The battle lines are drawn, a referendum is almost set and the stakes couldn't be higher.
One faction firmly opposes the proposed public-private partnership that will fund the Northern Rockies Community Health Centre and the other wants the town to go through with the plan, presenting it as the answer for Northern British Columbia's chronic doctor shortage.
Opponents say government should not be involved where private interests already exist. (Fort Nelson is currently home to one private medical clinic.) They also say taxpayers will be left to pick up the tab in the likely event that Northern Health fails to recruit doctors for the centre.
Last week they submitted a petition with more than two times the required 438 signatures needed to trigger a referendum. A date has not been set, but unless a compromise is reached soon voters will be asked to decide the fate of the Northern Rockies Community Health Centre within 80 days.
It's an issue that has divided the community.
"What's at stake is the future of healthcare in Fort Nelson," said Jaylene Arnold, Economic Development & Tourism Officer for the Northern Rockies Regional Municipality. "For the past five-plus years the community has told their elected officials they expect more and deserve more out of healthcare. They want to be able to deliver babies in their home community and need the confidence that if there is a critical injury they have the services to deliver the treatment they need."
The new facility would be home physicians who choose to practice there as well as Northern Health's services Mental Health and Addictions Support and Home & Community Care.
The concept of a community clinic has been debated since at least 2007, but the idea received new life after the Fort Nelson Primary Care Review initiated by Northern Health in 2011.
Fort Nelson and other northern communities have struggled to attract and retain physicians partly due to inhibitive startup costs associated with opening a clinic. Doctors fresh out of medical school are burdened by heavy debt, making large capital investments associated with opening a medical practice impractical, particularly in remote northern communities.
The solution on the table for Fort Nelson is a public-private partnership, where VanMar Constructors designs, builds, finances and maintains the facility for 25 years, after which the building will revert back to NRRM ownership.
"(Citizens) told us that they want more ownership of their future with regard to healthcare. This solution will achieve all of those calls to action," Arnold added.
This is the plan: The NRRM wants to enter into a lease with VanMar for an amount not to exceed $550,000 per year. Council has set that cost at $476,282 per year for the 25-year term of the lease. Northern Health would sublease approximately 50 per cent of that - $238,000 per year - and new physicians choosing to practice within the facility would pay a fair market rent for their respective space, accounting for additional revenue.
Under B.C.'s Community Charter, electoral approval is required for local governments to enter into a long-term debt over $5 million. That can be achieved in one of two ways: The so-called Alternate Approval Process or a referendum. The NRRM chose the former.
The Alternative Approval Process was passed by city council in a majority vote in the spring.
Mayor Bill Streeper is part of the minority on council who stand in opposition to the Alternate Approval Process.
"We have a private doctor who owns his own clinic. He pays property taxes on that clinic, operating on his own. And the municipality wants to operate a clinic that is going to be subsidized. Any shortfall is going to be picked up by the taxpayer," he said.
Streeper wants the fate of the current proposal to be decided in a referendum.
He might get his wish. The petition that was submitted to the Corporate Managers Office at town hall last week contained 860 signees, well above the 10 per cent threshold required for a vote. It's also close to half the turnout in the 2011 general election, in which a record 1,609 voters cast ballots.
The petition was presented to council last Monday.
Staffing is another issue. The municipality hopes the new facility will attract rent-paying doctors, mitigating the overall cost to taxpayers.
However the mayor has little faith in Northern Health's ability to recruit doctors to work in the new clinic. He claimed the organization has yet to secure a single doctor for Fort Nelson, which is 809 kilometres north of Northern Health's headquarters in Prince George.
"So to enter into a multi-million dollar building with zero recruiting from Northern Health I think is kind of scary," the mayor said.
Streeper doesn't think the adage "build it and they will come" applies. He said there is space in the existing clinic, "but (doctors) haven't come yet."
"In my mind 860 speaks for itself."