to transfer her practice and work on the West Side. With her came one of the best ARNP’s I have ever worked with: Melanie Rockwell. We scored a half-time pediatrician who was a gem: Meghan Hubbard. I would learn a lot of pediatrics in that by her being half-time, we had to integrate her work and she had to rely on us when she was not there. As the social trends found more and more parents directing their kids to pediatricians, we had a little island on the Far Side where we could retain some skill with the volume of such patients being seen. John Peterson joined us as the in- residence Optometrist. Again, the ability to walk down the hall and ask a quick question was invaluable for expanding the scope of practice and provide a nice service. John was always happy to bring them in for the exam, off the cuff, when indicated. We acquired Dave Remis and Mike Grady as new hires; Dave would eventually subspecialize and find a niche in Dermatology but was solid as a generalist for over a decade. Mike was a geriatrician and as most of us were still fairly young, this was a great relief. A hire within the first year at the new clinic was Liz Alberti, fresh out of school; the interview was short and to the point and the decision easy and never regretted. Randy Weiler, a PA with an Army background rounded us out and with him, a nurse named Randy Keen (we became known as the three Randy’s). The biggest surprise for me was a refusal; one of the new MD hires was assigned to us but had understood that he would work at the main clinic. I had interviewed Britt Smith in the same time frame and gave him a call. He was happy to join us and he would agree that it was the best professional decision of his career. We shared in the good fortune of his choice to join us and I specifically got relief: Britt succeeded me as clinic chief.

The design of the building worked perfectly for me: our nursing station faced the backs of the receptionist’s which made for quick communication on the fly. The lab and x ray was to our left as was our procedure room. I recall hearing the unmistakeable sound of a head hitting the floor in the lab as an adolescent male (it was always an adolescent male) fainted when blood was drawn—a doctor was on the scene in less than thirty seconds. The pharmacists had a short walk to our station to clarify a precription order or offer advice. More than once, I walked an old lady to the pharmacy window.

Sometimes a provider would get a patient they were not comfortable with and in our central common area, we providers would sometimes switch patients to get the right patient to the right provider — something we unfortunately called, “horse trading”—Randy Weiler would take my orthopedic cases in exchange for old folks with fatigue or diabetics or with medication issues. A most memorable consult was made by Melanie when she had a young woman with an unusual looking cervix; she asked me for advice and when introduced to the patient and then taking a look, I was greeted with pubic hair shaved into the batman logo.

We worked hard, made adjustments, and man, was it fun!

What was not fun, was the lack of an urgent care. Our patient population took for granted that we would do anything needed.

I was challenged by an Evergreen student, a woman who presented with a nail, driven by nail gun into two of her fingers. An exam and an X-ray showed no fracture or nerve damage. I had to go to my car for a pair of pliers (no available medical instrument in the clinic had the grip to pull the nail out) to treat her. We consulted orthopedics, managed her well and follow up was arranged. All of us had cases in our procedure room which served as our urgent care. Our reputation grew and I was able to score a surgeon to come and evaluate a patient with a recurring breast problem in my office. We even had a local orthopedist not in our system sometimes come to our clinic to provide in person care.

Our staff would ebb and flow as all clinic experience. During an economic crunch, we lost Mike Grady who returned to Oregon; we anticipated replacing him only to find there were no funds. His geriatric panel had to be re distributed to our already full panels of patients. I was reminded of Viktor Frankel in those days: One’s sense of meaning in life is a function of love, work, and suffering.

Trifecta!

A unifying feature of our West Olympia clinic was a common lunch time period and a large lunch room. All staff gathered as they could and we “broke bread” together every day. Stories were shared and relationships, professional relationships, deepened. Related to this was an easy going attitude about solving problems and flexibility no longer found in most systems. One summer, my pre adolescent daughter spent time in my office and proved helpful in the record room where she was shepherded by Shawn Simmon, (famous for having a Russian made motorcycle with side car) where she learned the system of storing the paper charts and often helped distribute them when needed urgently.

Our progress as a clinic in an integrated health care system was impressive:

In random order:

1995, the WOL received the United Way Silver Award for Outstanding Commitment to the People of our Community.

1989: we were chosen to be the pilot for Practice Management Project Team for the whole Coop. In support of this:

“This team sees itself as capable, effective, and personally satisfying for its members. The team has an unusually high number of strengths and no serious weaknesses. The team is in the best possible position to stay good and get better, if there is the recognition that a changing environment demands maintenance of team functioning. Our caveat to this team is to guard against complacency in its members and its functioning as a whole.”

1989: Randy Moeller was selected Manager of theYear (and accepting the award, proclaimed, Sally Field-like: “You like me, you really like me!”).

1993: WOL had the best work environment assessment results in the COOP

1990, We attempted to top our best Halloween clinic costume from a few years before and settled on a “Moeller look-alike” contest. The ultimate flattery ……..

Just as with marriage, my relationship with WOL had a mid life crisis of sorts. I looked at moving back to California. I looked at private practice as a different approach and even interviewed at a well known clinic; I realized I was nuts to leave and so, I rechanneled my energies which led to a mini career in management. This found me out of Olympia more than in Olympia but the WOL clinic continued the magical spell. I was then tasked with the economic reality as presented from Seattle, that we would have to close the clinic. Size (and distance from Seattle) did matter.

There was a discussion among leadership about keeping this very functional team intact and transplanting it wholesale into the main building in Olympia. It was felt that this would be a major disruption for the existing teams and with that in mind, the players of WOL were distributed across three teams.

Doctors, nurses, and other clinical supporting roles, like soldiers, are not interchangeable parts. Their motivation is not a function of the Coop's needs--it was to each other as well as the goal of providing outstanding care. It was apparent within just a few years that all the success from WOL was not going to be reproduced in the big clinic. My attempt to reignite some of the energy we had when I returned to a clinical practice had a very practical barrier. The larger clinic had no lunch room and those for each team could not comfortably hold more than five or six people at a time. There was a moment though: I suggested to my mini team in the big clinic that we would have a competition to see who could legitimately put in a clinic note, the term, “sexual repertoire.” Challenge accepted. The energy was good. At end of day, I was the only one who could demonstrate success: “28 yo male presents with concern about urethral burning and possible exposure to STD……” In the history, I noted: “Sexual Repertoire: male with female partners only,” and then the clinically relevant details referable to an exposure....

It was fun. My days were numbered.

The doctor who assumed my practice in 2018 worked with me for nine months prior to my leaving. He listened to my stories; on his door a few years after I left, a piece of paper was posted, stating: “It is supposed to be fun—Randy Moeller” I don’t remember saying that exactly, but it accurately reflects our modus operandi at the West Olympia Clinic and it is a great legacy to me personally and our clinic.

RIP

I did not attempt a comprehensive history of the WOL clinic and only started with the people best remembered from the early days. I offer the very incomplete list below to share those who worked with me at WOL. THANK YOU!!!

Liz Alberti

Jan ball

Cherri Berri-Lesh

MLiss Bentley

Eliz Booth

Teresa Davidson

Scarlett Glover

Mike Grady

Barbara Halloway

Liz Hamel

Karen Hayes

Helen Hollis