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Health Clinic: Working Toward Balance


By Sarah Cormell

LCO Health Center Director

We all get out of balance on occasion and look to self-care or a care team to help restore that balance. When seeking that support we look for responsive, knowledgeable, reliable, and caring individuals. Change in itself can knock us off balance and if we are not feeling in balance health wise, then changes only compound the issue—piling on. As a new health director, I realize that decisions I make will directly impact patients and team members. However, as a health director I must utilize my knowledge to be responsible, responsive, and ensure reliable care of our people. Sometimes it takes change to accomplish that end.

Boozhoo, my name is Sarah Cormell and I am the new health director for the Lac Courte Oreilles Health Center. Recent changes and reorganization for health care services, coupled with rates of primary care physician turnover historically at the Lac Courte Oreilles Health Center is not only frustrating but distressing to patients. Although administrators, quality improvement agencies, regulatory agencies, health boards, and leadership groups are the stewards with responsibility to patients and have specific criteria to follow when ending a professional relationship with a provider, it is the patient who is mostly faced with the sense of confusion, concern, and sometimes anger from losing a relationship that was built over the years with their primary healthcare provider. Despite the responsibility, turnover in itself is damaging to a patient and I do apologize for any distress you may be experiencing during this transition.

I wanted to take a moment to personally reach out regarding the reorganization and decision to release two providers, Dr. Cabeen and Dr. Starr from their roles on the Lac Courte Oreilles Health Care team. The decision to exit a member of a care team is never a decision that is approached lightly. The matrix criteria for efficacy, efficiency, and excellence are ongoing measures for care and compliance. Any identified concerns such as licensure or practice that hit the criteria as posing threats to the maintenance of a continuous, quality patient care model must be promptly and assuredly addressed within scope of practice for individuals and the health care agency. Findings of investigative approach to practice are weighed in addition to effects on health care use and outcomes. This must be balanced with impact of discontinuity of care that may result due to patient discomfort with establishing care with a new provider or being lost in the transition. Releasing a provider from a health care team is not a popular decision, even when founded. Decision-makers often cannot share the details of investigative findings leaving patients with questions and assumptions. However, we can and do take necessary steps to assure continuity of care and ensure no one is lost in the transition as well as recruiting providers that will improve care and stay on for more than two years at a time.

This transition was necessary. Although recruitment does take some time, we are working as quickly as we can: Spreading the word through professional networks and provider recruiting sites and actively listing in professional postings. In the meanwhile, Dr. Modesto Ferrer; Tony Manilla, Family Nurse Practitioner; and Jodi Schweitzer-Hopkins, Physician Assistant will be managing ongoing primary care and walk-in care as needed. If Dr. Cabeen or Dr. Starr provided your healthcare, you received a letter talking about transferring your care. How you do this is your choice:

· You can schedule with any one of the providers listed above for your next needed medical appointment.

· If your care plan allows, you can wait until a new provider joins the Health Center and schedule with one of the new providers when they join our staff.

· Or, you can schedule now if you would like to transfer your care and touch base with a provider for consult.

I do want to correct some misinformation. One of the providers recently released did not obtain his Wisconsin license. This somehow was translated into a rumor that Dr. Ferrer does not have a license. This is false. Dr. Ferrer does have his Wisconsin license and has practiced at the Lac Courte Oreilles Health Center for many years.

I do want to share something unique to Lac Courte Oreilles that I ran into during this transition. Apparently because the Lac Courte Oreilles Health Center was sanctioned by the DEA and IHS in 2013 for “numerous deficiencies in clinical care, specifically prescription and dispensing of narcotics and pain management,” we did run into an issue when transferring the medical director role to Dr. Ferrer under the DEA for oversight of the Pharmacy. This was not related to Dr. Ferrer or his practices to be clear. It was related to the Clinic’s stringent restrictions due to the sanctions in 2013. The address transfer from Dr. Ferrer as a private practice provider with his personal address to our interim medical director of the Health Clinic with our address for pharmacy oversight did not match and was flagged. This is unfortunately resulted in a delay in his prescribing abilities and is not a licensure issue. This is directly related to Lac Courte Oreilles Health Center site being a sanctioned site by the DEA. I had not experienced this before at any clinic or hospital system I have worked at so am working diligently with the DEA to remedy as quickly as possible. Tony and Jodi can both refill prescriptions and are doing so to ensure continuity of care.

What I would like to share is that I have been asked to come to Lac Courte Oreilles to improve patient care and to expand health care services for our people. This is an important responsibility. We will recruit physicians who will hold best practice, standards of care to reduce poor health outcomes as the foundation and build on the patient relationship which is fundamental in providing and receiving excellent care. The patient-physician relationship must be based on trust, honesty, respect and a mutual desire to improve health outcomes. This can only be done in the context where both partners participate fully and willingly on interventions.

This is something that I am passionate about and have been my entire life. We as a Native people were promised healthcare through treaties, presidential orders, and legislative processes. I believe and fight for quality healthcare through that promise as a steward of healthcare delivery for my relatives, community, and the larger population.

Throughout my years’ of service I have had the opportunity to work with several Tribes and private hospitals and clinics in operations, fiscal, and administrative strategic planning and implementation. My experience is in leadership roles including executive director both for health and human services, board president in private sector over regional hospital and clinic over five years, collaborative committee member with State and Federal Department of Health Services, Indian Health Service, and a clinician. This has given me the experience and expertise necessary to identify shortfalls based on standards of care, regulations, and licensure requirements; as well as vision and growth. When I first join a team I begin an analysis, through a critical eye I am able to identify areas that require improvement to ensure a high standard of care within the parameters of expectations of patient care from a patient, family member, friend, and loved one-- as well as regulatory and licensure agencies rules and regulations.

When reflecting on why substandard or inadequate practices are allowed to go unchecked it oftentimes leads to decision-making from a fiscal standpoint, or personal bias, or limited supervision leading to limited oversight from administrators. This has led to poor outcomes in health and other issues since the beginning of the delivery of medical services to Native people under the Department of War up to its delivery today. One of my books from school applies as much today as it did in the time it chronicles. It sets my standard for what to ensure is not repeated for our people. If you would like to read it, the book is titled: “If You Knew The Conditions-A Chronicle of the Indian Medical Service and American Indian Health Care 1908-1955” by David Dejong.

We as contracted IHS Clinics have had to fight for every penny of our 60% of obligated funds and still are faced with shortfalls in healthcare delivery. I have come to learn that some administrators have been good at budgeting and kept a close eye on the fund source, unfortunately making decisions about healthcare for our people based solely on the amount of funds available or additional cost of changes. I am thankful that Tribes can now pursue billing revenue and reimbursement. This allows Tribes to work past the contracted dollars and improve healthcare services for their unique communities similar to private hospitals and clinics-which lends to quality standards improving as well. We see examples of these Tribes who now have successful clinics, hospitals, and long-term care facilities that rival private sector health systems for both tribal people and expanded healthcare to larger public communities. Because in today’s healthcare environment, with insurance comes the right to shop and choose the healthcare system that meets your needs. With insurance and sound fiscal practices we can grow and pay for more services. We can be competitive in recruiting excellent team members to serve as your medical home. We are working diligently to build on the current healthcare system to be the best care available to you with the convenience of being located here at LCO.

I grew up in this community and am so honored to be able to serve in a leadership role to improve healthcare outcomes for my relatives through the many wonderful services offered through the Health Center. I approach my task with dedication, hard work, honesty, transparency, respect, sense of responsibility, kindness and care, and an obligation to ensure the best services available to reduce deaths and healthcare disparities among our people. The new Health Clinic and improved healthcare delivery team will be both the catalyst and the result of the reorganization and overall improvements. With a dedicated healthcare system that is state of the art, excellent services to support our community in healing and staying in balance from birth to walking on LCO will be the leaders in healthcare delivery and support.

Chi Miigwech for the honor and opportunity of serving you as the Health Director for the Lac Courte Oreilles Health Care team. I look forward to our collaboration and support of improving health and wellness!! In that collaborative spirit I am available to you to answer any questions or if you want to stop in and say hi—I can be reached at (715)638-5152 or email at or my office is located in the lower level of the Clinic.


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