MONTEZUMA CREEK, San Juan County -- A Navajo District Court judge has banned San Juan County health officials from a clinic the county operates and given day-to-day management back to a woman who was fired in November.
The Montezuma Creek Health Clinic has never been closed during the legal wrangling. But both sides agree that could change, since a sizable contract is in jeopardy because of the dispute.Cancellation of the $530,000 Indian Health Services contract would devastate the already cash-poor San Juan Health Service District, county officials say.
"If they lose that contract, it would gut (the clinic) of financial support. And it would be the Navajo people who suffer because they make up 90 percent of the users," said R. Dennis Ickes, attorney for the county. "They would have to go to New Mexico or Arizona for health care. . . . It would expose everyone to greater hazards, greater injury, greater suffering."
The clinic opened in January 1995 under county management but was established more than 40 years ago and was operated by the Utah Navajo Development Council until about 1992. Then IHS operated it until 1995 when the county took it over. The clinic averages 65 patients a day. It has one physician, one full-time physician's assistant and a part-time physician's assistant with a total staff of 16, including a dental clinic with one full-time dentist. It's located on state trust lands within the Navajo Reservation's boundary and shares space with a pharmacy and Montezuma Creek's only bank, which opened recently.
While up to 90 percent of the patients it serves are Navajo, San Juan Health Service District, part of county government, oversees its operation.
Or, rather, it did until mid-April, when Navajo District Judge Raymond Begaye signed a restraining order barring county-appointed chief executive officer Reid Wood, financial officer Mary Nielsen and patient services director Lauren Shafer from the premises. Begaye appointed a "special master."
Last week, he extended the order until mid-May, allowing more time for an investigation of allegations about the clinic's operation.
The action was brought by three of the clinic's current and former employees, Donna Singer, Fred Riggs and Alison Dickson. They asked for the order pending investigation into allegations of freedom of speech abridgment, racial discrimination and endangering the health and public safety of patients.
They call it a "civil rights" case. Ickes says it's a personnel matter that shouldn't be in the courts. Worse, he said, the clinic is now operating as an "independent, unlicensed clinic that has no authority from the state of Utah to operate" because the clinic operates as a satellite site under San Juan Hospital. "When the district cannot exercise supervisory control over that clinic, it's operating outside the parameters of its license."
County officials are frustrated because "we have responsibility for the clinic, but not authority," said Cleo Bradford of the health services board.
Singer, the clinic's manager, was fired in November, after working for the district for 18 years, because of "time card irregularities." County officials say she was warned several times of an ongoing problem.
Her attorney, Susan Schildmeyer, said she was never formally warned. An audit of more than two years' time cards found only minor mistakes. Also, she should have been a merit employee, not subject to time cards, she added.
Instead, Singer believes she was fired for "speaking out" about operating procedures. She had complained, she said, of financial irregularities. She said unexplained expenses were being charged to the clinic's budget.
Singer, Riggs and Dickson also claim an ongoing pattern of discrimination. As an example they cite the district's adopted policy of not providing care to Navajo patients until they produce a "Certificate of Indian Blood," used by Indian Health Services to prove eligibility for free treatment at the clinics.
Because the clinic -- in fact, the whole health service district -- was in dire financial straits, administrators opted to make sure up front that would-be patients had documentation to let the clinic to collect for its services.
But Schildmeyer said treatment had to be provided whether people brought the piece of paper with them or not. And she said it went against the IHS contract to turn anyone away for care because of the lack of that certificate number, if they otherwise qualified. Federal law doesn't require the certificate at all.