Frustration and pain rose to the surface Monday in the Southeast Alaska Regional Health Consortium’s annual “listening session” with the Sitka Community Health Council, and in the concurrent question-and-answer session with the public.

The annual one-hour listening session — which spanned about 150 minutes Monday — is mandated in the agreement the City and Borough of Sitka signed when it sold the community-owned Sitka Community Hospital to SEARHC in 2019, and the Alaska Native-owned nonprofit became the healthcare provider for the entire community.

The session was intended originally to give the general public, which isn’t allowed to attend board meetings, a chance to comment on SEARHC’s medical services, but on Monday many Indian Health Service beneficiaries also voiced complaints.

After a brief discussion of SEARHC operations at the board table, the panel opened the floor to some 100 people who had packed a side room at Harrigan Centennial Hall,

In the two hours and 30 minutes that followed, stories were told of medical care gone wrong, protests lodged against the SEARHC reorganization of home health care for elders, and complaints made that SEARHC’s medical system is difficult to navigate and doesn’t provide needed services on time.

About 20 speakers addressed the panel that included SEARHC staff and board members, an STA tribal liaison, an Assembly member and at-large council members.

Many speakers brought up the termination of a Home Health program that was modeled on the one it inherited from Sitka Community Hospital. SEARHC ended that program in the fall of 2023 and replaced it with an alternate program that has drawn intensive public criticism from the outset.

Karen Lucas was the first to ask SEARHC representatives on the panel about the status of home health care, recounting a story of a friend whose “husband was dying, and he was dying at home. He did not want to go to the hospital. He wanted to die in his own bed… There was absolutely nothing that SEARHC did for this man who pretty much spent his whole life here,” Lucas testified. She said the man died at home in pain.

“What is the status of restoring the Medicare-certified Home Health care that is free to Medicare recipients?” she asked.

Martin Benning, SEARHC senior vice president and chief of clinic and hospital operations, said SEARHC does not intend to return to the original Home Health program.

“Home Health is a very complex, highly regulated service. That is not a service that SEARHC provides anywhere across the rest of the organization. We ran it here in Sitka for a bit; it was not sustainable,” Benning said. “The model that we do provide is home-based care, and we do that very well. We actually have also taken care of a lot of end-of-life in our needs-care model. And that’s the service that we provide as part of our primary care service line, which is very robust.”

In response, Lucas said that regardless of SEARCH’s claim to provide end-of-life care for dying Sitkans at home, the man in question died without at-home care.

Home Health was one of the main topics for the remainder of Monday’s meeting, with more speakers testifying in favor of the old program, and taking issue with some answers officials gave.

A retired Sitka doctor, Marilyn Coruzzi, said, “We have no update, really, for all the meetings and all the concerns we had about Medicare-certified Home Health care. And I intimately knew that department. It was the best Home Health department I had ever worked for in my 40-year history… I think dollars were guiding (the SEARHC decision to change it) and not humanity and patient care. I still have yet to hear an update.”

Dr. Connie Kreiss, who worked at SEARHC for 25 years, also affirmed her support of Home Health care as it was formerly provided, and questioned the organization’s priorities.

“It’s frustrating now to get care in SEARHC. I’m very concerned about the lack of adequate Home Health services.” Kreiss said. “And I listen to your words, I think, what did you say? ‘It was not sustainable?’ Well, yeah, it didn’t make you money. This is a health care corporation that is very interested in making money… If SEARHC can’t afford it, then maybe it needs to redirect some of its money and pay its chief, that senior elite, less, and maybe decrease the amount of money spent on social media and ads.”

Another speaker in favor of the old Medicare-certified Home Health department was Cindy Litman, who said SEARHC doesn’t seem interested in hearing locals’ opinions on the topic.

“It feels like when there are critical issues or questions, you have already dismissed any reconsideration of them, and I appreciate the fact that you’re very concerned about signage and about swag… but you don’t seem to be as concerned about the shameful condition of not having Medicare-certified Home Health, and you don’t seem to be willing to reconsider that,” Litman said.

Earlier in the meeting, Martin Benning, SEARHC’s senior vice president, had reaffirmed for a second time that SEARHC had no plans to return to the prior model of Home Health care.

“Sustainability isn’t just an economic factor for us. It’s the amount of resources in structure to have to be involved to run a certified Medicare Home Health Department appropriately is a lot, and it serves a very niche group of people,” Benning said. “The model that we have in place serves a much broader scope of individuals, and we’re not interested in running a certified Medicare or Home Health agency. The model we have in place is the model that we provide.”

Litman responded.

“My husband was able to stay home in the last year of his life because of Medicare-certified Home Health here in Sitka; he’s not a niche. I do not want to hear that. This is not a niche concern. This is an aging community. A large percentage of Sitkans are going to be people who will benefit from Medicare-certified Home Health. And to me, it’s shameful and disgusting that you’ve already made up your mind, that you’re not going to reconsider or reinstate it.”

Litman said under the old system Medicare covered almost all costs, but SEARHC’s new home-based care program has co-pays and other fees that add up.

Michele Friedman, board president of Brave Heart Volunteers, which provides end-of-life companionship as well as other services, said that while BVH is still hard at work, it can’t make up for gaps in medical care.

“There’s been a lot of misconception from the time that Home Health shut down that like, ‘Oh, it’s OK. It’s OK because there’s still Brave Heart. So we’ve got that.’ Brave Heart is here, and we’re not going anywhere, but we are not Home Health, and we don’t do anything physical, medical,” Friedman said.

BHV program manager Maddie Gillissie reaffirmed that the small nonprofit is always open to hear from Sitkans.

“I just want to say how heartbroken I am to hear stories from some of you about people who had to die alone,” Gillissie testified. “I think that it’s really shameful that there is no more Home Health for folks in this community. I think that it’s really sad that our little nonprofit that barely breaks even every year is the one who will go and sit with your family in those final minutes. So I just wanted everyone in the room to be aware that we are here for you. You call our office number and you will not get a call center. You don’t have to press one or anything. I’ll be there. I’ll pick up. You tell me what you need, and I will do my very best to make sure it happens for you.”

Her statement was followed by loud applause.

More testimony

One of the first to speak was Pat Alexander, who expressed concern over what she sees as SEARHC’s lack of communication with the public, and her concerns about the possibility that cruise ship tourism would affect the accessibility of medical care for Sitkans.

“I very nicely write my questions down in writing so that you won’t misunderstand what I’m saying, and then I get nothing back in writing – that’s unacceptable,” Alexander said. “And for Tlingit and Haida, the last time we had a SEARHC representative there, they didn’t have even have half of the time that was needed. And what it does is it causes people to be disgruntled because they’re not heard. And I think you folks can do better than that.”

Paulette Moreno recounted the story of a severe shoulder injury, and subsequent difficult recovery, which she said included a denial by SEARHC for her effort to seek outside care.

“We, as the people, deserve the highest level of care and to be treated with the most respect as possible. My question is, in regards to this, I have been denied to go to (the University of Washington Hospital) until I check off these boxes, it has continued to cause me trauma to go to the places that had hurt my shoulder in the first place,” Moreno said. “It is completely unacceptable that we are not able to have these conversations.”

Stephanie Weddel, president of Alaska Native Sisterhood Camp 4, delivered a forceful critique of SEARHC’s quality of care and general practices.

“The decline in health care in the last few years has been noticed across the board,” Weddel said. “Our Indigenous people are suffering. Our non-Indigenous people are suffering. The elders are suffering. Our children are suffering. It’s not just one, and it’s not just here in Sitka, because I will tell you right now, I’m receiving complaints from other communities.”

She addressed the panel for about 30 minutes at the close of the meeting,

“As the president of ANS, it is my duty to care for my people, to be with them in times of trouble and when they need assistance,” she said. “Paulette here, when she went through all the stuff that she went through with her shoulder, I was there to witness it, and it was horrific… I have personally gone over and advocated for patients who have been terrified to see doctors. They’re tired of being dismissed and hearing, ‘You just need to lose weight,’ ‘Oh, you just have anxiety,’ ‘Oh, maybe if you sleep more,’ And it turns out that they have very real, very serious health issues that they have to fight and fight and fight to be heard.”

Blossom Teal-Olson told the panel she had to wait for a week before receiving a call back from SEARHC’s behavioral health call center.

“I don’t want beneficiaries pitted against non-beneficiaries, but I also want health care,” Teal-Olson said. “With the statistics that we are facing as Indigenous people, we need that health care. I suffer from PTSD and I required services. I called the helpline one night… It was a 24-hour line. It took them close to a week (to return the call). I forgot why, they were, ‘Oh, you called.’ It took a week,” Teal-Olson said. “And I have resources. I have loving family members. I have a community. How many suicides do we need to have in this community? That’s a red flag.”

Others told stories of long waits to receive care, and difficulty navigating SEARHC phone systems to make appointments, though some said they were pleased with the care they received once they were in an exam room with a provider.

Funding

Noting the uncertainty of federal funding as the Trump administration moves to pause federal grants, Sitka resident Harvey Brant voiced concern about the possible effect on SEARHC and the people who depend on the organization for health care.

“I am terrified right now, and I don’t know what to do about it, because I don’t know how the federal government is going to impact you… as an organization representing eventually probably about 74,000 people in health care in Southeast… That is my biggest concern. Will Medicare, Medicaid, Social Security be cut, or whatever? I could probably handle it personally, but I’m concerned about a lot of my friends and former students, and I’ll say it again, I am terrified.”

SEARHC spokesman Matt Carle replied, reaffirming the uncertainty of federal funding, but he did not offer specifics on how SEARHC executives are planning for possibilities.

“I’ve had a chance to visit most of the communities here in the region, the tribal councils. They share your same concerns,” Carle said. “The only thing that I could say with regard to what SEARHC is doing to position itself, your guess is probably as good as ours.”

He said that “with regard to what’s happening, what we have tried to do is we have various scenario-based planning that we try to follow. There’s different contingencies.”

Child care

Another issue raised was child care. Laurinda Martello asked if SEARHC would have interest in working to provide child care for their employees.

“Within Sitka, you have many highly skilled workers who work shift work, and daycares tend to go eight to five. There is an untapped pool of qualified parents that can work at SEARHC but lack the child care to do so,” Martello said. “… SEARHC is paying really high wages to attract a number of travel nurses and other travel providers. And my question is, if you can afford this out-of-town talent, why not support your local workers when they become parents? It seems to me that SEARHC is the single largest employer in Sitka. You should restore onsite child care to your staff.”

Benning said SEARHC isn’t looking at forming an internal child care system.

“We are in the business of providing health care, and, you know, solving some of these other community challenges is certainly something we want to participate in that process, along with other businesses that are also trying to hire folks,” Benning said. “But solving that child care problem is not something that we as an organization are going to tackle.”

Concluding

As the meeting drew to a close, SEARHC Chief Medical Officer Cate Buley said the organization plans to make improvements where possible in light of public criticism.

“What I did hear was the importance of communication,” Buley said. “Heard that over and over, the importance of behavioral health and why we need those services, and continue to try to meet that need. I heard so many times – I heard about the great care that you are already receiving when you get into that exam room with your providers, so that was inspiring to me, and we don’t want that just some of the time. We want that all of the time. I heard issues with HIPAA; that’s not acceptable. We aim to improve that. I heard hospice and home care, over and over, collaborating with Brave Heart, and how can we improve that.”

Pat Alexander spoke again, saying SEARHC’s model of care isn’t as effective as it could be and wait times are too long.

“I think the change that I’ve seen over the past couple of years is we’re moving towards a health maintenance organization model, where people are given 15 minute appointments, which doesn’t work if a person has six major illnesses and they have to wait two months for an appointment. You can see that really doesn’t work,” Alexander said. “… It would mean you’d have to hire more medical staff, because the ones that are there are working so hard and they can’t do any more than what they’re doing.”

• This article was originally published by the Daily Sitka Sentinel.