Addressing Grievances: How Health Care Dies

In a recent post, the issue of Dino’s courage was discussed as well as the ineffectiveness of bringing our grievances to the GC or the NABC.  The post ended with the idea that Conrad’s legacy of mismanagement and abuse lives on.  Dino also addressed that issue, as well as how that issue is rearing its head in our healthcare system and 638 clinic; issues that deserve more attention.

This issue is a monster with many faces. The first and primary face is that of Rick Brannan.  "King Rick", whose wife took down and caused the collapse of our Boy’s and Girl’s Club through blatant theft - an act that still affects our youth - yet she works in our healthcare system. Add to that, that the woman who was the prosecutor when this theft came to light works for Wind River Cares as well. King Rick removed the previous CFO for past behavior and now runs Wind River Cares with the aid of a known thief and someone who did nothing about that theft.

Incompetence, mismanagement, nepotism, scandal, and cover-up abound. The NABC had an independent team review and audit the casino under Conrad in order to determine if his business practices were sound or not. A similar review needs to be conducted here; one that includes anonymous surveys and interviews so that those with knowledge of what goes on can speak freely without the fear of repercussion.

Looking now to the meat of Dino’s complaint, King Rick himself has said that IHS has killed more Indians than the 7th Cavalry.  But we cannot forget that King Rick cut his teeth on the IHS model; this is what he knows, it is what he is comfortable with.  King Rick was the head of IHS, and during his tenure in that position he faced a Whistle-Blower complaint; a complaint that was found to be true.  Nonetheless, he remains the head of our healthcare system. King Rick has said that he loves the Arapaho people, and I want to believe he does; I just think he loves the money of the Arapaho people more. The top positions at Wind River Cares are currently held by himself, his wife, his son, his daughter-in-law, and his brother. If they were qualified for these positions that would be one thing; but they are not qualified. If someone other than King Rick was involved in their hiring and were their direct supervisor that might be acceptable; but he did hire them and he is their direct supervisor.

These are not sound business practices and they are not good for the Arapaho people; the people King Rick loves. His “Royal” family has created a funnel that brings all of the money into his home, while other qualified tribal citizens are on the outside looking in; but all of the Arapaho people that he loves are at risk.

King Rick sits atop his throne, ruling with impunity and an iron fist with striking similarity to the abuses uncovered by the investigation into Conrad.  Five nurses have come forward to complain about the system and with suggestions for improvement; they were removed.  The CFO reported misuse of funds to the council; he was removed. Whitehurst came forward complaining of King Rick’s misdeeds and his misuse of funds; he was removed within the hour. The next administrator questioned King Rick’s son Aaron’s effectiveness in his position in charge of procurement; he, too, was removed. The pattern? Dare to question the monarch, and you will disappear. It took fourteen years to remove Conrad and we nearly lost the Casino he oversaw, and we still have not stopped revenue generating business from going to non-native contractors from non-native towns and cities throughout Wyoming and Utah.

We do not have fourteen years to stop King Rick. Our healthcare is too important and the consequences of mismanagement are too severe. If he so loves the Arapaho people, why does he risk their healthcare, rather than work to provide them with the highest services possible?  He holds fast to his IHS model, complete with its ineffective drug therapy. He continues to buy up abandoned and condemned buildings in Riverton, leading to a healthcare system scattered about the area where patients travel from one incompetent provider to the next, receiving sub-standard care all the while.

Does King Rick have a plan for today? How about next year, or for the next three, five or seven years? Rather than squander the funds of his beloved Arapaho buying dilapidated facility after dilapidated facility, perhaps those funds should be focused on developing a centralized healthcare campus on the reservation itself, and training more Arapaho to work within that setting.

Insanity is often described as doing the same thing while expecting a different result.  King Rick holds fast to his outdated and ineffective IHS model while examples of flourishing 638 programs operate in Oklahoma and Alaska.  These programs should be studied, their administrators should be interviewed, and their experts should be invited here to train and consult.  The first step toward meaningful change is to change.

One place to start is with Nuka in Alaska.  "Nuka" means strong giant structures and refers to living structures.  It is the name given to the South-central Federation’s entire healthcare system providing medical, dental, behavioral, and traditional healthcare services and support to over 65,000 Alaskan natives.  Nuka is built on a simple, yet revolutionary, belief that that the relationship between the provider and the patient (they say customer-owner) is the single most important tool in managing chronic disease, controlling healthcare costs, and improving the overall wellness of a population.  Nuka recognizes that ultimately individuals are in control of their own lifestyle choices and their healthcare decisions.  The focus is on understanding each customer-owner’s unique story, values, and influences, in an effort to engage individuals in their own care, as well as to support long-term behavioral changes.

This focus extends beyond healthcare delivery; it also ensures whole system transformation.  Each and every key work system, including workforce development, compliance, human resources, and finance, has been redesigned to ingrain an organization-wide focus on relationship-building and shared decision-making.  Here is just one example of a healthcare organization that offers value-based solutions for data and information management, integrated care, behavioral health, workforce development, improvement, innovation, and so much more. We could step away from King Rick’s floundering IHS system, we could attend a Nuka Conference, request a speaker, participate in training programs, and consult with Nuka experts; but we do the same thing and we expect a different result.  This is insanity; but is King Rick the one who is insane, is it the council, is it the people who try to keep the problems from being discussed?  If we do not take control of this problem now, we are all insane.

There remains one more issue that needs attention; and while it may seem that issues are being mixed and blended, such is the nature of untangling a web of deceit, scandal, and cover-up.  King Rick and his Crowned-Prince Ryan Ortiz have been in charge of construction projects for our healthcare system.  Predictably, these projects have been mismanaged to the detriment of the Arapaho people.  They advertised and gave lip service to Indian Preference, they boasted about following TERO regulations to get Indians hired and working, and they claimed that they would use these projects to boost the economy and generate income opportunities for Tribal citizens.  Yet, when it came time to take bids on the 12th Street Medical Building Project the bid was awarded to a non-Native contractor from Rawlins, all of the sub-contract work also went to non-native companies.  Information provided shows that the accepted bid was for less than $2 million; the project, now nearing completion, has already cost $3.6 million according to a recent article; and the work completed was of substandard quality which required extra work to be done and extra time to complete the job.

All of this despite the fact that three Native contractors based on the WRIR were present and bid on the project; in fact, one of the Native contractors made a bid that was very close to the actual cost of the project.  Adding insult to injury, King Rick and Prince Ryan allowed the entirety of the Ethete clinic, a project within the exterior boundaries of the WRIR, to be completed under no bid contracts all of which were given to non-Native contractors.

King Rick wants us to believe that he is a benevolent monarch that loves the Arapaho people.  In fact, he is a tyrant who loves the money the Arapaho people generate for his family and his non-Native friends.  It is time to stop the insanity; we must stop the cycle of business as usual and truly change.

Rusty Gates