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We've Come A Long Way, Interview with OIHCD Commissioner Diane Boteler, MD

By Gray Gailey

Like any town, Orcas Island residents have an array of medical needs, and our rural location can make it difficult to address all of them. The Orcas Island Health Care District (OIHCD) strives to ensure that island-appropriate, quality primary and urgent care is available to all islanders, while also serving as a catalyst for collaboration among organizations addressing broader healthcare needs. With these goals in mind, District Commissioner Diane Boteler, MD, – who is currently serving her second term – tries to keep the best interests of our islanders at the forefront.

After serving with the U.S. Indian Health Service on the Navajo reservation in New Mexico, Boteler moved to Orcas Island in 1997 to work at the Orcas Medical Center as a physician and later a medical director. After leaving the Clinic in 2003, she studied Tropical Medicine in London, England. While serving as OIHCD Commissioner, Boteler also commutes to St. Joseph’s Hospital in Bellingham to work as a hospitalist. Though initially hesitant to run for the Board, she came to see the position as an opportunity to put her unique knowledge of rural healthcare to use and give back to her community. “[The Board] has been a lot of work… especially in the beginning… but I’m happy that we are at a point where the superintendent can run [the District], while the Board provides strategic planning and public oversight. We’ve come a long way.”

Anyone who has experienced healthcare on our island understands that what we need is much broader and more complex than what a suburban clinic can provide. When asked how the partnership with Island Health in Anacortes has changed the face of our Clinic, Boteler shared her opinion: “Island Health understands the islands, including the ferry challenges. Being a smaller hospital, Island Health has been incredibly responsive and willing to creatively address our needs. “Often, in meetings, we are talking directly to the CEO or other decision-makers.”

To improve their ability to work well together, the OIHCD Board recently participated in a one-day retreat at Camp Orkila’s Alumni House. “We discussed our goals for the year and gained a better understanding of each other’s roles. While some of the Board members have known each other for years, the retreat was an important opportunity to familiarize ourselves with our two newest Commissioners, Mark [Salierno] and Chelsie [Guilford].” Salierno specializes in healthcare finance and consulting, while Guilford represents and advocates for younger islanders, especially those with kids. Boteler is optimistic about the Board’s future and the unique perspectives and ideas brought forth by the newest Commissioners.

When asked about the planning of the 2024 Tax District Levy, Boteler emphasized that the Board is constantly aware that the levy comes directly out of taxpayers’ pockets. While recognizing unmet healthcare needs, the Board chose again this year not to take their full levy without a solid plan of how to spend it. The limit of their permanent levy is seventy-five cents per thousand. Each October, the Board sets its budget for the following year and sets aside a reserve fund for unforeseen emergencies. “There is a lot of nuance to how you manage it, but it is important to be cautious and thoughtful [of our community]” said Boteler.

OIHCD is enthusiastic about expanding partnerships with other organizations. The District recently received a planning grant to expand access to dental care for Medicaid patients. While their long-term goal is to house an in-clinic dentist, the District is supporting other community organizations as they develop a model that will serve as a temporary bridge to that permanent solution, providing much-needed dental care to Medicaid patients who are not currently served by dentists on Orcas. “[The program] will certainly be a relief for the community.”

A primary goal of the OIHCD is to prevent patients from making frequent trips off-island for healthcare. “We fly a lot of people off of Orcas for emergent care…” Boteler shared. “Our hope is that the Clinic can continue to work with Emergency Medical Services (EMS) to expand the services available, both emergent and non-emergent. Island Primary Care has taken big steps in expanding access to specialty care, adding  telecardiology this past year and working on providing telepulmonology in 2024. The hope is to extend these abilities into other needed specialties. Boteler says specialists from Anacortes may also begin to visit Orcas Island for in-person consultations. 

While translation tablets with real-time video have made visits for non-English speaking patients easier, Boteler recognizes the need for further outreach to our Hispanic population. She explained, “There is still work that needs to be done to ensure Spanish-speaking patients are receiving the highest level of care, just like the rest of our patients.”

What changes within the Health Care District are you looking forward to in the coming year?

Boteler looks forward to expanding the scope of care that Island Primary Care is able to provide. “The more we can help patients, the more fulfilling it will be for our providers. We are looking forward to improving access to lab draws and increasing use of our newly purchased ultrasound machine.”

“Delivering excellent care on a rural island is a complicated endeavor,” Boteler explained, “and there will always be areas where we can improve, but as an islander, I appreciate my fellow Commissioners and feel fortunate to be surrounded by people willing to step up and work to improve healthcare. I’m not sure you would find what we have everywhere… folks with this level of expertise, thoughtfulness, and care for their fellow islanders. It seems to be a uniquely Orcas Island experience.”

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