Tackling The Indian Health Service

‘My tribes have told me that they are getting poor care’

Editor’s Introduction: Last month Kristi Noem (R), South Dakota’s at-large representative in Congress, introduced two pieces of legislation to address major problems associated with the operation of the Indian Health Service (IHS). One is concerned with the operations of the agency; the other concerns mandatory drug testing. She recently talked with ICTMN about the bills.

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You introduced the Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare [HEALTTH] Act on June 8, calling for major changes to the way IHS operates. Senate Committee on Indian Affairs Chairma John Barrasso (R-Wyoming) introduced similar legislation, the IHS Accountability Act of 2016, in May. What are some of the differences? 

One of the things in my legislation that isn’t touched on in the Senate bill is requiring IHS to develop a new formula for allocating PRC (purchased/referred care) dollars. Every year, about June, IHS runs out of Policy Research Center money. Then they tell people they can’t treat them unless it’s a life-threatening situation.

We would require IHS to develop a new formula that would take into account those areas or tribes that have the greatest need for the dollars. Getting that new formula would ensure that we get more money to those regions that really do need the help.

And my bill would also change rates at which those dollars go out the door. It would require IHS to negotiate Medicare-like rates for services from private providers. IHS currently pays a premium for those services, so those dollars spend faster.

An April 2013 GAO report found that IHS could have saved an estimated $32 million out of $62 million that was spent on physician services. So reduced rates would stretch their dollars, which would get us much further into the year.

When you say a new formula would get money to the tribes that need it most, isn’t the need extreme everywhere?

No. In fact there are many tribes in the nation that provide their own healthcare. They find that they get much better healthcare or healthcare coverage if they insure their own people. Not every tribe in the country utilizes IHS dollars or utilizes them to the extent we do.

Unfortunately, because our tribes in South Dakota are in such remote areas where there’s a lack of access to care, they rely heavily on IHS facilities. That’s really their only option.

You spoke at the Senate Committee on Indian Affairs oversight/legislative field hearing in Rapid City, South Dakota on June 17. You said IHS should get out of the hospital business. What would the alternative be?

We would contract with private providers to run those hospitals. That is essentially what the tribes want to do. They would prefer to have local providers like Rapid City Regional or Sanford Health or Avera Health do a long-term contract with those facilities to run them.

My legislation starts us down that path. Eventually what the tribes would like to do is stand on their own two feet. They would love to be able to [take control of their hospitals] and run them themselves [using federal dollars] when they get the ability to do that. But in the meantime what my legislation does is allow there to be longer-term contracts with local providers.

How would longer-term contracts be helpful?

Right now the biggest problem we have with IHS and how they do their contracting is that they contract with a staffing service for a year or two so we have a constant flux of doctors and nurses and there’s no consistency. And then it’s not even people invested in the community. If you’re contracting with a local provider they are people from South Dakota, they’re licensed in South Dakota and they want to be successful here.

The IHS mandatory random drug testing legislation you introduced on June 9 seems a bold move. What led to that?

It was because of complaints I heard from tribal members and other people involved with these facilities. There have been repeated instances of medical staff coming to work intoxicated or stealing narcotic medicine.

What this [bill] would do is make those who work with patients subject to randomized drug testing. Mary Wakefield [Health and Human Services Acting Deputy Director] has told me they are implementing something like this—where the supervisor suspects drug use they can have [personnel] tested. My bill goes a little further in saying there will be mandatory random drug tests of anyone who is responsible for delivering care to patients.

And this would include doctors?

Yes, definitely.

Overall, what do you think are the factors that underlie IHS’s failures in Indian country? 

It has been decades of mismanagement. I think it’s a culture within the administration of IHS that needs to be changed, but whenever you push hard and start trying to hold people accountable, IHS moves them to a different position. They don’t fire folks; they just move them around and it gets even harder to get the answers you need.

The culture within IHS is probably the most toxic I’ve seen in any federal agency recently.

Could you elaborate on “toxic”?

The discouragement among people who work for IHS, the discouragement and lack of communication with tribal leaders, not knowing where the money really goes once it flows into the Great Plains region. There is a lot of doubt and questions about what’s happening to those dollars.

You have facilities where people are hand-washing surgical instruments and doctors are intoxicated when they’re working with patients and you have the theft of narcotics. This would never be acceptable in a private hospital in the United States. To allow this Third World country type of delivery of health care is unacceptable.

The fact that CMS [Centers for Medicare and Medicaid Services] came in and waved a red flag is how we became aware of how bad the situation really is. If it was up to IHS they would never have disclosed the real life situation. My staff has talked with a lot of people and they’re scared to be a whistleblower because they feel as though they’ll lose their jobs or be demoted if they really share what the situation is in these facilities.

You’ve been in Congress for just five years. Why did you take on this issue instead of someone from, say, Oklahoma or Arizona or New Mexico? 

My tribes have told me for several years that they have been getting poor care. So we’ve been working with them on separate issues. I did not realize until this came up in the last eight to ten months how bad it was. This is an issue of life and death. I’ll do anything to fix this situation. I just need my tribes working with me and supporting me as I go to war with IHS over this situation.

When you say “my tribes” you are referring to South Dakota tribes?

Yes, my South Dakota tribes are my number one priority. I’m concerned about the whole system, but there is agreement in Washington, D.C., that the Great Plains region is by far the worst situation. This region is in crisis right now.

What do think will be the outcome of your efforts in working with Sen. Barrasso? 

It’s our hope that we can end up getting elements of both bills into a comprehensive piece of legislation that can be signed into law. We’ve had conversations and by them allowing me to be a part of their Senate Indian Affairs Committee, it certainly gave us an opportunity to talk about both pieces of legislation and what the different elements are.

http://bit.ly/29fC1cH 

The Thirteenth Island

Archipelago chain now fully back in tribal hands

Bottom Line: The Grand Portage Ojibwe has completed its ownership of a precious Great Lakes resource.

There are 13 islands in the Susie chain in Lake Superior. And now—after more than two centuries of confused mapmaking and vague reservation boundaries—the Grand Portage Ojibwe will again own all of them.

Following much cooperative management and negotiation, the Nature Conservancy is returning to the tribe the one of the Susie Islands not in its possession—the namesake Susie Island itself. Nicknamed Big Susie, the 145-acre islet is the largest in the archipelago, which starts about a mile offshore in the largest of the Great Lakes. The final process formally began on January 22, with filing for trust status with the Bureau of Indian Affairs (BIA).

Grand Portage had already owned the other 12, all of which fall within the reservation boundaries. The band is now seeking trust status through the BIA for the archipelago, which would finish the job of giving them full control over the land. BIA approval may come through before the end of the year, at which time a “deed of conveyance” will be signed.

The band is already managing and overseeing Big Susie.

“The big thing is we can manage the whole area; we’ll be able to keep it that way,” said Grand Portage Chairman Norman Deschampe. He stressed that as is the case with the other islands, Big Susie will never be developed.

“We allow recreation out there, but we don’t allow any kind of development,” Deschampe said. “It’s preserved for the band here and the people here. Our people go out there fishing, gathering.”

Since the reservation was created under the 1854 Treaty of La Pointe, northeastern and western portions of Grand Portage lands—including the archipelago—were excluded on original maps and not restored to the reservation until a 1982 Interior Department proclamation. Some lands, though, were privately held.

“Grand Portage leadership at the time and since then have worked very hard to have this area restored,” said April McCormick, the band’s manager of Roads and Realty. “This transaction itself is about restorative justice on many levels.”

Big Susie is a gift from the conservancy, which acquired the island via piecemeal purchases between 1973 and 1991. However, the Grand Portage Band has been working hard to regain control of all land within the reservation. The band or tribal members now own 98 percent of land on the reservation, thanks to acquisition from non-Native owners. The purchases have been made possible by proceeds from the Grand Portage Lodge and Casino.

“It’s one of the bright spots as far as the revenue from the casino, to purchase a lot of tracts that were privately owned,” Deschampe said. “ It’s kind of ironic that you have to buy your own land.”

Effective local management is at the heart of the negotiated transfer of Susie Island. In a letter to the Cook County Board—which has formally supported the land transfer—the conservancy pointed to Susie Island’s remote location and difficult access: “[It] would be better managed by an entity with both a conservation emphasis and a strong local presence.”

In the past, the islands were logged and mined for copper. They were once home to commercial fishing, a practice the tribe did not always appreciate.

“In the 1880s and 1890s, itinerant Scandinavian fishermen regularly cruised up and down the north shore, taking herring, trout and whitefish,” notes a National Park Service website. “In 1889 band members complained to the government that these fishermen, some of whom camped on Susie and the other islands just outside Wauswaugoning Bay, spread nets so large that they monopolized the fish.”

“The human history of the islands is very interesting,” Novitsky said. “You can still see remnants of human use in several areas, from old dock cribs just beneath the surface to the old mining equipment that still rests on Big Susie Island and even an old engine block still sitting on the shoreline of Big Susie.”

Mainly, though, it was the preservation of plant life that spurred the Nature Conservancy to purchase all of Susie Island.

“Species that disappeared from the rest of Minnesota after the glaciers receded northward still survive here,” the Nature Conservancy observed. “Today, many of these plants are more typically found in Arctic and sub-Arctic regions.

“In addition the island’s sheer cliffs, rocky promontories and poor soils are inhospitable for many plants. This ‘cloud forest’ environment supports a rich variety of mosses and lichens, and a blanket bog of sphagnum mosses one to three feet thick has spread over much of the island.”

Federal government approval of trust status for Susie Island is expected later this year, and the tribe is looking forward to completing that last step.

“It’s deeply embedded into our history as Grand Portage, and how we’ve lived here for generations,” said McCormick. “It solidifies long-term management with lands around these islands. It’s really exciting to see this significant parcel returned to the band.”

http://bit.ly/29BRB1h

‘The Heartbeat Of Life’

Music and mathematics pulse among young Navajos

Bottom Line: Under a unique program, rhythms begin as numbers and end as Native notes.

A riot of sound spilled from a hogan on the Navajo Technical University campus in Crownpoint, New Mexico as a group of Navajo students joined in concert with a pair of rising violinists.

Students ranging in age from 7 to 16—all novice performers with xylophones, tambourines and recorders—kept time with two visiting musicians from the Juilliard School in New York City. The result, beginning on June 20 and ending on June 24, was a sound as unique as the circumstances.

“It’s not often that we get students from Juilliard on the Navajo Reservation,” said Wesley Thomas, a professor in the university’s School of Diné Studies, Education and Leadership. “What we have here is the Juilliard School of Music’s Navajo extension.”

For five days, the university played host to the inaugural “Heartbeat Project,” a course funded by a community engagement grant from Juilliard and designed to combine math and music skills in the classroom. Led by Ariel Horowitz and Leerone Hakami, both violin performance majors at Juilliard, the program attracted children and teens from Crownpoint, and nearby communities.

Inside the hogan, students sat on cushions around a fire pit and learned the basics of music: counting beats, reading notes and identifying rhythms.

“Really, you can’t separate math from music,” said Hakami, who coined the name of the program. “In this program we use both. The beat is the technical aspect, the math part. The melody is the heart and soul, the artistic part. So together we have the heartbeat of life.”

Horowitz and Hakami covered a white board with quarter notes, half notes, dotted half notes and whole notes. They led students in a series of exercises that challenged their addition, subtraction, multiplication and division skills.

The brother-and-sister team of McCalister and Alyanis constituted a recorder duo.  Alyssa Landry

The women, who spent their time living on campus and receiving a primer in Navajo culture, had three major goals: teaching the students to play a song, exposing them to the arts and boosting their understanding of math as a skill that is applicable to daily life.

“Experiencing art and music can change someone’s life, and we really wanted to share our passion for the arts,” Horowitz said. “But math is applicable everywhere, so the two concepts go hand in hand.”

The program targeted students in elementary school who are just beginning to tackle math concepts like multiplication and division. Horowitz and Hakami asked the class to think of musical beats like a pizza cut into eight slices. Using this comparison, two slices equal a quarter note while six slices would make a dotted half note.

“It’s hard,” said nine-year-old Cadence Joe, from Standing Rock, New Mexico. “We have to use math problems to learn music.”

Kyran Tso, from Winslow, Arizona, also nine, hoped to use his new skills when he starts fourth grade in the fall. “I’m not sure how I’ll use the dotted half note,” he said. “But I know how to play one on the xylophone. I know how to read notes and answer the math questions.”

Juilliard students Ariel Horowitz and Leerone Hakami led the students through their paces and accompanied them on violin.  Alyssa Landry

The program ran two hours per day for five days. At the end, students performed an impromptu concert for the university community, accompanied by Horowitz and Hakami.

“Our whole goal was to expose kids to things that are not normal occurrences here on campus or this community, not to mention the Navajo Nation,” Thomas said. “We’re using opportunities like this to move the whole university and surrounding community forward.”

http://bit.ly/29Wu5LE

How Did I Miss That?

Forced marches, the benefits of a Pulitzer nomination and death at Machu Picchu

It was widely reported that Oliver Park, 51, went into a restricted area of the pre-Incan ruins at Machu Picchu. He asked a fellow tourist to snap a smartphone photo as he jumped into the air, but he came down off-balance and fell to his death. It was a distance of between 130 and 650 feet, depending on which reports you believe.

My cousin Ray Sixkiller pointed out the death was probably not caused by a curse aimed at the Spanish—because the Spanish never discovered Machu Picchu.

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Navy Times reported that Lt. Cmdr. Bethany Busch was fired as commanding officer of the Bahrain-based coastal patrol ship Whirlwind “for alleged misbehavior.” A quick scan of all the Navy COs relieved of command in the last year showed 20, of whom eight were female.

“So,” Cousin Ray asked, “are 40 percent of Navy COs female?”

I doubt it, because it hasn’t been that long ago that women would not get command of a Navy vessel.

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The Navajo Times ran a story on the 150-year anniversary of the Long Walk, in which about 8,000 Diné were force-marched at gunpoint to join about 500 Mescalero Apaches at the Bosque Redondo concentration camp. One of four Diné would die—either on the 300-mile walk or from disease and malnutrition at the place they would call Hwéeldi, situated outside the bounds of the Four Sacred Mountains, where their creator had told them they belonged.

The Times story revealed that the National Park Service has done a study to determine if the route of the Long Walk would qualify for preservation under the National Trails System Act. The NPS found that the route qualified. But the Navajo Tribal Council voted down the proposal and the NPS turned over the results of the study to the tribal government, which will not release it.

Tony Joe, supervisory anthropologist of the Traditional Culture Program, told the Times that “our leaders at the time told us never to go back to that place, and it is the tribe’s position to take that advice.”

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Remembering another forced march that is part of the National Trails System, the Cherokee Phoenix reported that Cherokee Nation citizen Chance Fletcher, 20, spent a big part of his summer hiking the Trail of Tears, from Red Clay State Park in Tennessee to the Cherokee Courthouse in Tahlequah.

Fletcher had an ancestor removed by Andrew Jackson. He noted that he received excellent treatment by people along the way, unlike the way he imagined it was for his ancestor. He also noted that many of the people on the Trail of Tears had no shoes—and he was able to buy a new pair whenever he needed them.

He kept a journal of his experiences but did not tell the Phoenix what he intends to do with it. His summer exercise was funded by the Dale Summer Award from Princeton University. Princeton is quite a distance from Oologah, which is Fletcher’s home and Will Rogers’ birthplace.

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Native Times reported that the BIA is invoking a seldom-used authority granted in the Kiowa Constitution to call an election by September 30. The federal government has not recognized a Kiowa election since 2010.

Three of eight business committee members have either resigned or have quit showing up. The Kiowa Hearing Board does not have a quorum to examine the legality of the rump business committee. In the meantime, there have been abortive attempts to have elections in 2011, 2012 and 2013. The Tribal Election Board has also been unable to reach a quorum.

Cousin Ray was shaking his head. “Sounds like self-government has been cancelled for lack of interest.”

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“It’s sort of like being sprinkled with pixie dust,” Cherokee Citizen Margaret Verble, a finalist for the Pulitzer Prize in fiction for her novel, Maud’s Line, recently told the Lexington Herald-Leader. “I suddenly am a lot smarter than I was before, and the book’s a lot better than it was before.” She called the experience “disorienting,” but it did spike sales so much that the book will come out in paperback next month.

Verble was unable to find a publisher for her first two books. I predict they’ll get another look now. She is also on the eighth draft of her next book.

I can’t speak for the entire Cherokee Nation, but this Cherokee writer says we should all get so disoriented. Osda!

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