Attorneys for Alaska Island Community Services are asking the Borough of Wrangell to look into possible conflict of interest issues and delays in physician privileging by the Wrangell Medical Center board.
In a letter to Mayor Jeremy Maxand, dated Sept. 26, Danielle Ryman, an attorney for AICS, alleged that the board could be acting improperly after failing to adhere to their bylaws. The board, according to the letter, is not acting on a request by Dr. Greg Salard for emergency room privileges – a request that the board should have acted on within 90 days of his initial appointment, according to the letter.
Although Ryman said she stands by the statements made in the letter to the borough, she declined to comment further, referring to what she called the on-going nature of the matter.
According to Ryman’s letter to the borough, Dr. Salard was told that a decision for his reapplication to the hospital board for emergency room privileges was still under consideration and had not been determined due to changes in board policy.
“I can tell you I know of no change in our internal WMC processes that would have affected Dr. Salard’s privileging,” WMC CEO Noel Selle-Rea said. “I’m not sure what Ryman is referring to in the letter.”
The misunderstanding may arise from WMC’s use of Bartlett Regional Hospital in Juneau to handle credentialing and privileging work for Wrangell.
“We run all our logistics through Bartlett,” said Mari Selle-Rea, WMC’s Director of Development and Quality. “We started running things through them in the last year and any time a provider seeks privileges at our hospital, they have to go through this process.”
Salard said he should have been re-credentialed under a previous scheme used by the medical center.
“It should have been completed by very early this year and was put off initially because of outsourcing of the internal process to Bartlett,” Salard said. “What should have happened is it should have been done under the old system. After the Bartlett changeover was completed, they gave me the documents to go though Juneau. I should have been grandfathered in under the old plan.”
According to Mari, the credentialing process through Bartlett involves a series of professional inquiries, a background check, and is more rigorous than a standard job application process.
“The privileging process makes sure the provider is ready to handle the hospital privileges they have asked for,” she added. “The ultimate responsibility in approving the process is at the local level and falls to the medical staff for review and then the WMC board for action, which it has not yet taken in this matter.”
While the current sequence for privileging may be certain, Dr. Salard says he is also certain of why his process is taking so long.
“This is about retaliation, pure and simple,” Salard said. “There are so many things that I have spoken up about, including equipment that the doctors have wanted and not received. Once, we asked about getting a fluid warmer. The hospital unilaterally disregarded our request and purchased in-line fluid warmers instead.”
That equipment was inadequate for patient treatment, Salard added.
“None of the doctors wanted that,” Salard said. “I also raised questions about why so many nurses were quitting. Nobody wanted to answer that for me.”
A second issue raised by the letter is a possible conflict of interest involving board member Linda Bjorge and her husband, Melville “Bucky” Bjorge.
At the heart of matter, according to Ryman, is a claim where Bucky is a clamant against Dr. Salard in a professional negligence claim.
Ryman said Linda’s involvement with decisions by the board, while in executive session meetings, were a violation of section 3.01.112 the Wrangell Municipal Code. That section prohibits members of the board from participating in discussion or votes that may have an element of financial gain for the member.
“Ms. Bjorge’s involvement in matters concerning Dr. Salard and/or AICS is of great concern given her relationship with the plaintiff in that lawsuit,” Ryman said in her letter to Maxand.
Bjorge said she has acted completely legally and above reproach when it comes to her oversight duties.
“During that meeting I was the acting president during executive session and had to sign off on all the physicians,” Bjorge said. “But, when we came to Dr. Salard in the stack, I told the board I had to recuse myself for personal reasons and I wasn’t even involved in discussion.”
Dr. Salard was unable to comment on the issue due to HIPAA ethics laws.
Maxand said the borough followed internal procedures after receiving the letter and that they are the proper party to deal with the issue since the WMC is part of the borough.
“The borough manager has requested, via a letter on June 8, to the WMC administrator that any legal services related to hospital governance, public records requests, and the purchase of major medical equipment be coordinated through the borough attorney. This requirement is based on the municipal code under the borough manager.”
According to both Maxand and Rooney, borough attorney Bob Blasco is currently reviewing the letter from Ryman for possible action.
According to a source familiar with the workings of the WMC Board, Dr. Salard was among five physicians considered for privileging at the board’s most recent meeting – but Salard’s name was tabled until at least their Nov. 16 regular meeting.
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