Clinic on life support

Magalia’s only family practice may have nowhere to go because of county’s foot-dragging

IN LIMBO <br>Don Sakal says his rural health clinic may have to close because it’s taking so long to get permission from the county to build a new facility. A former Army Special Forces medic, Sakal is an outdoorsman who is fascinated by local history, as the photo of Ishi behind him suggests.

Don Sakal says his rural health clinic may have to close because it’s taking so long to get permission from the county to build a new facility. A former Army Special Forces medic, Sakal is an outdoorsman who is fascinated by local history, as the photo of Ishi behind him suggests.

Photo By Robert Speer

What is a rural health clinic?
The Rural Health Clinics program was established to stabilize access to primary care in underserved rural areas and encourage the use of physicians, physician’s assistants, nurse practitioners and certified nurse midwives. RHCs are eligible for enhanced Medicaid and Medicare reimbursement.

What does it take to get a small change made in the county zoning code? That’s the question Dr. Lijun Sakal and her husband and partner, Don Sakal, a physician’s assistant, keep asking themselves as they wait to see whether their business will be forced to close.

The Sakals operate the Magalia Pines Family Practice Medical Clinic, the only family practice serving the 18,000 people who live in the Upper Ridge community. It’s also an officially designated rural health clinic, which means it sees patients of all ages and incomes, including those receiving Medi-Cal, Medicare and Healthy Families assistance. Currently, it has a caseload of more than 2,000.

The clinic is located in a small complex on the Upper Skyway, in the heart of new Magalia, next to Dolly-O’s Donuts. The clinic has long outgrown its cramped 1,000-square-foot office space and has been trying to relocate for some time. Adding pressure is the fact that the building it’s now in has been sold, and the new owner intends to raze it and put in a Rite-Aid. The Sakals say they’ve been told they’ll have to move in six to 12 months.

The problem is two-fold: There are no suitable and available commercial buildings in the area, and the Sakals’ effort to build a new, larger clinic on five acres they own two miles up the road has been stymied because of a zoning conflict.

The land is zoned Agriculture Residential (AR), which allows a number of uses, including veterinary clinics and kennels, golf courses and associated restaurants and pro shops, commercial poultry farms, sales tract offices, bed-and-breakfasts, mobile-home parks, nurseries and plant gardens in addition to normal agricultural uses. It also allows “public and quasi-public uses.”

In the “Definitions” section of the code, “quasi-public use” is defined as “a use operated by a private nonprofit educational, religious, recreational, charitable, fraternal, or medical institution, association or organization, said use having the purpose primarily of serving the general public….” In other words, Feather River Hospital, a nonprofit facility run by the Seventh-day Adventist Church, could put a clinic on the Sakals’ land, but the Sakals are prohibited from doing so.

Not fair, they told the county. It can and will be changed, they were told. That was in January 2005. They’re still waiting, and time is running out.

Don and Lijun Sakal met at Emory University in Atlanta, where he was studying for his master’s degree and to become a physician’s assistant and she was a visiting research scientist from China.

He’d been an Army Special Forces medic and, for nearly 10 years, a medical tech assistant and LVN at state prisons in Susanville and Vacaville. When they married, they looked around for a place that had a need for their services. Magalia fit the bill—and also enabled them to get certified as a rural health clinic.

Originally trained as a dermatologist, Lijun Sakal has grown to enjoy family practice, her husband says. She likes the variety of it. They work as partners, with him backing her up as a PA and also handling clinic administration.

It hasn’t always been easy, and they haven’t gotten the support they wish they’d received. Feather River Hospital refused to give them privileges, stating it was against hospital policy to give privileges to PAs. When the Sakals appealed, noting that mid-level practitioners such as PAs are mandated in rural health clinics, the hospital again turned them down. The Sakals have a copy of the denial letter, along with copies of other documents related to their efforts, tacked to the clinic’s waiting room wall.

They then turned to Enloe Hospital, in Chico, which accepts PAs as parts of medical teams and granted them privileges. It was inconvenient because of the distance, but at least it allowed for smooth referrals. But after about a year, Sakal said, Enloe informed them that its policies required that the physician personally attend the admissions of a certain number of patients. Again because of the distance (nearly 30 miles), the Sakals were unable to comply.

As their patient load grew, they began thinking of moving to larger quarters. They looked at other sites to buy, including a former Chinese restaurant, but none worked out.

They’d bought the five acres up the road and built a home there, and the idea of having their clinic on the same site appealed to them. But the zoning didn’t allow it.

With the help of their supervisor, Kim Yamaguchi, they got the county Board of Supervisors to vote unanimously to ask county planning staff to rewrite the language of the AR zoning code to allow for-profit medical clinics, subject to a use permit. They were told it would take about three months—eight months at the worst. That was in February 2005.

The Sakals waited until January 2006, when their contractor applied for permits, only to be told the zoning change still had not been made. It will take a while longer, the Sakals say they were told.

Stacy Joliff, a principal planner at the county’s Department of Development Services, explained that the department had gone through big changes last year with the departure of former Director Yvonne Christopher and subsequent hiring of new staffers, and “some of the urgency of the matter wasn’t conveyed from previous planners to current ones.”

The newness of many staffers (Joliff herself arrived in May), the huge backlog they inherited and the urgency of developing a new county general plan all have caused delay, she said. “We’re improving the process and dealing with the backlog, and we’re begging the public for patience,” she said.

Originally the supervisors’ directive regarding the Sakals’ clinic was bundled with other proposed zoning adjustments, she explained, which slowed down the process. Now that the urgency of the matter is understood, she went on, the AR zoning change has been separated out and is being fast-tracked forward.

A full 20 percent of the county is designated AR, she pointed out, so any change in the code has a big impact. The new language to allow for-profit medical clinics will go before the Planning Commission on Oct. 28 and then to the Board of Supervisors in November. The Sakals will still have to obtain a use permit after that.

By then it will be winter, too late to begin construction. As a result, a number of factors will have to come together if the clinic is to remain open, Sakal explained. One is that Rite-Aid takes longer than expected to get its plans and permits together and the clinic doesn’t get evicted sooner rather than later. Second, Sakal needs to find a contractor who can do the job at a price he can afford and in a short period of time—"like three months,” he said—beginning next spring.

In the meantime, his current contractor has taken on other jobs, and Sakal has told his employees to begin looking for other work. “We’re in limbo,” he said. “Even if we get the permit, what’s the probability we’ll get the clinic up on time?”

Most of all, it upsets him that people at the county didn’t take the situation more seriously. He believes he and his wife are providing an invaluable, sometimes life-saving service that wouldn’t exist otherwise, and it’s disconcerting, he said, to experience such a lack of support from people whose salaries his taxes help to pay.

“You know what’s wrong?” he said. “If you or I don’t do our job right, we get fired or, in my case, I get sued. But if they don’t do it right, nothing happens.”