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Policy Dispute Highlights Communication Breakdown at Sunshine Clinic

by Phillip Manning ~ February 6th, 2014


This week, Sunshine Community Health Center Executive Director David Bryant sent communication to KTNA reiterating that after-hours service is currently being conducted by phone consultation only.  This comes after the practice was called into question by members of the Clinic Board of Directors at the monthly meeting last Tuesday.

In the past, it was possible to receive limited care in-person at the Sunshine Clinic after hours.  As of last fall, however, that was changed to a system of “phone triage,”  meaning that patients could receive advice from a medical provider through a telephone conversation.  That advice could range from calling 911 to using over-the-counter or existing prescription medication. Dr. Philip Hess, Interim Medical Director for the Clinic, says that a number of safety concerns led to the change.

“Patient care…often inadequate resources to treat the condition, number one.  Number two, safety for the provider showing up alone.  Number three, safety for the patient, in that the practice of the provider could not be monitored or overseen by other staff.  Number four, delay in care is [a] potential liability….”

The delay in care Dr. Hess refers to is a situation where a patient calls and is seen at the Clinic, only to discover that the situation is serious enough that they should be taken to the Emergency Room instead.  Dr. Hess says that the previous after-hours service was inconsistent and varied from provider to provider.

The change in services has caused questions to be raised in the community and by the Board of Directors.  One of the concerns expressed at the January Board meeting was that the policy had never been approved, but was being treated as active.  Dr. Hess says he drafted new policies in October for Board review, including the after-hours policy.

“…Sent them to the Board in the November meeting, and they just sat there.  They were not reviewed, they were not acted upon…nothing.  Those policies outlined how practice needs to be changed to address safety and liability concerns for the Health Center.  They’re awaiting Board review.”

Board Member Richard Burgener said at the January meeting that the policy was sent back for edits around December 11th, but was not returned by the January 14th policy committee meeting.

“The after-hours coverage policy, we didn’t like what it said in there, and we really didn’t like what the ancillary service ordered either.  We sent them back to the Clinic to re-work them, and if you amend a policy we asked that the new changes are red…and if you delete an item it should be crossed through.  We had a new policy meeting, and we didn’t get any fixed policies for that meeting.”

Executive Director David Bryant responded by saying that the requested changes were for format issues and did not deal with the content of the policy.  With regard to policy changes, Dr. Hess says that he is willing to speak with the Board regarding policy alternatives, but that he believes the Board is unwilling to talk.

“…The Board has never asked to speak with me.  In fact, I’ve been on the agenda at the Board meeting numerous times and been canceled.  I’ve asked repeatedly to speak with the Board [to] talk to them about the policy changes, rationales, and alternatives.  It’s been declined every time, so I’m not sure if the Board wants to hear about alternatives.  The messages that I’m getting is that they don’t want to speak with me.”

The Board seems to have a different view.  The following clip is also from the January Board of Directors meeting.  The first voice is Executive Director David Bryant, and the second is Board Member Richard Burgener.

David Bryant: “It would be helpful if the Board would write down what questions it would like to have answers to from Dr. Hess and present those to him.  Written questions really help a lot in avoiding misunderstandings.”

Richard Burgener: “We would like to talk to him directly.  In the policy meeting six weeks ago, we asked that when we had the last policy meeting that Dr. Hess would be here telephonically, and, if I remember right, you agreed to set that up.”

David Bryant:  “He was unable to be telephonically available at the last meeting because the notice time was too short.”

Richard Burgener: “It was four weeks.”

David Bryant: “It’s apparently too short for him.”

During Wednesday’s phone interview, Dr. Hess stated that his full-time work at Anchorage Neighborhood Health Center makes it difficult for him to call in to the policy committee meetings, which are generally held in the afternoon.

Executive Director David Bryant declined to make additional comment on the record, and stated that Dr. Hess was the appropriate person to explain medical practices at the Clinic.

2 Responses to Policy Dispute Highlights Communication Breakdown at Sunshine Clinic

  1. Dave Bryant

    Review of schedules from the time frame in question show that the reason Dr Hess was unable to attend the meeting was that he was out of state, on vacation.

  2. Duronda Twigg

    Without full knowledge of the communication details between the SCHC Board of Directors, the current ED, Mr. Bryant, and Dr. Hess, acting Medical Director, I believe the ultimate issue here is the absence of an onsite Medical Director who oversees the clinical staff and patient services. This key staff member also advocates for the clinical staff and is the bridge between staff, administration and Board of Directors.
    The clinical staff have been without leadership and advocacy for over 6 months now. I do not believe the “we said, they said” time and effort is productive. However, reporting the issue of communication conflict between Board, ED, and Medical Director, is helpful to the understanding of the real issues at hand.
    I am sure Dr. Hess is quite knowledgeable and conscientious about health care and patient services. However, it takes on site knowledge of actual procedures, staff, culture and needs of the population in regards to geographical location that directs the services. There is always room for improvement for patient services, but taking them away is not the answer. You work harder to ensure safer, higher quality health care services to the best of your ability so that all those involved are covered. Bottom line: healthcare is a liability. Where do you stop providing care when there is a need?