Kotlik death on plane highlights the difficulty of rural health care

The grieving family of a woman from Kotlik who died suddenly in September on a short plane ride headed for health care in Bethel say not enough was done and they want answers. The struggle of Eunice Andrews’ last days illustrates the challenge of providing health care in the sprawling Yukon-Kuskokwim Delta. Related: Finances looking up at YKHC but rural needs remain big -- and expensive Double dose of heartache in Kotlik She was just 53, a cook at Kotlik School who went boating and looking for berries on the tundra over Labor Day weekend. That Saturday, she twisted her ankle, then complained of not feeling well, said her longtime boyfriend, George Waska. “She had -- what you call it -- sore throat and fever and aches and pains,” Waska said. Her ankle hurt too much for him to massage it. Kotlik is home to fewer than 600 people, a remote village near where the Yukon River empties in the Bering Sea. Yukon-Kuskokwim Health Corp.’s Kotlik clinic was closed for the weekend, like normal, and that Monday, because of the Labor Day holiday. YKHC has a system in place for after-hours emergencies. Andrews texted the on-call health aide in the hopes of being seen over the weekend, Waska said. He didn’t have her phone and didn’t know what precisely she texted, but one of her sons, Stephen Andrews, said she was asking for crutches and to be seen for a sore throat. She was told the situation wasn’t an emergency but kept texting for help, Waska said. She was feeling sick all weekend. They ate Top Ramen, dry fish and crackers. She drank some tea. That Tuesday, Sept. 2, Waska said Andrews’ daughter brought over crutches from the clinic and helped her get there. Waska said he overslept and missed them leaving. He went to the clinic on his four-wheeler to pick her up. By then Andrews couldn’t even walk, so he carried her on his back, he said. “I pack her down like ... a little child,” he said. Andrews made an appointment to be seen that same Tuesday in Bethel. She took a Grant Aviation flight and wasn’t medevacked. When the plane stopped 45 minutes later in Emmonak on the way to Bethel, Andrews was “unresponsive,” according to an Alaska State Troopers report. Health workers from the YKHC Emmonak clinic determined she had died and notified troopers. The state medical examiner decided against an autopsy and released her body to her family. Now her family questions why she wasn’t seen over the weekend, why she wasn’t medevacked, and why there was no autopsy. “She just dropped dead, and we don’t know what the cause of death is,” Stephen Andrews, who lives in Kotlik, said. “She didn’t even reach Emo,” short for Emmonak. “She died right there.” Another son, Tony Andrews, is a retired combat veteran who lives in Anchorage. He talked with his mother by phone soon before she died. “She said she was getting on a plane and wasn’t feeling well,” Tony Andrews said. Waska said he gave her a hug before she left and asked her to call and say how she was doing. Her grown kids and boyfriend couldn’t believe she was gone so fast. “I was taking good care of her. She was the love of my life to be with her,” Waska said. “She was a little caring mother,” Stephen said. “She didn’t hurt anyone. She was always herself, having fun. She was a good influence all the time.” Tony Andrews said he pushed for an autopsy but the medical examiner told him that she probably died of a heart attack, an air pocket in her bloodstream -- or maybe it was just her age. “They said she was old. She was a healthy woman,” Stephen said. YKHC officials said they can’t discuss a specific patient but described general practices. Health aides aren’t called in for non-emergencies, said Rahnia Boyer, director of the community health aide program for YKHC. Some villages just have one or two aides with the training to work on-call. The job is draining enough with emergencies, high demands during regular work hours, and the pressure of providing care for one’s own friends and family, Boyer said. Examples of emergencies that would justify after-hours care are severe pain, head injuries, possible broken bones, unconsciousness, rape, chest pain, difficulty breathing, severe bleeding and complications related to pregnancy, according to a flier posted in village clinics and provided by YKHC. Sore throats, achy bones, earaches, runny noses and urinary problems are not emergencies, the flier says. Health aides use a detailed manual that specifies what to do in every situation. They are required to turn to the manual, no matter how experienced they are, Boyer said. Tribal leaders in Kotlik last month told YKHC president and chief executive Dan Winkelman they were concerned about several recent deaths and about people who weren’t medevacked. He told tribal leaders that deaths are reviewed by top medical staff. The goal, he said later, is to determine whether YKHC needs to change any practices to improve care. As to getting patients to Bethel, Winkelman said, “I can’t do anything to call a medevac. The administration can’t. A board member can’t.” The local health aide consults with a doctor in Bethel to decide that, he said. The chief medical examiner, Dr. Gary Zientek, said through a spokeswoman that not all sudden deaths fall under the office’s jurisdiction for an autopsy. Most sudden deaths are natural deaths such as from a heart attack or embolism, and families can still arrange a private autopsy, said Dawnell Smith, a spokeswoman for the state Department of Health and Social Services. The family now is waiting Andrews’ medical records. Son Tony Andrews said he’s spoken with a lawyer. “My mom could have been alive right now,” he said. This weekend, her family gathered in the village to hold the traditional memorial marking 40 days after a death.

Paralytic shellfish poisoning could be 'underreported' cause of death for marine birds

Humans are not the only species vulnerable to the deadly effects of paralytic shellfish poisoning, commonly known as PSP. In a recently published study by the U.S. Geological Survey, the disease has been named as the cause of death for multiple Kittlitz's murrelet chicks -- a species of concern -- found dead on Alaska's Kodiak Island. Scientists believe that these are not the first seabirds to die because of PSP. "The impact of PSP in marine bird populations may be more severe than previously recognized," the study says. According to the study, similar cases are likely "underreported." Related: Summer heat, invasive insects take toll on Interior Alaska birch trees Study shows unique diet, challenges for Alaska's Malaspina Glacier bears Valerie Shearn-Bochsler, a USGS diagnostic pathologist at the National Wildlife Health Center, said it is likely underreported because biologists don't test for it. She said it is possible that the Kittlitz's murrelet deaths are a rare occurrence but because the test is not typically run in seabird mortalities and it is a difficult test to run, she doesn't believe "people think about it." Infared cameras placed by researchers recorded the nestlings consuming fish just hours before their death. The study said that at the time of death, the chicks were apparently healthy, weighing a normal weight and living in mild weather conditions. After they were found dead, their bodies were collected, placed in an ethanol solution for preservation and sent to the USGS Wildlife Health Center in Wisconsin, where necropsies were performed. Of the eight birds that could be tested for PSP, all but one tested positive. Shearn-Bochsler said it is not unheard of for other species to feel the effects of PSP. "It has been recorded in humpback whales along the New England coast," she said. "It is not terribly surprising that the birds that eat fish could be affected." She added that the number of adult Kittlitz's murrelet deaths are "extremely difficult to track," as they spend most of their time at sea, making it difficult to collect and preserve their carcasses. Kittlitz's murrelets are found from southeastern Alaska to the eastern coast of Russia.

State's angry letter defends Susitna dam salmon science

WASILLA -- The state entity pushing a contentious dam on the Susitna River fired off an outraged response this week to the federal contention that the project’s salmon science is flawed. The National Marine Fisheries Service last month filed a critical letter with federal regulators saying the Alaska Energy Authority's fish data was so unreliable it wasn’t usable. The NMFS critiqued everything from juvenile coho salmon wrongly labeled chinook to shortcuts in field studies and problems with scientific models. Related: House lawmakers vote to keep Knik Arm bridge, Susitna dam money in budget After almost 20 years, Iliamna hydro project finally hits its stride Wayne Dyok, the authority’s dam project manager, dismissed the agency’s flawed science claims as "untenable, bordering on the absurd" in an aggressive and at times abrasive letter filed Tuesday with the Federal Energy Regulatory Commission. “We really needed a strong letter,” Dyok said during an interview Thursday. “We felt that the professionalism and integrity of our team, particularly the fisheries team, was being questioned, and we really take that challenge very seriously.” The tone of Dyok’s letter was unusual for a federal hydro filing, especially when compared to letters from agencies like the Alaska Department of Fish and Game or Department of Natural Resources, said Jan Konigsberg, an energy analyst and Susitna dam critic who has spent years evaluating projects going through the federal licensing process. “They certainly don’t take that sort of tone with any of the public filings,” Konigsberg said. The tension between the agencies reflects the fact that the Susitna’s salmon -- and the dam’s effect on them -- are at the heart of the dam debate. The state’s proposal to put a 735-foot, 600-megawatt-capacity dam on the Susitna is touted as a major influx of renewable energy to the Railbelt but also castigated as too great a threat to the river’s world-famous salmon runs. The project to date has cost more than $190 million. Current estimates put the cost of building the dam at more than $5 billion. The state’s salmon studies will form the basis of a much larger Federal Energy Regulatory Commission decision to license the project. The authority expects to file a license application with FERC in December 2016. NMFS, the federal agency responsible for protecting anadromous fish like salmon and marine mammals, came out swinging last month in its critique of a June report summarizing the state’s first-year dam studies. The agency’s top Alaska official in a Sept. 22 letter told the authority that the report contained “data issues” that undercut the state’s ability to understand the health of Susitna salmon now and predict the effects of the massive project on fish in the future. Among other things, the letter faulted data collection methods -- it describes a “very high percentage” of misidentified juvenile salmon -- and said problems getting access to Alaska Native corporation lands last year led to incomplete studies. The authority initially failed to get permission to conduct research at the dam site and project area from a number of Alaska Native village corporation landowners. The agency also contends federally approved study plans aren’t being correctly followed. The problems should be fixed before the state does any more field work, Alaska region administrator James W. Balsiger wrote. “NMFS recommends that the data issues be resolved as soon as possible,” the letter states. Dyok, in his response letter, says the authority was “largely successful” putting a FERC-approved study plan into place last year. That included 10 studies covering more than 200 sampling sites across more than 200 river miles. Yes, land access problems and late breakup in the spring of 2013 stalled field work, but the state modified study plans in response, he said. As for the misidentified salmon, Dyok writes, the state “takes exception to any suggestion that it has not implemented the FERC-approved study plan in a professional manner.” He praises the qualifications of what he calls nationally renowned experts working for five contractors with highly qualified field technicians, many with advanced degrees from the University of Alaska system. Identifying young salmon can be tricky, Dyok said. Photos the authority included with a press release this week show the same 10-centimeter juvenile salmon -- a chinoho? -- in different pictures facing different directions. Arrows pointing to markings indicate the fish in question could be either coho or chinook. Dyok’s letter also accuses NMFS of making “a number of outright errors and instances in which you ignore available information,” specifying pink salmon counts, relative salmon abundance information and development of fish passage criteria. A table details authority responses to NMFS concerns. NMFS officials this week said it would be counterproductive to issue a response before they join the authority and numerous other agencies at a series of technical meetings coming up next week in Anchorage. Agencies and interested parties involved in the Susitna licensing process will meet for six days to talk about the state’s studies. “Any comments we were to make now would be detrimental to the meetings next week where we will be discussing these issues,” said Doug Mecum, the agency’s deputy administrator in Alaska. It’s not clear how FERC will view the skirmish between the agencies. A spokesperson didn’t return a call for comment. The federal agency comments at this stage are only preliminary, Konigsberg noted. FERC will look much more closely at formal comments filed in February. “I don’t think this is as critical,” he said.

Moose kill near Homer by Fish and Game official brings charges

A state wildlife biologist who claims to have gone to extra lengths to find a moose he wounded while hunting near Homer is in trouble now. The Homer News reports 33-year-old Jason Herreman, assistant area management biologist for the Alaska Department of Fish and Game, has been charged with using illegal means to kill a moose and with unlawful possession of game. The charges stem from an Aug. 23 hunt and the Aug. 24 use of an aircraft. Herreman claims he wounded a moose on the Aug. 23 but couldn't find it. He came back the next day to track down the injured animal with help from a spotter in an airplane. It is illegal to use planes to help spot and kill game in Alaska. Related: Swan shooters face wanton waste charges, too Homer woman more than 8 months pregnant bags a moose The law on using them to help recover wounded animals is less clear. Lawyer Myron Angstman from Bethel, who is representing Herreman, called the case unusual. "This is a case of an interpretation of the law ... that needs to be resolved by the court,” he told the Homer newspaper. The lawyer told the Homer News that state law allows hunters to use any reasonable means to track down and salvage a wounded animal. He added that salvaging an animal using radios and aircraft should be considered against the alternative of not salvaging the animal at all. That could be considered wanton waste, he said. Herreman has pleaded not guilty to the crimes. The illegal possession charges stems from his keeping the moose Alaska Wildlife Troopers believe was taken illegally with help from a spotter in the airplane.

Federal agency plans action against 'invasive caribou' in Aleutians

Two islands in Alaska's Aleutian Chain, both of which were once caribou-free, are now the subject of an effort to prevent the species' spread from Adak -- already home to thousands of caribou -- to nearby Kagalaska. According to a Monday announcement from the U.S. Fish and Wildlife Service, the federal agency is now accepting public comments on a recently completed draft of Environmental Assessment of Caribou Control on Kagalaska, Alaska Maritime National Wildlife Refuge, in an effort to control the "invasive caribou." Related: Orphaned black bear cubs sent to Alaska Zoo Ned Rozell: Recalling the lightning strike that leveled 53 caribou "The Introduction, Increase, and Crash of Reindeer on St. Matthew Island" by David R. Klein The "proposed action," as described by U.S. Fish and Wildlife, would send AMNWR staff, volunteers or contractors to the island of Kagalaska, adjacent to Adak, to shoot caribou they spot as preventative measure to keep the species -- which isn't native to the region -- from forming a herd. AMNWR manager Steve Delehanty said a couple of caribou, which he describes as being "pretty good swimmers," swim to Kagalaska every year, on a short, 8-mile journey through a narrow passage of the Bering Sea. The route they take is only a half of a mile wide at its least narrow portion. The environmental assessment estimates zero to 10 caribou living on Kagalaska, but last year only three were spotted. According to Delehanty, eliminating the caribou would only be a "preventative measure" to keep the species from disrupting the island's natural habitat. "If we do nothing, they could build up a population on the island and damage the island, and they could use it has a stepping stone to get to the next island," said Delehanty. Caribou were brought to the region in the 1950s and introduced to Adak while the U.S. military occupied the island. A press release from Fish and Wildlife said the species helped provide "recreational opportunities for military personnel." In 1997, when the base shut down, Adak's human population shrank while the caribou population thrived. Since then, Adak has had relatively liberal hunting laws -- there is currently no closed season -- which helps with caribou population control, said Delehanty. But even with a year-round hunting season, the island's 283 residents are significantly outnumbered by the estimated 2,690 caribou Delehanty said were counted in 2012. "When the species is brought to an island with good, healthy conditions, they thrive, build up population and eat themselves out of house and home," said Delehanty. Delehanty used St. Matthew Island in the Bering Sea as a prime example. In 1944, reindeer were introduced to the area. The reindeer were managed by the local communities and used as a food resource. "They were brought there with good intention, but when human activity ceased, the (reindeer) population exploded," said Delehanty. David Klein, who Delehanty said studied the St. Matthew reindeer "extensively," published his findings (PDF) in 1968, in The Journal of Wildlife Management. Klein found that from 1944 to the summer of 1963 the caribou population went from 29 to 6,000, but were unable to sustain the population. "In a hard winter there was a massive die-off, and that is a pattern that has repeated on other islands," said Delehanty in a phone interview. As he describes the chain of events that unraveled on the remote island, St. Matthew's reindeer population went from zero, to a couple dozen, to hundreds, to thousands and back to zero -- leaving long-lasting marks in the decades since their deaths. "It caused long-term damage," said Delehanty. "And we don't want that in Kagalaska. We don't want to disrupt the natural habitat" -- or, as Fish and Wildlife puts it, they hope to "maintain its natural character."

Feds' cutback of observers aboard trawlers plying Alaska waters questioned by judge

A federal court judge has questioned whether the National Oceanic and Atmospheric Administration is doing enough to protect salmon and halibut from trawlers whose massive nets strip mine the ocean off the Gulf of Alaska coast. District Court Judge H. Russel Holland's opinion comes in the wake of a decision by the agency that led to a significant cut in the number of independent observers tracking salmon and halibut bycatch on Gulf trawlers. NOAA, which oversees the North Pacific Fisheries Management Council, two years ago went along with a North Pacific council plan that ended up halving the number of people monitoring the trawl fisheries. Related: Canada's trawlers drastically cut bycatch, why can't Alaska's? To protect Alaska king salmon, pollock trawlers face new caps Trawlers are 100- to 250-foot-long fishing vessels that drag large nets to catch tons of pollock, Pacific Ocean perch and other species. They operate with bycatch limits designed to force closures if too many salmon or halibut are caught. Lacking observers to track bycatch, there is nothing to stop trawl skippers from rolling salmon and halibut overboard and pretending like they were never caught in order to ensure fisheries remain open. Most trawl-caught fish dumped back into the sea die. When observer coverage fell from about 30 percent of the trawl fleet to less than 20 percent because of program changes, a group called The Boat Company sued NOAA. The Boat Company is a Southeast Alaska-based nonprofit funded by sport fishing and eco-tourism interests that wants to clean up the Gulf fisheries. "One hundred percent observer coverage is what we would prefer,'' Joel Hanson, the organization's director of conservation programs, said Thursday. The National Marine Fisheries Service has argued that 100 percent coverage is financially unreasonable, because trawlers pay the full cost of posting observers on board. The federal agency now pegs the cost of an observer day at $872, and contends it can collect adequate data with observers on just a few boats. Noting the latter conclusion originally came when observer costs were estimated at only $472 per day -- not nearly twice that -- The Boat Company argued that even if the limited observer plan as written was adequate, it needed to be reviewed before being cut in half due to increased observer costs. Holland of Anchorage agreed. He ordered the National Marine Fisheries Service to prove that the shrunken program was adequate. “NMFS must prepare a supplemental EA (environmental assessment) that addresses the question of when data being gathered by the restructured Observer Program ceases to be reliable, or of high quality, because the rate of observer coverage is too low,'' he wrote in an opinion issued Thursday. "Hopefully, it will get NOAA to go back and do a decent analysis,'' said Hanson, who noted that trawlers drag huge nets through the water and then basically crush fish as those stuffed nets are pulled aboard. There are often cleaner ways to fish, he said, and he hoped the NPFMC and NMFS encourage cleaner fisheries. "The more public scrutiny there is,'' he said, "the higher the chances they'll adopt a better program.'' He noted that there is now 100 percent observer coverage on trawlers in the Bering Sea-Aleutian Islands area. That came after Alaska Native fishermen on the Yukon and Kuskokwim rivers made a huge stink about declining numbers of king salmon. King catches in the Bering Sea-Aleutian trawl fleet have fallen since the political heat was turned up. "But it's been a challenge to get the National Marine Fisheries Service to recognize the need to do anything in the Gulf (of Alaska),'' Hanson said. He fears the current situation with limited observer coverage could drag on until the trawlers push to change the regulatory system. Canada shifted from area-wide bycatch quotas in its trawl fisheries to individual boat quotas, which favor trawl skippers who can figure out how to fish with a minimum of bycatch. Responsible boat owners in Canada found the new system benefited them. But, Hanson noted, there's no chance of talking about individual boat quotas for bycatch in Alaska before there is 100 percent observer coverage, because without such coverage some commercial fishermen could simply lie and say they never caught any bycatch species. Contact Craig Medred at craig(at)alaskadispatch.com

Coast Guard searching for Oregon boater missing in Southeast Alaska

The Coast Guard is searching for a 21-year-old Oregon man who went missing while boating near Yakobi Island in southeast Alaska on Thursday. The man, Gus McConnell, was following a larger boat to the Tlingit community of Hoonah in a 16-foot white and blue skiff. Around noon Thursday, the operator of the larger boat looked back for him, and found that the skiff had disappeared from sight, said Petty Officer Third Class Diana Honings, a Coast Guard spokeswoman. At 8 p.m., eight hours later, the Coast Guard was notified, Honings said. Command center watchstanders in Juneau issued an urgent marine broadcast and launched an MH-60 Jayhawk helicopter crew from the Coast Guard's Sitka air station to search the surrounding area. As of about 8 a.m. Friday, neither McConnell nor the skiff had been found. Honings said McConnell had been fishing throughout the day and the boats were returning back to the harbor. He was unfamiliar with the local waters, she said. “It’s possible he may have taken a wrong turn through one of the inlets,” she said. McConnell was last seen wearing blue jeans, boots and an Oregon sweatshirt. Anyone with information about McConnell’s whereabouts should contact Coast Guard Sector Juneau at 907-463-2990. Contact Devin Kelly at dkelly@adn.com, Google+ or Twitter