Health

Southeast Alaska’s Native-run health consortium is acquiring another privately owned health care facility in downtown Juneau. 

Southeast Medical Clinic will join SouthEast Alaska Regional Health Consortium, or SEARHC, in April.  

SEARHC has absorbed many small practices in recent years as it expands its reach across Southeast Alaska. In the past two years, it’s acquired Juneau Youth Services, Juneau Obstetrics and Gynecology and Juneau Physical Therapy – along with other clinics throughout the region. 

“SEARHC shares in our vision of creating a medical practice that treats every patient with dignity and optimum care,” said Dr. Catherine Peimann, the clinic’s founder, in a press release. “We are eager to combine the strengths of our respective organizations and further enhance the services we can offer the Juneau community and greater southeast region.”

Southeast Medical Clinic was founded in 2003 and is located downtown near Foodland IGA. It offers primary care, gynecology services and lab work. According to its website, the clinic staffs six medical providers. 

“This partnership reflects our shared commitment to serving the health care needs of the Juneau community and the greater Southeast region,” said SEARHC President and CEO Charles Clement, in the release. “It enhances our ability to offer the best possible care to our patients by integrating internal medicine and family medicine in one mission.”

The release says the merger will result in SEARHC offering more comprehensive care in the region. 

Current patients will not lose access to care and its staff will “continue offering the same high-quality care at the current clinic location.” 

Juneau has a new mobile crisis team dedicated to assisting people with mental health emergencies. 

Bartlett Regional Hospital Chief Nursing Officer Kim McDowell said the city looked at similar models across the country when it developed this program.

“It’s kind of the first window of opportunity to provide de-escalation for somebody in crisis in the field that doesn’t involve EMS or the police department,” she said.

Juneau police dispatch can choose to call the crisis team when an emergency call comes through, based on a list of what situations are appropriate. The team may also be deployed based on calls to the national 988 Suicide and Crisis Lifeline.

McDowell said the team responds in cases when the individual is not in imminent danger of hurting themselves or someone else.

The team is made up of a Capital City Fire Rescue paramedic and a Bartlett Regional Hospital clinician. Crisis care consists of immediate response to a situation or crisis, further assessment of the person undergoing the emergency, stabilization, and follow-up involving other services. That could be case management or checking in with services the person regularly uses.

McDowell said this program allows people to receive care where they are, instead of having to come to the emergency room. 

“There’s nothing like providing them resources where they live, and that gives you the opportunity to wrap in family, if there’s family there,” she said. “And to give them all the resources that they might need to be able to go day by day and without having to come to the hospital unless it’s needed.”

The rollout of this new mobile crisis team began last month. Now, the team is officially responding to calls from 9 a.m. to 6 p.m. daily. McDowell says the city hopes to expand those hours in the future. 

 

Municipal utility staff say they need to raise Juneau residents’ water and sewer rates by more than 50% over the next five years to address critical infrastructure repairs. 

At an informational meeting at Thunder Mountain Middle School Thursday evening, residents reacted to the news. Jesse Hay, a Mendenhall Valley resident, said he understood the need for repairs, but he’s disappointed with the city’s overall approach to spending. 

“The utilities are definitely a requirement. But I think people just get frustrated that every time we turn around, the city’s asking for more and more,” he said. “The residents are just kind of getting tired of it because it’s getting too damn expensive to live here.”

Juneau’s utility rates have gone up 2% each year since 2020. The last time rates were increased was this summer. 

Now, the division proposes increasing the flat residential water rate by 10.25% starting next July. Then, another 10.25% each July until 2029. The proposed sewer increase is between 12 to 13% each year. 

At the meeting, city staff said it could have been much higher. In October, Juneau voters approved a wastewater bond to borrow $10 million to replace critical infrastructure at the Juneau Douglas Wastewater Treatment Plant. 

Alan Steffert with the Engineering and Public Works department said the bond helped shave off a significant amount of repair costs – but there are still a lot of upgrades that need to happen beyond that. 

“We’re actively replacing our infrastructure, be it wastewater or water, be it treatment, be it collections, be it distribution,” he said. “There’s no end of products or projects we can spend on and it’s a matter of prioritizing.”

Some residents, like Shawn Lovell, wanted to know how much cruise ship traffic takes a toll on the city’s wastewater infrastructure, and if residents will be the only ones paying if rates increase.

“How much are we actually getting from the cruise industry to offset that? Because it seems like we, as the locals, are the ones that are footing that excess bill, where maybe a little bit more should be twisted or pushed on to help them pay for it,” he said.

His comments, and many others from residents who attended the meeting, will be passed on to the Juneau Assembly. Residents may also submit comments about the proposals online. The Assembly will vote on the rate proposal before July.

The PeaceHealth Ketchikan Medical Center Emergency Department is staffed 24 hours a day, and for many services, it’s the only option on the island. The medical center is a “critical access hospital” — if patients arrive badly hurt, the goal is to stabilize them until they can get them to a bigger hospital in Seattle or Anchorage. It’s often a critical step in keeping people alive.

Recently, though, emergency room physicians went multiple months without pay, and to some, the future of services seemed uncertain. Sarah Hines, a nurse practitioner in the PeaceHealth emergency room, said the physicians received an email at the end of October saying payroll would be late.

“Then I found out by just talking to the other providers that they weren’t getting paid at all,” Hines said. “So they had been working for free since the end of August. And additionally, NES couldn’t provide them with proof that they had medical malpractice insurance.”

NES Health was a third-party firm that staffed PeaceHealth’s emergency department. Jared Kosin, CEO of the Alaska Hospital and Healthcare Association, said companies like NES are basically a one-stop staffing shop — the hospital pays a fee and the agency provides a group of physicians. They also provide malpractice insurance, which is extremely risky for an emergency physician to work without.

“The group still becomes integrated in the community, but it’s a way of basically contracting for services and having them take care of the recruitment and supply of the physicians, the billing, all of that stuff,” said Kosin, whose non-profit represents and supports hospitals across the state.

Kosin explained that it is “very normal” for hospitals to contract with third-party staffing firms, especially medical centers in rural or remote locales.

The California-based company staffed around 35 ERs across the country — everywhere from Ketchikan to Texas to Philadelphia. At the end of October, they sent those hospitals scrambling when they announced that they didn’t have the money to pay their doctors.

In the October email from CEO Jose Aguirre’s office, NES blamed the missed paychecks on transitioning to a new billing company. It’s just a “temporary shortfall,” they said. “Rest assured that everyone will be paid and made whole.”

But that never happened.

Instead, Aguirre and the firm’s chief medical officer soon resigned. At the end of November, they sent a brief saying the company would “wind down its operations and cease doing business.”

Hines said at this point, there was a deep sense of unease among the staff.

“I mean, that’s just dangerous for them, because that’s their whole livelihood at stake,” Hines said. “And then we have some new providers who just recently moved to Ketchikan to cover and help us out. They were going to be long-term providers here, and they can’t pay their bills.”

Kosin said for physicians and hospitals, the situation was dire.

“That’s a huge deal, right? If you’re not getting paid for doing your job, that affects your livelihood, and ultimately can affect your ability to be there and be present in that situation,” he said.

Some hospitals across the country did have to suspend services and shut down their emergency rooms in recent weeks due to NES’s closure. In Ketchikan, though, emergency room physicians and staff kept working — without pay.

“They can’t pay their bills if they don’t have payment,” said Hines. “I know these physicians really want to stay here and they want to provide for the community, but their hands are kind of tied right now because of NES.”

Could PeaceHealth have stepped in to pay the physicians in the interim? According to Kosin, the laws around how doctors get paid could complicate that.

“I think there would be a lot of compliance and analysis that would have to be done to make sure everything is being done in a way that complies with all the rules and regulations that are in place at the federal level,” he speculated.

PeaceHealth Ketchikan’s Communications Manager Kate Govaars confirmed that in an email, saying that “Due to legal limitations, PeaceHealth is not able to provide coverage for work done under NES.”

In mid-November, the physician’s group entered into an agreement with the hospital to keep working. A staff member who wanted to remain anonymous provided KRBD with a screenshot of a clause in the contract addressing the unpaid wages. It said PeaceHealth “desires and intends to provide additional compensation to [Physician] in recognition of uncompensated services [Physician] provided at the Hospital.” However, the contract said that the compensation for wages lost under NES was not “addressed in this Agreement.”

The Ketchikan Medical Center is one of ten hospitals operated by PeaceHealth. The not-for-profit healthcare organization operates hospitals and clinics across the Pacific Northwest.

In an email, Govaars confirmed PeaceHealth extended contracts that covered malpractice insurance and compensation, but Govaars said she couldn’t comment on the new contract or any additional agreements because “The nuances of individual contracts gets into personnel maters [sic], which PeaceHealth holds confidential.”

Govaars also wrote that PeaceHealth is committed to keeping the emergency room open and that hospital leaders “care deeply for our staff and value the care they extend to the community.”

“This group we have now is just fantastic,” Hines, a six-year Ketchikan resident, said of the current ER physicians. “They’re really good, and our community would really benefit by keeping them here. The problem in Ketchikan is we just don’t have a pool of people to pull from.”

Hines said the physicians’ last payment from the staffing firm came at the end of September, for the work they did in August. By the time PeaceHealth started paying them at the end of November, the Emergency Room staff were out two and a half months of wages, with no guarantee they’d ever see that money.

This is Tongass Voices, a series from KTOO sharing weekly perspectives from the homelands of the Áak’w Kwáan and beyond.

Oncologist Dr. Paul Weiden has been treating patients with cancer in Southeast Alaska for 23 years. Now, he’s retiring at 83.

For the past two decades, he would travel to Juneau monthly to see patients who might have otherwise flown to Seattle to see a specialist. He also provided remote care for patients in other Southeast communities.

Although he’s seen treatment access improve over the years, he says there are still gaps.

Listen:

This transcript has been lightly edited for clarity.

Paul Weiden: I’m Paul Weiden. I’m a physician, a medical oncologist, hematologist, and I have come to Juneau monthly to see folks up here since November of 2001.

In the 20 years prior to that, I was at Virginia Mason, and we saw a lot of patients who came from Southeast Alaska – particularly Juneau – to Seattle, particularly to Virginia Mason for care for cancer. So the folks that bothered me most were the patients at the end of life who had been treated up here and would come down to see if there was anything more that could be done.

And they’d come with the patient and the family, often spending their last resources — monetary resources, energy resources, psychological resources — to come down, and almost always for me to say, you know, “You’ve had pretty good treatment up there in Juneau or Wrangell or wherever you were, and there’s really nothing more that could or should be done.”

So when I left Virginia Mason, I said, you know, “I don’t need to have those folks come down here, I can go up there.”

If I have a patient in Sitka or Wrangell or Skagway, or whatever, we do telemedicine, unless they need to come to Juneau for the radiology facilities that are here.

There are more towns in Southeast Alaska now that are able to do that, but it stretches their resources, because not so much the administration of the chemotherapy. That’s not so hard, but it’s the complications of the chemotherapy that occur unexpectedly between the times a patient gets chemotherapy, and that’s a lot of responsibility for somebody, and let’s say in Skagway or Wrangell or Petersburg, where there are limited resources, so that that is still a tension.

But on the other hand, I think that problem is better solved by us here in Juneau being the center hub than trying to do it when I was practicing in Seattle, I didn’t really understand where the hell Skagway was in relation to Juneau.

So now I have a pretty good understanding of where everything is, and can work with the patient and the family and whatever local medical facility is in that town to see what’s reasonable to do. You know, you also understand that a patient from Skagway can get to Juneau pretty reliably in the summer, but come winter, and, you know, it’s a little dicey.

As I say, it’s rare that a patient really needs to, let’s say, get the hell out of town to get good care. And there are two or three patients over these 20 years that I really struggled to get out of town today, and not only get out of town, but to go somewhere where they would be taken care of that night.

And there are at least two that come to mind who, if you know, I hadn’t seen them on the day that I saw them and made the diagnosis and understood the situation, if they’d called the University of Washington or Virginia Mason and said, “I’m sick,” they’d get appointment for two weeks later, or even a week later, they’d be dead. That’s rare. I mean, it’s good television drama, but it’s actually very rare, and I can think of two in 20 years for that.

Now, I’ve probably forgotten two, but it’s not 10s or 20s, it’s single digits of patients where that kind of encounter is a difference between life and death. And if I go back to like the 30, 40 years before 2000, there are also two or three patients in my career where I can think, on this day, I made the difference between life and death. It’s rare, but it is, you know, extraordinarily exciting and rewarding.

Friends and colleagues will celebrate Dr. Weiden’s retirement Thursday at 5 p.m. at Amalga Distillery.

A recent state investigation found that the Alaska Office of Children’s Services failed to offer enough support for a foster child with aggressive behaviors. It originated from a 2022 complaint from a foster parent.

The report from the state Ombudsman’s office found in part that OCS did not follow policy when making a placement decision for the child, did not fully explain the child’s behaviors to a foster parent, and mishandled Protective Services reports about child maltreatment. It also found OCS did not fully provide appropriate mental health interventions for a child with complex needs.

A spokesperson for OCS said in an email that OCS is committed to addressing the recommendations from the Ombudsman.

Kate Burkhart is the Alaska Ombudsman. Her job is to evaluate the way state departments do their jobs from an objective, third-party perspective. 

“We give people who don’t have a voice, a voice,” Burkhart said. “So, often in child protection cases, when foster parents feel like they have been treated unfairly by the agency, they don’t have a lot of recourse.”

The report responded to six allegations from the foster parent and offered recommendations. One complaint — that OCS unfairly investigated the foster parent — was not supported by the evidence. But the other complaints were supported by evidence found in its investigation. The Ombudsman worked with the Office of Children’s Services to discuss the findings and propose possible recommendations. 

“In this case, OCS and the Department of Family and Community Services and the Department of Health all participated in that process to help ensure that our recommendations made the most sense,” Burkhart said. “And really led to improved — we hope — improved, services for foster youth that have complex disabilities and needs”

The Ombudsman’s office publicly released five recommendations related to the case. OCS accepted most of them. It partially rejected the recommendation that OCS develop policy and procedures to address the issue of child-on-child sexual abuse between children in its system. The office made the same suggestions after a similar case in 2017. 

The agency said it is unable to create a standard definition of of child-on-child sexual abuse because it’s unable to investigate a child as a perpetrator. Burkhart says the ombudsman doesn’t have the power to enforce these recommendations if agencies choose not to follow them.  

OCS accepted a recommendation to create and file “foster parent agreements” that address a child’s known behavior with foster parent placements and another to strengthen relationships with other state agencies and programs.