Jodi Rave, 10-22: IHS needs surgery

By Jodi Rave, Journal columnist | Saturday, October 22, 2005

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MISSOULA, Mont. - Indian Health Service workers prescribed antibiotics last spring for Leola Kennedy's swollen neck.

The pills didn't work, she said.

She returned, again and again, to the Blackfeet Community Hospital in Browning.

Her three brain tumors went undiscovered.

Finally, when she started vomiting blood, her family took her back to the reservation emergency room.

And this time, after her sister insisted the hospital keep the sick woman, a doctor referred her to a hospital 125 miles away in Great Falls.

Radiation and chemotherapy since July have reduced her tumors by 95 percent, she's regained some of the 100 pounds she lost and she's returned the Blackfeet Reservation to recover.

But she won't return to the Indian Health Service in Browning, she said this week.

The Indian Health Service serves some 1.4 million Native Americans in 35 states. But too many of those receiving medical care from the Indian Health Service pay for it with their last breath.

Patients between 15 to 44 are dying at a rate at least twice that of the general population, according to a recent Government Accountability Office report: "Health Care Services Are Not Always Available to Native Americans."

The report, recently submitted to the Senate Committee on Indian Affairs, points to the need to improve health care - particularly mental and dental health services - for Native people. And it arrives just as Congress is again considering reauthorization of the Indian Health Care Improvement Act.

Sens. John McCain, R-Ariz., and Byron Dorgan, D-N.D., introduced legislation to revise the act and improve community, home, children's and long-term health care in Native communities.

The U.S. Department of Health and Human Services oversees the Indian Health Service and its 2005 $2.6 billion budget. Native people receive health care either directly from Indian Health Service hospitals and clinics or through outside contractors.

As lawmakers debate the act, they should consider the following:

-- Of the 13 health care operations the GAO visited, four reported the demand for mental health care outstripped their ability to provide it. One provider cited a need for two to three times the amount of psychiatric care it could offer. The GAO did not identify the names or locations of the operations.

-- One Indian Health Service clinic estimated it turned away 25 to 30 dental patients daily. And patients typically filled the 20 to 30 available dental slots within 15 to 30 minutes.

-- Six facilities did not offer inpatient mental health care treatment to all patients - of these, four did not offer inpatient substance abuse treatment.

-- Officials interviewed for the report said the lack of services harmed patients. One elderly woman wasn't diagnosed with cancer until after her leg broke. And a young man was being treated for pneumonia when a trip to the emergency room revealed a tumor. He died three weeks later.

Native patients eligible for health care through contract providers face other problems.

The GAO reported 10 of 15 contractors - health systems, hospitals and physician groups - said the Indian Health Service delayed or denied payment. Some had terminated their services or were considering ending their relationships with the service. And one obstetrician who was owed $60,000 stopped seeing all of his Indian Health Service patients.

The reauthorization of the Indian Health Care Improvement Act would likely bring Native patients a step closer to receiving improved health care. The Senate Committee on Indian Affairs has scheduled a hearing on the legislation Oct. 27.

It's been 13 years since Congress revised the act. When lawmakers passed it in 1976, their goal was to create health care parity between Native people and the rest of the U.S. population.

But the testimony of Indian Health Service patients, providers and the GAO report show that health care in Indian Country doesn't seem to be improving.

True parity will only be achieved when Native patients stop paying for health care with their lives.

Jodi Rave covers American Indian issues for Lee Enterprises and the Missoula (Mont.) Missoulian. Reach her at (800) 366-7186, ext. 299, or jodi.rave@lee.net.