Two years after leaving the University of Wisconsin amid allegations of workplace bullying, Dr. Barbara Knox, UW’s former top child abuse pediatrician, is drawing similar scrutiny at her new job in Alaska.

Seven current and former employees of Providence Alaska Medical Center say they made dozens of complaints about Knox’s management and medical judgment to supervisors, with no response for months.

Knox now heads Alaska CARES, a statewide child abuse forensic clinic operated by Providence that, over the past two years, has lost its entire medical staff to resignations or eliminated positions, the Anchorage Daily News has learned.

Providence, which houses Alaska CARES, is investigating the clinic’s workplace environment. Two sources with direct knowledge of the clinic operations confirmed that Knox was placed on leave. Those sources declined to be named for fear of retaliation. Alaska CARES declined to confirm Knox’s employment status.

Knox formerly led the UW’s Child Protection Program in partnership with American Family Children’s Hospital in Madison.

She left that job in 2019 after being placed on paid leave while the UW investigated claims that Knox bullied colleagues who disagreed with her. A settlement agreement shielded details of her exit from future employers, including Providence.

Although Knox once testified she had never made a mistaken diagnosis of child abuse, Wisconsin Watch found a dozen instances in which criminal justice system officials, child welfare workers and medical specialists rejected Knox’s suspicions of abuse. Other defendants, proclaiming innocence, remain in prison amid appeals.

On Friday, a Dane County, Wisconsin jury quickly acquitted a day care provider who the state criminally charged after Knox declared a child in her care was the victim of “obvious child abuse.”

Knox had been scheduled to be a “key witness” in the trial, but the prosecution removed her name from the witness list, and Judge Susan Crawford ordered both parties to refrain from mentioning her findings.

In Anchorage, all six Alaska CARES medical staff members there when Knox took over — advanced nurse practitioners and forensic nurses charged with examining children believed to be victims of abuse — quit or saw their positions eliminated over the past year.

Sarah Duran-Wood, a former forensic nurse at the clinic, said she brought concerns about Knox to Providence officials multiple times without a response before her position was eliminated in March 2021.

“It was swept under the rug,” she said.

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

Knox declined to comment through a Providence spokesperson.

High stakes

The new job put Knox in charge of a department that assesses 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’s national reputation for her expertise, Duran-Wood said.

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 wrote a follow-up story days later.But before ADN published its story, a director at Providence emailed more than 75 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.”“We are confident Dr. Knox is the right person for this role.” Skinner wrote.

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.

“We believed her and discounted the story,” said Anastasia Kenney, a former family care coordinator at Alaska CARES. “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, a tense time during 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.

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 four 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 questions for the remainder of the case, Kenney recalled.

‘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.

“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.

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 UW upon resigning may have prevented Providence from hearing the whole story behind her departure from the Madison children’s hospital.

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 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 agency 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.

Dr. Sabrina Butteris, the pediatrics department’s vice chair, wrote in a 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.”

Butteris added: “This leaves a pit in my stomach.”

Wisconsin Watch reporter Dee J. Hall contributed to this story, which was a collaboration between Wisconsin Watch and the Anchorage Daily News.

The nonprofit Wisconsin Watch (www.WisconsinWatch.org) collaborates with WPR, PBS Wisconsin, other news media and the University of Wisconsin-Madison School of Journalism and Mass Communication.

All works created, published, posted or disseminated by Wisconsin Watch do not necessarily reflect the views or opinions of UW-Madison or any of its affiliates.

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