by Clara NiiSka

“They have had many challenges at that clinic, the [Indian] Health Board … they are trying to deal with it diligently,” Dr. Catherine Annette told Press/ON.  Dr. Annette, Bemidji Area Director for the Indian Health Services (IHS), is the liaison between IHS and the Minneapolis Indian Health Board.  IHS contributed $1.3 million dollars last year to the IHB’s budget; Health and Human Services’ Bureau of Primary Health Care also provided major funding to the IHB.

The Phillips neighborhood IHB clinic, located at 1315 E. 24^th Street in south Minneapolis, was organized as a nonprofit community agency [501(c)3] agency in 1971.  According to funding IHS’s statistics, in the year 2000 there were 4,429 Indian people using the services provided at the IHB, about 15% of the 29,439 Indian people IHS statisticians have determined to be its ‘service population’ in Minneapolis.  The IHB clinic provides medical care, dental care, mental health care, and a number of special-needs programs including: fetal alcohol syndrome (FAS) assessment and services, HIV/AIDS programs, and diabetes prevention and treatment.

The most recent available IRS Form 990 reports, which the IHB is required to file with the Internal Revenue Service, are for fiscal years 1998 – 2000.  The clinic requested a deadline extension for FY 2001 reports, not yet filed on February 27, 2002.

The Form 990 reports reveal that IHB revenues decreased by slightly more than $1.27 million over that three-year period.  In FY 1998, the organization’s total revenues were reported to be $5,560,396 and its total expenses $4,521,684.  In FY 1999, revenues dropped to $5,024,108 and expenses rose to $4,804,690.  In FY 2000, revenues had declined to $4,359,667 and there were $4,575,818 in expenses, for a net loss of $216,151, although the clinic’s net assets for FY 2000 remained ‘in the black’ at the end of June 2000, at $1,956,372.

The IRS reports also show top-heavy administrative expenses, with former executive director Norine Smith’s salary reported at $144,861 for FY 1998.  Smith’s reported IHB salary rose to $193,528 for FY 1999.  During her years as executive director, Smith is alleged to have received substantial additional income as executive director of COPE 1, a holding company which leased the IHB building to the IHB clinic at inflated rates.

In July 1999, Yvonne Bushyhead replaced Noreen Smith as executive director of IHB.  Bushyhead, originally from Cherokee, North Carolina and enrolled with the Eastern Band of Cherokee (she also has Winnebago ancestry), has a bachelor’s degree in social work, a masters degree in education, and a law degree.  Bushyhead faced the difficult task of ‘turning the clinic around’ after years of problems under Smith’s administration.  Bushyhead’s income as IHB executive director was reported as $79,042 for FY 2000 (July 1, 1999 – June 30, 2000) – less than half of Smith’s salary, but according to an informed source significantly higher than what it would be at a comparable non-Indian clinic.

Although non-medical administrators at IHB were paid extremely generously, the Form 990 reports show that the salaries for the highest-paid doctors were less than half of what they could have earned at other non-profit clinics, and far lower than what they could earn in private practice.  Despite the comparatively low pay, IHB’s staff has long included some dedicated physicians and other medical practitioners.

Press/ON has tried repeatedly over the past several weeks to contact Yvonne Bushyhead for comment.  At press time, she had not responded.  Press/ON also telephoned board of directors chair Kim Mammedaty, IHB interim executive director Penny Scheffler, and board financial manager Stephanie Autumn.  At press time, of these only Autumn had returned our phone call.  She declined to comment, explaining: “I have to honor what the board has committed to.”  The board of directors agreed, she said, that the “two people who know what everyone else knows,” Scheffler and Mammedaty, should publicly represent the board of directors.

Yvonne Bushyhead’s faced a difficult task in her efforts to, as she told Press/ON in November 1999, “get more Indian community members involved in our programs. I’m going to need help to get things [at IHB] turned around.” There had been serious problems at IHB for years, and according to Bushyhead, shortly after she took the job, she and two other staff members were fired for four days and then hired back by IHB’s board of directors in an apparent conflict among board members that had nothing directly to do with the staff members involved.

Under director Noreen Smith, the IHB was plagued by civil rights violations, mismanagement, and lawsuits.  The clinic was the subject of several years of federal investigation, although the U.S. Attorney’s office eventually decided not to pursue criminal prosecution.  Smith, a Red Lake enrollee, was the Indian representative on Hillary Clinton’s national health advisory board, and had extensive contacts and political influence.

Bushyhead’s approach to solving the problems at IHB included ridding the clinic of the ‘leftovers from Noreen Smith’s administration,’ and about a third of what Bushyhead termed the “old guard” were fired or encouraged to resign during Bushyhead’s administration.  Such tactics are not uncommon in efforts to turn around deeply troubled organizations, which IHB clearly was in July 1999.

Pediatrician Dr. Lydia Caros, former medical administrator, nationally-recognized expert on FAS, and 18-year veteran of IHB, saw the problems at IHB from a different perspective than did Bushyhead, and was critical of the executive director’s priorities.  “Instead of really buckling down and working on the finances” and other problems plaguing IHB, Bushyhead “spent who knows how much money traveling and on unnecessary consultant fees.  She tried to shame the staff, and got rid of a third of the staff,” Dr. Caros told Press/ON.

On October 23, 2001, Dr. Lydia Caros was suspended: after a meeting between Bushyhead and Dr. Caros, four Minneapolis police officers arrived at the clinic and escorted Caros from the building.  Other IHB medical providers, including Dr. Carol Krush, Dr. Lori Banaszak, Dr. Patrick Rock, Dr. Mitchell LaCombe, and Susan Hibbs objected vigorously to Dr. Caros’ dismissal and removal.  Dr. Caros and two other terminated medical staff were reinstated during an emotional IHB board of directors meeting on November 2.

On February 12^th, 2001 – at the end of the work-day and after she had seen her patients, Dr. Caros was fired.  According to Minneapolis Star Tribune columnist Doug Grow, Dr. Caros explained that recently-hired executive director Penny Sheffler, “announced that I was being terminated because the Indian Health Board was going in a different direction. … She said the board was not happy with my presentation of goals for 2002.”  Grow also quoted from Sheffler’s board-prepared statement: “From time to time, there are difficult, operational decisions that have to be made and we have made them.”

The re-firing of Dr. Caros has catalyzed action by IHB staff.  All of the medical staff with whom Press/ON has discussed the matter spoke of Dr. Caros with high regard – even lauding the former medical director’s reputedly strict administration in areas like grantwriting.  “They were targeting Lydia,” one said, “although she was not a voice in the wilderness.”

There was a board of directors’ meeting scheduled on the evening of February 25^th at the IHB.  Spurred by community concerns, Press/ON went to cover the meeting.  The board of directors met in closed session for nearly two hours, while about ten physicians and other medical staff members waited in the employee’s break room.

Most of the staff members requested anonymity from Press/ON because, they explained, they had been ordered not to talk to the press.  They expressed a series of concerns including, from a number of staffers, deep disquiet about how Dr. Caros, who they described as a near-indispensably valuable member of their team, was fired.

Medical staff also told Press/ON that they were deeply concerned about resolving the problems festering at IHB – and about how, as expressed in a printed flyer handed to this writer, “for the first time in IHB’s history, its ability to provide health services is being threatened.”

The staff’s key concerns included: a climate which one described as “secrecy and lies,” and another as “tyranny” from the board of directors and central administration towards the medical staff; a board of directors which, several staff claimed, did not represent the interests of the community; lack of information about clinic budgets and priorities – “there is no communication at all”; and staff shortages which, they said, are beginning to adversely affect the quality of patient care at IHB.

They also repeatedly raised questions about a report done by Indian consultant Bill Means.  One staffer explained that they had “confided” in Means in the understanding that Means’s findings would be shared with clinic staff, but instead the contents of the report were being kept secret.

Several staff members also expressed concerns about the IHB’s budget: both the budget for Fiscal Year 2001 – 2002 (approved by the board of directors at the February 25^th closed meeting), about unexplained budget shortfalls, and several allegations that there were funds missing and that perhaps the money was being used by IHB administration to pay legal fees and/or former executive director Bushyhead’s severance pay.

How do you propose fixing the problems, Press/ON asked.  “We want the board of directors to resign,” one medical staff member responded, and several others concurred.  “We want a board that will allow everyone to do our jobs, to give IHB back to the Indian people.  We need rules and regulations about how to select a board.”  [New board members are presently nominated by sitting members.]  “It’s the same for processes.  They need to consult with us, rather than telling us what to do.”

“There are good things about the IHB,” another staffer told Press/ON.  “We are still trying hard to serve our patients and clients.”  The staff’s urging that the current board of directors resign comes after long-term efforts by the staff, “to work with the board – but it’s like putting our heads against a brick wall.”

February 25^th board meeting

At press time, Press/ON had not obtained a copy of the budget passed during the executive session of the IHB.  Press/ON is continuing to investigate the situation at IHB, and this story will continue next week.

- to be continued -