Guest Commentary

from the February 14, 2003 Skagway News

Clinic grievances were ignored
You know, I get asked a lot, “Where have you been?, You’ve been here, we never see you?” Well, I’m gonna tell you why. I worked at the clinic for two years and saw, in action, how the Skagway political network worked. It wasn’t pretty. Most of the problems that I will be writing about have already abated. I’m not writing this piece to make a scandal. But I believe in the public’s right to know.
Even before moving to Skagway, I was taking anatomy and physiology classes, thinking I might want to become a nurse one day. I spent some time working at the senior luncheon, both as a paid employee and as a volunteer. One winter I became the janitor at the clinic, a contract job. The administrator at the time asked me if I would like to become a medical assistant in the spring of 1999, after taking the EMT I course.
I was told that since I was already an employee as the janitor, that the job was mine, even though an advertisement for the job still had to go out. Another medical assistant, I’ll call her MA #2 was hired instead, to the full-time position, I was hired part-time. Both the previous medical assistant, MA#1, and I were told that MA#2 had previous medical experience, and that’s why she was hired ahead of me. When I later questioned MA#2, she had no idea what I was talking about, and that she didn’t have any medical experience. I went quickly from part-time MA to being a full-time MA, as every summer, the clinic was incredibly busy.
My first two months at the clinic were grueling, and I didn’t think I would make the cut. This was on top of my janitorial duties. With the great help of MA#1 and MA#2 I learned to draw blood, take X-rays and do EKGs among other things. The work was exciting and interesting, and I got to help and make a difference, to actually see people of the community become well from both long-term and short-term illnesses. To hold your hands. To kiss your booboos and help to make it all better. And to occasionally get to talk to people for longer than a hand wave.
And then the winter came, and new employees. MA #1 quit, because we had both been accused of “breach of confidentiality.” We were both suspended for three days, with pay suspended as well, while the administrator “investigated” these allegations. We were treated as if we were guilty. And I know other people, in the past at the clinic, who had been accused of “breach of confidentiality,” without getting automatically suspended. In fact, I think that MA#1 and myself were the only people that I ever knew of that were suspended for this offense. We were both allowed back, I was told that perhaps I had “unintentionally” breached confidentiality. Our pay for those three days was reinstated. But MA#1 was also disallowed from filing patient charts, which would pretty much make her useless at her job. A sort of smack on the wrist. She quit because we had done NOTHING wrong. We were never allowed to know our accuser, or what we were accused of exactly. Isn’t there some Amendment that says it’s a person’s right to know who their accusers are? After that, I stopped asking people in public, “How are you doing?” for fear someone would overhear and misconstrue my meaning. Later, MA#1 discovered , from her accuser, a prior roommate, that it was all a set-up, and for some reason I was caught up in it as well. If an “investigation” had actually taken place, this would have been known.
Medical Assistant #2 took a leave of absence for the winter. When she came back she was put in the position of desk clerk, while that employee went on leave. MA#2 didn’t want this position, but it was made clear that this was the only job she was wanted for. MA#2 did not like this kind of work to begin with, and was harassed out of her job that she hated, by an overzealous micro-manager. MA#2 had complained to the administrator about this harassment, several times in fact, but the situation never improved.
One day MA#2 was finally provoked to the point of walking out, and she was completely right to do so. She was never asked back to do the job she was hired to do, as medical assistant, something that she was good at and that she liked to do. Also, the physician’s assistant that we had from Canada left the clinic under dubious circumstances. New employees were hired for these positions.
I saw things happen at the clinic that weren’t necessarily correct. I documented some incidents, not all. I spent another year at the clinic. I complained about the problems, nothing ever changed. Once, after complaining to the administrator for the third time about another employee’s lack in job performance, I went directly to that person to work it out. I felt horribly uncomfortable confronting that person, but I spoke evenly, and did my best to keep anger out of my voice. After confronting the person, that person went directly to the administrator, and I got torn a new one.
Also, my job as janitor was summarily taken away from me. It was made apparent that I was not to question the decision. That job was a contracted job, and I don’t think you can just take something like that away without discussion. Also, at the time I was told, someone had already been hired for that position. After that I was afraid to complain for fear of losing my job.
I took a week off after the season was over, in October, to reconnoiter myself. After being back at work for a couple of days I realized I couldn’t remain there. Not with the mental strain of knowing that the community wasn’t necessarily getting the medical treatment that it deserved. Also the indignity of never being listened to. I left the clinic in October of 2001. Please realize how despondent I had to be to give up a job in October. Fortunately my English husband was given the go ahead from the INS to begin working that September, after not being allowed to work for two years.
After I left the clinic I spoke with a medical board member at length about the problems I had seen. The medical board president was out of town at the time. This board member appeared to speak to me in the guise of someone concerned about what I had to say. He assured me he would “investigate,” talk to the people involved, ask some questions. I came to find out later that he never spoke with anyone at the clinic. In fact, at the next board meeting he advocated for the physician I was complaining about. This really saddens me because this person had helped me in the past, and his wife is a very wonderful person whom I feel uncomfortable speaking to now.
This same provider made allegations against me to the medical board, in a November 2001 letter. That’s what I expected after I had made claims against that provider in a letter to the board a week earlier.
1) This physician implied that I did not want to “understand and learn about medical conditions.” This was in response to me not wanting to do procedures that I was not qualified to do.
2) Provider #1 alleged that I lied to them so that I could have a patient talk to Provider #2, after hours at the clinic. I did it! I used the personal line to call Provider #2 on the phone, at the clinic, after hours. It happens that Provider #1, whom I have made claims against, was at the clinic that night as well, and was the one to pick up the phone. I had a sick friend, who was also currently Provider #2’s patient. The friend was very worried about her condition. I didn’t think Provider #2 would mind talking to her. To paraphrase the accusation against me, “I confronted Allie the next day, she said I knew you wouldn’t let this patient talk to Provider#2 so I led you to believe it was me who wanted to talk to Provider #2 first then I put the patient on.” Provider #1 also goes on to say that we spoke of me violating clinic policy and trust. This is an outright lie. I never made that statement, and we never spoke about violating anything.
3) This provider also alleged that it was my personal fault that the flow of patients was usually running behind. The administrator at the time even timed with a watch, with patients during their intake procedures to see how long I took, can you imagine how humiliating that was for me to hear? Like a rat in a maze. The test proved that I was thrifty with my time. This provider also made particular mention of one day, complaining that I was on the phone with my personal doctor in Anchorage, and that this completely inconvenienced all of their patients. This provider had time to annotate where I was every minute of that morning, but not a moment to take their own patients back for intake. I have this bladder problem called Interstitial Cystitis, it feels like having a urinary tract infection all the time. I had made an appointment to talk to my urologist by phone the previous Thursday, when the clinic is closed in the afternoon. But my urologist never called that day, and chose this particular morning to call. The call lasted five to ten minutes, and I was back to work. The provider in question was completely indifferent to my problem and my condition. And there is an unspoken policy at the clinic that if a medical doctor calls to speak to you, about yourself or another patient, you speak to them. It would be rude to put off an MD calling long distance.
Since talking directly to a board member didn’t accomplish anything, I decided to tender a grievance directly to the board. This grievance consisted of ten points of contention. I gave my grievance to the medical board president. The director told me I would get a letter concerning my grievance within a month, and an answer to my grievance in three to six months. One month went by – nothing. Two months – nothing. I spoke with the president two to three times during the six month period. The president informed me that my grievance was at the lawyer’s office and that the lawyer was very busy. Once, I briefly spoke with a city official about the situation, since I thought the city might be interested in what was going on at the clinic. Unfortunately, he had to hand the information back to the board in charge, i.e. the medical board and the president. After waiting six months for an answer I spoke with the administrator at the clinic. The administrator called the president to come to her office, a provider sat in as well. Anyway, the president stated that since I was no longer an employee, and that I wasn’t tendering my grievance as a patient, that my grievance was invalid. Makes you wonder what the lawyer was doing for six months? Also, none of the patients stated in my grievance ever came forward to complain. Of course these patients had never known about the probable inconsistency of their care. And also, a couple of medical board members told me they never saw my grievance, so my grievance was never seen by the group responsible for such issues. I asked the president for a final letter concerning my grievance, why it wasn’t valid, etc. The president gave me a letter which included some observations of his own.
Now, of course I can’t tell you, the public, confidential information. I’m going to tell you as much as I can without, hopefully, getting into trouble myself. This is obvious in the fact that I am not mentioning any names. The first part of my grievance consisted of the fact that that medical board member assured me he would look into the situation, and then did the complete opposite. The president’s letter stated that this board member had no supervisory authority. When this member spoke with me on the phone it seemed to me as if he did. A large part of my grievance consisted of allegations against a particular provider. My claims were that I had concerns about the treatment of this provider on particular patients. I also had concerns about this physician’s demeaning attitude toward fellow employees and patients of a specific gender. As for the particular patients, none of them ever came forward, and I can’t complain for them.
In one instance, I was ordered to do something I was not qualified to do, something that I did not do enough to be proficient at, and something that I did not feel comfortable doing. I did voice my concern to the administrator at the time. One thing the president observed was that if any disciplinary action were taken against a provider, that the public would not be allowed to know. It’s the provider’s right to privacy. It’s hard to believe that any action was taken since the problems I speak of are still happening. And you will probably be told that I am not a medical professional and don’t know what I’m talking about. While working at the clinic I had the opportunity to work next to six different providers, and there was only one whose practices sent up red flags.
Here’s the favorite part of my grievance: that three to four members of the clinic staff including the administrator, went into the administrator’s office to pray at least two days a week, during the winter of 2000-01. This went on in the morning before we opened, between 8:45-9:00 a.m. How does that make you feel, Skagway? Knowing that the clinic staff was praying for your well-being and ever-loving soul a couple of days a week? I’ll tell you, it made me feel discriminated against. I believe in the separation of church and state quite adamantly. The president observed that praying at work is not against the law regardless of religious affiliation. Also, the president suggested that I should have complained, but there was that pesky fear of losing my job thing. I don’t feel that praying in a city building is proper. Even though the president stated that these people were not paid for their praying, I believe they were. If a salaried employee is praying in the clinic at any time, they are obviously being paid for it. And also, most of the staff arrived at 8:30 a.m. or earlier to get things up and running. The time they arrived was the time that went on their time sheets.
And finally, the last part of my grievance was that the administration and medical board allowed an environment of harassment to exist. You know I’m not a perfect person. I made a few mistakes while working at the clinic. Any mistakes I made at the clinic were purely because I wanted what was best for the patients. I realize that people make mistakes and it’s not like I haven’t taken this into account. I’ve never been out to ruin anyone’s career, but there needs to be a system of checks and balances. As I’ve said, most of the problems that I’ve spoken of in this letter, have already abated, there are only a few that still exist. It’s been a heavy weight to carry and sharing this weight with the community has been my greatest desire. I was waiting for the new board to get organized, and I was going to try to re-tender my grievance. But it’s really not as important for them to know as it is for the community’s need to know. It was no secret to many people in the community that something rotten was happening at the clinic. And I wasn’t the only employee afraid of speaking out.
At the time of this letter’s publication, many decisions concerning the clinic will have already been made. Including the question of having Bartlett Hospital take over the management of the clinic, which seems a good idea to me. It’s never good to have the inmates taking care of themselves.
Finally, let us talk a little bit about indignity. I complained to the administrator on several issues, nothing changed. I spoke with the Alaskan Medical Association to lodge my complaints about the provider in question, there were no other complaints against this provider to substantiate my claim. No one else had spoken out, nothing changed.
I spoke with a board member who assured me he would look into the situation, he did not, so nothing changed. I took a grievance directly to the board, apparently the only people to see this grievance were the president and the lawyer, so nothing changed.
I even tried to get the city to look at my grievance, but it wasn’t in their jurisdiction, so nothing changed.
So here I am, still at square one, banging my head against the wall. You don’t see me because of the indignities I faced to improve the clinic, and the indignity of not being able to do anything at all. Then there’s the indignity of seeing you people in the community everyday, and knowing that an injustice may have been done to you, or one of your family members. And the indignity of seeing the people who were in positions of power who I thought would help you and me. Not to mention seeing their family members and no longer being able to talk with them without gagging.
Another question would be, why don’t I sue? Well, apparently I could only sue if I wanted my job back, which I most definitely do not.
I believe that the clinic is getting better and better all the time. And if you need to go in and don’t have the money, the clinic will set up a payment schedule for you. And then there’s the added attraction of having a former medical assistant back on the job. So, please, continue to give the clinic a chance. Many people are now working very hard on the problems at hand. I urge you, the community, to complain when complaining is needed. Complain to a physician at the clinic, write a letter to the editor, put in a grievance to the new medical board. And if you’re worried about putting someone out of a job, it’s something you shouldn’t be worried about. This is the medical field, and sometimes lives hang in the balance. If a medical professional is doing something wrong concerning your care, they’re probably doing the same with other patients, maybe even worse. – Allison D.S. Smith (formerly Stahl)