When it stops snowing, people stop skiing and snowboarding. When people stop skiing and snowboarding, they stop crashing. And when people stop crashing, they stop going to the Girdwood Health Clinic to get put back together.
After two years of poor snow conditions at Alyeska Resort, the clinic came close to going out of business in 2015. Winter care for injured skiers and snowboarders with health insurance had allowed it to provide community care year-round, including for seasonal hotel workers and summer visitors without the ability to pay.
"It sounds like a strange business model; it certainly does," said Lou Theiss, president of the nonprofit Girdwood Health Clinic Inc. "Normally, the orthopedic injuries will beef up the savings and then we'll have quiet summers. We offered medical services to hippies at the Forest Fair who didn't have a dime in their pocket."
But now the clinic is back on firm footing, saved by donations from generous citizens, the foresight of the late Sen. Ted Stevens and new money flowing in from the Affordable Care Act.
Girdwood is a cozy resort town in a microclimate of heavy precipitation. All that rain and snow grows big hemlock trees, the last stand of the coastal rainforest. Alyeska Resort usually measures winter snow in the hundreds of inches. Last winter and the winter before, the resort measured about 30 feet of snow at the top of the highest lift, an elevation of 2,750 feet.
But 30 feet was a lot less than normal. On the lower mountain, near sea level, most of the precipitation fell as rain or quickly melted. Icy or slushy conditions prevailed for much of the season. The expert trails on the North Face rarely opened.
Ken Waugh said skiing on the upper mountain was good for much of last year, but not many people came. He has been a ski patrol member for more than 25 years and, as a physician assistant, takes care of patients at the clinic.
The system to get injured skiers and snowboarders off the mountain and to medical care has many parts and includes around 15 paid ski patrollers during the week and another 10 to 15 volunteers on the weekend, Waugh said. They ski patients down the mountain in toboggans, give initial care in an aid station at the base, and then hand them off to the clinic.
Medical staff at the clinic can handle most cases and have telemedicine capabilities to link in surgeons from Orthopedic Physicians Alaska, a practice in Anchorage that sponsors the ski patrol. The clinic's digital X-ray machine, which providers said is not common in such a small community, permits the doctors in Anchorage to see images in real time.
But life was slow at the clinic during the winters of 2013-14 and 2014-15, with the smallest amount of snow since at least 2000. Normally several skiing accidents a weekend would keep life interesting at the clinic and keep medical bills going out, but not enough people were breaking wrists or twisting knees on the slopes.
The entire town suffered, with fewer visitors renting rooms, eating in restaurants and booking activities. People get hurt or sick doing all kinds of winter activities, not just skiing, said Kerry Dorius, the director and founder of the clinic, who is a nurse practitioner.
"There's just a lot more people here when there's snow," she said.
By the spring of 2015, the clinic was running out of money and in danger of closing, Dorius said, but Girdwood residents and Anchorage doctors helped raise $120,000 to keep the doors open, with the biggest donations coming in anonymously.
"People came together to save the clinic," Dorius said.
Notes from grateful patients decorate the waiting room and entry of the clinic, including one from Sen. Lisa Murkowski, who hurt her knee skiing in 2009, and another from the ambassador of Swaziland, thanking Dorius for caring for her queen.
A long-term solution came in the summer, when the clinic won designation as a Federally Qualified Health Center from the U.S. Department of Health and Human Services. The program funds basic care in underserved areas through nonprofits that charge sliding-scale fees for low-income patients.
Stevens had long supported the program as a solution to rural Alaska health care needs and helped a nonprofit in Girdwood get federal land for a clinic years ago. But Theiss said that effort didn't work out, and a clinic owned by Dorius opened up in the space on Girdwood's town square. Four years ago, that clinic became the nonprofit. The board structure and business plan were designed to fit the federal program.
"Obamacare" boosted funding for low-cost clinics, but Theiss said the Girdwood clinic narrowly lost its first application because federal officials held off on making new grants while a legal challenge to the Affordable Care Act was headed to the U.S. Supreme Court. After the court upheld the act in June, another round of grants was funded, including Girdwood.
Now the clinic will offer preventive care for Girdwood residents and other communities on Turnagain Arm, with a satellite office operating once or twice a month in Hope. Instead of helping needy patients at its own cost, the clinic will receive federal reimbursement for their care.
Financial backing for primary care will contribute to the health of ski bums and anyone else in Girdwood, but winter traffic could still help with financial reserves. Dorius said this winter's numbers were looking up.
"They were looking better than last year — we were seeing more ski injuries," she said. "But then we started getting this rain."
Charles Wohlforth's column appears three times weekly. Email cwohlforth@alaskadispatch.com.