‘What’s the best use of public funds to help the most people?’

PHD, BOCC discuss future of clinics

By Soncirey Mitchell
Reader Staff

Representatives from Panhandle Health District met with the Bonner County Board of Commissioners on Feb. 23 to discuss a recent audit of the organization’s clinical services. Following a Jan. 14 meeting on the same topic, the presentation explored proposed changes to PHD’s clinical model and touched on upcoming negotiations for the district’s Fiscal Year 2027 budget.

A crowd of more than 30 attendees sat through the two-hour meeting, many holding up signs reading “I AM NICHE,” crossing out “niche” and adding another descriptor, such as “51%.” These signs were designed by the local reproductive health care nonprofit Pro-Voice Project in response to comments made by Commissioner Ron Korn and PHD Medical Director Gregory Pennock at the Jan. 14 meeting. The audit — conducted by Pennock — revealed that women account for 70% of PHD’s clinical patients.

“For Panhandle Health — to some extent — that is the niche,” he said at the Jan. 14 meeting. “It’s female patients, women’s health care, gynecology, family planning that is the niche that we’re currently serving, whether we should be or not.”

In response to the presentation, Korn stated that he did not “want to be responsible at a county level to look like we’re funding a Planned Parenthood service.” 

Pennock and PHD Board of Health Chair Thomas Fletcher clarified at the Feb. 23 meeting that they have no intention of cutting women’s programs, as “the female of our species drives the bulk of health care,” in Fletcher’s words.

“Women are the cornerstone … of the family,” said Pennock. “They’re the cornerstone of medical decision making within the family, and we have an existing women’s health clinic that we can focus on and build upon.”

Regardless, the audit found that clinic usage has decreased in recent years, and loss of staff has necessitated limited hours. PHD hosts clinics five days a week at its headquarters in Hayden, once a week in Sandpoint, and once a week divided between Kellogg and St. Maries. Clinical services account for approximately 18% of PHD’s total budget but generate about 10% of its revenue.

After the audit, Fletcher said PHD had three choices.

“Broadly speaking, we could do nothing — just continue what we’re doing. I don’t think anyone thinks that’s acceptable,” he said. “We could shut the whole program down. There are two other health districts in Idaho that have done that. … Or a third option would be [to] continue to provide health care, but do something different. And that’s what we did.”

The “something different” aims to attract new patients by using an “integrated primary care model” that incorporates “allopathic, functional, alternative and nutritional medical philosophies,” focusing more on the surveillance and treatment of chronic diseases and, “maybe,” a “men’s program.” 

With that, PHD will also reduce its “surveillance of infectious disease.” The district plans to hire a “preventive chronic disease nurse practitioner” and “functional alternative medicine physician” to facilitate those changes.

According to Fletcher, although PHD’s proposed services may act “at variance with” the Centers for Disease Control and Prevention and the Federal Drug Administration, Idaho Risk Management — the district’s insurance provider — has provided a written legal opinion that “they have our back,” he said.

These policy changes have been shepherded, in part, by the newly established PHD Board of Health’s finance subcommittee, created following negotiations between the district and the BOCC regarding the FY ’26 budget. In FY ’25, the district received a total of $2,496,906 from Benewah, Bonner, Boundary, Kootenai and Shoshone counties. Of that, Bonner County contributed $513,798 — $136,041 of which went to the clinical services budget. The BOCC reduced that number to $472,317 in FY ’26, and the commissioners have hinted at additional cuts in the future unless Bonner County receives increased services, such as more clinic days and mental health resources. 

Pennock agreed that the Sandpoint clinic “has not been staffed adequately or to its capacity.”

To offset its current losses, Fletcher said PHD will “trim the fat” by restructuring or cutting underutilized and unprofitable programs, with Pennock adding they will try to “reduce the district support from the counties” overall. The board also considered renting clinics to private practices to increase revenue.

“Building costs are one of the biggest costs of any practice, and we’ve got five clinics that are sitting there not being utilized,” said Pennock. “So yes, we can lease those out and get money and help defer costs. That’s certainly one of the things we talked about. But another thing is to utilize that space by taking care of patients.

“I mean, it sort of comes to a fundamental question: What should public health be doing? … What’s the best use of public funds to help the most people?” he added.

To lower costs while increasing staff, PHD plans to work with the Medical Reserve Corps to recruit volunteer or part-time health care workers.

“Many of them are retired. Many are still licensed, and they have a few hours every week or every other week to donate their time,” said Pennock, later adding that there are “120 licensed professionals” in the five northern counties.

Despite these cost-saving proposals, BOCC Chair Brian Domke still raised concerns about the district’s clinical services in general, questioning if they were in competition with the private sector, and, because PHD’s clinics operate at a deficit, if they’re “using county tax dollars to provide socialized medicine.”

Pennock admitted to “some overlap” with private practices, but maintained, “We could add another 200 providers and still not have competition” due to the unbalanced ratio of patients to practitioners. As an example, he cited the four-month wait for an OB-GYN appointment at Kootenai Health. He and Fletcher further reasoned that the proposed approach differs significantly from other regional practices.

“We will be providing a style of medicine that is altogether different — we hope effective, successful,” said Fletcher.

Korn further questioned whether the county government should be involved in clinical services at all, suggesting that some of the “thousands of nonprofit organizations across this country and across the world” could step in to take “government out of servicing .1% of the population.”

“True preventative care: Who wouldn’t want that? True informed consent: Who wouldn’t want that? Big Pharma — I’m sorry,” said Korn. “But most of us want that stuff, right? I’m just not sure that’s what the government is supposed to be providing.”

“We all pay for health care one way or another,” countered Pennock. “We’ll pay for it in county taxes. We’ll pay for it in state taxes. We’ll pay for it in federal taxes, but we’re going to pay for it one way or another.”

He went on to argue that “point of service care” prevents medical issues from spiraling into emergency room visits and hospitalizations, which ultimately reduces “overall health care costs.” Fletcher agreed, adding that PHD’s clinics allow local governments to take “responsibility and ownership of your own health care.”

“So you say, ‘What business do we have — the county, the local taxpayers — being involved in delivery of point of service health care?’” said Fletcher. “Another way of looking at it is: We retain the ownership of how we treat people. We have not succumbed to the authoritarians, the people elsewhere who are imposing upon us a codified standard of care — all of the protocols, all of the standard stuff.”

Among these ‘protocols,’ Fletcher cited the “250 items of health care delivery” prescribed for pregnancy.

“That is amazing — something that has been done for millions of years without much complication,” he said, adding, after laughter from the audience, “Well, no, there were complications. Women died.”

According to the Idaho Maternal Mortality Review Committee, the state averaged 22.6 pregnancy-related deaths per 100,000 births in 2023. The rate previously peaked in 2021 with 40.1 deaths per 100,000, and IMMRC ruled that 95% of deaths between 2019 and 2023 “have been determined to have some level of preventability,” according to a 2025 report.

Neither the commissioners nor PHD’s representatives made any decisions regarding the FY ’27 budget or allocation of resources. Pennock agreed to bring the commissioners additional data and a “proposed business model” to supplement PHD’s budget request, which the district will present at a to-be-determined date.

“Panhandle Health should be able to see more patients, keep costs controlled, get more providers in — if we run a good business, along with practicing good medicine,” said Pennock. “Is that going to happen in the first year? Probably not, but over five years, we’ll have a program that everybody’s going to be proud of and happy with.”