People in Grand Marais are protesting the dismissal of a beloved doctor from their emergency room — a medical outpost isolated by miles of lakeshore and forest in Minnesota's Arrowhead.

Two doctors with senior roles at North Shore Hospital publicly criticized the Nov. 1 removal of Dr. Bruce Dahlman, and residents decried it as the latest in a series of administrative moves that has gutted the hospital's staff.

Michele Miller was relieved last summer when paramedics took her to the ER and Dahlman was there. The doctor has worked in Grand Marais for three decades but also completed medical missions to Africa and was the American Academy of Family Physicians' humanitarian of the year in 2020.

"You have to know him; the man just reeks of integrity," said Miller, a local musician. His dismissal "feels rotten and wrong. I don't recognize anyone at the hospital anymore. It's all just traveling doctors."

The hospital's fate affects more than the 5,600 people in Grand Marais and surrounding Cook County. The region annually draws 1 million tourists, and some break their legs skiing or stab themselves with fishhooks. The next closest emergency department is 83 miles down the Lake Superior shoreline in Two Harbors.

"If you call 911 from anywhere in this vast area," Miller said, "if you fall down a cliff and break a leg, you're coming to our ER."

Who is responsible for Dahlman's dismissal is in dispute. Hospital leaders said they issued no "corrective action" against the doctor and that the decision rested with Wapiti Medical Staffing, the South Dakota agency that employed him. The agency's chief executive declined to comment, calling it a confidential matter.

In a Nov. 16 community meeting, Dahlman accused hospital leaders of pushing him out because of his opposition to policies that he believed undermined patient care.

"That's the closest thing I can come to," he said, "that I am an insurrectionist."

Hospital administrator Kimber Wraalstad stressed that the change hasn't upset emergency room care. North Shore's ER averages 2,400 to 3,000 visits per year and is usually staffed by a single Wapiti doctor over 24 to 72 hours.

"We're still here, we're still taking care of patients," she said. "That has never lapsed."

Pressure on rural hospitals

The dispute comes amid challenges for North Shore, one of Minnesota's 76 critical access hospitals that have stayed open despite financial pressures.

North Shore Health lost money on the operation of its hospital and other facilities for five straight years through 2021 and meets Minnesota's definition of financially distressed. The hospital was among the first in Minnesota in 2015 to stop providing non-emergency baby deliveries because of declining volumes and rising insurance costs.

North Shore also lost access this summer to doctors from the local Sawtooth Mountain Clinic that for years had made rounds at the hospital and cared for patients admitted to inpatient beds. The clinic had experienced turnover and couldn't find recruits willing to provide inpatient care in addition to office visits.

All of that makes Dahlman's dismissal perplexing to supporters, who are seeking candidates to run for the hospital board and change its leadership. The hospital is one of 31 in Minnesota managed by local governments or advisory boards.

Medical staff chief Dr. Michael Sampson accused North Shore's administrator of being "devious" and concocting disciplinary issues against Dahlman last summer after he criticized her plans to revise inpatient care. Sampson called on Wraalstaad to resign in a letter Friday to the Cook County News Herald.

Dr. Milan Schmidt, the hospital's medical director until his retirement last year, said it would be unusual for Wapiti to dismiss a doctor without the hospital's input. Schmidt said Dahlman angered leaders by sometimes giving patients breaks on their billing but was a compassionate doctor who kept up with changing techniques and technology.

"Never in the time I was working as medical director was anybody dismissed from Wapiti when we didn't request it. … It's not like this was a new thing where the hospital has never had a physician dismissed from the staff, but this doesn't smell right," he said.

Sheila Dianoski, a former technician at the hospital, was among several who quit in frustration, leaving its diagnostic laboratory with a skeleton crew of part-time and contract workers. The staff has turned over dramatically because workers are being asked by hospital leaders to do more with less and are burned out, she said. Dahlman's dismissal magnified the staffing problem.

"It's the one that finally got the attention of the community," Dianoski said.

North Shore leaders defended their practices, which landed the hospital on a national top 20 list for patient satisfaction, but they acknowledged the "emotional response" over Dahlman's dismissal. A letter in Friday's Cook County newspaper offered sympathy but no explanation.

"North Shore Health cannot speak to the decisions between Wapiti and their contracted providers," hospital spokesman Todd Ford said.

Correction: Previous versions of this story misstated the next-closest hospital emergency department to Grand Marais.