This story is a collaboration between the Anchorage Daily News and Wisconsin Watch, a nonprofit newsroom that focuses on government integrity and quality of life issues.

Providence Alaska Medical Center is investigating the workplace environment of Alaska CARES, its statewide child abuse forensic clinic, after a wave of staff departures, including the entire medical staff.

“Providence is aware of increasing concerns about the workplace environment at Alaska CARES,” a spokesperson for the hospital system said in a statement. “We take these concerns very seriously, and per our normal process, Providence is conducting an investigation into those concerns.”

At the center of the investigation is medical director Dr. Barbara Knox. Two people with direct knowledge of the clinic operations confirmed that Knox was placed on leave pending an investigation. Both declined to be named for fear of retaliation. Providence declined to confirm Knox’s employment status.

Seven current and former employees say they made dozens of complaints about Knox’s management and medical judgment to Providence supervisors, with no response for months. Knox, a nationally known child abuse pediatrician, left the University of Wisconsin in 2019 after being placed on paid leave while the university investigated claims that Knox bullied and intimidated colleagues who disagreed with her clinical approach.

A settlement agreement shielded details of her exit from future employers. That included Providence, which hired Knox as Alaska’s top child abuse pediatrician.

Wisconsin Watch, a nonprofit investigative newsroom, found Knox left a trail of families and caregivers behind in Wisconsin who claimed she wrongly diagnosed child abuse. Although Knox once testified she had never made a mistaken diagnosis of child abuse, Wisconsin Watch found a dozen instances in which Knox’s suspicions of abuse were rejected by officials in the criminal justice system, by child welfare workers and medical specialists. Other defendants, proclaiming innocence, remain in prison and have appealed their cases.

“I felt articulate in my concerns”

In Anchorage, Knox’s former colleagues describe a dysfunctional work environment that led to resignations of highly trained medical staff tasked with emotionally grueling work of examining children for child abuse.

Since Knox became medical director, all six members of the Alaska CARES medical staff — advanced nurse practitioners and forensic nurses charged with examining children believed to be victims of abuse — quit or saw their positions eliminated.

“I am very fearful for anybody who has to bring their kids to Alaska CARES right now,” said Sarah Duran-Wood, a former forensic nurse at the clinic. Duran-Wood said she brought concerns about Knox to Providence officials multiple times without a response before her position was eliminated in March 2021.

“I felt articulate in my concerns,” she said. “We all were. And it was swept under the rug.”

Duran-Wood said she believes in the work of her colleagues who remain at the clinic but questions the leadership of Knox.

Anastasia Kenney, a former family care coordinator at Alaska CARES who also described a toxic work environment, said that families can still safely bring children to the clinic, despite the problems.

“There’s still a strong, competent team that’s dedicated to the care of Alaska’s most vulnerable children and families,” she said.

Knox declined to comment through a Providence spokesperson.

[Earlier coverage: Allegations of ‘bullying’ behavior in previous job surface against Alaska child-abuse clinic director]

High stakes

When Knox took over at Alaska CARES, her new job put her in charge of a department that makes medical assessments about whether a child has been abused.

The stakes are high: The medical opinions of Knox and her staff can be used by agencies such as the Office of Children’s Services and law enforcement to take children into state custody or can lead to criminal charges for alleged abusers.

At first, staff members at Alaska CARES were star-struck by Knox, Duran-Wood said. Knox had a national reputation for her expertise and had been a frequent speaker at conferences.

Then in February 2020, a few months after Knox started work in Alaska, Wisconsin Watch published its investigation into Knox’s treatment of a Mount Horeb, Wisconsin, family who said she wrongfully accused them of abusing their 9-month-old son.

The Anchorage Daily News, in partnership with Wisconsin Watch, wrote a follow-up story days later. But before ADN published its story, a director at Providence emailed dozens of people connected to the child welfare system around Alaska, warning them of the additional impending negative news story about Knox.

Bryant Skinner, the director of forensic services, assured recipients that the hospital had thoroughly vetted Knox with background checks and pre-employment inquiries, and that Alaska has a “rigorous licensing process. ”He sent the email to more than 75 people in the child protection community, including Alaska CARES staff, law enforcement, lawyers, nonprofit advocates and public school employees. “We are confident Dr. Knox is the right person for this role.” Skinner wrote. “And a great addition to our care team.”

Knox dismisses news reports

Knox explained the 2020 news story to staff at her new job as a hazard of working as a child abuse pediatrician, two former staffers said.

“It was, ‘This is somebody who abused their children and they’re trying to discredit me,’ " Duran-Wood said. “It was very open and shut.”

“We believed her and discounted the story,” said Kenney. “Then our team unfortunately experienced similar bullying over the next year and a half.”

According to interviews with seven current and former employees at Alaska CARES, concerns about Knox developed around the spring of 2020, an already tense time when the team was figuring out how to work amid the coronavirus pandemic.

Five of the seven people interviewed asked not to be named because they still work for Alaska CARES, in the Providence system or are seeking employment.

At least three nonmedical staff have left Alaska CARES during Knox’s tenure in addition to the entire medical staff’s departure, said Duran-Wood. Kenney blamed a toxic workplace environment.

“All four of our seasoned, wonderful advanced nurse practitioners who had been with Alaska CARES and Providence for many years all quit within a year solely because of their treatment by Dr. Knox,” Kenney said.

Kenney said the final straw came for her when, in front of a group working on a case, Knox “cut a co-worker off in midsentence who was speaking to the team by throwing her palm up about 4 inches from my co-worker’s face and angrily said, ‘You stop talking.’ "

Knox then refused to talk to the co-worker or answer her medical questions for the remainder of the case, Kenney recalled.

“Dr. Knox did that to our co-worker, and Providence did nothing,” she said.

‘They were wrong’

Other staff members criticized Knox’s approach to families, and how she would not tolerate dissenting medical opinions.

In one case that another co-worker was handling, Knox blamed an injury on intentional abuse that others considered a potential accident.

“Rather than (Alaska Office of Children’s Services) and advocacy talking to me, they called her,” Duran-Wood said. “She made decisions. And OCS followed those decisions. And they were wrong.”

The following Monday, according to Duran-Wood, Knox called multiple radiologists looking for someone to agree with her opinion about the cause of an injury.

“None of them would,” Duran-Wood said. Still, Knox’s judgment “resulted in an infant being removed from the custody of a nursing mother for over a month,” she said.

Veteran child protection advocate Pam Karalunas’s experience of Knox differed. The former head of the Alaska Children’s Alliance said, “In my experience, she’s always been respectful, always eager to learn about new cultures . . . and passionate about keeping kids safe.”

Karalunas said Knox reached out to her, a lifelong Alaskan, for help understanding Alaska Native cultures after she was told she was being insensitive. The two have had a professional relationship for years. Karalunas has invited Knox to speak at several child maltreatment conferences in Anchorage in the past, and added Knox was “always a very popular speaker.”

Former and current staff members described lodging dozens of complaints, first through supervisor Skinner and then on up the Providence chain.

“I went to my manager. I went to his manager,” said Duran-Wood. “They seemed to all side with her.”

Providence did not answer questions about how it handled complaints about Knox.

“We will not comment on or share details about specific investigations or personnel actions taken regarding caregivers,” Providence said in a statement through spokesperson Mikal Canfield.

Settlement shields reasons for leave

A settlement agreement Knox made with the University of Wisconsin upon resigning may have prevented Providence from hearing the whole story behind her departure from the children’s hospital in Madison. Under Wisconsin public records law, Wisconsin Watch obtained a document showing University of Wisconsin officials agreed to keep the terms of her departure secret from future employers and credentialing processes unless she first released them from liability. Internal UW hospital communications revealed that top officials there knew Knox was accused of mistreating her colleagues and patients’ families. In an April 2019 warning letter, the UW Health pediatrics chair told Knox to change her interactions with colleagues and patients or face disciplinary action. Dr. Ellen Wald wrote that two patient families had complained, and Knox’s colleagues reported “feeling intimidated” by her and feared retaliation if they “disagreed with (Knox’s) approach to a clinical or administrative matter.”

Co-workers reported Knox’s interactions with patients seemed more focused on " ‘collecting evidence’ than interacting with the patient and family,” Wald wrote. Two months later, in June 2019, the hospital suspended Knox and prohibited her from practicing while they investigated complaints about her behavior. Knox’s October resignation was voluntary, according to the settlement agreement. Upon her departure, the hospital gave Knox $20,000 and was required by the agreement to send the Alaska medical board a scripted letter that said her administrative leave “did not relate to dishonesty, clinical skills, medical diagnostic abilities, or incorrect medical diagnoses,” and “no disciplinary action” was taken against her.

What it did not say: That Knox’s alleged bullying prompted the leave, during which she was barred from contacting patients or co-workers.

Alaska medical board had ‘general knowledge’ about Knox

A spokesperson for the Alaska State Medical Board said the board had “general knowledge” of UW’s reasons for placing Knox on leave but had not been provided the letter detailing the reasons. Wisconsin Watch shared the letter with the board; the spokesperson said the information “would likely not have resulted in a different decision by the Board to issue a license to Dr. Knox.”

Recognizing and reporting child abuse can save lives, but labeling accidental injuries and medical problems as abuse can destroy the lives of otherwise stable families. And wrongful allegations can lead to criminal charges, landing innocent caregivers in court.

In Wisconsin, when presented with the allegation that Knox triggered child abuse investigations that were later unsubstantiated, UW Health spokesperson Tom Russell cited state law requiring physicians to report a reasonable suspicion of child abuse. ”The School of Medicine and Public Health took appropriate action in line with standard practices for reviewing human resources concerns,” Russell wrote about UW’s handling of Knox’s exit. UW was not at liberty to discuss personnel matters, he added.

The Child Protection Program’s staff and physicians, he wrote, are “committed to continuous improvement.” The program in 2019 “underwent a comprehensive review … to ensure that the health and wellbeing of our young patients and their families continue to come first.” UW Health declined interview requests on behalf of staff and administrators.

UW Health also did not answer a question about whether it had investigated how many families were harmed by interactions with Knox. Nor did the spokesperson give specifics of how it plans to safeguard against wrongful diagnoses of child abuse in the future.

After hearing concerns about Knox’s interactions with families, Dr. Sabrina Butteris, the pediatrics department’s vice chair, wrote in a Feb. 27, 2019, email to the department’s chair: “I wonder how many other families there are out there like them. And how many families from disadvantaged groups that don’t have a voice may have been treated the same or worse.”

“This leaves a pit in my stomach,” Butteris wrote in the message to Wald. “And I do not have clarity about what to do about it.”

Additional reporting from Dee J. Hall of Wisconsin Watch.