Panhandle Health District to host meeting on clinical services

By Soncirey Mitchell
Reader Staff

The Panhandle Health District Board of Health met April 17 to discuss the logistics of its upcoming “strategic planning meeting,” which will be a public workshop on the district’s clinical services hosted by Idaho Association of Counties Executive Director Seth Grigg on Saturday, May 10. The board also further discussed Idaho Open Meeting Law and the future of public comment and clinical services in the district.

The May 10 meeting will run from 9 a.m.-1 p.m. and the agenda and additional information will appear on panhandlehealthdistrict.org. Anyone interested in giving public comment can send written statements to [email protected] until Wednesday, May 7. The meeting will be streamed on the district’s YouTube channel but will not offer remote participation, so those wishing to speak will have to attend in person at the Kootenai County Administration Building (451 N. Government Way, Coeur d’Alene).

Board Chair Thomas Fletcher of Bonner County was adamant that the meeting will only cover clinical services, not other issues under the board’s jurisdiction, such as environmental quality, septic systems and waste disposal.

“If someone says ‘chemtrails,’ for instance — if I hear that again, I might have to commit suicide,” said Fletcher. “That was a joke.”

To prepare for the May 10 meeting, PHD Director Erik Ketner presented the board with data on the district’s clinical services for the past 10 years.

The district currently employs a “barebones crew” of 4.5 medical staff members, including 1.5 nurse practitioners, 1.5 nurses and 1.5 medical assistants. That number is down from 15 in 2015. Ketner attributed the loss of personnel to the scarcity of medical professionals and the passage of Medicaid expansion, which lessened the need for free clinics. In light of the recent federal funding cuts and the new requirements to qualify for Medicaid in Idaho, Ketner anticipates that the need will only grow. 

“I think that the additional requirements that the state of Idaho took on will likely mean that one in four individuals will fall out of Medicaid expansion,” said Ketner, citing news coverage of House Bill 345.

H.B. 345 was intended to cut Medicaid costs, mandating that Idaho seek work requirements for citizens on Medicaid and offer tax credits for qualified individuals to buy private insurance through the state’s health care exchange. The bill was based on similar Arkansas legislation, which, once passed, meant that “one in four people subject to the rule lost coverage,” according to the Idaho Capital Sun and the Center for Budget and Policy Priorities.

Currently, the National Institute of Health’s HDPulse estimates that 11.1% of Bonner County citizens under the age of 65 are uninsured and 7.5% live in poverty. Both statistics are higher than Idaho’s averages of 9.8% and 7%, respectively.

Ketner anticipates that Idaho’s smaller counties will feel the need for free clinical services the most.

“We are transitioning from a private health matter — which, you know, your health is frankly a very personal issue — to where this becomes a public health issue,’ said Ketner. “I mean, if we’re seeing an additional spread of communicable diseases, if some of these same programs no longer exist, what is going to be the solution, and how is that going to bleed over onto individuals that do have health care?”

The board intends to discuss the topic further at the May 10 meeting, but Ketner cautioned that PHD won’t know the full impact of recent legislation for several months.

While planning the May 10 meeting, the board debated the importance of public comment and the request made by members of the public that they be able to participate in all PHD meetings remotely.

“I have a strong opinion as it relates to verbal questions [at the May 10 meeting] — only people who show up, not on Zoom. If you want to say something, go to the meeting,” said Fletcher.

Bonner County Commissioner Ron Korn recommended that the board allow remote participation or give people the opportunity to email questions in advance.

“You’re representing people multiple hours from here,” he said.

The district extends from Boundary County to Shoshone County.

Medical Director Duke Johnson, of Kootenai County, agreed that the district should encourage more public participation.

“I think that the more people feel that they are a part of Panhandle Health, the more it’ll be a utilized entity and feel more like them, and that’s good,” he said.

“Let [the May 10 meeting] be P.R.,” said Fletcher, paraphrasing Johnson’s point. “So, actually, if we are interested in promoting Panhandle Health clinical services, make people believe you love them … Give people the opportunity to speak, to participate and then they will appreciate you, and if they appreciate you they will come to your clinic.”

Though the May 10 meeting will only stream via YouTube, the board voted to use Microsoft Teams for future meetings to allow remote participation.

Fletcher said that the board will not be making any decisions at the May 10 meetings and that he will be “asking questions and providing information as substrate for stimulation of thought.” 

“Not only in this meeting, but just in general, I just want to make sure that when we’re out facing the public in any way, shape or form, that we’re very cognizant about the fact that we are in a position by being on the board where people can make easy assumptions that maybe this is what the board thinks about XYZ,” added Vice-Chair Jessica Jameson of Kootenai County.

Peggy Cuvala of Benewah County and Jameson referenced statements made by Fletcher, which Ketner said alluded to “radio shows” and “various public meetings” at which Fletcher made comments that “may be construed that that’s the board’s opinion.”

Fletcher has spoken before the Bonner and Kootenai County boards of commissioners and the Bonner County Republican Central Committee, pointing to various conspiracy theories and questioning the safety of the Centers for Disease Control and Prevention’s childhood vaccine schedule. Fletcher has denied that he is an “anti-vaxxer.”

During the Feb. 18 BOCC meeting, Fletcher stated, “If nothing else, this COVID pandemic experience has taught us one lesson, and it is that public health institutions are capable of deception. The deception goes from the global scale — the World Health Organization — all the way down to your local public health district.”

Jameson’s and Cuvala’s comments alluded to a broader pattern of unconventional leadership by Fletcher since he took over from former-Chair Marlow Thompson and began running PHD meetings in September 2024. Fletcher does not regularly take attendance, conform to meeting agendas or keep track of motions, amendments and votes.

As with his Feb. 20 agenda item on “informed consent” — which worried and confused board members and area pediatricians — Fletcher stated that he didn’t “actually have a specific agenda” for the May 10 meeting and originally wanted the discussion to be more free-form.

“I have to confess that the lawyers altered my thinking about all of this [the May 10 meeting] at our last board meeting,” said Fletcher.

“Now, the lawyer sat in the chair over there at the last meeting and said, ‘Well, you know, in Idaho, we have to follow these open meeting law rules. That means you have to have a specific agenda, specific topics, specific items and it all has to be put out so many days before so that the public knows what to expect.’ And I went, ‘Oh, OK.’ Then I spoke to some commissioners about this and, in fact, that’s what all the commissioners — that was the feedback I got,” Fletcher later said.

Fletcher said he was “left flat-footed” when told he had to set an agenda for the May 10 meeting to comply with the law. When asked by the Reader to clarify whether Fletcher’s statement meant that previous meetings had violated open meeting law, PHD Communications, Health Promotion and IT Manager Katherine Hoyer said that the district “follows Idaho Open Meeting Law.”

“Ensuring our public meetings and agendas are properly noticed, in accordance with Idaho Open Meeting Law, is a key responsibility of the district director and supporting PHD staff,” Hoyer told the Reader. “We are committed to full compliance with open meeting laws in order to maintain transparency and ensure the public has access to our board’s decision-making process.”