Those who spoke at the Senate Committee on Indian Affairs’ field hearing about The Indian Health Service last week brought up many issues, but they had few answers on how to solve these problems.
Participants in the meeting at the Billings Public Library included U.S. Sen. Jon Tester, acting IHS director Yvette Robideaux and representatives of seven tribes from across Montana and Wyoming.
“We’re not having this hearing for the sake of having a hearing,” Tester said. “We’re having a hearing to find out what the problems are, how pervasive they are, and how we can fix them.”
According to Darrin Old Coyote of the Crow Tribe, Native Americans not only deserve better health care but are owed it as well.
“The tribe’s ancestors signed treaties with the federal government ceding many millions of prime acres rich in resources in exchange for goods and services,” he said. “One of those services was healthcare, not only for themselves but for generations to come. The tribe held up its end of the exchange, but the federal government has failed, and the tribe should not be in a position where it is having to continually fight for something it is owed.”
Dr. Robideaux speaks out
Dr. Robideaux oversees the Billings IHS office, which serves more than 67,000 Native Americans in Montana and Wyoming. Robideaux is in charge of the office until a replacement can be found for outgoing director Anna Whiting-Sorrel, who left the position less than 18 months after she was appointed.
During her prepared statement, Robideaux acknowledged that changes needed to be made, but she didn’t specify what those were. In fact, she more frequently directed attention to the progress that IHS was making in areas such as communicating better with local tribes and monitoring the productivity of IHS staff.
However, as she answered Tester’s questions, Robideaux opened up about the problems facing IHS.
“What keeps me up at night is the funding situation,” she said. “The population is growing and the budget, even though it is growing, isn’t big enough to meet the demand … . We’re funded much less than other federal healthcare programs. My top priority is fighting as hard as I can to get us more resources, because in the end that will make the biggest difference.”
Indeed, funding is a problem for IHS. According to a 2013 report by the National Congress of American Indians, IHS spent only $2,741 per patient in the year 2010. This is stark contrast to the per capita spending of Medicare ($11,018), the VA ($7,154), and Medicaid ($5,841).
This lack of funding keeps IHS’s beneficiaries from accessing a wide variety of care. In a 2010 survey of 740 federally employed physicians in the IHS, less than 50 percent reported adequate access to high-quality specialists, nonemergency hospital admission, and high-quality outpatient mental health services.
During last week’s field hearing, Robideaux addressed another problem.
“For a long time, the model of IHS was to make sure that we were meeting the standards that have been set nationally for healthcare systems. Our facilities are accredited so we do meet the standards objectively, but that’s not the point. The problem is that in the eyes of the patients we are not meeting expectations and we are not meeting their needs … . We need to have more accountability and more focus on our patients … . That’s a very different perspective that’s going to take time to achieve.”
Concerns of the tribes
One of the many concerns from speakers was that inferior medical care has led to lower life expectancies for Native Americans. Tester mentioned a 2013 report by the Montana Department of Health and Human Services that said white Americans live an average of 20 years longer than Native Americans.
“These statistics are staggering and unacceptable,” Sen. Tester said. “When we’re discussing the IHS, we are literally discussing issues of life or death.”
A.T. Rusty Stafne of the Fort Peck Reservation echoed Tester’s statements when he said, “We have lost fathers, mothers, sons, daughters, brothers, and future leaders because they were unable to get the health care they needed … . This is too high a cost to our community.”
Another concern is the money owed to the tribes by IHS. The beneficiaries of IHS are required to pay up front for their health care services, but IHS has not been able to pay them back due to its low funding.
Stafne said that his tribe was experiencing a shortfall of $1.2 million. Carole Lankforde of the Confederated Salish and Kootenai Tribes estimated that her tribe was experiencing a shortfall of nearly $2 million.
Darrin Old Coyote disagreed with Robideaux’s claim that money would fix some of the issues with the IHS. In fact, he was concerned about how top-heavy IHS was - nearly 66 percent of last year’s Billings IHS budget of $10 million went to administration while only 15 percent went to actual health care services.
Old Coyote suggested an audit of the Billings IHS office and said that more money could be spent on health care if the area office was eliminated entirely.
“We go to the central office and they send us to the area office,” he said. “And then the area office sends us back to the central office. To tell you the truth, I don’t think we need area offices because they’re duplicating services … . People aren’t getting the proper healthcare. We need to have a direct channel to the decision makers. If we had that, we could have better health care for all people.”
Tester agreed. “We need more accountability and less ping-ponging between offices,” he said.
One of the primary concerns of Fort Belknap’s Mark Azure was his reservation’s ambulance service.
“We’ve had difficulty putting an ambulance service in place on the southern end of the reservation where approximately 50 percent of our residents reside,” he said. “We’ve tried to take it upon ourselves to get that rolling. We had 12 community members take an EMT course and get certified. In the end, the ambulance service hired only one of the 12 individuals and put him on the north end of the reservation, which defeated our original purpose. We still don’t have an ambulance on the south side, so there’s still that lack of care on that end of the reservation … . We recently lost a young tribal member in a vehicle accident on the south side. We don’t know if that ambulance on the south side would have saved her life, but now we’ll never know because it wasn’t there.”
Tim Rosette of the Rocky Boy Reservation echoed the concerns of many participating in the forum when he addressed how IHS lacks mental health services - especially for children 17 and under.
“The tribes in our region … lack qualified in-patient facilities that deal with the nature of the problems facing our children today. For example, we recently had two adolescents attempt suicide. One was 9 years old and one was 14 years old. The only resource they had available was the hospital. Two days later, the hospital said they were fine and could go home … . I think the mental issues associated with these attempts definitely take more than two days to address.”
Other concerns expressed by tribal leaders during the two-hour meeting included limited time with doctors and low staffing of medical facilities.
Prioritizing human life
Both Robideaux and the tribal leaders seemed to agree that lack of sufficient funds was the central cause of most IHS problems. Although they were in disagreement about how to fix this issue, they all thought that IHS needed to work harder to take care of those in its jurisdiction.
“We need to do more to find out what quality healthcare is - as defined by our patients and not by us,” said Robideaux.
Rosette agreed that the problems with IHS need to be solved.
“We need to get answers to these questions,” he said. “We’re told that the federal government doesn’t have the money, but we’re going to spend over $20 billion in fiscal year 2015 on the Department of Defense budget - so there is money for priorities. When are we going to be a priority? What I am asking is that IHS, and the government as a whole, learn to prioritize basic human life.”