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.
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.