Guest Commentary

Why I left Wrangell

by Dave McCandless, MD

I have always considered my patients and the community to be my employers, no matter who signs my checks. Having cooled off a little, this is my “exit interview” to my employers on why I chose to leave Wrangell, which may be helpful in recruiting and retaining the health care providers you want in the future. It is interesting to me that no board member of AICS (Alaska Island Community Services) or WMC (Wrangell Medical Center) have asked about this. I suppose it is because they accept what they are told by their administrators, neither of whom would want to have this discussion. My answer to all is the same. AICS and WMC need to reorganize around the specific purpose of serving the needs of the community.

Many of my former patients have recently asked if I would consider returning now that “the hospital problem is solved”. Thanks for asking, because there is nothing I would like better than to return to our home and finish my career in Wrangell. Unfortunately, there are four main problems as follows.

1. The hospital problem is not solved. I salute those who brought the issues to the public, but it will take a good administrator and a united board some time to change the culture of this organization. I have only heard one or two of the new board members express a commitment to real change. Without this commitment, there are a lot of people in the second tier of management who are determined and probably able to sustain the current culture of the organization. Also, if not carefully handled, the legal and financial consequences of prior decisions may drain their time and resources for years. Finally, the administrators, boards, city council, and the community are distracted by the details of the building projects and administrator contracts and have yet to turn their focus to the core problem: instead of serving the needs of the community, the administration is using the community to serve the desires of the organization or its administrators

2. I want to be crystal clear that I am not singling the hospital out for criticism. I did not decide to leave just because the hospital mistreats health care professionals, which I have put up with for years. A larger factor was repeated mistreatment by the administration of AICS, which has developed the same attitudes. I found it increasingly difficult to provide good clinical care. The quality of care is neglected, while billing, paperwork, and organizational problems have become the primary focus of every day. Like the hospital, the AICS clinic undervalues the staff in the clinic who work with patients. I believe that every problem that has come to light at the hospital exists to an equal degree in AICS. Because of its important role in the clinic, and in recruiting the health care providers in the clinic and hospital, this organization deserves the same scrutiny of its decisions and contracts, but will be a much tougher nut to crack as the administration and self-appointed board are less accessible to the public.

3. I have made a major effort in my career to teach students who could become our health care providers in the future. Wrangell has been, but sadly no longer is, an appropriate place to teach students. Neither organization is supportive. Students very quickly pick up on the lack of support and sometimes outright hostility toward health care providers in both organizations. My goal is to attract them toward a career in rural health care, not to drive them away.

4. Finally, and ironically, I cannot get the health care I need in Wrangell. I cannot afford it, even though I have insurance and I am financially better off than most people. The charges are rejected by insurance as outrageous compared to the usual or customary standard, and are well beyond what I am now paying in a similar sized town (Haines). It doesn’t have to be that way. It is one more consequence of both organizations failing to cooperate in any way EXCEPT to negotiate separate monopolies to their mutual financial advantage. This limits the public’s access to services and allows excessive fees. It would be easier to pay extra if I thought the money was used toward health care, rather than flowing into other administrative projects and pockets.

For these reasons, I do not wish to participate in this system. Because I need health care coverage and services for myself and my family, I cannot return at this point. There is a persistent rumor that I am retired. I continue to work full-time providing health care. Wrangell does not lack personnel, equipment or facilities. The organizations are jockeying to improve the status and well being of themselves with jealous animosity toward each other. What Wrangell needs is cooperation and coordination of services for the well being of the whole community. Because the boards of these organizations have become oriented toward serving their administrator’s desires instead of the public interest, nothing will improve until the community demands a change. In a future letter I hope to hone in on the underlying problems and some suggestions for the future.