A decision on what level of safety conditions must be imposed for the proposed medication-assisted treatment (MAT) clinic is expected by Dec. 18.
The City of Sequim’s appointed hearing examiner Phil Olbrechts heard four days of testimony between Nov. 16-24 in a virtual hearing with high winds and internet outages postponing one day of testimony.
Despite the City of Sequim and Jamestown S’Klallam Tribe agreeing upon a stipulated settlement of conditions in early October, Olbrechts still went forward with a hearing.
In an email, he wrote that a hearing must be held on modifications to the revised Mitigated Determination of Nonsignificance (MDNS) and the tribe and/or city must defend the modifications are consistent with State Environmental Policy Act (SEPA).
Olbrechts was hired in-part because the tribe appealed MDNS conditions for its proposed 16,806-square-foot medical facility off South Ninth Avenue where doctors would dispense daily doses of methadone, Suboxone and Vivitrol for patients with opioid-use disorder while offering wrap-around services.
Tribal officials largely felt the city’s imposed conditions didn’t relate to environmental impact nor would they be imposed upon any other clinic.
Olbrechts said the city’s Ordinance No. 2020-009 expands examiner authority to set the ground rules for SEPA appeals, and he included Save Our Sequim’s (SOS) attorney Michael Spence to cross-examine witnesses due to the high level of concerns by community members.
At the end of the hearing Olbrechts said he’s in a “golden handcuff situation.”
“The conditions may be so good, it may prevent me from requiring anything,” he said. “It puts me in a little bit of a difficult spot.”
However, he said his decisions are detailed, even-handed and unbiased.
“I’m not trying to be friends with anyone,” Olbrechts said. “I will give you a decision that follows the law.”
Olbrechts previously denied five other appeals against the MAT clinic because they “lack standing.”
Parties have 21 days to appeal Olbrechts’ decision under the Land Use Petition Act (LUPA).
In the city and tribe’s agreement, it kept conditions, such as mitigating for construction dust affecting air quality and determining if a cultural survey is necessary prior to construction.
Tribal officials voluntarily agreed to conditions, such as:
• On-site security, transportation for those who need it to and from the clinic, and no patient loitering.
• Creating a monitoring and evaluation program developed by a Community Advisory Committee made up of: Brent Simcosky, the tribe’s health services director, Sequim City Manager, Sequim Director of Community Development, Clallam County Sheriff, Sequim Police chief, tribal council member, city councilor, and health field worker with experience treating Opioid Use Disorder.
During the hearing, Simcosky agreed to add a community member position.
• Post a bond of $250,000 prior to occupancy to support local first responders’ efforts, only if available on the market on commercially reasonable terms; and if over a six-month period calls for service to the clinic exceed calls for service to the other medical clinics/ offices within the city.
• Fund a Social Services Navigator position through the city to provide social service assistance to patients and other persons in need of Substance Use Disorder and mental health assistance within the city.
• Comply with federal law regarding notification requirements to the city if the tribe applies to place the land upon which the clinic is built into Tribal Trust land.
Of the agreed upon conditions, six were struck from the city/tribe settlement during their discussions. Some of those stricken conditions included using the tribe’s “Jamestown S’Klallam Tribe Preliminary Medical Outpatient Clinic and Community Response Plan,” and creating a Good Neighbor Agreement.
Barry Berezowsky, Sequim’s director of community development, said during the hearing he did not tell Simcosky the Response Plan would be included as a condition, but translated conversations with him and the clinic developer into mitigation measures.
“It contained elements they presented to the community … This was a coauthored attempt to respond to the community, and hold the developer to their commitment,” Berezowsky said.
When asked by the tribe’s attorney Andy Murphy if Berezowsky would have imposed similar conditions on the MAT as other medical clinics, he said no.
Berezowsky later said through city/tribe mitigation they removed asking the tribe to waive sovereign immunity and the response plan because “we walked away with something rather than nothing” with the voluntary conditions.
He told Spence that the city is unable to stop the tribe from putting the property into Tribal Trust, and they were unwilling to do so.
Simcosky said even if the tribe did have sovereign immunity they’d still be required to follow state and federal operating regulations. He later added there’s no advantage to putting the clinic into a trust at this time, either.
City of Sequim attorney Kristina Nelson-Gross said city officials don’t believe they have many conditions they imposed they could enforce, hence why they came to a voluntary agreement.
Berezowsky said elements of the Good Neighbor Agreement were included in other conditions.
Spence later questioned Sequim Police Chief Sheri Crain where she said with the other mitigation efforts in place, she didn’t think the Response Plan was necessary and that other agencies like the Drug Enforcement Administration had more oversight on restrictions making a Good Neighbor Agreement superfluous.
Crain said removing neighborhood sweeps always felt “awkward” because it could cause more troubles than it solves with “people assuming there could be a problem.”
Spence reiterated SOS’s position that they agree with opioid treatment, but not the location of the tribe’s proposed clinic near businesses, residences and retirement facilities.
He asked Berezowsky if he asked the tribe to build elsewhere; Berezowsky said it’s not in his job responsibilities with the planning department to do so.
Simcosky said they chose to pursue the clinic because no other entity was offering “daily, intensive wraparound services (and) we felt this was the next step.”
Tribal leaders chose the property, he said, because it was discounted $600,000, close to a highway, faces the mountains and is close to the tribe’s Jamestown Family Clinic.
Crain said the MAT clinic’s property is “off the beaten track (and) it’s not in a well-traveled, visible area.”
Crain testified that she is aware of its proximity to a retirement center, but that “regardless of where it is, it’s always going to be next to something.
“I don’t think the impacts from this clinic are going to be of any dramatic effect it’s going to negatively impact our services.”
Simcosky said tribal officials chose not to build in Blyn because available land is targeted for hotel/casino expansions and the city property was already zoned for health care.
“I never thought there’d be this backlash,” he said.
Since plans for the clinic were released, Simcosky said he’s consistently heard they’re going to be busing patients into Sequim from areas like Seattle.
“We have no intention of doing that whatsoever,” he said. “There are services in King County and (other counties). No patients would want to spend three hours trying to get here.”
Simcosky said they won’t transport people to the clinic from outside Clallam or Jefferson counties.
“You have to depart the way you arrived; the only exception is with pre-approval,” he said.
There will be strict rules in place, Simcosky said, with drivers trained to identify potential issues in patients if needed.
He said if a patient comes from outside Clallam or Jefferson counties they’ll refer them to a resource in their area.
Simcosky said one or two patients not from Clallam or Jefferson counties may get services in extenuating circumstances, such as a college student from out-of-area who lives with his/her local family.
During cross-examination of SOS chairperson Jodi Wilke, Murphy asked her if SOS members said the tribe was going to bus people into Sequim. She replied that she couldn’t remember everything she said.
However, she said the City of Seattle committed to a program busing people out of the city to neighboring areas for treatment.
Olbrechts also asked her about this.
“(It) is a concern our organization has,” Wilke said. “The business plan of the project is to bring people form outside of the community, attract them, whether commute or bus in to this community. It will create an impact to the community at large.”
Olbrechts followed up asking if the tribe’s shuttle program sufficiently addressed her issue.
“I don’t know if the facility or the tribe has the legal authority to compel a person where they can and can’t go,” Wilke said.
• Walk-ins, walk-outs
Simcosky said most patients will be self-referred and must set up appointments. Walk-ins won’t just be accepted but rather examined at a scheduled date for a few hours, he said, and this means the “ramp up” of patient load will take some time because of the involved process to admit each patient.
While rare, Simcosky said if a patient isn’t accepted, and hey don’t have transportation the tribe would take them back to their home.
For patients in treatment, Simcosky said, there won’t be a reason for patients to “just walk off.”
“Our security would go with a social worker and remind them what the rules are,” he said. “If they (decline) then they’d be terminated and returned to their home base.
“(You) have to trust we run things in a safe way. I can’t detail every single sentence of how it’s going to happen. We are going to make it safe and return people to their home base.”
Simcosky said they won’t accept court-ordered patients, but might consider them later on.
For those with no insurance, he said, the tribe offers a sliding payment scale, the opportunity to make payments, and working with a social worker to connect those patients with medical assistance programs.
As a rebuttal witness called by Murphy, Dr. Paul Cunningham, chief medical officer for the proposed MAT clinic, said that there aren’t more Opioid Treatment Programs (OTPs) in smaller communities because they require a lot of resources.
He said the new clinic is modeled after Anacortes’ didgwalic Wellness Center and would combine MAT services with wrap-around services, such as onsite counseling, peer support, social work, dental care and more.
MAT patients range from needing treatment for a few months to a lifetime with some needing more intensive services that the new facility would offer, he said.
While the Jamestown Family Health Clinic offers MAT to about 100 patients, Simcosky said daily treatment such as methadone requires a different license and “a lot of space, and we don’t have a lot of space.”
Simcosky said the current clinic has about a 75 percent success rate with Suboxone, and that they have a lot of certified providers to offer MAT services with many at the Fifth Avenue clinic seeing one or two patients, and a few physicians seeing a bulk of the patients.
Wilke contested Simcosky’s success rate, saying a 2017 Washington State Department of Social and Health Services (DSHS) study shows only a 51 percent success rate in similar clinics, and that those afflicted aren’t Sequim’s older population.
“Sequim as a city is not a high-risk community for having a lot of addicts,” she said.
Wilke added that there isn’t an emergency room or a hospital to accommodate incidents from clinic, and that even one patient who leaves the program could negatively impact the people around them, and thus the community.
“To expect there not to be any impact is, I think, it’s blind — willful blindness,” she said.
Wilke said omitting the Community Response Plan from the conditions puts the community at risk and the potential for sovereign immunity means “there’s no recourse” for the tribe.
“There’s the simple fact that the Jamestown facility takes away — by virtue by being an OTP — takes away access. I know people waiting years to get an appointment (from a doctor’s office),” Wilke said.
When asked if the Sequim clinic will do better than Anacortes in retention, Cunningham said he can’t say with certainty but he doesn’t believe the populations are comparable.
“I truly believe there will be a benefit to the community,” Cunningham said. “As we get more people into treatment, we’ll see less people in the ER, hospitals and using other services. I don’t think there will be any significant impact on the community. Patients with OUD (opioid use disorder) already exist.”
Cunningham said he’s unaware if any of the tribe’s existing MAT patients are “truly homeless.” He described patients who leave the program as diverse, with some leaving the program because they move, stop coming or reach sobriety.
“They do not set up tents or in neighborhoods around town,” Cunningham said.
He said some patients take “months or years to build up courage to talk to anyone about their addiction.”
Both Cunningham and Simcosky said there are no plans to add additional housing north of the proposed facility. Early plans discussed a 16-bed inpatient facility in its second phase but were dropped, tribe officials previously said.
When asked about the proposed second phase, Wilke said she believes there’s a caveat that allows the tribe to later pursue a second phase with the phrase “unless a future need.”
“The public has no recourse if there is sovereign immunity,” she said.
Murphy contested this saying tribal officials face perjury for lying about no second phase and that the only reference to housing is an outdated map labeled as future housing.
Crain testified that the city’s homelessness count has remained consistently low for more than a decade.
Simcosky said many of the plans included in his Response Plan are in the conditions.
“It doesn’t mean we won’t follow them,” he said. “We’re also governed by (Substance Abuse and Mental Health Services), (Drug Enforcement Administration) and the Department of Health.”
He said they removed a complaint line proposal because he feels it would be abused and that “if there is a real issue with our property, people will know how to get a hold of us.”
In his 20-plus years of experience, Cunningham said, there’s never been stolen medications off a cart. The medications are “under lock and key” and require at least two people to count every pill and ounce of methadone distributed, he said.
Simcosky said he understands people’s fears.
“I understand people confuse addicts and addiction,” he said. “The people we’re seeing are people who don’t want to be that any more.”
Wilke said conditions such as adding the Community Response Plan and community members to an advisory committee would alleviate some fears.
“I feel there are people in the community they want to ignore,” she said. But she was “heartened to hear Mr. Simcosky’s willingness to make some changes.”
Wilke feels more stakeholders, such as the from the Sequim School District and church community, would provide more balanced input.
“I do think that (formalizing to plan for contingencies) would be helpful and set up a feedback loop that involves the public that is committed and robust (with a) discussion about best practices,” she said.
Public comments included those for the clinic, including current OUD patients and physicians, and those against its location and/or stating the conditions don’t do enough.
Bill Staeger, an environmental consultant for 40-plus years, said the city/tribe’s agreed upon security measures aren’t as “reassuring” as the one in the Community Response Plan,” and that with the agreed upon $250,000 bond there’s verbiage that leaves the tribe the option not to pursue it. He recommended creating a “what if” account.
In closing arguments, Nelson-Gross said city officials believe “through cooperation and the tribe’s willingness, the city has done its best to alleviate concerns of community in its legal authority.”
She said that officials agreed to the bond “goes to the tribe’s willingness to alleviate concerns.”
Murphy said the tribe has “already gone above and beyond to meet community concerns (and) volunteered changes.”
“There’s no reason to believe the tribe will run it like a dose-and-go (clinic), and no reason for the tribe to bring problems to Sequim,” Murphy said. “The tribe will always be here. The tribe has a vested interest.”
Olbrechts said one thing he felt was missing was a “monitoring program with some teeth” and action steps for potential issues like homelessness.
“It’s not a new concept,” he said. “That kind of mitigation would go a long way (and you) could set up a monitoring program that’s fairly specific.”
Find more information about the process at www.sequimwa.gov/964/MAT-Clinic-Appeals.