November 9, 2001

Native American Press / Ojibwe News

Dr. Carol Krush IHB general practitioner Dr. Carol Krush speaks to the IHB board on Monday, November 5th.  The difficulties between the executive director and the clinic staff, she said, had been “framed as a struggle between Yvonne” and Dr. Caros.  “Dr. Caros was a spokesperson for the clinic staff, and as a result had gotten targeted for removal by Yvonne” Bushyhead, the executive director.  There had been difficulties in “direct communication” between the executive director and the staff, Dr. Krush continued, the staff was “frustrated,” and eventually “had to go above her to get help … we went to [Star Tribune columnist] Doug Grow.”

HB board reinstates terminated doctors, lab supervisor, decides to hire outside consultant to make “internal assessment”

by Clara NiiSka

In a Monday, November 5th meeting opened with a tobacco ceremony, the Minneapolis Urban Indian Health Board (IHB) began what board member Avis Poupart described as a healing process, “to begin anew” and restore harmony.

The board meeting was attended by a number of clinic staff, as well as by Indian Health Service (IHS) personnel including Bemidji area director Dr. Kathleen Annette, and by Dr. Helen Stone, who flew in from Chicago.

For two hours on Monday evening, the Minneapolis board members listened to the concerns of clinic staff and discussed how to begin addressing the clinic’s problems impartially and fairly.  The board then voted 9:0 with one abstention to reinstate terminated medical providers Dr. Lydia Caros, Dr. Lori Benaszak, and lab director Judy Day.  The board’s decision to reinstate the two doctors and the lab director was met with applause from clinic staff attending the meeting.

The board then went into closed session to discuss the hiring of an interim executive director.  The board intends that the interim executive director shall conduct an internal review during the thirty-day suspension of IHB executive director Yvonne Bushyhead, who had been suspended by a 5:4 board vote the previous Friday. As one board member put it during the November 5th meeting, the interim director would “gather that information … will be interviewing the staff,” determining “what led up to the problems” in the first place.  In a later telephone interview, board chair Kim Mammedaty explained to Press/ON that the board is hoping that the internal review process will enable the board “to find some answers and arrive at a more complete picture of what is happening” at the IHB clinic, so that the problems there can be addressed effectively.  Press/ON also contacted Yvonne Bushyhead, who stated that she preferred not to comment at this time.

The Urban Indian Health Board Clinic, at 1315 E. 24th Street in the heart of the Phillips neighborhood in south Minneapolis, has been beset with problems for years.  Yvonne Bushyhead was hired to repair the damage left by the administration of Noreen Smith, who left amid longstanding allegations of financial and other mismanagement.

Despite Bushyhead’s efforts, problems at the clinic continued to fester, then were precipitated into crisis when the clinic’s medical director, Dr. Lydia Caros, was suspended after writing an open letter to the executive director.  Dr. Caros’s letter, published in full on page 4 of this issue, was described by clinic director Carol Bell as an “inappropriate sharing of confidential information with the entire staff.”  On October 22 Bell informed Caros, in a courier-delivered letter, that she would be suspended for one week.  “I need some time to make the best decision on how to handle this difficult situation,” Bell wrote.  As Jean Pagano wrote for Press/ON’s November 2 issue, Dr. Caros was subsequently removed from the IHB clinic building by Minneapolis police after an October 23rd meeting with Bushyhead.

IHB medical providers, including Dr. Carol Krush, Dr. Lori Banaszak, Dr. Patrick Rock, Dr. Mitchell LaCombe, and Susan Hibbsobjected to Dr. Caros’s suspension in a jointly signed October 24 memorandum to the executive director and the clinic director.  “Writing an open letter in response to one of [clinic director] Yvonne’s comments in the personnel meeting hardly constitutes a ‘breach of confidentiality’ that warrants a suspension,” the medical providers wrote.

Four days later, the IHB clinic’s troubles were publicly aired in the Minneapolis Star Tribune.  Doug Grow described the removal of Dr. Caros from the clinic by “four Minneapolis police officers” in his Sunday, October 28 column. “Clinic director, Carol Bell, is the fourth person hired for that No. 2 position in less than two years,” Grow wrote. “The three previous clinic directors are considering legal actions based on the ‘hostile environment’” at the IHB clinic.  “Historically,” Grow continued, “there have been tensions between staff and administrators at IHB. But longtime workers say that the clinic has collapsed into critical condition because of the executive director, Yvonne Bushyhead, who took over two and a half years ago. Since her arrival, a third of the people on the staff (22 of 65 employees) have left or have been fired.”  Four of the former employees—executive administrative assistant Francis Lovelace, human resources staff Rita St. John, HIV/AIDS case manager Anita Symonds, and clinic director Felicia Hodge—have reportedly filed lawsuits against the clinic, and there are said to be two additional lawsuits pending.

Tensions at the IHB continued to increase, and on Friday, November 2, Dr. Lori Banaszak and lab supervisor Judy Day were both terminated, along with Dr. Caros.

During the November 5th board meeting, IHB board member Angeline Clark stated that the IHB board of directors had held a meeting on that Friday to address the burgeoning problems at IHB, and executive director Yvonne Bushyhead told the board of directors, “that everything was fine.”  But then, Ms. Clark continued,  “I got home and got a phone call from someone in the community.”  The caller told her that the two doctors and the lab director had been terminated “when they got home on Friday night.”

Staff and administration presented very different understandings of the conflict at the IHB clinic.

Staff physician Dr. Krush, speaking at the board meeting, said that the staff was “frustrated” at communication problems with Bushyhead.  Dr. Caros, she continued, “was speaking out for the rest of the staff.  I would not see that as taking sides.  … My feeling is that Dr. Caros was the voice of the staff.”  Several other staff, including psychologist Michael Harris, expressed similar support of Dr. Caros at the meeting.  “We would be open to any type of investigation,” he said, we “think that the firings were totally unjust.”

During a subsequent telephone interview, Dr. Krush said that there were a number of things which would help the situation at the IHB clinic, including unionization of staff, open communication, and, she said, “there needs to be accountability.”  Dr. Krush expressed concern about Bushyhead’s competence, as well as about her priorities for expenditure of IHB funds, and the integrity of clinic financial management under Bushyhead’s directorship.  “Yvonne,” said Dr. Krush, is “corrupt and incompetent,” and “in total cahoots” with former board chair Beverly Little Thunder, “26 people left because of Yvonne.”  Dr. Krush also told Press/ON that she wanted to publicly thank, “Indian leaders Clyde Bellecourt and Franny Fairbanks” for their support of clinic staff during the turmoil.
Indian Health Board Meeting
photos © Clara NiiSka
IHB Lab Director Judy Day addressed the IHB Board at a public meeting on the evening of Monday, November 5th.  Others attending the IHB board meeting included staff members and Indian Health Service officials.  Ms. Day was fired on Friday in conjunction with the clinic unrest following the suspension of Dr. Lydia Caros, then called back to work temporarily on Monday at the request of three Board members: Avis Poupart, Alberta Van Wert, and Stephanie Autumn.  As Ms. Autumn explained at the meeting, the clinic lab was not in compliance with regulations without a lab director, and the three board members who asked Ms. Day to return were prepared to pay her wages if their actions had not been subsequently approved by the Board of Directors. When Ms. Day addressed the Board on Monday night, she did not know, as she put it, “whether I have a job or not.”  Later that evening, Judy Day was reinstated, along with Doctors Lydia Caros and Lori Banaszak, by an 9:1 vote of the Board of Directors.

IHB member Avis Poupart
IHB Board member Avis Poupart (center) began the meeting with a tobacco ceremony, “to begin anew,” leaving behind the “negativity” and conflict which has troubled the IHB.  Standing in this photo between board secretary Linda Azure (left) and board member Alberta Van Wert (right), Ms. Poupart also urged the board to address underlying problems, including, she said, “we are operating under bylaws that were for a tribal college.”
Kim Mammadaty
New IHB chair Kim Mammadaty (left) weighs the problems faced by the board on Monday night, including most board members’ expressed interest in reinstating Doctors Lydia Caros and Lori Banaszak and lab director Judy Day, versus the powers of the Board of Directors as delineated in the IHB bylaws. “I am concerned,” she said, about “policies and procedures.  When we chose here and there not to follow what we have laid out” in the bylaws, “that puts us at a considerable risk.

Angeline Clark
IHB board member and ‘check signer’ Angeline Clark (left) addresses the difficult problems of balance and fairness faced by the board during its Monday night meeting, November 5th.  As she explained, on Friday November 2nd, “we had a board meeting and she [Executive Director Yvonne Bushyhead] said that everything was fine.”  But then, Ms. Clark continued,  “I got home and got a phone call from someone in the community.”  The caller told her that the two doctors and the lab director had been terminated “when they got home” on Friday night.  Ms. Clark also thanked the clinic staff who attended the meeting and ‘spoke up.’

Little Thunder, whose tenure on the IHB board expired October 31st, presented a very different perspective on the problems at the IHB clinic.  She also said that accountability was a key issue, but saw the problems as arising from the staff.  “It is apparent that no one is held accountable,” she said, “as long as the doors are open, it’s ‘OK’” from the staff’s perspective.  “But, from a business standpoint,” Little Thunder explained to Press/ON, “there has to be a profit to take care of the things that grants do not cover.”  She said that there was “resistance from the medical staff,” and that the number of “people seen in primary care do not justify the money that we are giving” to the clinic.

Little Thunder said that the total budget of the IHB is about $350 million annually, serving 3,000 patients a month “at one time.”  (Press/ON made several phone calls in an attempt to confirm the budget figures; the phone calls had not been returned by press time.  Medical staff estimated the annual budget at between $100 and $150 million annually, and said that the number of patients served at the IHB clinic was between 1,000 and 1,500 per month.)  Little Thunder justified Bushyhead’s travel expenditures—much of which was sharply criticized by staff—as a necessary aspect of clinic fundraising and training.

Little Thunder described the “conflict” between administration and staff as involving “a lot of resistance” from staff: “Yvonne tried to tighten up ship, to have people do what they were hired to do … she met a lot of resistance.”  Little Thunder said that, “it seemed like Dr. Caros was undermining Yvonne.”  She noted some of the problems at the clinic were “residue” from Noreen Smith’s administration.  It’s “like a marriage ended in divorce,” Little Thunder told Press/ON.  “The kids do not consider the ‘new mom’ … and like stepchildren, they ‘act out’.”  She also sharply criticized Dr. Caros’s actions after her suspension, which she described as a “cooling-off period.”  “In my opinion,” Little Thunder said, “someone who cared about the clients would never have allowed staff to walk off while she went off to talk with the police.  Everyone walked off the job,” abandoning the patients, according to Little Thunder.

Both clinic staff and clinic administration explained to Press/ON that their primary concern was the patients at the IHB clinic.  Dr. Krush cited the IHB mission statement, “The mission of the Indian Health Board of Minneapolis is to provide quality health care services to the American Indian population and the general public at large,” and Beverly Little Thunder similarly explained her and Yvonne Bushyhead’s actions in terms of the effectiveness of the clinic and the welfare of the patients.  “The clinic is really needed” in the community, she said, “the bottom line of IHB is to serve patients.”

In a telephone interview on the evening of November 6th, current board chair Kim Mammadaty expressed concern about the patients, as well as concern about “patient confidence” in the clinic—and patients’ trust that the processes being used to address the problems at IHB would be effective in resolving those problems.  She said that the intent of the board was to hire two interim staff: one to handle the “day to day” matters at the clinic, “and another person to do an internal assessment,” to research “what happened leading up to the events, then report back and make recommendations to the board. … We would like to be able to find some answers and arrive at a more complete picture of what’s happening.”

Mammadaty responded to staff concerns about Bushyhead’s travel, explaining that, “Yvonne’s travels are on behalf of the agency, something that the executive does. … [I am] not aware of any excessive travel.”  She stressed that the IHB clinic’s finances were properly audited, that “the audits have come back with no problem” found, and that the quality of health care at the clinic “just went through a couple of reviews” successfully.

Mammadaty also noted that, “the clinic will be celebrating thirty years in the community.  The Minneapolis Urban Indian Clinic is one of the oldest clinics of its kind in the country.”  She said that she sees the clinic as a valuable part of the community, and emphasized her intent to find a “good neutral solution” to the problems which the IHB clinic currently faces.