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The emails started arriving late on a Monday night.

"The Department of Health and Human Services (HHS) proposes to reassign you as part of a broader effort to strengthen the department and more effectively promote the health of American people," the email read. "One critical area of need is in the American Indian and Alaskan Native communities."

Amid the Trump administration's massive layoffs at HHS, these reassignment emails accelerated an apparent purge of leadership at federal health agencies. Top officials in different parts of HHS were put on administrative leave with the option of relocating to a new job in Alaska, Montana, New Mexico or other postings within the Indian Health Service (IHS).

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"I did not see this coming at all," a senior executive at the Department of Health and Human Services told NPR. The executive asked not to be identified for fear of retribution from the administration.

William "Chief Bill" Smith chairs an organization that advocates for the IHS on behalf of tribes, the National Indian Health Board. "Any major leadership changes within IHS should be made in full consultation with Tribal Nations, as required by law," Smith wrote in a statement to NPR. "Tribal Consultation is not just a procedural step—it is a fundamental responsibility of the federal government."

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"Utmost disrespect"

The number of health leaders who got the emails and the reasons for who was picked remain unclear. The email doesn't specify what will happen to those placed on administrative leave if they don't accept the offer.

HHS did not respond to NPR's questions about the scope of the reassignment offers. NPR has confirmed that nine leaders got the reassignment email; there may be more.

"The move displays the utmost disrespect for public service. It is clearly designed to force talented scientists and health experts to leave government," says Richard Besser, CEO of the Robert Wood Johnson Foundation, a nonprofit philanthropy focused on health. "It is also an insult to those health care professionals in the Indian Health Service who dedicate their lives to providing health care services on tribal lands."