Toxic environment at the Tinian Health Center

Tinian Health Center has an in-house policy that employees do not speak to the press that I have, until now, respected. However, I wish to say my farewells. There are people on Tinian I love dearly, people I returned to share life and laughter with, people who I will miss. As with all people we hold dear in our lives, we did not always agree, we often fought, but in the end we learned to respect each other’s individuality and forgive each other our idiosyncrasies. In my time here I have had disagreements with people, patients, and politicians, but I think even my biggest detractors would have to admit that even in disagreement what I have done and said always arose from my passion to deliver the best health care possible with the resources available to the people of this island, both as individuals and as a community. In the next few days it would not surprise me to see all kinds of controversy in this paper, from quiet sanity to foolish proud chest-thumping to just out and out self-serving falsehoods. This is my statement, my story, my truth—judge it and I as you will.

These are terrible and hard times for health care in the CNMI. Hardworking and brave individuals are putting in tireless hours behind the scenes to try and resolve issues and it has led to great conflict. On Nov. 17, 2003, Arly Long is quoted from an email memo she provided to the press in the Marianas Variety. The article states, in her words “…it was actually Dr. Steven Lebamoff that left the clinic when there were no other contracted providers to provide coverage.” I guess the key word is contracted. I cannot say, because even though I have been granted the title of Medical Director and, as a midlevel provider a nurse practitioner is in theory subordinate to me, I am unaware of the details of Ms. Long’s contract, and neither she nor anyone else has seen it necessary to include me in on any final discussions. I do know a few things, as of this date, Ms. Long has never suffered a disruption or discontinuation of her benefits, salary, accrued leave, or any other term of her employment. She has, and would have to admit, that she has been treated fairly in this transitional time and never had to suffer financially in any way. Actual contract status, I can’t say, I don’t have the details, employment status has never, however, been disrupted. Another thing I know is that Ms. Long has worked long and hard to achieve her degree, and to also promote the ability of her peers as nurse practitioners to legally practice medicine without the supervision of a doctor, unlike physician assistants in the CNMI. So going back to Ms. Long’s statement, while I want to make it clear that I do not accuse her of being deliberately misleading, I do feel that her statement is vague and seems to lay blame unfairly on me. So let me say, that after working from Oct. 31 until midnight on Nov. 10, manning the five-day per week clinic as well as providing 24-hour per day emergency medical coverage, I handed over the responsibility of the clinic to a legally licensed health care professional with the government granted authority of independent practice who agreed to accept the responsibility until my anticipated return on Monday, Nov. 14, when I would start another 11-day run (which, by the way, turned into a 22-day run until Monday, Dec. 2). Whether meant to wound or not, I find the implication in Ms. Long’s statement hurtful and damaging and to this point in time, it is a statement that remains explained to me by Ms. Long but not apologized for or retracted.

What happened after and before my return from Guam is an area of controversy that would bewilder even the wisdom of Solomon. It is enough to say that Ms. Long and I are deeply divided both morally and ethically on what transpired. In a discussion that became heated and yet never developed into name-calling or threats, we became aware that we both see the same issue, but just from completely different points of view. I cannot say she is wrong, I will not say she is right. Dr. Dearie came from Saipan to mediate between us all, but a factor soon to be brought up limited my input. When he left, everyone felt that three providers had agreed to continue to work at THC.

It is not easy. As Medical Director I have received written complaints from two of the previous providers and verbal complaints as recently as last night from two of the other providers about difficulties in working with Ms. Long. This also was part of a heated discussion on Dec. 5. Five providers since 2007 have difficulties with her, two have offered, inappropriately I concede, through me as Medical Director to return and work here as long as they do not have to work with her. In our discussion Ms. Long at first denied such a thing, and in the end said the problem lies with us. She fervently believes she is in the right, she has worked with 18 providers in 16 years, she informs me, and any problems with others, like these five providers in four years, or former directors, are because they are in the wrong. This validates to her, as she explained to me, her frequent use of contacting and asking for support from politicians. Indeed, she and her husband are so convinced that they are right, that on Nov. 15, Philip Long blogs, again in the Marianas Variety, “Don’t worry about all the local agencies, we have already contacted the federal EEOC and will file complaints against THC, Freddy, and Dr. Lebamoff. If you would like to discuss this further, why don’t you visit my office, I am sure you know where my office is. At least I am not afraid to post what I think with my real name to own what I say. I guess you don’t have the guts nor the dignity to stand by your ignorant words.” Pretty strong words for a man who later in the same blog says, “Let go of the hate and the jealousy.” I have discussed this issue at length with Ms. Long. She does feel and has stated to me and others that many of her problems stem from jealousy of her education and the success of her husband.

But here, I must say, is where I break. Multiple times I have asked Ms. Long, even in front of Dr. Dearie, to confirm or deny this suit. She has brought it to up to me many times in the last six months. I have made administration aware of it. I have as recently as Monday tried to get a straight answer from Ms. Long, who coyly smiles and has answered, “Oh, I didn’t know Philip put that in print,” or “I don’t want to say no,” and countered with “but I didn’t say yes.” I have discussed with her that such intention will force me to release my position, and without other employment opportunities on Tinian, literally chase me from the Commonwealth. That does not seem to faze or deter her. For better or worse, depending on opinion, Mr. Hofschneider works endless hours just trying to keep things going and has yet to receive pay, unlike those sitting at home on full leave without a contract. To sue him I believe is frivolous and spiteful. I have even pointed out to her that Tinian Health Center now belongs to the larger Commonwealth Healthcare Corp., that such a move will embroil the entire public health care system in a controversy that it cannot afford at this time. She coolly and correctly asserts her right to bypass the locals and go to the feds to prove a point she assures me is “not about money.” It is here where I break. I cannot operate and enforce any form of discipline on someone constantly holding the threat of suit over the heads of myself, my director and the very people I work for, the people who sign both of our checks. It was on this rock that the relationship between Ms. Long and I shattered. She does not see why a suit should disrupt our friendship, and the only excuse I can give is that I am human. I do not ask her to give up her right, and I know she feels deeply about this. But others do also and again, as Medical Director, I am receiving offers of sworn affidavits from the mainland, Guam, even as far as the Middle East that want to add their testimony to the defense of the Tinian Health Care Center and myself. Even when you are right, a course of action may be wrong for those that surround you. It has reached such a point of tension, that on Nov. 30, I formally handed in my letter of intent to resign rather than continue to deal with the pressure this suit applies to me, my friend Mr. Hofschneider, and the new organization just trying to survive its own birth.

Ms. Long entered my office on Monday wanting answers. I forewarned her she would not like them. Over and over until it got loud, I implored her to at least do all of us the dignity of a yes or no answer to her husband’s claim of the impending suit so that we could be prepared. She asserted her rights, she explained the love that drove her husband, she explained how she felt I had bought local affection by hanging out with “them” while she preferred the isolation of her family, she was all over the map, but never yes and never no. Until in frustration, I raised my voice and shouted, “Take it, have it, you win, it’s all yours, so whatever you want, come and go as you please, make your own rules, but I do not want to work with you. I am out of here.” She has her rights, I have mine. She left the office through the door that was never locked when she entered, she was never sworn at, name-called or threatened. Over the next few hours, I walked outside and around the building rather than down the hall past her office attempting to avoid any conflict until the tension got so thick I went home sick. And while Saipan called to offer condolences and sincere well wishes for the future, I received texts that because she did not feel it was a fair discussion, Ms. Long had called the police on me to file charges of harassment. According to the director at 5pm she insisted on him her intent to file civil suit as well as the impending suit with the EEOC. Apparently, not wanting to work with her or be sued by her is in Ms. Long’s opinion harassment and she will not even let me walk away without getting her licks in. I apologize to the people of Tinian who I have disappointed by deserting them. I did not see my return as a short-term commitment I just cannot work in such a toxic environment.