Letters: “Fake news’ about Tuba City hospital

This letter is in response to the “fake news” reported by Krista Allen in the July 13, 2017 Navajo Times article entitled, “TC hospital flubs care for elderly Dine.” I want to correct errors from the article and provide facts about Tuba City Regional Healthcare Corporation and the rigorous requirements we fulfill to provide safe, accessible, quality, and culturally sensitive health care.

I work at TCRHCC as a pediatrician. I am also the chief of the medical staff. The CEO did not hire me. I am elected by my peers to represent the medical staff to the hospital board of directors. This letter is not from the hospital administration but from the medical staff who feel they were unfairly slandered in this recent Navajo Times article.

First, I would like to address the qualifications of our medical staff. The claim that our physicians are practicing on expired licenses is absolutely false. Every physician and mid-level provider on the medical staff has an active medical license. Every. Single. One.

It is well known that an active license from “any” state in the U.S. is required to work at federal/tribal/military sites. Whether the license was issued in Arizona or Pennsylvania, for example, does not make a difference.

I challenge the Navajo Times to provide proof that a physician is working here with an expired license; when they cannot do so, I ask that the Navajo Times print a public apology and retraction of this falsehood.

Additionally, licenses are only one of many requirements to work on the medical staff at TCRHCC. Every provider is thoroughly vetted over several months through the credentialing process.

Also, unlike many sites in the United States, every single doctor at TCRHCC has completed residency training and is board certified or board eligible Ñ yes, 100 percent of us are board certified or board eligible. This is a higher standard of training and education that we require for our physicians. Our requirement for board certification is a higher standard than the U.S. as a whole where only 85 percent of physicians are board eligible/certified.

Next, I would like to address the article’s claim that physicians are leaving and that many of our physicians are “medical tourists in itinerant positions.” Our medical staff vacancy rate is 12 percent and has been steady at this rate for the last three years. This matches national norms and is far less than the 30 percent vacancy rate in IHS and Navajo Area.

We are doing an excellent job of recruiting and keeping quality physicians in Tuba City. Primary care across the United States is at a critical shortage, which makes it even harder to recruit physicians to Tuba City and other rural areas. However, we have been able to recruit highly trained providers and even increase the number of doctors caring for the Tuba community over the past several years.

The TCRHCC medical staff comes from all corners of this country for a multitude of reasons. Some docs come for family reasons or to return to their native communities, some to serve their nation in the Public Health Service, some out of altruism and personal beliefs that motivate them to serve an impoverished community, some to help ensure that treaties are upheld, and some for the challenge of practicing in a rural site. But for all of the reasons we find ourselves in this remote little town, we are committed to caring for our patients 100 percent. The job of a physician in Tuba City is not an easy one – anyone in the ER at midnight on a Saturday night can attest to this fact.

To further speak to our medical staff’s roots in this town and in our hospital, many members of the medical staff hold academic appointments at various medical schools and universities around the country and teach residents and students. We are held to a higher standard in our roles as instructors and mentors, higher than even most community doctors who do not have these appointments. Teaching the next generation has also allowed us to recruit many providers to TCRHCC and also to other IHS sites on Navajo and beyond.
Additionally, we have an active volunteer presence in our community. You may have seen us coaching youth on the soccer or T-ball fields, speaking at community forums, doing healthy cooking demos, presenting at garden expos, or participating in community clean ups.

In summary, we are far from “medical tourists.” We care for patients, work to improve public health, teach residents and students, and work to make excellent health care at TCHRCC a reality today and for years to come.
We are proud of the safety and quality of care at our hospital. Many nationally recognized regulatory bodies regularly come to our hospital to evaluate our care, review our charts, and ensure that our staff, our doctors, and our patient outcomes are of appropriately high quality. We are the only hospital on all of Navajo Nation to hold a three-star rating from Centers for Medicaid and Medicare Services; all others have only two stars. We are accredited by the Joint Commission, CMS, and The Arizona Perinatal Trust (for obstetrics and newborn care). We are also certified as a Baby Friendly Hospital and a Level III Trauma Center.

There are unfortunate medical outcomes at all hospitals, outcomes that we do our best to prevent and take very seriously and fully investigate when they occur. Illnesses can get worse, unexpected things may happen, mistakes are sometimes made; we try to learn from each of these unforeseen events to make the problem less likely to happen again.

The article claims there is “no process” to review problems. This is completely false. There is a well-defined process for reviewing any adverse outcome and every patient complaint.

A full investigation of Ms. Begay’s complaint was completed, and I personally sent her a letter a month ago to let her know. I am grateful that Ms. Begay’s father has recovered and is back to enjoying time with the community. I wish him well and hope his family, in time, understands his diagnosis and the chain of events that led to his illness. Blame the disease, blame the system, but in this case, do not blame the physician.

Yes, there are challenges to working here. Our nursing shortage affects the ability to keep patients in Tuba City, our outdated facility and lack of fast Internet makes advanced computer systems less efficient, and the lack of child care affects our employees.

But for so many of us on the medical staff, we find it worth the sacrifice to be able to live and work and serve in the wonderful community of Tuba City. There are real threats to health care for Native Americans in the potential repeal of Obamacare. I wish that Ms. Allen could have focused her attention on this serious problem and not a made up one.

Finally, I am dismayed by the blatant untruths and inaccuracies that were reported by Ms. Allen in her July 13, 2017, article. There appeared to be a lack of even simple fact checking done prior to publication.
In addition to providing false information to the readers, this also calls Ms. Allen’s journalism ethics and competence into question. Until the name and credentials of “one physician” quoted in the article are reported, I will assume these comments were made up by Ms. Allen or Ms. Begay.

Sara Jager, MD
Pediatrics
Chief of Staff
Tuba City Regional Health Care Corporation
Tuba City, Ariz.

Editor’s note: Krista Allen, our Western Bureau reporter, checked physician’s licenses on the Arizona Medical Board web site and searched Doximity, which shows doctor’s profiles, and checked other states’ web sites to find out some physicians’ licenses are expired. Most of Jager’s letter complains about the views expressed by our anonymous source and this does not reflect upon Allen’s competency. We invited Jager and her staff to meet with Allen to provide whatever information they wish.

We are serious about maintaining quality of medical staff

As the co-chairs of the Credentialing Committee for the physicians and advanced practice nurses of Tuba City Regional Health Care Corporation, it was with great alarm that we read the article “TC flubs care of elderly Diné.”

While every daughter with an elderly father should be vigilant about the care that her parent receives, it is inaccurate to say that the physicians of TCRHCC are not licensed or practice with expired licenses. As a federally funded facility, physicians may hold a valid license from any state, but all the physicians working at TCRHCC have a valid, unexpired license.

A license is one requirement, and it is issued by a state. Board certification is an additional standard, and this requirement addresses mastery of a physician’s specialty. All physicians must either be certified by their specialty or be actively seeking certification to work at TCRHCC.

For physicians that have recently completed their training, the written and in-person oral examinations required can actually take several years to complete, as they are arduous and suitably challenging to ensure that the physicians have mastered the complexities of their chosen specialty.

It is with pride that we assert that those of us involved in the credentialing process are serious about maintaining the high quality of our medical staff. We ensure that physicians have both appropriate medical licenses and board certification. We want no less for this community.

Sophina Calderon, MD
Co-Chair of Credentials Committee
Board Certified in Family Medicine
Tuba City, Ariz.

Katherine Glaser, MD, MPH, FACOG
Co-Chair of Credentials Committee and Deputy Chief of Staff
Board Certified in Obstetrics and Gynecology
Tuba City, Ariz.

Veterans need demographic study

I recently attended a one-day Veteran’s Summit on the Diné College campus in Tsaile, Ariz. It was good to see long-standing friends and relatives who have all aged just like me.

I am a concerned Vietnam combat veteran and have attended many local, state, and national veteran’s meetings over three decades. It appears the complex veteran’s issues and concerns are still in limbo, or even at a crossroads, if you will. In the interim, veterans are frustrated and aggravated as expressed at the veteran’s summit. I wanted to suggest and share a recommendation, but due to limited speakers and time constraints, I didn’t speak.

It would be in the best interests of all Diné peacetime (stateside) and Diné veterans, who participated in direct combat or indirect combat support in all major wars in all war eras abroad, to conduct a Diné Nation comprehensive demographic study. This important study is long overdue!

This study will look at quantitative and qualitative statistical date of noted veterans currently residing in the six Navajo regions. I know I have seen available data but not in the context of a comprehensive study. A complete and thorough needs assessment should manifest the true status of socio-economic conditions of Navajo Nation veterans. Thus, new policy directions should be developed from the study.

For instance, the in-depth study will look at age brackets, military branch served, major war served in, education/training status, employment status – includes government/private sector, current unemployment status, level of income, sources of income, disability ratings, status of VA benefit entitlements, type of VA benefits, marital status, dependent children educational benefits, health care status, domiciliary care, housing entitlements status, housing condition updates, specially adapted housing, etc. There are other numerous critical issues that could be included in this proposed study.

With all due respect, the Navajo Nation government has not made a real effort to look at a more realistic picture of the state of Diné veteran’s populace and issues on a larger scale. This rather harsh critique comes in the form of a constructive analysis relative to capstone and/or overview of veteran’s issues.

The tribal divisions have pertinent paid tribal employees who should be charged with administrative, legislative, and judicial responsibilities to assist in this endeavor. Veterans should not be given the typical bureaucratic run-around of come back tomorrow or he/she is on leave/training, late lunch, or in a do-not-disturb meeting, etc.

For instance, on the Navajo Reservation, there is no 1) collective veteran’s accountability standard or track-record; 2) no fair and equitable Cost-of-Living Adjustments for those receiving disability, compensation, and pension benefits; 3) no realistic veteran’s health care cost containment strategies – includes co-pays and affordable insurance updates; 4) no sound regional socio-economic recourse, projections, and updates; 5) no realistic and creative relevant Diné-based on-the-job training opportunities; 6) no culturally-tailored rehabilitation centers; 7) no unified and collective “one-voice” effective and systemic veterans organization to voice, monitor, and solidify critical issues; 8) no viable partnerships with neighboring colleges and universities to enroll Diné veterans who want to take advantage of educational and training opportunities like the Veteran’s Upward Bound Program; 9) no legal recourse and advocacy assistance for incarcerated Diné veterans; and 10) no effective strategic plan and mechanisms to hold veteran’s forums, stand downs, symposium, colloquia – an academic specialists meeting to address on topics of veteran’s issues, annual conferences, summits, and town house meetings, etc., to name but a few viable options, alternatives, and opportunities.

Essentially, what this means is that so long as there is no strategic framework in place to address or redress complicated veteran’s issues, the sessions will continue to be “gripe sessions” without a sound strategic plan. Diné veterans deserve better!
This also means it’s now incumbent on Navajo government branch chiefs and tribal officials, including the executive administration, council delegates, chapter officials, attorney general, legislative counsel, associate justices, and staff attorneys to have an open mind and if they all mean well.

The eventual spin-off would be to update policy directions where warranted. Thus, new, or refined policy guidelines should be developed and eventually put in place to significantly improve and substantiate service delivery to the local veteran constituents and their families.

The Diné Nation government should not appropriate funding in a piecemeal, fragmented, or disorganized fashion. This has been the case over the years, and sad to say, it continues to linger on today. It is rather overwhelming to learn of unspent HUD/NAHASDA tribal monies.

Something significant certainly needs to happen. Otherwise, critical veteran’s issues will continue in a perpetual rut system and continue to remain at crossroads with no bearings and nowhere to go.

Quite frankly, the system for addressing veteran’s issues today is unruly, unmanageable, and more intractable in many ways. The tribal veteran’s affairs offices must do a better job than just duplicate or rubber stamp the federal veteran’s administration offices on the state and national levels. The Navajo Nation must develop its own capability to ensure its Diné warriors are effectively represented in Congress.

In addition, I wish to point out a well-versed veteran’s board of director’s must be put into place. Members of the board must be experienced, aggressive with poise and stature, have practicable understanding, and knowledgeable in veteran’s plight and issues at the local (tribal), intertribal, state, and national levels. This networking is necessary to put Navajo on parity with other national recognized veteran’s organizations. Navajo Nation veterans are not quite on the map, just yet.

Furthermore, the networking principle will require gall, audacity, strong leadership skills, and vision to establish a government-to-government and organization-to-organization working relationships with unwavering support and assistance from the tribal leadership and thereby set precedence in working with state and national government officials.

Veteran’s preference needs to be activated. It is now sitting idle and lonely. From a historical standpoint, this working relationship and networking principle just hasn’t been attempted.

Finally, as a tribal leader, it requires perseverance, persistence, to listen closely to your constituents, the ability to withstand public pressure, and refining and building upon your leadership skills, the ability to accept constructive criticism from folks who put you in office, especially if they are Diné warriors.

Accepting constructive criticism makes you a strong person and more so a distinguished tribal leader. Either that or your leadership flaws will become transparent and become exponentially worse and you will lose your public trust. Case in point: The gold ring craze and stealing tribal money mania must stop.

With an open mind, you will become and be respected as a true tribal leader. You will earn the trust of Diné warriors. From this point on, it will be about trust-building to make significant headway.
As for Diné combat veterans, they all earned the right to express their conscience based on their life experiences, concerns, rights of personal liberty premised on Diné dignity, integrity, aboriginal rights, civil rights, and human rights. I wish you wellness.

Anthony Lee Sr.
Lukachukai, Ariz.

Tax suggestions are refutable

Letters from Elroy Drake and Al Henderson to the Navajo Times concerning taxation might sound like a sure thing in theory. Their suggestions however are refutable.

First, there is no existing tax model on which to make these unfounded suggestions of taxing income, especially on the Navajo Nation.

Secondly, there is little to no income. For the last 40-plus years reported unemployment on the Dine’ Nation has never been less than 50 percent.

Thirdly, our so-called sovereign status. We have no such thing. That thought can be put to rest, as our leaders demonstrated recently when they buckled under to SRP and the renewed lease agreement. The Navajo Nation will never be sovereign until it consistently acts as such.

Fourth, if the suggested taxing of personal income is based on the existing U.S. Tax Codes, we are really asking for trouble.

No one in existence understands the U.S. Tax Code. It is very complex because it is intended to be complex. It is unfair because it is designed to be unfair.

The people of the United States are fed up with the income tax and the whole tax system. And the politicians are always promising tax reform, but nothing changes and nothing will ever happen. The powers that be will never allow anything to change.

I have no desire to be a wet blanket Indian but in truth a great war was fought in this country because of forced taxation. The American patriots dressed up like Indians to make their statement to the British Crown: “We want to be like these American Indians and not pay taxes.” They then tossed the British tea into the Boston Harbor and the American Revolution began.

In the real world, the U.S. Tax Code is based on the concept of “you work and I eat.” It is a sick swindle instituted by the super rich and the very wealthy. Just do some research and follow the money.

We already work five months out of a year just to pay our taxes Ñ income, property, sales, Social Security, self-employment, and it goes on. I suggest to anyone who thinks taxation of income is a problem – solving solution, look at its evils and its destructive forces first.

There is also a worldwide economic war and the United States dollar is no longer considered a valued currency. The phony dollar you have in your wallet is worth less than four pennies, and is only a symbol of our monetized debt.

The plan now is to digitize the dollar so it will have even less value. That is the reason the tribal government needs to give our Diné the $410 million settlement money while the dollar still has some purchasing power.

If there is to be an income tax, it must be totally fair. And the only way to do that is to get rid of the tribal government bureaucrats. In other words, send the government employees home. Give them the opportunity to find employment so they can experience the “you work and I eat” corruption.

Maybe the rest of the country can learn from our Diné that only a few people should ever be paid with taxpayer money to do service work.

Wally Brown
Page, Ariz.

Money for Shiprock hotel is not wise

A few weeks ago we read in the newspapers that Navajo Nation Gaming was reactivating and pursuing the building of a hotel in Shiprock. While funding had been earmarked to the tune of $8.3 million, some of us do not believe this is a wise investment nor a positive economic venture.

A few years ago, while some houses were being renovated in south Shiprock, vandals got onto the property and destroyed the homes while they were still in the building stages. This vandalism resulted even while the property was secured with chain link fencing.

Sadly, this has occurred more than once and also in other places. Our fear is that this could also happen to the proposed hotel. This is more likely to happen because the proposed site is more remote and probably less secure.

Additionally, data that was collected to support this venture said the occupancy rate would be low at the beginning of the week and grow towards the weekend. However, the average occupancy never rose above 75 percent. The median hovered around less than 50 percent. Not a wise investment.

Let’s say the hotel was built and we had some foreign visitors to this proposed hotel. Where would they go for dinner? All we can offer is KFC, Burger King, Sonic, or the flea market. Contrarily, in 15 short minutes they could be in Farmington, where they could choose between Outback Steak House, Olive Garden, Texas Roadhouse, Los Hermanitos, and so on.

If the Navajo Nation is so intent on spending $8.3 million in Shiprock, we would suggest a better investment to be in a nursing home. This is a project that is so badly needed, as a lot of our elderly are in nursing homes in the border towns of Farmington, Aztec, and Bloomfield.

The occupancy rate on this venture would be 100 percent from day one, and build a long waiting list. This will also bring economic development in building the homes, staffing, maintenance and so forth. To staff this facility adequately, we could work with San Juan College and put potential staff through their nursing and other pertinent programs. Of course, we would hire professional staff, not current Navajo Nation employees, to manage this facility.

If the Navajo Nation is still wanting to go into the hotel business, perhaps they should pursue reviving and managing some recently abandoned hotels in Farmington and Gallup. These buildings have not been idle very long so refurbishing them would not be too costly.

With recent budget cuts and other dilemmas, we should think seriously about our return on investments.

Anthony Allison
Navajo Voters Coalition, Inc.
Fruitland, N.M.

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