Providers describe confusion and challenges accessing services after Spokane Regional Health District dropped the program serving people with low and no income.
In June, the Spokane Regional Health Department (SRHD) quietly stopped administering the Breast, Cervical and Colon Health Program (BCCHP). That program, which is federally funded and administered by the Washington Department of Health, offered cancer screening and treatment services to community members in nine eastern Washington counties who couldn’t otherwise afford testing and treatment.
As the “prime contractor” of this program, SRHD’s role was to serve as a connector and facilitator by distributing funding and connecting patients who couldn’t afford cancer care with support to either get state insurance or cover insurance premium costs so those patients could access cancer screening and treatment. The health district worked closely with providers and local nonprofits to alleviate the financial burden of cancer screening for hundreds of Spokane residents each year over the 20-plus years it administered the program.
Funding is still available for local providers through the Washington Department of Health (DOH). But, since the program was abruptly dropped by SRHD this summer, patients, providers and local nonprofits have described uncertainty about how to access the program’s services as DOH seeks a new organization to run the program. Dropping this program is one of many structural and community health changes at SRHD that has former employees and community members concerned about the future of public health in Spokane County.
“We were blindsided,” said Marien Wilkonski, the director of breast imaging for Inland Imaging, one of the companies SHRD sent patients to for screening. “To be told they were pulling it out of Spokane altogether without any communication, other than a letter that gave us two weeks [saying, in effect], ‘sorry, we're pulling it out of your area’ — it was a big deal.”
Other groups that worked closely with the program say they weren’t given notice until after SRHD dropped the program. “We were notified seven days after the program ended,” said Deb Pike Barnes, the founder and board president of Every Woman Can, a local women’s health nonprofit that provided financial assistance to extend the reach of the BCCHP.
Not only were these organizations given short to zero notice that SRHD was dropping the program, they also weren’t consulted about the value of it or given a chance to advocate for keeping this regional program in Spokane. “As far as I know, none of us were given an opportunity to speak to anyone about the impact [of the program],” said Pike Barnes. “We could have worked a lot of things out, I think, to keep the program here if any of us had an opportunity to speak directly to whoever was making this decision.”
According to Kelli Hawkins, the public information officer for the health district, the program cost the health district roughly $100,000 a year – less than 2 tenths of one percent of the agency’s $47.8 million dollar budget for 2022.
Service providers and nonprofit partners weren’t the only ones left in the dark about the changes to the program. There have been no public announcements by the SRHD that they are no longer administering these cancer screening and care services. And, there is no indication on the program’s web page that the health district is no longer operating the BCCHP.
Hawkins explained why the health district didn’t announce it was no longer running the program. “The administration decision was part of SRHD’s budget planning process, so this was discussed with the Spokane County Board of Health publicly during a Board of Health Meeting,” she wrote in response to questions from RANGE. “There was no loss of community services or resources to announce.”
In response to concerns from service providers, which I relayed to Hawkins, she wrote: “We are sorry to hear that some providers did not feel they received adequate communication. When we notified them of the change in administration for the program, we provided our contact information and encouraged providers to reach out with questions or concerns. Those that did were given a warm handoff to other prime contractors in the state or were connected with our colleagues in BCCHP at DOH.”
County Commissioner Mary Kuney, who sits on the Board of Health, which oversees the governance of SRHD, said that she couldn’t speak specifically on the termination of the program. “That’s one I will look into and ask questions,” said Kuney during press availability after her state of the county presentation. Previous attempts to reach out to her office were not answered. “That was an administrative decision that was made.”
Amelia Clark, SRHD’s administrator at the time, has since left the health department amid state investigations into how she handled the firing of former county health officer Bob Lutz. While the investigation concluded without formal charges against Clark, she has agreed to never again serve as SRHD’s administrative officer.
The DOH, which administers the program at the state level, said that they were informed by SRHD that they would be dropping the BCCHP program early this summer. “In June 2022, Spokane Regional Health District (SRHD) notified DOH that SRHD made the difficult decision to end their role as Prime Contractor of the BCCHP in the eight-county region the program serves due to the cost to administer the program,” wrote Eloise S.L. Harris, a communications strategist with DOH, in response to emailed questions from RANGE. (DOH documents show SRHD administered 8 counties as part of this program, while SRHD documents indicate the agency was also the prime contractor in a ninth: Adams County.)
Cancer care providers already trying to catch up from pandemic
The regional health district’s unexpected jettisoning of the program comes at a time when cancer care specialists are playing catch up in the wake of pandemic disruptions in regular cancer screenings. “There was a two year period there where probably half the women who should have, didn't schedule [screenings] — and lots of those that did, did not show up for the exams,” said Ed Renouard, the director of marketing at Inland Imaging.
Now, service providers like Inland Imaging are trying to work through a backlog of patients even as uncertainty hangs over how to access financial assistance through the BCCHP program. “We're seeing increased demand now as people are more comfortable getting out into the world and taking care of business that they've neglected for a while,” Renouard said.
This loss of continuity in the program threatens to exacerbate existing public health inequities. During the height of the pandemic, the populations least likely to access cancer screening services in Washington were women of color and women living in rural areas according to a study by Washington State University (WSU) researchers. SRHD’s program served nine counties in eastern Washington, a predominantly rural swath of the state.
“Our study findings suggest that health care providers need to double down on efforts to maintain prevention services and reach out to these underserved populations, who faced considerable health disparities even before the pandemic,” said Ofer Amram, an assistant professor at WSU whose research focuses on health inequities, in a WSU press release. SRHD’s health equity officer role is currently vacant and has been since July 2021, according to SRHD organizational charts obtained through public records requests.
Renouard said that the service gap as the BCCHP changes contractors is a major concern. “Not having [the regional health district] to work with to provide those services is a huge deal.”
The decline of the program can be traced in part to SRHD firing the former program lead Donna Oliver last December, according to Pike Barnes of Every Woman Can. “When Donna left the program, I feel like we lost our advocate,” Pike Barnes said. Oliver, who ran the program over two decades, was fired in a move the district chalked up to budget cuts.
“I feel like it's an important thing to have the health district as a partner for goodness sakes,” Pike Barnes said. “To not have that anymore, it's a loss for all of us.”
Delays in life-saving screening and treatment
Early detection and treatment of cancer is crucial to fighting the disease. According to Oliver, the former program administrator, every year she worked in the program she heard stories from people whose lives were saved by the BCCHP program. “They would tell me, ‘if it wasn’t for this program I wouldn’t have had that lumped checked out,’” Oliver said. “You can literally see and meet the people whose lives were saved.”
Now, as screenings are backlogged by pandemic delays and challenges accessing the BCCHP program, cancer care providers are concerned about the community health impacts.
In recent months, Jennifer Lazzara, an advanced practice cancer care nurse at Cancer Care Northwest, said there’s been an increase in advance-stage breast cancer diagnoses. “We're definitely seeing more advanced stage cancer than we did before the pandemic when we had all of these programs in place and we had the ability to get people in for screening and early detection,” Lazarra said.
While SRHD and DOH maintain that the BCCHP program is still serving the community and accessible to patients, it’s clear from the perspective of service providers that the way the transition has been handled has hampered access to cancer care not just inSpokane, but across eastern Washington.
“We can no longer schedule [patients] for anything until we get approval through BCCHP,” said Wilkonski with Inland Imaging. “Women are waiting a week or two longer to get in for their additional imaging, which then if they need a biopsy again, they have to wait. It's the stress of these women, knowing they may have a little cancer, but we can't do anything about it until we get funding from BCCHP which has been moved out of our area.”
While some women are having screening delayed as their program coverage is processed, others are skipping screenings completely. “We did have women that came in, we told them BCCHP was no longer local and they said, ‘well, then I'm not doing my biopsy or my imaging until I know if I have coverage,’” said Wilkonski. “My biggest worry is women are foregoing their diagnostic testing and biopsies just due to no funding being available locally.”