Twice delayed, the Osage Congress’ Health and Human Services Committee finally met on Feb. 15 to continue its discussion about troubles at the WahZhaZhe Health Clinic.
The committee skipped around several topics, including:
- The number of employees who have been fired or left;
- How referrals for care outside the clinic are working;
- Reported long waits for outside dental work and prescription glasses; and
- The Health Authority Board’s habit of conducting weekly “planning” meetings that are not publicly announced in apparent violation of the tribe’s Open Meetings Act but that the board said comply with that law.
The meeting was more tempered than the committee’s January inquiry into reports of deteriorating patient care and morale at the clinic that was blamed on poor management.
Several employees past and present have been critical of the management by Chief Medical Officer Amanda Bighorse since she assumed her post on July 1, describing her as incommunicative, unavailable and spiteful.
A few days after the January meeting, Bighorse announced she was going to resign but said she was staying on through at least April to help with the transition to new leadership.
In response to a lingering question from the January meeting, clinic manager Kirk Shaw told the committee that 24 employees and contractors at the clinic had left or been fired between Jan. 1, 2021, and June 30, 2021, which would have been before Bighorse took the helm as CMO. Under her leadership, Shaw said, 17 employees departed in the last half of 2021.
Committee Chair Paula Stabler, who worked for the clinic for several years, said that her independent research showed those numbers had been reversed – 24 left since Bighorse arrived and 17 before.
Shaw said that the clinic had extrapolated the numbers from Paycom, the personnel management software system the tribe used, and would double-check.
Dr. Ron Shaw led the clinic until he resigned in April; within days of his resignation he was diagnosed with terminal brain cancer.
At the committee meeting Tuesday, Speaker Angela Pratt inquired about whether those who had left had been given exit interviews – which would be illuminating – but no clear answer was forthcoming.
“I’ll have to talk to [Human Resources Director] Julie Gilmore to make sure we have all that stuff,” said Casey Johnson, the Nation’s director of operations. “I don’t sit in on exit interviews. That’s done through HR so I’ll have to give you a list.”
Purchased referred care or PRC is a perpetual issue at the clinic. The clinic receives federal money – $3.2 million this year – to pay for outside imaging, surgical and other services it doesn’t offer. Those payments are usually made at low Medicare rates, except in the case of dental referrals, which are not discounted, Shaw said, and can be quite pricey. “If the bill is $35,000, it’s $35,000,” he said.
Many have griped about referrals being slow to process and complain about waiting months to get, for instance, an MRI.
Shaw said 91 percent of provider referrals are approved at the WZZHC, a much higher rate than is approved at the Indian Health Service office at which Shaw used to work.
“At the area office the percentage of approved referrals was about 60-65 percent,” Shaw said. “They were ranked 1-5 by medical necessity and at the area office 3, 4 and 5 were not even touched. I always say we’re lucky here because we can do more for our patients.”
Congress member Brandy Lemon raised questions about whether even more could be done, however: The clinic carries over about $1 million a year in unspent PRC money, a number that spiked in fiscal 2020 to $2.13 million due to the Covid-19 pandemic.
“The glaring thing to me is that you’re sitting on almost $4 million in referral dollars,” said Brandy Lemon, urging spending on mental health, cardiac, diabetes and other referrals that would help prevent illness.
“Is there any plan at all to contract MRI services that you can’t provide within a 30-day window, let’s say, with the MRI people at Servant Imaging?”
Replied Shaw: “That’s what we do. We frequently use Touchstone Imaging.”
Lemon noted that complaints about referrals aren’t new.
“I remember negative talk about IHS referrals when I was a kid,” said Lemon, the daughter of Cecelia Tallchief, a nurse and member of the Health Authority Board that oversees and advises the WZZHC. “And I’m certainly not a kid anymore; I’m knocking on 50 years old.”
She suggested that instead of waiting two weeks for outside vendors to respond to referrals, PRC workers at the clinic should intervene sooner.
Shaw said that the clinic had tried that, but vendors complained that they were being harassed and hassled.
Said Lemon: “It’s just another way to oppress Indian folks. It’s just another form of oppression.”
Delays in getting glasses and outside dental work were harder to pin down. Shaw said that the clinic uses Brewer Lab in Tulsa for outside dental work, and it has a three-week turnaround at minimum.
Prescription glasses should take about one week and are sent to a lab in Lawton. “It can vary,” Shaw added.
Tallchief: CMO job ‘overwhelming’
Tallchief, the Health Authority Board member, lamented that Bighorse was leaving.
“We’ve put people in positions and overloaded them,” Tallchief said. “Dr. Bighorse’s position has been overwhelming … It’s overwhelming for her to have all of these duties and she’s been working as best she could with Kirk.
“She has been criticized. I feel so sorry for her. I wish she would stay. I don’t believe we’ve had any formal written complaints. It’s just the general public and Facebook.”
Weekly meetings, held privately
Tallchief said that the Health Authority Board had been meeting for “planning sessions” every week, a fact that was confirmed by the board chair, Cindra Shangreau.
“I’d like Congress and the Osage Nation to know that the board hears your issues and we’re working forward,” Shangreau said.
“We’re constantly having meetings every week trying to meet with different people to work out ways we can bring better healthcare to the Osage Nation and able to also help repair the problems that are being seen such as the phones.”
Among the changes the board has discussed: Rewriting job descriptions so the clinic can hire a health system chief executive officer, a new chief medical officer and a director of nursing, Shangreau said. She added that they have also been working on building a new larger clinic that will have expanded dental care and a dental lab, and possibly installing CT and MRI machines so the clinic would not have to refer those services out to other providers.
Sunshine law violations?
After all the mention of planning sessions or meetings, Lemon said she wanted to clarify that the weekly “planning sessions” were not in violation of the Open Meetings Act. She said a question from Congress member Eli Potts about whether the health board had properly noticed a meeting prompted her to make the clarification.
“Ms. Shangreau mentioned that they’re having weekly meetings,” Lemon said.
“It’s imperative and absolutely important for the public to know that the Health Authority Board does more than just have one meeting a month. As far as open meetings for the Open Meetings Act – a structured meeting – they do those correctly.,
“When she’s talking about weekly meetings, and please correct me if I’m wrong Ms. Shangreau, you as board members get together … and have planning sessions. I want to make that very clear that they’re not meeting without posting their meetings correctly.”
Shangreau agreed. “Yes, any meeting that we have where we take action is always a posted open meeting,” she said. “We will have planning sessions to plan, to plan. But … we do not take action on those plans that we make in planning sessions.
“We do quite often meet that way. But any board action taken is always done in an open meeting, open session. Thank you for that clarification.”
In fact, the Open Meetings Act makes no allowance for “planning sessions” to be held privately. If a quorum of any board or committee is present to discuss public business or form policy, it is a public meeting requiring notice notwithstanding whether action is taken.
Potts said he had received no response to his inquiry more than a week earlier and said Lemon had misrepresented what he had asked.
“I’m well aware of our Open Meetings law,” he wrote after listening to a tape of that part of the Dec. 15 meeting.
“I don’t believe it contemplates private ‘weekly planning meetings’ for the purpose of formulating a decision to be made public at the next formally noticed meeting.
“If the decision is to be made in public, then the discussions on how that decision was arrived at should also be public.
“Furthermore, these problems at the clinic do not exist only on social media or Facebook as was characterized by a member of the Health Authority Board.
“I and others have received numerous complaints of delayed referrals that have led to further health complications, missed patient instructions that have resulted in further accidents involving patients.
“I believe in our clinic and our health care workers, but we need leaders who recognize there is an issue that needs to be fixed, not just blame social media for the problem.”