Photos by CHAD HARDER
The Root of the Problem
As it prepares for a new life in Missoula, The Medicine Tree health center faces an uncertain future. Can the clinic heal itself?
Down in the Bitterroot Valley on U.S. Highway 93 outside the town of Sula stands a towering Ponderosa pine bedecked with ribbons, flowers and other offerings of reverence, worship and prayer. Known for more than a century among the various tribes of western Montana as the Medicine Tree, this spot has long been held as a place of personal power and good fortune, a resting spot for sojourners traveling through the valley.
In recent years, however, this stately pine became the unlikely focal point of controversy and scandal when it was suspected that someone had tried to poison its roots, perhaps believing that it was an obstacle to the widening of US Highway 93. How this innocuous cultural landmark became the target of such animosity is truly an enigma, but today the tree still stands, though it appears all but dead.
On a different stretch of U.S. Highway 93, on a north-facing hillside overlooking the majestic Mission Mountain Range in St. Ignatius, stands another Medicine Tree, this one a medical clinic established by a well-to-do physician long known for her down-to-earth common sense and generous nature. Built as a place for people seeking healing of their body, mind and soul, The Medicine Tree has earned a reputation for standing on the cutting edge of medical practices that integrate modern and ancient healing traditions.
|Dr. Mary Stranahan's clinic, The Medicine Tree, has earned a reputation for standing on the cutting edge of medical practices, integrating modern and ancient healing traditions.
How all this came to pass in four short years requires a closer examination of just what lies at the root of the Medicine Tree's troubles.
To say that The Medicine Tree had humble beginnings would not be entirely accurate, considering that Dr. Stranahan comes from a wealthy family from Toledo, Ohio that built its fortune by making Champion spark plugs. However, Stranahan began her medical practice in the Mission Valley back in 1981 when she opened a small health clinic in an old gas station in Arlee.
Dr. Stranahan-or as some of her patients and co-workers affectionately call her, "Dr. Mary"-soon recognized a growing interest in herbal remedies, both among the valley's Native American population, with its long history of reaping the medicinal benefits of indigenous plants, as well as the region's Mormon population, which has traditionally put great stock in natural remedies.
"I realized that I couldn't be all things to all people with all skills," says Stranahan, who brought in other non-Western practitioners to complement her own osteopathic training. When the clinic outgrew its cramped quarters, Stranahan tried to expand the clinic, until the builders made a disturbing discovery: Beneath the old gas station lay about half a foot of oil sludge.
"I said, I can't build a holistic clinic on a toxic dump," she says.
So in 1995 The Medicine Tree moved into its current location on Highway 93 in St. Ignatius: a 16,000 square-foot, state-of-the-art medical facility that offers services in homeopathy, naturopathy, acupuncture, physical therapy, massage, mental health and Western medicine.
Initially, one of the obstacles to overcome in creating a truly "integrative" health care clinic, says Stranahan, was to head off the inevitable turf battles that can arise between medical practitioners, some of whom might feel protective not only of their own medical disciplines but also of their own professional egos.
|"Much of what we call alternative medicine is primary care for 80 percent of the world's people," says Dr. Marc Micozzi, keynote speaker at last October's Mansfield Conference on The Healing Arts in American and Asian Cultures at the University of Montana.
One solution was literally to pair up the clinic's Western providers with its alternative care counterparts, so that by physically sharing office space, each was compelled to share and discuss treatment options and methodologies with the other. Among the more successful efforts in this regard has been The Medicine Tree's chemical dependency program, set up in cooperation with the Confederated Salish and Kootenai Tribes, which combines physical therapy, acupuncture and mental health counseling to break the cycle of addiction.
As with any emerging discipline or school of thought, alternative medicine has been undergoing not only a revolution in popularity and acceptance, but also in the jargon used to describe itself. Dick Hamilton, chief executive officer of The Medicine Tree, calls the clinic's services "integrative, complementary, alternative medicine." This multisyllabic mouthful describes more that just a place where different medical disciplines are practiced under one roof. It also reflects a philosophical approach to healing and health maintenance that recognizes that the human body is more than just the sum of its parts.
Unlike what is often referred to as "mainstream" or "Western" medicine, complementary and alternative medicine (or "CAM," as the National Institutes of Health now call it) places greater emphasis on maintaining wellness and preserving health, rather than simply treating diseases as they arise.
As Hamilton points out, other clinics across the country label themselves "integrative," yet no two are exactly alike. They range from the Patch Adams model, where a commune of providers from various disciplines provide free health care to its own members, to the retail outlet in a shopping mall that offers the services of a medical doctor, a physical therapist, a massage therapist and a chiropractor.
Over the years alternative medicine has gone under many names and guises, variously known as "popular medicine," "folk healing," "holistic medicine" or "ethno-medicine." But in 1993, a study published in the New England Journal of Medicine estimated that one-third of all Americans use at least one form of unconventional treatment in addition to their regular medical care. By 1998, that number was revised to one-half of all Americans. The study also revealed that three in four patients did not inform their doctors about their use of alternative remedies. As physicians find themselves straying into waters uncharted by Western medicine, they have begun to demand more clinically proven data in order to more effectively treat and advise their patients.
Dr. Stranahan's latest project aims at doing just that: building a body of clinical evidence that demonstrates how alternative remedies can be integrated into the treatment of cancer. In June, she and others from The Medicine Tree appeared before the Missoula County Board of Commissioners requesting approval to issue industrial development revenue bonds to finance the Dinny Stranahan Research Institute, a $7 million not-for-profit cancer research center in Missoula.
Slated to open sometime next year, this 20,000 square-foot facility will be located on 4.7 acres just off Reserve Street, and will be staffed by approximately 50 employees with a payroll of about $2.5 million. Named after Dr. Stranahan's sister who died of a brain tumor in 1993, the clinic will conduct clinical studies on cancer patients brought in from around the country .
|"Her [Dr. Stranahan's] vision was wonderful," says nurse and former Medicine Tree employee Catherine McConnell (left), who claims she was fired for her union activity. "I wanted to be a part of her vision. But it's like the vision suddenly changed when we said we wanted a voice."
But the importance of scientifically validating the effectiveness of alternative remedies goes well beyond its medical benefits. The demand for more clinical data on alternative medicine is also coming from insurance companies, health care plans and health maintenance organizations, which are under increasing pressure from consumer groups and lawmakers to foot the bill for alternative treatments.
Most insurers do not reimburse for even the most widely used forms of CAM therapies (chiropractic, acupuncture, homeopathy, herbal medicine, massage and naturopathy) fearing that patients will prefer these more pleasant, nonintrusive treatments over more conventional ones. Insurers also cite concerns over incurring the additional expense of paying for CAM therapies in addition to the expenses of conventional care.
Both Stranahan and Hamilton say that reimbursement issues for alternative treatments are largely responsible for the financial troubles that The Medicine Tree has found itself in during the past four years.
Stranahan readily admits that The Medicine Tree has been hemorrhaging about a half-million dollars a year since 1995. Complicating the problem is the large percentage of patients who come from poor communities, including the nearby reservation, who rely upon Medicare, Medicaid or Indian Health Care to meet the lion's share of their medical expenses.
These treatments, like most mainstream medical services, do not come cheap, and when insurance companies fail to pay or challenge claims, Stranahan says that she is usually forced to absorb those costs herself.
As medical practitioners occasionally discover, however, sometimes it can be difficult to distinguish between the causes of an illness and the symptoms of a more serious underlying problem. This, in fact, may have been the case during last year's labor dispute at The Medicine Tree.
According to some former employees, The Medicine Tree's fiscal woes had more to do with a management team that was either out of touch with or unresponsive to its employees' concerns. They say that in 1998, while the clinic was pleading financial hardship in order to justify a wage freeze and eventual lay-offs, it was also spending money liberally on such items as new telephones, computers, management bonuses and expensive outside consultants.
Moreover, according to Secky Fascione of the United Health Care Workers Union of Missoula (the union elected in June of 1998 to represent The Medicine Tree's employees in their contract negotiations) the workers' complaints had less to do with wages than with what they perceived as a lack of a voice in workplace decisions, and not being respected for their input.
|"Mary [Stranahan] has the kindest, most giving heart of anyone I know," says Medicine Tree CEO Dick Hamilton, "The labor dispute was real hard for her."
But when nearly the entire staff of The Medicine Tree was dismissed on Christmas Eve 1998, the union petitioned the National Labor Relations Board, charging that the clinic's management team had bargained in bad faith, had refused to negotiate over a number of points-including the decision to discharge its workers-had unlawfully discharged one employee for union organizing, and had failed to provide other relevant information to the union.
Those charges were later withdrawn in early 1999 when the union withdrew interest in representing the employees, since virtually none of the original bargaining unit was still employed at the clinic.
"One of the most painful things about this entire effort has been the inability to figure out or even guess what has gone on in Mary [Stranahan]'s mind," Fascione says. "I will forever believe, unless Mary calls me and we can sit down and work it out differently, that she engaged in union-busting."
During last month's revenue bond vote, members of Missoula's Living Wage Coalition asked the county commissioners to delay approval of the Medicine Tree's bond request until an agreement could be reached with the clinic's management, assuring them that such labor practices would not occur at the new cancer institute, and that a living wage would be paid to its workers. According to both Anita Anderson of the Missoula Living Wage Coalition and Dr. Stranahan, a verbal agreement to that effect was reached, and the bond issue was approved.
Physician, Heal Thyself?
Neither Stranahan nor Hamilton are willing to directly address questions relating to the clinic's past labor troubles, except to say that the NLRB has warned them against discussing this matter publicly for at least six months following the dismissal of the allegations against them. According to Laurie Halpern of the NLRB, however, no such "gag order" is in effect.
"The things that were being said about The Medicine Tree [at the county commissioner's meeting] are completely contrary to our philosophy and our purpose in life here," says Hamilton. "Part of the reason for all those hard feelings is that some people did not want to believe that The Medicine Tree was losing the amount of money that it was. And then you have to ask yourself realistically, who would expect to suffer that kind of financial loss every year and still keep the doors open?"
As for the charge of firing workers in the midst of labor negotiations, Hamilton insists that the decision was based entirely on the need to downsize and cut expenses, and had nothing whatsoever to do with unionization.
"Financially, the union made no difference one way or the other," says Hamilton. "The two were not related to each other at all. No way. That'd be crazy."
Nevertheless, the damage had been done, both to the workers who lost their jobs and to the reputation of The Medicine Tree and Dr. Stranahan herself. Although those wounds may prove slow to heal, as most caregivers know, sometimes a wound heals quicker when it has an opportunity to air.
Meanwhile, the future of The Medicine Tree in St. Ignatius remains uncertain. Hamilton says that a decision on whether the clinic will remain open will not be made until the end of this year. In the meantime, we can only watch and wait to see whether this tree stands or falls.