By Melinda Munson

“We are having trouble over at the clinic,” said Borough Manager Brad Ryan at the July 9 Health, Education and Welfare Committee (HEW) meeting. Like most of the nation, Skagway is scrambling to recruit healthcare workers. Dahl Memorial Clinic (DMC) also struggles to retain their workforce.

According to KHNS, DMC lost 75 percent of its staff this year. In June, Nurse Practitioner Johanna Huff stepped down as medical director to focus solely on patient care. Dr. Terence Barlow (DNP), one of three providers, resigned earlier this month. The municipality recently hired a temporary provider at $858 per day, plus housing, to fill the void. 

“It’s expensive and it’s an emergency measure,” said Vice-Mayor Orion Hanson who signed the paperwork with the staffing agency as Mayor Andrew Cremata was out of town.

Currently, Skagwegians who call the community clinic cannot immediately schedule treatment. Patients are asked about their medical status, then receive a phone call days later to book an appointment.

Approximately 30 citizens attended the HEW meeting held on a Friday evening to accommodate the committee’s schedule. Assemblymember Jay Burnham was not in attendance because of a work emergency.

The meeting’s only agenda item was to discuss a memorandum of understanding (MOU) between SEARHC, a non-profit health consortium based out of Juneau with clinics located in 27 Southeast communities. SEARHC describes itself as “Alaska Native People working in partnership to provide the best healthcare for our communities.”

Ryan said he initiated contact with SEARHC, which then made a public presentation in Skagway on June 21. 

“SEARHC has expressed interest since I’ve been here,” Ryan said. He later added, “I’m not trying to railroad this but I am trying to get the answers.”

One section of the MOU outlined a short-term plan for SEARHC to immediately provide management services to the clinic. The second aspect of the document invited what Ryan described as “further investigation of the services that SEARHC can provide to the community.” Community members were vocal during Citizens Present.

Shelly O’Boyle, former clinic manager, felt she didn’t have enough information about what a future with SEARHC would look like. 

“Educate us, slow down,” she advised the HEW Committee. She also wondered about the financial ramifications of giving up control of the community clinic.

‘We worked really hard to get $1.3 million of grant money to this community … That $1.3 million employs eight positions at that clinic. It takes care of the dental program. It does the dispensary technician, the health and information technology specialist, the administrative manager, behavioral health … the accounts benefit position, the seasonal RN, one MA (medical assistant) and one provider,” O’Boyle said. 

“I did not hear at that meeting the other week that those positions are going to be in this community, that those services are going to be in this community … I did not hear them say that they were going to protect those positions. What I heard them say is they are going to take our $1.3M and absorb it into SEARHC…” O’ Boyle continued.

Cory Thole, president of DMC Board of Directors, also had financial concerns. He wondered if the clinic would lose grant money if SEARHC took over management or ownership of the clinic.

“I would like to make it very clear that the board is not making a recommendation on whether or not the municipality should move into a management agreement with SEARHC as this should be based on an informed decision and a vote by the community. That said, the MOU as written raises a lot of red flags and puts the municipality and the clinic at risk of jeopardizing the $1.3M under the current HRSA/330 grant,” Thole said.

Thole further explained the principles of the grant requirements for DMC.

“…The only reason that the municipality is able to get that grant is because the board of directors has nine people sitting at that table which the assembly does not. If the assembly had nine people at the table, they could sit as the board of directors for the clinic but they do not meet the requirements of HRSA … Under that agreement, we are the management of the clinic, not the assembly…” Thole said.

Speaking for herself and her husband, not as a member of the DMC board, Nicole Goodman appeared troubled.

“I’ve lost sleep over all this for the last month,” she said. 

“We are curious how this situation is that much different than the fight that’s been going on over the waterfront for years. The city gave up control and now they want it back, so why would we be so quick to give up control of our clinic without really ensuring that that’s what’s best for our community,” Goodman said.

Darren Belisle testified in support of seeking assistance from SEARHC. He described himself as “a white guy that uses SEARHC” and said “it works out pretty good.” 

“I feel the health and welfare of this community is at risk,” Belisle said. “We need to move faster on this than it would take going the long route.” 

Belisle said DMC “brought me back from the dead.” He described the staff as “running ragged” and wants to provide help before Skagway loses any more health professionals.

The HEW Committee voted to meet again with all three members present, to discuss a revised MOU or MOUs that are attorney reviewed, and present those documents to the assembly. The next HEW meeting is July 28 at 7 p.m.

HEW Chair Reba Hylton, a former Haines resident and user of SEARHC, is open about her issues with DMC.

…“As a community member, I don’t use our clinic for a reason. There has not been, through all these years, the continuity of care, and that’s really lacking here — and that really hurts our clinic. And for them (SEARHC) to be able to bring providers from the outside, and have that network, is a huge advantage for us…” she said.

“It’s not in any way putting down what we have. How do we make what we have better? How do we make it different? Do not be afraid of change… ” Hylton said.

Despite her strong opinions, Hylton believes the community should have the final say. She hopes the HEW Committee will vote to put a resolution regarding SEARHC before the assembly and that the body will then place it on the Oct. 5 ballot.

In order to appear in this election, the resolution must be approved by the assembly at the Aug. 19 meeting.

“That’s why we’re doing this before we know what the scope of services is,” Hylton said.