In the wake of several complaints, the Osage Congress’s Health and Human Services Committee held a three-hour meeting at which just one topic was discussed: Troubles at the WahZhaZhe Health Clinic.
Both patients and employees past and present have raised concerns about increased chaos at the clinic, ranging from phone calls going unanswered to more serious questions about alleged failures in patient care.
Dr. Amanda Bighorse, who has been the Chief Medical Officer at the clinic since July 1, did not attend the meeting – raising some eyebrows.
“Is Dr. Bighorse on the call?” Congresswoman Jodie Revard asked toward the end of the remote meeting.
No, responded Health Authority Board Chair Cindra Shangreau: “She had a meeting this afternoon” regarding the nation’s Primary Residential Treatment facility.
“Hmmm. OK,” Revard intoned. “I wish she were here since she’s the person in charge of the clinic. But thank you, Kirk (Shaw, clinic manager), for being here and answering as best you can.”
The clinic has lost staff since Bighorse took over, but Shaw could not immediately answer questions from Congress members about the number and the reasons they left. Congressman Billy Keene said there was a “veil of secrecy” around the staff departures and alleged that several people had asked for the information and been ignored.
For an upcoming article, the Osage News filed an Open Records request for that and other information on Jan. 19 but has not received a reply. Shaw said he would respond to Congress’ requests for employment numbers and other data by Wednesday, Jan. 26.
According to a press release from the clinic in September 2018, the clinic had 75 full-time employees at that time. This week, the clinic’s page says it has 45 full-time staff.
“It’s always difficult to keep providers in rural health,” Shangreau told the committee at the Friday meeting, which was attended by all members of Congress. “I want you to know that we’re addressing the recruitment and retention part.”
She said the clinic recently named Laura Brooks, who was a nursing assistant, as its recruitment and retention officer.
For its future article, the Osage News has interviewed several employees, including medical providers, who departed the clinic since Bighorse took the helm, and found that every one of them wanted to stay. All expressed great fondness for the clinic, its patients and their colleagues.
Since June, one doctor, Trudy Milner, and two nurse practitioners, Kim Holt and Cherri Lawlis, compliance officer Laura Sawney, several nurses and even the business manager, Margie Williams, have either had their contracts not renewed, been fired or resigned since Bighorse was named CMO.
Sad to go, but new beginnings
Kim Holt, a nurse practitioner, said her contract wasn’t renewed after Bighorse was named CMO. She believes that one reason for her departure was because she was frank when it was announced at a staff meeting that Bighorse was not going to see patients.
She recalled commenting, “We’ve already been down that road and it’s not practical for this clinic. This clinic isn’t big enough to have a CMO who doesn’t see patients.”
Soon thereafter, Holt, who had been promised contract extensions, was gone. She now works at the White Eagle Clinic near Ponca City. Along with Holt, that clinic has drawn 64 new patients with charts from the WZZHC. All see Holt.
Milner, the chair of the Board of Regents at Oklahoma State University, is working for Ascension St. John Medical Center in Tulsa. Lawlis is now working as a medical provider in the Virgin Islands. Sawney has hired on with the Centers for Disease Control Foundation, and Williams took a big promotion to move to Crownpoint, N.M., to work for Indian Health Service on the Navajo Reservation.
The Osage News has also talked to several patients who have also decided to seek medical care elsewhere, some because of perceived medical missteps, including a few who were denied care they urgently needed when the clinic shut down Jan. 10 and 11 while its staff tested all Osage Nation employees for Covid. During previous mass-testing events, the clinic remained open.
Patients moving on, too
At Friday’s congressional meeting, Health and Human Services Chair Paula Stabler noted that the frustration with the clinic is escalating.
“This is not meant to tear down the clinic or tear down any one person,” she noted at the onset of the meeting.
“I want the clinic to not only survive but to thrive.”
Congressman Joe Tillman said he had been contacted several times with complaints: “Not answering the phone, and on and on and on and on.
“I had a relative who called and said he took his chart back to Pawnee, another one said they couldn’t get in to see a doctor for three weeks, so they just went to Dr. (Cameron) Rumsey at the Pawhuska Family Medical Clinic and got in the same day.
“I want to get it fixed.”
Casey Johnson, the Nation’s Director of Operations who is over all personnel, including all clinic staff, told the committee that he had received few complaints about the clinic, “maybe two,” and that they were resolved to everyone’s satisfaction.
Complaints should be sent to Constituent Services, he said.
“They’re basically the clearinghouse,” Johnson said. “They keep track of them; I’m not going to keep track of every complaint like Constituent Services would.
“And they hold your feet to the fire. They’re real good at that.”
Hitherto, complaints have gone to various people, including members of the Health Advisory Board over the clinic.
Complaints not addressed
Congresswoman Brandy Lemon, somewhat apologetically, asked Kirk Shaw if there was any truth to the rumor that at some time in the past, before Bighorse’s tenure, complaints had been found stashed in a drawer, unresolved.
Yes, Shaw replied: “There have been times when I was moving offices and found some that hadn’t been addressed from previous fiscal years. I went the route of getting them over to Constituent Services.”
Observed Lemon: “They give up because they feel like they haven’t been heard.
“I’m not trying to be ugly about it, but I know people submitted things, but they never got to you. Or they’re worried about retaliation.”
Chairwoman Stabler agreed: “I’ve had a lot of people say that they are afraid of reprisal, that they’re afraid they’ll be stopped from being able to come to the clinic.”
Employees, too, said they fear losing jobs or even professional licenses by speaking up.
“I know there have been complaints from employees because they have CC’ed me on complaints,” said Congressman Eli Potts. “They are crying out for help and in many instances, this has led to employees leaving the Nation.”
A systemic failure?
Angela Pratt, the speaker of the Congress, said that the seesawing of who has authority to fire and hire at the clinic has long been an issue since the WZZHC compacted with Indian Health Service and struck out as a tribal entity in 2015.
“This has been ongoing, back and forth from administration to administration,” she said. “It’s an authority board then it’s an advisory board then it’s an authority board then it’s an advisory board …
“Earlier in this meeting, I heard circus music in the background, which is appropriate.
“If we in the seat in the government don’t know what’s going on, I feel bad for our people who don’t know what’s going on …
“We’ve been talking about getting a new clinic forever now. If we can’t take care of the quality of care inside the few walls we already have, it’s scary.”
Shaw, as he did before the Health Authority Board meeting the day before the congressional committee met, noted that overwhelming phone volume – 500 calls a day – was to blame for some frustration patients are experiencing. He noted, again, that the clinic is hiring three extra people to help handle the calls.
Stabler said the call volume would drop dramatically if the phones were answered: “You wouldn’t have that many calls if you got the response time improved. Calls are repeated all day long because people keep calling back.
“Six of those calls were from me in just one day.”
Health Board chair Shangreau noted that the clinic is keenly aware that the phone failures are a “hot topic” and repeated that the WZZHC is in the process of getting the system upgraded, but it will take up to four months.
Referrals delayed; care denied
Referrals for medical care outside the clinic, such as to see a specialist or surgeon, or have special diagnostics done, are also the subject of complaints.
The clinic receives a certain amount of federal money each year – over $3.2 million this year – to pay for such services, generally at low, Medicare rates. A provider recommends a referral, which is then reviewed and approved or disapproved.
Congresswoman Alice Goodfox is among those with a litany of complaints about the process: Her son injured his knee and X-rays at the clinic in late November showed something distinctly wrong. He was referred to Tulsa Bone and Joint, but that clinic required him to have an MRI before he was seen. The WZZHC referred him to Claremore Indian Hospital for the imaging, but Claremore couldn’t schedule the procedure until the end of February.
Goodfox was exasperated at the lack of urgency for her son as well as others.
“People are waiting 10 months to go in for dental cleanings!” she said. “We ended up paying for the MRI out of pocket.
“They say you were approved for the MRI but it was two months down the road at IHS. Why? To save $200? Personally, I am not happy with the referral process … Making our kids wait 2½ months to go to Claremore to save $200?
“By the way, his knee was in such bad shape that when Tulsa Bone and Joint saw him on a Monday, they scheduled him for surgery six days later …
“I’m not looking for a response on this but anyone who can hear my voice can tell I’m frustrated by it.”
‘Unplug deaf ears’
Such delays in care can lead to permanent injury. Congresswoman Lemon, a registered nurse, said that she wished the Nation would hire a truly experienced person to operate the clinic.
“We can do this. I know they can do this. I’m going to be honest with you, I was really fearful and against the compact,” said Lemon.
“My biggest thing about it was this right here. The work culture that currently exists and has always existed on the hill, and the culture of thinking up there.
“This is uncomfortable to talk about, but I have to say it. And I’m going to continue to say it and it may continue to fall on deaf ears. Hopefully maybe someday someone will hear it and hear us pleading for our people and for betterment.
“I truly believe we have never been able to get over the hump of being able to hire someone, whether they’re Osage or not … who actually has the experience, the education, the background, and the knowledge (to administrate). We’ve never done that since we’ve compacted in my opinion. We’ve never had someone over the clinic who has actually run a clinic as an administrator with a CMO and CFO by their side for five years or more, someone who’s not a doctor or a nurse, but who is actually in the administration of public health care.
“I feel this is one area where we’ve really let ourselves down.
“And I really hope that the deaf ears are unplugged and listening.
“We’ve got to have somebody who looks at it from a 30,000-foot view.”
If you have complaints about the WahZhaZhe Health Center, Constituent Services can be reached on the Nation’s website at https://www.osagenation-nsn.gov/services/constituent-services, by phone at (918) 287-5555 or by email at email@example.com. Complaints can also be put in the dropbox outside the Welcome Center at 239 W 12th St. in Pawhuska or mailed to Constituent Services, 627 Grandview Ave., Pawhuska, OK 74056