Upheaval between health corporation and tribe in Bristol Bay stirs healthcare worries

People attending BBAHC’s meeting in Dillingham on Tuesday, Feb. 18, 2020. (Isabelle Ross/KDLG)

The Bristol Bay Area Health Corporation held a public meeting last week to discuss its healthcare services in Dillingham. The meeting came several months after the Curyung Tribe said it was withdrawing from BBAHC because of its concerns about patient care and the corporation’s administration.  

First, a little background: The Curyung Tribe is the largest of the 28 Alaska Native tribes that currently authorize BBAHC to provide care to their members through a contract with the Indian Health Service. In 1980, it authorized the health corporation to provide healthcare services through the Indian Health Service on behalf of tribal members. It reissued that authorization in 1994.

In the fall of 2018, the Centers for Medicare and Medicaid Services found that the Kanakanak Hospital pharmacy in Dillingham, which is managed by the corporation, was putting patients at risk of harm or death. CMS put the pharmacy in “immediate jeopardy” status. In November of 2018, the Curyung Tribe passed a resolution authorizing the council to leave the corporation if its concerns were not addressed. The hospital was deemed compliant a few months later, but the Curyung Tribe said that it had difficulty working with BBAHC. In May, it passed a resolution to withdraw from the corporation.

For the past several months, Curyung and the corporation have been negotiating that withdrawal. The earliest it could take effect would be in May. A major issue is that Curyung says that it does not have enough say in BBAHC’s operations.

First Chief Thomas Tilden said they hope to come to an agreement with BBAHC that will allow them to stay, but there are issues that need to be fixed. Tilden said that the health corporation is currently structured so that the executive committee has the most power, undercutting tribes’ effectiveness on the board. 

“The executive board basically has all the say in regards how the services are provided and what the priorities are,” he said. “We, as the largest tribe in Bristol Bay, had no seat on the executive board. We have had a number of members that have tried to get on the executive committee and basically could not make it on that board.”

He pointed out that the members of the executive committee come from communities whose populations make up 22% of the entire region. 

Curyung’s Second Chief Gayla Hoseth spoke at BBAHC’s public meeting Tuesday. She stressed that the tribe’s first priority is healthcare. She also pointed to what she sees as structural problems in the hospital’s administration.

“If you serve on the full board, you have no say of what that executive committee does. None. That’s a problem. That’s backwards. It’s a backwards pyramid,” she said.

Robert Clark, president and CEO of BBAHC. (Isabelle Ross/KDLG)

Two weeks ago, the Indian Health Service determined that the tribe would receive the full amount of the funding currently allocated to the corporation for care of tribal members. That’s a third of BBAHC’s IHS funding. The corporation said that it is still considering how to respond to the IHS determination.

One of the main questions is whether the tribe’s withdrawal would affect patient care. Robert Clark, the health corporation’s CEO and president, said at the meeting they didn’t yet know what it would mean for residents of Dillingham.

“It is possible that the final withdrawal agreement will result in Curyung members and perhaps other beneficiaries who live in Dillingham no longer have access to BBAHC services. We are months away from knowing for certain if Curyung will pull out and what the final agreement will look like,” he said.

Brenda Akelkok is a member of the Curyung Tribal Council. She said she was worried about the speed of the withdrawal.  

“I’m just really worried that people are going to suffer if there’s not enough time and effort put into it by both parties to do the type of transition where people aren’t going to get hurt, or they quit going down to get care,” she said. 

At the meeting, several people expressed concern about healthcare services for members of other tribes who live in Dillingham. According to BBAHC’s attorney, Geoff Strommer, if the tribe decided to put the entirety of its IHS funds towards a new healthcare program, BBAHC could decide to charge IHS beneficiaries in Dillingham who wanted to continue using hospital services. 

“It’s unclear right now, how much money might leave the system, and what programs, functions, services and activities might go along with that money that Curyung is going to take,” Strommer said.

First Chief Tilden said that in order for IHS to approve a withdrawal, the tribe has to have a plan in place for healthcare. 

“There will be no diminishment of care to the residents of Curyung or other tribes or people receiving services now,” he said. “That service is going to continue to be administered by — it’s just a matter of who is going to provide that service.” 

Clark said BBAHC has also held meetings in Togiak, New Stuyahok, Goodnews Bay and Chignik Lagoon.

BBAHC’s executive committee and the full board will meet with the Curyung Tribal Council next month to continue mediation.