Community Health Care (Tacoma)

  • By Kim Davenport
  • Posted 11/20/2019
  • HistoryLink.org Essay 20907

Community Health Care is a network of medical clinics providing comprehensive primary medical, dental, pharmacy, and behavioral healthcare. Inspired in the late 1960s by physicians and concerned citizens in Tacoma and Pierce County who recognized the need for access to quality healthcare for the county's low-income and under-insured residents, Community Health Care began humbly in 1969 with one part-time clinic staffed entirely by volunteers. The path ahead was not always obvious or easy, and the organization suffered some setbacks along the way. Yet by 2019, its 50th anniversary, Community Health Care was expected to serve nearly 50,000 people in the Tacoma/Pierce County region.

'I Have an Idea for You'

Dr. George Tanbara (1922-2017) played a central role in the establishment of the first volunteer clinics from which the Community Health Care network would develop. Tanbara, who opened his medical practice in Tacoma in the early 1950s, was known as a generous and caring physician, as well as one of the few in Tacoma who would treat African American children. In addition to his private practice, he worked with both Pierce County Hospital and Puget Sound Hospital. When it became clear that the latter was going to close in the late 1960s due to budget shortfalls, Tanbara recognized that a significant number of Tacoma residents from low-income, uninsured, and minority communities would need other sources of medical care.

Meanwhile, in 1969, Dr. Eugene Wiegman, who had recently been hired as president of Pacific Lutheran University, was asked by the community to chair the newly formed Tacoma Urban Coalition. The Tacoma chapter was part of the National Urban Coalition, an organization intended to bring together 'movers and shakers' to solve problems in urban areas around the country. In a video commemorating 40 years of Community Health Care's existence, Wiegman recalled Tanbara saying to him, at a Coalition meeting, "I have an idea for you" (Celebrating 40 Years ...).

That idea was a health clinic to serve Tacoma's Eastside. Joining the effort with Tanbara and Wiegman were members of Tacoma's African American community. James Walton, who had just been hired as executive director of the Tacoma Urban Coalition, would quickly identify healthcare as a primary area of focus for the Coalition's efforts. Lyle Quasim, a representative of the Black Collective, a leadership organization for issues facing the African American community in Tacoma, would help to secure State resources to support the clinics, from his position in the Washington State Department of Social and Health Services.

With the support of the Urban Coalition in hand, Tanbara rallied 50 Pierce County Medical Society physicians and community leaders to a meeting in the Tacoma Community House gymnasium, where he shared his idea for a clinic to be located at Salishan, staffed entirely by volunteers. The specific question Tanbara asked of the doctors was whether they would see the Salishan clinic patients for free. Every doctor in attendance said yes, and the first volunteer-operated clinic was born.

The Community Pitches In

The clinic operated first out of Lister Elementary School, and later moved into a Quonset hut in Salishan. Each Wednesday evening, Tanbara, supported by volunteers as well as his wife Kimi and their oldest children, would manage the clinic from 6 p.m. until the last patient was seen, serving any adult or child who needed medical services. Puget Sound Hospital provided peanut butter and jelly sandwiches for the volunteers, who conducted examinations on school desks and tables. Good Samaritan Hospital provided lab services, and Dr. Dick Driscoll, a pharmacist at Tacoma General Hospital, worked with pharmaceutical representatives to receive medication samples for distribution at the clinic.

In 1971, the Tacoma Urban Coalition, in continued support of the fledgling clinic's efforts, published the results of a study confirming that Tacoma lacked sufficient accessibility to healthcare, especially in the Eastside, South End, and Hilltop neighborhoods. The study's preface concludes with the following statement:

"The Urban Coalition has undertaken the study with the hope that the information gathered will be of assistance to those individuals who share our concern that solutions must be found to make quality health care a reality for everyone in the Tacoma area regardless of socio-economic standing" (Pfotenhauer, 1).

A second clinic opened in 1974 in the basement of the School of Nursing at St. Joseph's Hospital in Tacoma's Hilltop neighborhood, reaching another population pinpointed by the Urban Coalition study. As with the Salishan clinic, all services were provided by volunteers and supported by in-kind donations from local hospitals.

Although Tacoma's Urban League hired a staff member, Aaron Miller, in 1974 to manage the two clinics, and Tacoma's Metropolitan Development Council contributed outreach workers in 1976, the 1970s were an uncertain time for the future of the clinics. Federal Model Cities funding provided modest financial support for the clinics' operation, but that program came to an end in 1974. With no permanent source of funding, or any paid medical staff, it would be difficult to ensure the continued operation of the clinics, much less their expansion.

Expansion in the Early '80s

What did not change over this decade, however, was the commitment of doctors and community leaders to the continued operation of the clinics. The Pierce County Medical Society included reports on the number of patients served by the clinics in their monthly Bulletin, and a number of the society's leadership -- including Tanbara, but also Dr. George Race and Dr. Wayne Zimmerman -- wrote regularly in the Bulletin about the need to support the existing clinics and foster the growth of a sustainable infrastructure for serving low-income patients.

In 1980, the Urban Health Initiative (UHI), a federal funding source, would spur new growth for the fledgling clinic network. Tom Hilyard, program development specialist in Tacoma's Human Development Department and a member of the Pierce County Health Council, was instrumental in writing the first UHI grant request. When the proposal became stalled in Washington, D.C., Norm Dicks, the long-serving 6th District Congressman, ushered it through what was then called the Health, Education & Welfare Committee.

Under the terms of the UHI grant, which was issued in January 1980, three clinics -- Eastside, Hilltop, and a new clinic in Lakewood -- would become part of the Tacoma-Pierce County Health Department, and be fully operational by June. A new clinic in Sumner would follow soon after, opening in April 1981.

Florence Reeves, a Public Health nurse with the Health Department, put in her application, alongside more than 100 others, to lead this newly structured clinic system. Reeves was selected, and would go on to manage the organization for nearly 15 years, hiring the first paid medical staff, and overseeing a great deal of change and growth. Described by those who worked with her as "a dynamo," "tough," and a "leader among leaders," she was involved in both the day-to-day operation of the clinics and maintaining an effective relationship with Congressman Dicks and other leaders, calling upon them when necessary for support.

1981 marked a significant moment for the clinic network, which had relied exclusively on volunteer medical staff for more than a decade: The first two doctors, Dr. Charles Weatherby and Dr. Doug Jeffries, were hired. Each physician took responsibility for two of the four clinics, and also started an OB program, delivering as many as 350 babies per year.

Also in 1981, Tanbara served a term as president of the Pierce County Medical Society. Among his many other responsibilities that year, Tanbara worked to build an effective relationship between the Society and the newly configured clinics by establishing a Quality Assurance Committee, which would ensure that members of the Society were involved in oversight of the care being delivered at the clinics. 

In his eloquent columns in each issue of that year's Society Bulletin, Tanbara taught his colleagues the meaning of certain Japanese words as a means for inspiring involvement. One example: "Only by each and every one of us striving our utmost -- iishokenmei -- can we attain our individual and mutual goals for our patients, city, county, state and nation" ("Iishokenmei").

Reeves would later stress in a 1991 interview the importance of Tanbara's role during this phase of the clinics' development: "Under his presidency we resolved issues; we set up relationships so that the medical society was not at odds with the clinics and that was a tremendous step to our improvement in getting resources and growing in the community" ("CHCDS History").

More Funding, More Services

In 1982, Dr. Tom Heller, a professor with the University of Washington School of Medicine, took on the role of medical director, supervising the staff doctors, whose numbers would grow to four -- one for each clinic -- by 1984. The early 1980s were a time of substantial and significant growth and change for the clinics. But another fundamental change was coming to the organization: separation from the Health Department and creation of an independent nonprofit status that would facilitate access to a more sustainable source of federal funding.

In August 1986, the four clinics incorporated as the Community Health Care Delivery System (CHCDS). This new, independent nonprofit status enabled the organization to apply for Community Health Center funding through the federal Chapter 330 Public Health Services Act. This allowed for more stable budgets, the purchase of the organization's first building, and meant that the organization could serve medicaid-eligible patients. Reeves maintained her leadership role with the organization through this transition. The original mission statement for CHCDS was: "To maintain a system of comprehensive health care for all, which ensures access for the medically and dentally underserved populations of Pierce County."

The late 1980s and early 1990s saw steady growth and expansion for CHCDS. Dental care was added, first with a single chair located at Tacoma Rescue Mission, later in donated space in the office of Tacoma dentist Dr. Sal Giusti at 38th and Pacific, and finally with the establishment in 1989 of the first official CHCDS dental clinic, co-located with medical services in the Hilltop clinic.

In 1990, a Health Care for the Homeless Program opened under sub-contract with Metropolitan Development Council, and CHCDS received federal support for HIV/AIDS care through the Ryan White Title III HIV Early Intervention Program. A new children's clinic was dedicated in the Hilltop neighborhood in August 1991, with Representative Norm Dicks, continuing his faithful support for the clinics, in attendance.

A $25,000 grant from the Cheney Foundation enabled renovation of the Eastside clinic in 1992, the same year that CHCDS added a Foot Care for Seniors program. In September 1993, a new clinic opened in Tillicum. In spite of this impressive growth and expansion of services to the low-income population of Pierce County, however, trouble was brewing.

Turmoil, and Change at the Top

By 1994, CHCDS managed an annual budget of nearly $4 million and served nearly 15,000 patients annually in five clinics around the South Sound. But 1994 also brought a negative audit from the Department of Health and Human Services (DHHS), which threatened the continuation of federal funding. 

The critical report from DHHS highlighted budget deficits, clinic facilities that were not up to required standards, inconsistencies in board oversight, and staff doctors being spread too thin. Local media coverage made the issues public. A September 2, 1994 News Tribune article got right to the point: "Bad management threatens the future of a Pierce County agency that provides medical care for about 14,000 poor people, according to a stinging federal report. The turmoil at the Community Health Care Delivery System has led four of eight doctors to quit in the past year, along with several top administrators" ("Low-income Clinics ...")

It was a dire situation for the nonprofit. If the issues raised in the federal audit were not addressed, federal funding would be lost, crippling the organization's ability to meet its mission. Even if this hurdle could be overcome, patient and community faith in the clinic system would need to be rebuilt. Fortunately for CHCDS, there was enough collective will to make the necessary changes. Community leaders, elected and otherwise, rallied around the fact that CHCDS provided a critical service to a substantial number of low-income citizens of Tacoma and Pierce County, and must therefore be saved. Congressman Dicks stepped in, facilitating the rebuilding of the advisory board, as well as making clear the need for a change in leadership.

In 1995, David Flentge was hired as the new CEO, tasked with bringing the organization back into compliance with federal standards in order to renew funding. Flentge found that all but one of the organization's original founders were still involved, and, understanding the need to draw upon that history and foundational vision, reached out to them to earn support for his plans.

According to CHCDS' annual report from 1995, the organization was able to serve 11,297 patients even in this year of transition; the budget also came back in line, with spending of $3 million against revenue of $4 million. By 1996, auditors were satisfied that the bulk of the pressing issues detailed in the 1994 report had been resolved, and funding was renewed. Seven new doctors were hired that year, replacing those who had left during the turmoil of 1994-1995.

Rather than taking a cautious view following this success, however, Flentge advised the board to prepare for further growth. At the time, the organization was serving only about 10 percent of the eligible population in the area. In 1997, the organization changed its name to Community Health Care (CHC), and revised its mission statement: "To ensure a dynamic system of comprehensive health care which provides compassionate, high quality service to all, with special emphasis on those most in need." This new name and mission statement signaled to the community that the organization intended to grow, serve more patients, and maintain a new standard of quality.

In 1997, the organization purchased and renovated a building to house a new children's dental clinic and downtown (formerly family) medical clinic. The adult dental clinic retained its existing space and expanded. In 1998, the Eastside clinic was expanded and renovated, and in 1999, new administrative offices were opened, and new medical staff were hired for the first time since the rather frugal spending of the mid-1990s.

Vision Realized

As CHC entered the 2000s, growth and expansion continued, and the organization responded to changes in the area's population: By 2000, CHC employed 11 bilingual medical and dental providers and 35 bilingual support staff. The year 2001 brought accreditation from the Joint Commission on Accreditation of Healthcare Organizations. Between 2000 and 2006, CHC celebrated the opening of new clinics in Parkland, McKinley (later renamed Soundview), Spanaway, several new pharmacy and dental sites, and the addition of behavioral healthcare. 

In 2009, 40 years after the creation of the first clinic, Dr. Tanbara was honored with the opening of the new Kimi & George Tanbara, MD Eastside Family Medical Clinic at Salishan. Staff from the women's health clinic, family dental clinic, children's dental clinic, Soundview clinic, Sumner clinic, and Eastside clinic were combined to provide care in this new, state-of-the-art facility.

In recent years, while continuing to increase the number of patients served, CHC has embarked on a new venture: residency programs. One of the impacts of the Affordable Care Act, aside from bringing more eligible patients into the clinics for care, was to establish Teaching Health Centers, allowing Federally Qualified Health Centers such as CHC to host residency programs. Both Flentge and CMO Dr. Jeff Smith immediately saw the value of adding such programs to CHC, especially as a tool for recruiting new medical staff. According to Smith, though, the CHC board should be credited for approving the new venture "only after the benefit to patients, not just the benefit to the organization, was made clear" (Smith interview).

In 2012, the first residency program, for nurse practitioners, was launched. The program (in 2019) is managed by Kimberly Sales, ARNP, who has a long history with the organization. Tasked with launching the Tillicum Clinic in 1993, she describes herself as now being on her "second tour of duty" with CHC, after Dr. Tanbara convinced her during a chance meeting at Tacoma Mall to return after having left for another job. "When Dr. Tanbara talks, people listen," she explains, thankful for the opportunity to continue serving his original vision of "putting the patient first" (Sales interview).

The year 2013 brought the grand opening of the Hilltop Regional Health Center, which serves as home base to CHC's several residency programs: the Dentistry Residency Program, launched in 2013; the Family Medicine Residency Program, started in 2014; the Pharmacy Residency Program, which commenced in 2018; and the Leadership Academy Program, a residency for administrative positions, which began in 2019.

Each of these residency programs has created more access for patients, as well as providing training for new medical professionals to serve in community health settings. This investment, as well as those made by CHC over the past 20 years into the creation of state-of-the art facilities, go well beyond the pressing need of the mid-1990s to reinstate federal funding. They ensure that patients have access to quality medical care, regardless of the ability to pay. Tanbara believed that all people deserve quality care, and those who joined him in creating his vision of the clinics, under the auspices of the Tacoma Urban Coalition, knew that low-income members of the community struggled to find such quality care. In the words of Dr. Charles Weatherby, "healthcare is an equalizer, like education" (Weatherby interview).


Sources:

Olga M. Gribble, Community Health Care: Celebrating 40 Years of Providing Care to Pierce County (video, Wonderdog Media, 2009). https://vimeo.com/3829897; Bob Pfotenhauer, The Tacoma Health Delivery System, A Comparative Study (Tacoma: Tacoma Area Urban Coalition, 1971); HistoryLink.org Online Encyclopedia of Washington State History, "Tanbara, Kimiko Fujimoto (1924-2017) and George Tanbara, M.D. (1922-2017)" (by Tamiko Nimura), historylink.org (accessed October 26, 2019); HistoryLink.org Online Encyclopedia of Washington State History, "Ribbon-cutting ceremony for the Kimi and George Tanbara, MD Eastside Family Medical Clinic in Tacoma is held on July 29, 2009" (by Tamiko Nimura), historylink.org (accessed October 26, 2019); HistoryLink.org Online Encyclopedia of Washington State History, "Tacoma Neighborhoods: Salishan Housing Project-Tacoma Housing Authority" (by David Wilma), historylink.org (accessed October 26, 2019); "What is a Community Health Center?" National Association of Community Health Centers website accessed October 26, 2019 (http://www.nachc.org/about/about-our-health-centers/what-is-a-health-center/); "Our Place in the Community," Community Health Care website accessed October 26, 2019 (https://www.commhealth.org/about-us/); George A. Tanbara, "Iishokenmei!!," Pierce County Medical Society Bulletin, March 1981 (Vol.LIII, No.3); Dave Seabrook and Florence Reeves, "CHCDS History", transcript of tape-recorded interview, February 1991; "40 Years of Caring" (program), July 29, 2009, copy in Community Health Care archives, Tacoma; Elaine Porterfield, "Low-income Clinics in Bad Shape," The News Tribune, September 2, 1994; "Bulletin Archive," Pierce County Medical Society website accessed October 26, 2019 (https://www.pcmswa.org/bulletin); "Annual Reports," Community Health Care website accessed October 26, 2019 (https://www.commhealth.org/about-us/annual-reports/); Kim Davenport interview with Dr. Charles Weatherby, September 20, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma; Kim Davenport interview with David Flentge, July 11, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma; Kim Davenport interview with Dr. Greg Fisher, September 6, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma; Kim Davenport interview with Dr. Jeff Smith, September 9, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma; Kim Davenport interview with Dr. Eugene Wiegman, July 23, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma; Kim Davenport interview with Greg Tanbara, July 17, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma; Kim Davenport interview with Jim Walton, August 9, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma; Kim Davenport interview with Kimberly Sales, September 13, 2019, Tacoma, notes in possession of Kim Davenport, Tacoma.


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