SEARHC medical director Dave Vastola, M.D. (foreground, left), and CEO Chuck Clement make the case for the $6.5 million dollar takeover of Sitka Community Hospital, during a May 30 meeting with the Sitka assembly. (KCAW photo/Emily Kwong)

The Southeast Alaska Regional Health Consortium presented its proposal to take over Sitka Community Hospital this week (Tuesday 5-30-17) — a cash offer that the Sitka assembly will take a hard look at in the coming weeks.

But the deal is much more than a real estate transaction. There is a long history of tribal health in Sitka — a history rife with highly-charged issues of patient access, hiring practices, and racism.

After SEARHC’s lengthy presentation, the Sitka Assembly dove in and began to question SEARHC’s top management directly about the issues.

Downloadable audio.

So it was assembly member Bob Potrzuski, naturally — a former high school teacher and basketball coach — who put the ball in play for SEARHC’s CEO Chuck Clement.

Potrzuski – I don’t know how to delicately put this, but it’s been brought to my attention over and over again — and I think I know the answer. In timeliness of service, is ethnicity a factor?
Clement – No. When someone calls to make an appointment — when I call to make an appointment — it’s just the person at the end of the line.
Potrzuski – If we’re in a triage or emergency situation?
Clement – No. If you walk into the ER you’re going to get seen based on the level of care that you need.

SEARHC medical director Dave Vastola agreed. “It’s simply not an issue,” he said. “Our patients are colorless.”

Potrzuski – I wish that we could say that more clearly, but that’s about as clearly as it can be said. So I hope the people who keep asking me that question have gotten a solid answer.

There is a rare exception, however. Vastola said that occasionally a visiting specialist from the Alaska Native Medical Center in Anchorage is required — by the mission of the ANMC — to prioritize Alaska Native patients. Vastola said that SEARHC has remedied that circumstance by hiring independent contractors for many specialties, like neurology.

But Vastola also had this observation: Concerns over the ethnic divide at SEARHC go both ways.

Vastola – I will tell you on the flip side since we’ve covered some history here. I’ve had the opposite question come to me from our beneficiary population, where in some of the communities we started seeing non-Natives. The clinic was typically a social place. People would go, they’d get seen, they didn’t necessarily have an appointment. We started getting patients in who didn’t have appointments. And they’d come in, it would be their appointment time, and they’d get seen. And it would be, Hey why’d that person go in front of me? Because they had an appointment and you didn’t, and that’s the way the scheduling rules work. It’s the same set of rules for every patient, whether it’s scheduling a routine appointment or receiving emergency care. We treat everybody the same.

Read SEARHC’s formal presentation.

Listen to Part 1 of SEARHC’s May 30, 2017 presentation to the Sitka assembly.

Listen to Part 2 …

Listen to Part 1 of the assembly’s questions for SEARHC’s Chuck Clement and Dave Vastola, M.D.

Listen to Part 2 …

Patient access was one of the major unresolved questions during SEARHC’s and Sitka Community Hospital’s efforts to create a joint venture last year. Another was Native preference in hiring. Mayor Matt Hunter said people frequently expressed concern to him about it. Clement, however, has never been anything but straightforward about the issue. Native preference is the policy.

“We continue to anticipate, under any scenario in which we move forward, that hiring practices will be the same. Which is: We are committed to being the employer of choice and hiring the most qualified candidate for any position. In the event that two candidates are legally qualified, we are legally required to give preference to the Native candidate.”

Another widespread assertion is that SEARHC is not good to its employees. Assembly member Kevin Knox asked Clement if there were objective measurements of employee satisfaction at SEARHC, and Clement responded that turnover and tenure were the most objective tools he had available, and the occasional survey of employee engagement.

Member Steven Eisenbeisz wasn’t quite satisfied.

“I never did hear the answer. Are your employees happy?” he asked.

Dr. Dave Vastola, who’s been at SEARCH over twenty years, was candid.

“Morale, like most things, waxes and wanes. I’ve certainly seen times when the employee workforce as a whole seemed happier than others.”

Vastola felt that SEARHC took pains to measure employee satisfaction at the department level, and engage the workforce “and address the things at the top of the list that made them most unhappy.”

And then there’s the hospital property itself. SEARHC is offering to purchase the assets of the hospital, and lease the land it sits on for five years at $600,000 per year.

What then? Asked member Eisenbeisz. Clement wasn’t sure.

“The real estate is not our primary interest in any potential deal. (As Mayor Matt Hunter pointed out) maybe that’s a future conversation. If the city felt that it was of value to the city, we would be open to just walking away from it. If the city felt it was a liability, I think we could come to some understanding of how to repurpose it. The sky’s the limit.”

Clement took over as CEO of SEARHC five years ago. He told the assembly that just one-quarter into his first year, the organization was already $7 million “underwater,” and he took out a loan on his first day of work just to make payroll.

Salvaging the SEARHC budget required some severe measures, and many in Sitka remember that important programs — such as the inpatient behavioral health clinic and an air ambulance service — were shut down. But it wasn’t half the staff.

“It was nowhere near 50-percent. And I can tell you to this day that it is something that affects me as a person.”

The Sitka assembly will take a month to consider SEARHC’s offer. Sometime later this summer — likely in July — they’ll hear a counter-proposal for sustainability by Sitka Community Hospital.