Crisis of Indian Health Care the Focus of Public Hearing in Montana

By- Shelley Bluejay Pierce

8/20/2007

CROW AGENCY, Montana- Senator Byron Dorgan (D-North Dakota) who chairs the Senate Indian Affairs Committee, journeyed to the Crow reservation in Montana on Wednesday for a hearing which focused on the crisis of health care in Indian country.

An elite panel of experts joined lawmakers in the public meeting that offered the tribal communities a chance to voice their grievances prior to a renewed effort to reauthorize the Indian Health Improvement Act that has not been renewed since 1999.

The hearing prepares the way for the Senate Finance Committee, which is addressing the act.

The Indian Affairs Committee, which has primaryjurisdiction over the bill, has given approval to it. Senate Finance Committee Chairman Max Baucus (D-MT), whose committee has partial jurisdiction over portions of the bill, stated that he would schedule a committee session to act on the bill September 12, 2007.

Indian Health Service, (IHS) is a program that provides health care tothe tribes. In Treaties with the United States, provisions for health services to the Tribes became a federal trust responsibility. Despite these agreements made more than a century ago, current health care conditions on the reservations are described as being at "third world levels."

Senator Dorgan has stated in earlier press that he "would not allow another Congress to come and go without acting to improve it. The Indian Affairs Committee approved similar legislation in the previous Congress, but the full Senate never considered it."

According to IHS estimates, Indian patients receive $2,158 per person a year in health care services compared to the average of $5,921 for the general population in the United States.
Senator Dorgan stated in testimony to Congress earlier this year, that even federal prisoners have more spent on them each year, at $3,900 per person.

For more than a decade, the reauthorization of the Indian Health Care Improvement Act has lain at lawmaker's feet but Congress has taken no action. The act expired in 2000 and attempts to reauthorize it have been met with opposition by many Republican members of Congress.

Panel member, Dr. Charles North, Chief Medical Officer (Acting), for Indian Health Service told the attendees that while the mortality rates for Native Americans have improved in recent decades, death and disease rates still exceed that of the general population. Rates of diabetes are 200 percent higher, alcoholism rates are 550 percent higher and suicide rates 57 percent higher than those found in non-Native populations.

Witnesses testified at the hearing of their account of poor health caregiven which included examples of cancer victims received diagnosis long after they might have survived had they received earlier treatment; year long or longer waiting lists for needed surgeries; and trauma victims turned back from tribal clinics not equipped to handle critical cases.

Crow Tribal Chairman Carl Venne voiced his thoughts during the hearing and encouraged IHS employees and tribal leaders to call for more funding. He revealed to the attendees that the Pryor Mountain wild horses receive more annual funding than the Crow-Northern Cheyenne Hospital.

Testimonies at the hearing included information regarding the 1.9 million patients dependent upon the federal Indian Health Service, onec omment was heard frequently. "Don't get sick after June 1."

This comment is referring to the fact that once the yearly funding is depleted, usually during the last quarter of the fiscal year, there is no available funding for health needs in the Native communities. Other testimonies included patients needing specialized care for arthritis, heart conditions, complications from diabetes and other more involved health issues remain on long waiting lists and are left untreated unless they are in danger of losing life or limb.

Basic care is available at local reservation clinics and extreme trauma patients often receive immediate attention as they are referred to emergency rooms or evacuated to larger hospitals.
However, those patients who need specialists necessary for their health care but are not considered life threatening go without treatment.

Jonathan Windy Boy, enrolled member of the Chippewa Cree Tribe, a state Representative in the Montana Legislature, and serving as Chairman on the Committee on Health Care for Montana/ Wyoming Tribal Leaders Council recounted the disparity in care for the more remote reservations.

Since his home reservation is in a remote area, he explained that members with health needs were made to travel hundreds of miles per week to receive treatment in larger cities equipped to deal with their health issues. In his testimony he restated the critical need for Congress to fund the health care at 100 percent and not at 40 to 60 percent that theyhave in the past. According to reports, funding levels in remote communities fair even worse when it comes to the needed levels offunding.

Rep. Windy Boy told the hearing attendees, "The medical inflationary rate over the past ten years has averaged 11 percent. The average increase for the Indian Health Service (IHS) health services accounts over this same period has been only 4 percent. This means that IHS/Tribal/Urban Indian (I/T/U) health programs are forced to absorb the mandatory costs of inflation, population growth, and pay cost increases by cutting health care services."

Windy Boy further detailed the disparity in funding by explaining, "In Fiscal Year 1984, the IHS health services account received $777 million. In FY 1993, the budget totaled $1.5 billion. Still, thirteen years later, in FY 2006 the budget for health services was $2.7 billion, when, to keep pace with inflation and population growth, this figure should be more than $7.2 billion. This short fall has compounded year after year resulting in a chronically under-funded health system that cannot meet the needs of its people."

Another of the panel speakers, Stacy Bohlen, Executive Director of the National Indian Health Board, spoke of the critical need for orthopedic surgeons to address the critical needs of patients requiring such things as hip replacement surgeries. She stated that a patient from the general population in the U.S. will wait two to three months for an orthopedic procedure while Indians in Montana are waiting six years. During this time the patients are using large doses of narcotic painkillers that in the end may lead to substance abuse problems.

Bohlen further explained that many of the joint treatments, if performed earlier,would not need the drastic repairs required when the conditions areleft without proper and immediate care.

Senator Jon Tester (D-Montana) held a telephone press conference immediately before the public hearing began at Crow Agency. His opening remarks highlighted that Senator Dorgan was coming in from Washington D.C. to chair the hearing and highlighted the need to address critically important health care issues in Indian country.

"Improving health care on reservations is critically important to improving all conditions in Indian country. It seems that every time Indian leaders submit a budget for what they truly need to provide basic services, the government says there is just not enough money. This issue is not about money, it's about priorities. If we can spend $3 billion each week in Iraq, then we can surely develop health care systems that live up to our trust responsibilities in Indian country,"stated Senator Tester.

"All the information we say and hear today will become part of theofficial record of the Indian Affairs Committee. This information won't just be stored away in a library in some basement. Sen. Dorgan and I will be taking this information back with us to the Indian Affairs Committee and we will continue to work to change policy toimprove Indian health care," concluded Senator Tester.