North Shore Health Board still working to finalize a date in January to address community concerns

Nearly two months after Dr. Bruce Dahlman’s contract ended with Wapiti Medical Group, the North Shore Health Board is still working to finalize a date to address growing community concerns.

“We are trying to finalize a date in January,” Kay Olson, North Shore Health board chair, told WTIP following the recent Dec. 21 board meeting.

It is unclear whether it will coincide with the Jan. 18 board meeting or if the board will set a special meeting date.

Dr. Dahlman, who has served the community as a reliable and trusted doctor for over 39 years, had a contractual relationship with Wapiti Medical Group to staff the Emergency Department (ED) at North Shore Health. His contract with Wapiti Medical Group ended on Nov. 1, 2023.

In response to the news, nearly 50 community members attended the Nov. 16 North Shore Health Board meeting in search of answers and to voice their concerns on the matter. The North Shore Health administration and board have maintained that no corrective action was taken or proposed by North Shore Health, and the decision to end Dr. Dahlman’s contract was strictly a contractual matter between Wapiti and Dr. Dahlman. However, statements given recently by Dr. Dahlman and Chief of Medical Staff Dr. Michael Sampson in the Cook County News Herald have shed light on the discrepancies and reasoning behind Dr. Dahlman’s dismissal from Wapiti Medical Group.

When WTIP asked if the North Shore Health Board had seen or requested the termination letter between Wapiti Medical Group and Dr. Dahlman, board chair Olson said, “The end of contract was between Wapiti and Dr. Dahlman, we would not get a copy.”

During the recent Dec. 21 North Shore Health Board meeting, nearly 30 community members attended to again show their support for Dr. Dahlman and seek answers. During the meeting, two individuals, Rovena Claxton, a representative from the newly formed Concerned Citizens for Cook County Healthcare group, and Dr. Milan Schmidt, a retired North Shore Health doctor, formally requested that the board pursue an independent investigation into the matter. 

Kelly Swearingen was the third individual to speak during the public comment period, stating that while she supports a comprehensive culture study, she stands behind North Shore Health Administrator Kimber Wraalstad and finds her time at North Shore Health rewarding. 

The Dec. 21 meeting included a handful of agenda items, including financial reports, the 2024 budget, a high-value network presentation by Nathan White, CEO of Cibolo Health, and numerous management report updates. One of the listed management report items was a Dr. Dahlman update. The management report stated: 

Dr. Dahlman is no longer eligible for Active Medical Staff membership at North Shore Health because such membership requires a physician to attend, admit, or be actively involved in the care of at least twelve (12) patients per year. Since Dr. Dahlman does not currently maintain a private medical practice and cannot provide coverage in the Emergency Department, he will not be able to satisfy this requirement. However, he is eligible for appointment to the courtesy staff if he likes. An entirely new application would not be required, only updates to the existing application. The medical malpractice insurance coverage currently on file for Dr. Dahlman is no longer in force, so he will need to provide evidence of appropriate medical malpractice coverage. We would also like to know his new office address and confirm he has coverage arrangements in place for his patients when is unavailable. We communicated this opportunity to his attorney last week but have not yet received a response. 

Dr. Dahlman has been working with Jason Yuhas, quality improvement coordinator, on a quality project needed for his recertification with the American Board of Family Medicine. This project requires him to have access to North Shore Health quality data. We have agreed to support this effort so Dr. Dahlman can maintain his board certification status. Mr. Yuhas will serve as the point of contact and provide the necessary data.

WTIP contacted the North Shore Health Board members for comment following the Dec. 21 meeting. Board members Mary Sanders, Kay Olson, and Randy Wiitala responded. Board members Patty Winchell-Dahl and Steve Frykman have yet to respond to WTIP. 

When asked if the board was planning to take legal action regarding defamatory statements made against the hospital following the Dec. 5 special meeting, Olson said, “The Board received legal advice about the Board’s legal options and strategies relating to such statements and any future defamatory statements against the hospital. This will be a continuing conversation.”

Olson confirmed to WTIP that per the management agreement between St. Luke’s and North Shore Health, the board has complete independence to make decisions regarding the administrator’s employment. Annual reviews of the administrator are conducted during a closed session per Minn. Stat. sec 13D.05 subdivision 3 (a). The most recent annual review took place on Apr. 20, 2023, and involved the North Shore Health Board and North Shore Health management team. 

Transcripts and audio of the Dec. 21 public comment period are below. 

During the public comment period, Rovena Claxton, a representative from the newly formed Concerned Citizens for Cook County Healthcare group, read aloud:

Good Morning my name is Rovena Claxton.

Thank you for allowing me to make this presentation on behalf of Concerned Citizens for Cook County Healthcare.

Our group is made up primarily of Cook County residents as well as others who have connections to Cook County through family and/or tourism. We are committed to ensuring that an impartial and independent investigation takes place as soon as possible into all aspects surrounding the non-renewal of Dr. Bruce Dahlman’s contract and that those findings be presented to the citizens of Cook County. We wish to work collaboratively with the board of directors to ensure that an appropriate entity is found to perform this investigation and define its scope.

While this event was the catalyst for our formation, Dr. Dahlman’s contract is not our only concern. As a second priority, our members have expressed their serious alarm regarding the testimonies of a surprising number of past and present NSH employees who have publicly cited a troubling workplace culture at NSH revolving around their experiences with NSH administration. We are asking the board to collaborate with the citizens they represent, including our group, to identify a third party to assist them to complete and act upon the employee engagement survey that was begun prior to the pandemic and, again, to make public these findings and their intentions regarding how they will act upon those findings. We believe these actions, with the involvement of a liaison or independent HR specialist, is a necessary first step toward re-establishing public confidence in the administration of North Shore Health. We specifically ask that this independent investigation into the hospital’s culture and work environment be conducted immediately and completely separate from the Board’s strategic planning endeavors.

Third, we ask that you refer to the documents we are providing today regarding other goals to which our organization is committed. They describe our further requests for an active process to improve this board’s communication with the citizens of Cook County. These include livestreaming and recording all board meetings for public consumption, providing a larger meeting room with more public seating, providing an adequate sound system so visitors can hear what’s being said, and making board agendas, minutes and proceedings more accessible. Many of these items are requirements under Minnesota Open Meeting Law statutes. We want to make clear our resolve to pursue these matters and ensure the public has viable conduits for communicating their many concerns and for getting responses they can have confidence in.

And now, we wish to address the board members directly. We want to remind you that you are elected officials and you are required to represent the district’s constituents and respond to their concerns. You are responsible for any decisions that you delegate to administrators, vendors, or staffing agencies, such as Wapiti. These responsibilities to the citizens who elected you are a matter of law. Your positions are not about loyalty to any one person or to the “institution” itself only.

Our members feel that the NSH Board members and the current administration have yet to fully acknowledge, address and take responsibility for the core reasons behind the non-renewal of Dr. Dahlman’s contract, the loss of so many NSH staff members, and the decline in public trust in the board of directors and the administration of this institution. We have researched and discussed the process of recalling board members (in the event that these responsibilities are not met), but we sincerely hope it will not come to that. It is not the primary focus of our group. Our efforts are about principle, not personalities. And we seek progress rather than perfection.

In closing: We deeply value the existence of North Shore Health and the services it provides to our community. We recognize the awards that our hospital has justifiably been given due to the outstanding care that patients have experienced at the hands of our doctors, nurses, EMT’s, lab techs and other patient care staff. We want our hospital to not only survive, but to thrive. However, we do believe our hospital is in jeopardy, due to the above-described loss of essential workers and an apparent declining public trust.

We look forward to future timely communications and collaborations with the NSH Board. Our requests are all relatively simple. We have described them more fully in the letter and outline we are submitting as part of our presentation today. In addition to providing you these materials, we have made them available to the media and will make them available publicly to anyone interested in knowing our positions more fully. Thank you for your time today.”

The second individual, Dr. Milan Schmidt, a retired North Shore Health doctor, read:

Members of the Board to Directors, Administration, and members of the public:

North Shore Health is at a crossroads. Dr. Dalman’s detailed piece in the News Herald seems a fair summary of his dismissal as I understand it. Though it is long, it deserves a careful reading if you have not yet done so.

The minimally veiled threat of litigation against community members for defamation inherent in publishing the sole agenda item of the last closed board session, as well as the divergent statements from NSH and Wapiti, make me believe the Board is not taking community or employee concerns as seriously as they deserve. I doubt this is intentional on the part of the board but rather the result of relying overly on information provided solely by the CEO. Recent events suggest that failure to follow policy and procedures approved by the medical staff is becoming a pattern, but I am not prepared to examine the evidence for or against that at present. That is a job for the Board. It does bring the issue of a just culture into sharp relief.

I fully acknowledge that there have been many successes under the current CEO, and I will not enumerate them. Suffice it to say this is a challenging time in medicine. Many crises have been met and addressed successfully. The largest challenge of culture change – set as a board priority several strategic planning sessions ago – has not been advanced and appears to have regressed rather dramatically. This is evidenced by many of the stories we have already heard. I do not believe staffing problems are solely an issue of our remote location or changes in medicine in general.

Though it may seem “soft” relative to financial and organizational concerns, a culture of trust and mutual respect will allow the organization and its people to thrive even during these times of challenging change. There is no guarantee that this or any hospital as isolated as ours will survive the changes to come, but our best hope of ensuring that our health needs will be met is by truly working together.

In my opinion, the hospital board MUST move forward to have any hope of NSH surviving as an intact institution. As a start, agreed upon policies and procedures which are necessary for the effective and fair governance of any institution must be followed in spirit as well as in letter.

Current immediate priorities which I encourage the board to act on are:

1. The time has come to replace Kimber Wraalstad, preferably by resignation. Otherwise, termination via processes outlined by the St. Luke’s contract is appropriate.

2. The board should issue a public apology for threatening members of the community with litigation and acknowledge its incomplete understanding of the facts.

3. Commit to the process of seeking justice, or at least a fair hearing, for those who feel harmed by administrative action and or policy.

4. Truly commit to building a culture of trust and mutual respect. Though an argument could be made for just moving forward following a change in leadership, I believe that a full hearing of those with grievances will help the board understand the scope of the issues and rebuild public trust. The board and administration must renounce what I see as a condescending and punitive approach to employees and the public. The problem with intimidation is that it works – short term! It may move others to act in a way you desire but when the fear settles the next emotion is anger. Long term, intimidation has no place in an institution truly committed to benefitting the common good. Certainly, it does not foster Compassionate Care for All.

After these things have been accomplished, the hard work of designing – and the commitment to following – just procedures must begin. I strongly encourage the board to own the challenge and move forward with courage and resolution.

Thank You,

Milan Schmidt MD (retired)

Then, Kelly Swearingen, the business office manager who has worked at North Shore Health for over two decades, spoke. “I would agree with one thing Dr. Schmidt said, and that is that we should do another culture study,” she said. 

However, Swearingen disagreed with many of the comments presented during the public comment period and circled on social media. “What I do want to say is that working here has been rewarding for me. I have formed relationships. I have been able to advance my career here, under the direction of the former administrator and the current administrator.”

Kalli Hawkins December 30, 2023