Monticello • A proposal to build a new $5.4 million medical clinic near the border of San Juan County and Grand County is the latest controversy associated with Spanish Valley, a 500-person community just south of Moab that could be poised for a major growth spurt.

A 2018 land use plan for 6,400 acres in the valley — the vast majority of which is currently managed by Utah’s School and Institutional Trust Lands Administration (SITLA) — has sparked fierce debate in San Juan County over several years as consultants have laid out a development vision that could eventually bring in 14,000 residents, nearly doubling the population of the entire county.

In order to get ahead of that possible growth, representatives of San Juan Health — a special services district that receives property tax revenue to support health care facilities in Blanding and Monticello — worked with San Juan County to purchase 12 acres of land in Spanish Valley from SITLA in late 2018. Five of those acres will be used for the clinic.

There was little fanfare associated with the county’s $750,000 land buy, but the health district’s subsequent application for $5.4 million in grants and loans from the Utah Permanent Community Impact Fund Board (CIB) in September has generated increasing opposition from health care providers in nearby Moab who fear there isn’t enough demand in the area to sustain a new facility.

Jennifer Sadoff, CEO of the nonprofit Moab Regional Hospital, said the new clinic is slated to be built less than a mile from the Grand County line and only eight miles from Moab Regional, which is itself planning to expand.

“Our concern is that they're using CIB money — which the purpose of CIB money is to offset the impacts of mineral lease development in areas — to basically subsidize a clinic that just duplicates services in this area,” Sadoff said. “Nothing in their proposal is not available eight miles away.” The area is in need of dental, emergency medical and other services, she said, but not another clinic.

And growth is not certain, Sadoff noted. Just because SITLA has a road map for a 14,000-person city, that doesn’t mean the area will explode anytime soon. The population of Grand County where Moab is located, for example, has grown from roughly 6,500 to 9,500 residents over the last three decades even as visitation to the region surpassed 3 million annually.

In San Juan Health’s proposal to the CIB, Sadoff said, “they said health care runs on razor thin margins, it’s capital intensive and we can’t do this project without you. And then on the other hand, they’re like, ‘It’s OK. Competition is good.’”

This is not the first time San Juan Health has attempted to run a clinic in Spanish Valley. The district opened a smaller facility in 2010, but it closed less than four years later.

Steve Simpson, who has been on the board of the health district for 13 years, said the closure was due in part to the facility’s less-than-ideal location in an industrial park and a lack of parking. He believes that things will be different with the current project now that the health district has new leadership and is in a more secure financial position.

“The idea of building a clinic in the Spanish Valley to service the northern part of the county has been discussed among board members for several years,” he said, “certainly before the establishment of the initial Spanish Valley clinic.”

Simpson said there are advantages to buying cheaper land before an area sees development and noted the difficulty of hiring contractors in ever-expanding Moab.

Jimmy Johnson, COO of San Juan Health, said the organization has run multiple analyses and is confident the clinic would be able to sustain itself even at the current population.

“We asked ourselves, if it was the worst case scenario and we had our current patient mix of those who are already users in our health system — and if there was no growth in Spanish Valley — would we be able to financially sustain the operation? And the answer in our analysis is: Absolutely yes,” he said.

Johnson said fears that the clinic could hurt both Moab Regional Hospital and San Juan Health are overblown and competition will give patients more options, which in turn will lead to better health care outcomes in both San Juan and Grand counties.

But patient demand is not the only concern, said Joette Langianese, chair of the Canyonlands Health Care Special Service District, which — like San Juan Health — sees Spanish Valley as part of her district’s service area.

“In rural communities, it’s hard to find doctors,” Langianese said. “So if you’ve got two clinics, where are professionals going to come from? Our big concern is that it’s going to hurt the services that are already available. Without a detailed, thorough needs assessment, it’s hard for us to know if it’s going to hurt or not. [San Juan Health] can’t just say, ‘We did this simple feasibility study and the numbers are there.’ We’d have to see a little bit more details for us to feel comfortable too.”

Moab Valley Healthcare, Canyonlands Health Care Special Service District and Moab City Mayor Emily Niehaus have all sent letters to the CIB requesting they wait on approving funding to the clinic, which is scheduled to be finalized at a Thursday meeting in Salt Lake City. The CIB is expected to approve a nearly $1.4 million grant and a $4.1 million loan at 1% interest.

“I’m not necessarily against the health care clinic in Spanish Valley,” Langianese said, “but I want to make sure that it’s going to be in the best interests of the residents that live here and for all the health care industry in this valley.”

But Simpson doesn’t think slowing down the process will reveal any new information, adding that San Juan Health is “uniquely qualified” to do the assessment for the region.

Johnson did not respond to a request to allow The Salt Lake Tribune to review San Juan Health’s financial analysis for Spanish Valley, but he did note San Juan Health was met with similar opposition when it built a clinic across the street from the nonprofit Blue Mountain Hospital in Blanding in 2010. He said the two entities have since developed a symbiotic relationship of “collaborative competition” where they share a surgeon, a mobile MRI machine and other services either provider would have a difficult time sustaining on its own. Johnson hopes a similar relationship can eventually be reached with health care providers in Moab.

Sadoff responded that just because it worked in Blanding doesn’t necessarily mean anything is guaranteed in Spanish Valley. “Each situation is unique and deserves study before slapping up a clinic with subsidized money,” she said.

Another concern from San Juan County residents is a tax increase recently imposed by the County Commission to shore up several funds, including its public health department, which is not related to the health district. San Juan County residents already pay the highest property taxes in the state with around 7% of the total tax burden going to the health district, or roughly $800,000 annually. The county is the poorest in Utah with a poverty rate of 43.7% for Native Americans in San Juan County and a rate of 10.8% for the nonHispanic white population, according to an American Community Survey from 2008 to 2012.

San Juan Health has had over $600,000 in net revenue for several years and the board chose to collect slightly less property tax than it was eligible for in 2019.

Johnson said he’s confident the Spanish Valley clinic will not lead to a tax increase for residents, adding that part of the impetus for the project is to make sure taxpayers in the northern part of the county have increased access to services.

Moab Valley Healthcare hired a law firm to recently submit a 23-page petition to the CIB. The letter asks the CIB rethink its funding for the clinic and makes a detailed case for why a better regional study is needed, though Sadoff said it appears the CIB won’t consider the petition at its upcoming meeting. The state agency also has a policy that it does not accept public comment at its meetings.

Simpson doesn’t see a scenario where San Juan Health will change its plans. “This is a reality … we will build the clinic,” he said. “We’re determined to build the clinic because we are determined to satisfy the needs of our constituents.”

Zak Podmore is a Report for America corps member and writes about conflict and change in San Juan County for The Salt Lake Tribune. Your donation to match our RFA grant helps keep him writing stories like this one; please consider making a tax-deductible gift of any amount today by clicking here.