The story is entitled:
Promises, Promises Indian health care needs go unmet
I publish the complete story below or you can click on this link:
The Indian Health Service is in fact a model health care program based upon socialized health care; but, the Indian Health Service, like most public programs in this country is being sabotaged by those politicians who want to privatize everything from health care to education to maintaining our streets and sewers and hydro dams.
These politicians sabotage these public programs first by appointing people to administer these programs who are opposed to the very programs they are administering; then these politicians underfund the programs... then they come along and say public programs don't work. Of course the programs aren't going to work if you don't appoint people who will strive to make them work and provide them the needed money and resources required for success.
That the United States Congress allowed and enabled a crooked and corrupt racist bigot like Gale Norton out of the law firm to the mafia and lobbyists to politicians--- Brownstein/Hyatt/Farber/Schreck--- to become the Secretary of the Interior overseeing the Indian Health Service is in itself a racist crime of immense magnitude which tells us a great deal about why there are these serious short-comings in the Indian Health Service. No doubt Jack Abramoff carried enough money around in brown paper shopping bags that he distributed to politicians so that the Indian Health Services could have been funded three times over.
The Indian Health Service is one classic example; here in Minnesota the Department of Health and Human Services is an even better example with Republican Governor Tim Pawlenty appointing one of the most racist, bigoted and viciously anti-working class, anti-people, pro-corporate, pro-free enterprise Neanderthals--- Cal Ludeman--- to head up the Minnesota Department of Health and Human Services.
When politicians appoint those opposed to public programs to oversee these very programs they are opposed to, this is a recipe for disaster.
One has to ask, since the health care needs of Native Americans has been going unmet for so many years, why then, has it taken so long for the media to bring this matter to the attention of the public and politicians? The answer is very simple: The mainstream media is as viciously racist, biased and bigoted as the very politicians who make the decisions and those they appoint to administer social and public programs which are supposed to be about taking care of the needs of the people but are turned into nothing but big government boondoggles where all the friends of these politicians and administrators end up getting rich as people suffer because instead of, in the case of Indian Health Services, you have all these people scamming the system doing everything except providing the government mandated services.
Anyone can look at the budget of the Indian Health Service and see that the problem is a bunch of racist "entrepreneurs" with their dirty, corrupt fingers constantly in "the cookie jar" enabled by a bunch of uncaring administrators.
Barack Obama could pump billions upon billions--- even trillions--- of dollars into the Indian Health Service and it wouldn't improve the health care Native Americans receive because this excellent system of health care is being intentionally sabotaged by a bunch of greedy, profit gouging swindlers who are stealing the funds before these funds can provide the health services people require.
It is ironic that the same tribal governments who operate the casinos send their emissaries out to plead for more funding for the Indian Health Service when the casinos they operate--- and how they operate these casinos--- are responsible for a good share of the health care problems Native Americans are experiencing which is putting a drain on the Indian Health Service which is plagued with corruption--- on and off the reservations.
Here is an example.
This past spring I responded, on behalf of the Midwest Casino Workers Organizing Council as its Director of Organizing, to the Red Lake Tribal Council's presentation to federal government officials who made a presentation at a hearing on the terrible situation regarding Indian health care... I submitted my response to U.S. Senators Amy Kolbuchar (Minnesota Democratic Farmer-Labor Party), U.S. Senator Carl Levin (Michigan Democratic Party), U.S. Senator Debbie Stabenow (Michigan Democratic Party, U.S. Congresspersons Colin Peterson (DFL-Minnesota), James Oberstar (DFL-Minnesota). I would note that these politicians over the combined life of their political careers has solicited, received and accepted MILLIONS of dollars in campaign contributions from the lobbyists of Indian Gaming Industry.
This was my letter to them which received no response:
U.S. Senators Amy Kolbuchar (Minnesota Democratic Farmer-Labor Party)
U.S. Senator Carl Levin (Michigan Democratic Party)
U.S. Senator Debbie Stabenow (Michigan Democratic Party
U.S. Rep. Colin Peterson (DFL-Minnesota)
U.S. Rep. James Oberstar (DFL-Minnesota)
April 6, 2009
Senators and Congresspersons,
The Midwest Casino Workers Organizing Council was not informed of the March hearings on Indian health care even though each and everyone of you has been repeatedly asked to keep us apprised of hearings which relate to these kinds of issues.
It is with this in mind that I request my comments here be included in the hearing testimony.
You, elected officials, claiming to be public servants with the good of the public at heart in your actions, have gone out of your way to deny us casino workers the right to participate in any hearings relating to labor, health care and environmental issues; and, then, you have the unmitigated gall to preach that we live in the world's greatest bastion of democracy.
As you are fully aware, our Organizing Council consists of Organizing Committees in Minnesota, Wisconsin, Michigan and Iowa assisting casino workers in their attempts to organize unions in an industry--- the Indian Gaming Industry--- which all of you have had a hand in creating through your support of the most anti-labor, most racist vile "Compacts" which have forced over two-million casino workers (and given the huge employee turnover in this industry, millions more) to work under the most disgraceful and Draconian conditions in loud, noisy, smoke-filled casinos at poverty wages without any rights under state, federal or tribal labor laws in this industry now comprising over 350 casino operations many of which include hotels/motel, restaurants, a variety of small shops and boutiques ranging from hair-dressers to artists and even water parks and various theme parks.
And here you are sitting and listening to those like the spokespersons for the Red Lake Nation Tribal government--- a supposedly sovereign nation, but a government that has to ask the federal and state governments for approval before doing anything and begging for tax-dollars as casino revenues in the billions and trillions of dollars go completely without any accountability to anyone except for a bunch of mobsters who own the slot machines and table games leaving the Indian Nations stuck with nothing but a pile of debt and poverty--- talking about how the Indian Health Service is underfunded.
We agree that the Indian Health Service is underfunded. But, the funds are being stolen in many cases before they ever reach the stage of their intended purpose of keeping Indian people healthy and getting them well when sick.
The Indian Health Service is a model program which should be serving as a guide for the kind of socialized health care system we all need in the United States. Instead, you are allowing it to be sabotaged by greedy profit gougers at every level as your colleagues in Congress then point out "socialized health care doesn't work."
A program is intentionally underfunded and then greed takes over with "administrative supervision, oversight and approval" and here we are with one big mess of sick people who can't get the health care they are entitled to.
And, to make maters worse, the very people who provided this testimony from the Red Lake Nation did not tell you that the primary reason for the very substantial need to increase the funding for the Indian Health Services is the direct result of the Indian Gaming Industry.
Common sense tells us that if you put people to work--- force people to work--- in smoke-filled casinos day in and day out seven days a week 365 days of the year, these employees are going to suffer serious health problems because we all know the scientific and health consequences people suffer working under these conditions.
The cancers, the heart and lung diseases, the ill affect on pregnant women and the damage to their unborn children; and, in talking about health problems and risks, perhaps among no other population in America, is diabetes such a killer than on the Indian Reservations. And the medical and scientific community has long ago shown the severe adverse impact that second-hand smoke has on those with diabetes.
So, while the Red Lake Nation Tribal Council has sent their representative to plead the case for an underfunded Indian Health Service, these representatives have failed to state that it is the very policies of this very Tribal Council who control Red Lake Gaming Enterprises who by allowing smoking in their casinos are contributing to the ill-health of the people of the Red Lake Nation, many, who because of the racist hiring practices of employers in northern Minnesota cannot find employment elsewhere, are forced to work in these smoke-filled casinos making them sick--- or sicker than they already are--- which in turn requires an expanded Indian Health Service, which in turn requires greater funding.
Our Organizing Council and our Organizing Committees take the position that Congress should appropriate every single penny required to provide adequate health care to Indian people through the Indian Health Service.
We also insist that there be accountability in gaming revenues and these revenues should be confiscated by the federal government to cover the health care problems being created by an unhealthy working environment.
To add insult to injury to this racism, the Indian Health Service is not even monitoring the health of those people employed in these smoke-filled casinos.
Therefore, it is our contention, that these casino enterprises like Red Lake Gaming Enterprises should be billed for the health care received through Indian Health Services for whatever treatment casino workers require for anything.
Quite frankly, we consider the testimony offered on behalf of the Red Lake Nation Tribal Council to be deceitful and dishonest in not bringing forward the role the tribal government plays in making people sick. Needless to say, these representatives did not make any mention of the way present funding is abused and misappropriated by crooks and thieves.
We point out that dishonesty has been a hallmark of the Indian Gaming Industry from its very inception which began with all of you taking bribes to create this industry which has now resulted in two-million workers going to work in smoke-filled casinos at poverty wages in an industry where the workers have no rights under state, federal or tribal labor laws--- truth is not one of the virtues of such thieves and those like yourselves who pander to these thieving mobsters for campaign contributions.
It is rather ironic that the Red Lake Tribal Council which is wholly and fully complicit in stealing from, and abusing, their own people and everyone else in quest of greater profits... would, under these circumstances, have the unmitigated gall to come before any Congressional Committee demanding funding to solve problems they have helped to create.
Might we be so bold as to suggest that you and your colleagues in the United States Congress contribute the bribes you take from the National Indian Gaming Association and the various state Indian Gaming Associations like the Minnesota Indian Gaming Association and contribute this money to the Indian Health Service?
And then maybe if you would stop wasting our money on wars and maintaining military bases all over the world you could provide an expanded version of the Indian Health Service to include everyone residing in the United States including the thousands of undocumented workers employed in the Indian Gaming Industry.
In closing, let me just say that we know you will take issue with the tone of this letter; but, it is your continued lack of response to our concerns over problems you created in the first place in the way you intentionally created these "Compacts" creating the Indian Gaming Industry that any thinking person would know was going to result in these problems; problem you now want to pretend you had nothing to do with their creation--- including the health care problems being experienced by Indian people.
Alan L. Maki
Director of Organizing,
Midwest Casino Workers Organizing Council
I then had the following communication with Dr. Nathaniel Cobb of the Indian Health Service:
From: Alan Maki [mailto:firstname.lastname@example.org]
Sent:Wednesday,April 22, 20099:47 PM
To: Kimi De Leon; Joan Kim
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Subject: Re: Question on Indian Health Summit
To whom it may concern;
Could you tell me if there will be a discussion at the Indian Health
Summit---July 7-9, 2009 in Denver,Colorado---concerning the issue of casino workers in the Indian Gaming Industry and the impact to their health of second hand smoke in their workplaces?
Could you advise me if there have been any discussions about this with the American Cancer Society and/or the Heart and Lung Foundation?
I am very concerned since I find nothing on this important topic among any of the materials you are distributing for the Indian Health Summit.
With health care costs become an important topic for discussion it would seem that this issue would at least merit some kind of mention at an Indian Health Summit considering the large number of Native Americans employed in the Indian Gaming Industry.
Perhaps you would be interested in having me address one of the plenary sessions since this topic has not been considered previously.
I would point out that I have contacted my of the local offices and administrators of the Indian Health Services concerning this issue and no one will speak to me.
With the Indian Health Services being part of the Department of Interior and associated with the Bureau of Indian Affairs, it would only seem logical that no further casino "Compacts" would be approved unless they contain provisions banning and prohibiting smoking.
I would also suggest that the Indian Health Services insist that all existing "Compacts" be re-opened so a ban and prohibition on smoking can be inserted into them.
"Compacts" are nothing more than contracts and the Obama Administration has seen fit to insist that previously negotiated contracts with labor unions be re-negotiated so there is definitely a precedent that has been established for doing this and I am sure you will agree with me that there could not be a better argument made for renegotiating these "Compacts" than to protect the health of hundreds of thousands of workers employed in these casinos who, in addition to working in these smoke-filled working environments are not protected under any state or federal labor laws, which makes this problem of being employed in a work environment detrimental to human health even a more serious concern.
Perhaps the Indian Health Services could make a recommendation to the Bureau of Indian Affairs and the Secretary of the Department of Interior that the Secretary of Labor, Hilda Solis, becomes involved so that the protection of casino worker's rights under all state and federal labor laws protecting all other workers in the United States be included at the time the Compacts are re-opened to protect the health of casino workers.
If you have any doubts second-hand smoke contributes to an unhealthy work environment and that second-hand smoke is recognized as a leading contributor to a variety of cancers and heart and lung diseases please do not hesitate to request additional information. I will be more than happy to attend your Indian Health Care Summit with the necessary resource materials.
With some two-million workers now employed in the Indian Gaming Industry we want to make sure everything possible is being done to protect the health and well-being of these workers.
If I have addressed this letter to the wrong persons, would you please provide me with the name of the proper person/s and department/s this letter should be sent to.
If you think this issue concerning the impact of second-hand smoke on the health of casino workers is not significant enough to be discussed at the Indian Health Summit would you be so kind as to advise me of your decision and how it was reached?
Thanking you in advance for your timely consideration;
Alan L. Maki
Director of Organizing,
Midwest Casino Workers Organizing Council
58891 County Road13
Check out my blog:
Thoughts From Podunk
Cc: Maggie Bird
Midwest Casino Workers Organizing Council
Dr. Nathaniel Cobb’s response to me:
Dear Mr. Maki:
Your email (below) was forwarded to me for response, as the Agency lead for tobacco control. Thank you for your suggestions - I completely agree that environmental tobacco smoke (ETS) in Casinos is a serious health issue for both the employees and the patrons. Labor law is outside my expertise and purview, but I will try to address a few of the many questions you raise:
1. Can we have a session on casino workers and ETS exposure at the Indian Health Summit?
- reasonable suggestion, but the practical answer is that we did invite the public to submit abstracts, that deadline has passed, and we have already finalized the agenda and cannot add another session. We do have a tobacco session scheduled, but nothing was submitted that focused specifically on casinos.
2. Have we discussed this issue with ACS, AHA, or ALA?
- yes. In discussions with ACS, we have agreed that local advocacy may be the most effective way to approach this issue.
3. Can IHS work with BIA to ban smoking in Casinos?
- IHS is an agency of Health and Human Services, not Interior. We have no regulatory role with regard to Gaming compacts, so no direct influence. In our advisory role with regard to health issues, we may make recommendations to another agency. Your suggestion has merit, and I will discuss it with senior leadership within IHS. I note that you have cc'd your email to your congressional delegation. The Congress has much more power to dictate terms of Indian Compacts than we do, so you should continue to work closely with them. A formal letter to a Member of Congress or to an Agency Head, with a clearly worded request, will always get a response.
4. What else can we do?
- It is true that ETS exposure is a health issue, but the solutions are political. We have great respect for Tribal Sovereignty, and unless and until Tribal Leaders support a smoking ban in casinos, it is not likely to happen. So my suggestion is that you contact the National Indian Health Board and ask for a time slot to present the issue at their next Consumer Conference. That meeting is a great opportunity to influence the thinking of Indian Country leadership.
Thank you for your concern, and I look forward to attending your session at the NIHB conference! If you have any educational materials or scientific studies of ETS and casino workers, I would appreciate your sending me copies.
Nathaniel Cobb MD
Chief, Chronic Disease Branch
Division of Epidemiology
Indian Health Service
5300 Homestead Rd NE
My response back to Dr. Cobb:
Dr. Nathaniel Cobb, MD
Division of Epidemiology
Indian Health Service
5300 Homestead Rd NE
Dr. Nathaniel Cobb,
Thank you for the quick response.
As I am sure you must have been thinking as you wrote this response to me, I would not find it satisfactory.
I have contacted all the heads of Indian Health at each of the tribes that operate casinos over the last three years on this issue--- NOT ONE SINGLE ONE has responded to my e-mail or been willing to talk to me on the phone.
Quite frankly, I seriously doubt there are circumstances where the impact of second-hand smoke can be dealt with in one fell swoop.
Yet, we both know this is more about casino PROFITS and the way casino PROFITS influence POLITICS.
What are you suggesting, that it will take some kind of revolution in this country before an agency like yours who has a mandate to educate on this serious issue will act?
I find this coming from a medical doctor such as you very strange; that on this one single issue involving human health where so many lives can be saved and health maintained you suggest that it is up to a union to take the action rather than you.
What are you suggesting is that tribal leaderships motivated solely by profits are to be given into on a health care issue so adversely affecting human health as the issue of being forced to work in an environment composed of second-hand smoke because you do not want to rock the boat--- using as your excuse: "sovereignty."
Is human health not an issue for a “sovereign” nation to be concerned about when it comes to the health of its own people?
There seems to be a clear admission here on your part that these tribal governments involved in gaming have been so corrupted by money they don't even care about the health of their own people; let alone the health of anyone else.
As you are fully aware, most of these casinos are run by outside management firms only using sovereignty to bolster their profits in escaping protecting the rights of casino workers to be free from second-hand smoke in their employment.
You come up with this flimsy excuse that the issue of smoke-free casinos cannot be addressed because the details of the conference are already set and established. However, what is preventing those who will be doing the presentations on the serious consequences of tobacco from raising the issue concerning the need for these casinos to go smoke-free because it is a matter of fundamental human rights for workers not to be forced to work in these conditions that we all know are seriously detrimental to human health.
You, as a medical doctor, are requesting that I should send you further information regarding the consequences of working in these smoke-filled casinos?
It is almost unbelievable that you, being a medical doctor, have even written these words.
That you acknowledge you have known about this problem and not insisted the politicians correct this, is a disgrace. You are the expert witness here.
I find it very difficult to understand how the scientific and medical community has managed to turn out the most respected from these professions to testify:
- Against the tobacco companies in law suits;
- At Congressional and State Legislative hearings;
- In support of smoke-free workplaces for everyone else except casino workers.
But, for some reason there is complete, total, overwhelming and absolute silence when it comes to the issue coercing these casinos in the Indian Gaming Industry to go smoke-free to protect the health of two-million casino workers.
At this point, since you agree this is a very serious problem; I would request that you convey my concerns---AND WHAT YOU CLAIM ARE YOUR SHARED CONCERNS--- to each and everyone of those people who will be participating in the tobacco workshops, forums or making any presentations on tobacco and request that they specifically address the problem of second-hand smoke in casinos and make suggestions and recommendations how this issue will be resolved by coercing these casino managements to go smoke-free.
The Manitoba, Canada provincial government has taken the stand that they will not approve any further casino Compacts or upgrades or new licenses for any casino unless it will be smoke-free.
Something is very wrong with the scenario you bring forward here. I find it kind of strange that a public official such as yourself, who has a legislated mandate to provide the leadership in protecting human health, would tell a citizen writing to you to go and do your job for you.
I expect you to communicate your concerns regarding second-hand smoke (environmental tobacco smoke) to each member of the United States Congress, every single state legislator in each and every state; and, I expect that you will convey your concerns as a medical doctor and in your capacity as a public official with the specific mandate to raise this concern with the Bureau of Indian Affairs and the Secretary of the Department of Interior; and further, that you instruct all of those employed at the local and state levels working for Indian Health Services to immediately undertake discussions about this with their tribal governments.
Sovereignty has nothing to do with this issue.
Can you provide me one single instance where the human health and welfare of a nation’s people is compromised under the guise of “sovereignty” as you are blatantly doing here? No; you cannot provide any such example. How could “sovereignty” possibly be compromised by protecting the health and well-being of any people from any nation? Do you realize how utterly stupid this sounds coming from an educated man like yourself and a doctor on top of that?
Your department and agency is involved in this conference. As a result, you have a mandate to bring this issue forward.
I assume you do not request permission from tribal governments to raise any other issues related to human health; so, why would you conceded your mandate on this vital health issue to tribal governments with no demonstrated concern on this issue or for the human health of their own people?
To suggest that this issue can wait until another conference, where both you and I know that I will never receive permission to speak on this issue, is about as insensitive and uncaring a response that anyone could ever expect to receive from a public official who has the scientific and medical background to know and understand that thousands of casino workers will lose their health while others will die from second-hand smoke they are forced to breath as forced and coerced terms and conditions of their employment.
I am requesting that you carry out the mandate you have from the United States Congress and act to make sure this issue is addressed at your upcoming conference with the aim of resolving this issue once and for all.
I expect to receive written confirmation that you have taken such action.
I assume that President Barack Obama would not appreciate you dragging your feet on this issue since he is so concerned about health care costs; I don't think I have to lecture you, a medical doctor, about the costs involved in trying to cure cancers and heart & lung problems associated with second-hand smoke in the workplace.
With all the attention now focused on accusations of frivolous government spending, I would think you would be more sensitive to the need to bring this issue forward at your upcoming conference.
Alan L. Maki
Director of Organizing,
Midwest Casino Workers Organizing Council
Cc: Maggie Bird
Midwest Casino Workers Organizing Council
With all that has take place, along comes the Washington Post and the rest of the mainstream media acting as if no one has known about the health care problems of Indian people.
I would also note that not one single newspaper, radio or television station has documented what is going on in the Indian Gaming Industry when it comes to the health and welfare of casino workers.
Why didn't the mainstream media examine how the Indian Health Service was doing while Gale Norton was in charge at the Interior Department for so many of the Bush years?
But, the larger question is why has hasn't the mainstream media seen fit to explore the conditions under which two-million people are employed in the Indian Gaming Industry in this country of which Indian Country is a part... if it wasn't, the Red Lake Tribal Council wouldn't have sent its representatives to the United States Congress begging for more health care funding.
The United States government shoved Indian people onto reservations after stealing their land and the natural resources; proclaimed these Indian Reservations to be "sovereign nations," intentionally leaving these "sovereign" nations without adequate resources to create real nations... and then, through the development of these anti-labor, racist "Compacts" designed with intent to allow a group of vicious mobsters to control the political, economic, social and cultural life of these "sovereign" Indian Nations; the politicians of this country stand back and say, "We can't do anything. We don't want to intervene in the affairs of sovereign Indian nations. We don't want to be in the position of creating problems among Indian people."
How racist and arrogant. The politicians set up a system of native "self-government" in a way designed to get people fighting amongst themselves and then these politicians stand back holding their bribes and pay-offs in the form of campaign contributions claiming their hands are tied.
I hope this blog posting has given people something to think about;
Alan L. Maki
PROMISES, PROMISES: Indian health care needs unmet
Note: The slideshow is available at the link:
SLIDESHOW Previous Next
People sit in the waiting room of the Indian Health Service clinic in Crow Agency, Mont., Oct. 16, 2008. The Indian Health Service system serves almost 2 million American Indians in 35 states. An oftt-quoted refrain on some reservations is "don't get sick after June," when the federal dollars run out. (AP Photo/Mary Clare Jalonick) (Mary Clare Jalonick - AP)
This July 2005 photo provided by the Little Light Family shows Ta'shon Rain Little Light in Crow Agency, Mont. Five-year-old Ta'shon had stopped eating and walking, and complained constantly to her mother that her stomach hurt. On her first and subsequent visits to the Indian Health Service clinic on the Crow Agency, Mont., Ta'shon's mother was told her daughter was depressed, when in fact she had cancer, and died some months later. (AP Photo/Little Light Family) (AP)
Ta' Shon Little Light, 5, right, who died of cancer following a misdiagnosis by the local Indian Health Service, is seen with her sisters Thea Little Light, 13, left, and Tia Little Light, 10, at their home in Crow Agency, Mont. in this undated photo. Ta'shon died of cancer some months after a repeated diagnosis of depression by the Indian Health Service clinic. (AP Photo/Little Light Family) (AP)
Ada White talks about her great niece Ta'shon Rain Little Light, seen in the photo, during an interview with the Associated Press in Crow Agency, Mont., Oct. 16, 2008. Ta'shon died of cancer in a matter of months subsequent to a misdiagnosis of depression by the local Indian Health Service. (AP Photo/Mary Clare Jalonick) (Mary Clare Jalonick - AP)
In this photo taken Oct. 14, 2008, pedestrians walk past the Standing Rock Reservation Tribal Headquarters in Fort Yates. N .D. The reservation's Indian Health Service staff say they are trying to improve conditions. They point out recent improvements to their clinic, including a new ambulance bay. But in interviews on the reservation, residents were eager to share stories about substandard care. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, a small child walks toward the front door of the Public Health Service Indian Hospital on the Standing Rock Reservation in Fort Yates. N.D. The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, people sit in the Indian Health Services waiting room on Standing Rock Reservation in Fort Yates. N.D. Statistics for health and disease in Indian country are staggering: American Indians have an infant death rate that is 40 percent higher than the rate for whites, are twice as likely to die from diabetes, are 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure, and 20 percent more likely to have heart disease. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, Rhonda Sandland weeps as she talks about almost losing her fingers to frostbite at Standing Rock Reservation Tribal Headquarters, in Fort Yates. N .D. Sandland says the reservation's clinic decided to remove five of her fingers because of the pain, but a visiting doctor from Bismarck, N.D., intervened, giving her drugs instead. She says she eventually lost the tops of her fingers, and the top layer of skin. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, Ron His Horse is Thunder, chairman of the Standing Rock tribe, talks about the Indian Health Service at Standing Rock Reservation Tribal Headquarters, Fort Yates. N.D. His Horse is Thunder says his remote reservation on the border between North Dakota and South Dakota can't attract or maintain doctors who know what they are doing. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, Dr. Vincent Barnes points out the great distance he and his staff must travel to treat people on the Standing Rock Reservation at Fort Yates, N.D. Barnes is a psychologist with the U.S. Public Health Service. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, sisters Marcella Buckley, left, and Tracy Castaway pose at Standing Rock Reservation Tribal Headquarters, Fort Yates. N .D. Castaway says her sister is in $40,000 of debt because of treatment for Stage 4 stomach cancer after being misdiagnosed for years by the local health clinic, including for the possibility of a tapeworm and stress-related stomachaches. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, Marcella Buckley talks about her medical condition at Standing Rock Reservation Tribal Headquarters in Fort Yates. N .D. Buckley says she visited the local clinic for four years with stomach pains and was given a variety of diagnoses, including the possibility of a tapeworm and stress-related stomachaches. She was eventually told she had Stage 4 cancer that had spread throughout her body. (AP Photo/Will Kincaid) (Will Kincaid - AP)
In this photo taken Oct. 14, 2008, Victor Brave Thunder talks about his medical condition at Standing Rock Reservation Tribal Headquarters, in Fort Yates. N .D. The reservation's clinic failed to diagnose Victor Brave Thunder with congestive heart failure, giving him Tylenol and cough syrup, when he told a doctor he was uncomfortable and had not slept for several days. He eventually went to a hospital in Bismarck, which immediately admitted him. Brave Thunder, 54, died in April while waiting for a heart transplant. (AP Photo/Will Kincaid) (Will Kincaid - AP)
By MARY CLARE JALONICK
The Associated Press
Sunday, June 14, 2009
CROW AGENCY, Mont. -- Ta'Shon Rain Little Light, a happy little girl who loved to dance and dress up in traditional American Indian clothes, had stopped eating and walking. She complained constantly to her mother that her stomach hurt.
When Stephanie Little Light took her daughter to the Indian Health Service clinic in this wind-swept and remote corner of Montana, they told her the 5-year-old was depressed.
Ta'Shon's pain rapidly worsened and she visited the clinic about 10 more times over several months before her lung collapsed and she was airlifted to a children's hospital in Denver. There she was diagnosed with terminal cancer, confirming the suspicions of family members.
A few weeks later, a charity sent the whole family to Disney World so Ta'Shon could see Cinderella's Castle, her biggest dream. She never got to see the castle, though. She died in her hotel bed soon after the family arrived in Florida.
"Maybe it would have been treatable," says her great-aunt, Ada White, as she stoically recounts the last few months of Ta'Shon's short life. Stephanie Little Light cries as she recalls how she once forced her daughter to walk when she was in pain because the doctors told her it was all in the little girl's head.
Ta'Shon's story is not unique in the Indian Health Service system, which serves almost 2 million American Indians in 35 states.
On some reservations, the oft-quoted refrain is "don't get sick after June," when the federal dollars run out. It's a sick joke, and a sad one, because it's sometimes true, especially on the poorest reservations where residents cannot afford health insurance. Officials say they have about half of what they need to operate, and patients know they must be dying or about to lose a limb to get serious care.
Wealthier tribes can supplement the federal health service budget with their own money. But poorer tribes, often those on the most remote reservations, far away from city hospitals, are stuck with grossly substandard care. The agency itself describes a "rationed health care system."
The sad fact is an old fact, too.
The U.S. has an obligation, based on a 1787 agreement between tribes and the government, to provide American Indians with free health care on reservations. But that promise has not been kept. About one-third more is spent per capita on health care for felons in federal prison, according to 2005 data from the health service.
In Washington, a few lawmakers have tried to bring attention to the broken system as Congress attempts to improve health care for millions of other Americans. But tightening budgets and the relatively small size of the American Indian population have worked against them.
"It is heartbreaking to imagine that our leaders in Washington do not care, so I must believe that they do not know," Joe Garcia, president of the National Congress of American Indians, said in his annual state of Indian nations' address in February.
When it comes to health and disease in Indian country, the statistics are staggering.
American Indians have an infant death rate that is 40 percent higher than the rate for whites. They are twice as likely to die from diabetes, 60 percent more likely to have a stroke, 30 percent more likely to have high blood pressure and 20 percent more likely to have heart disease.
American Indians have disproportionately high death rates from unintentional injuries and suicide, and a high prevalence of risk factors for obesity, substance abuse, sudden infant death syndrome, teenage pregnancy, liver disease and hepatitis.
While campaigning on Indian reservations, presidential candidate Barack Obama cited this statistic: After Haiti, men on the impoverished Pine Ridge and Rosebud Reservations in South Dakota have the lowest life expectancy in the Western Hemisphere.
Those on reservations qualify for Medicare and Medicaid coverage. But a report by the Government Accountability Office last year found that many American Indians have not applied for those programs because of lack of access to the sign-up process; they often live far away or lack computers. The report said that some do not sign up because they believe the government already has a duty to provide them with health care.
The office of minority health at the U.S. Department of Health and Human Services, which oversees the Indian Health Service, notes on its Web site that American Indians "frequently contend with issues that prevent them from receiving quality medical care. These issues include cultural barriers, geographic isolation, inadequate sewage disposal and low income."
Indeed, Indian health clinics often are ill-equipped to deal with such high rates of disease, and poor clinics do not have enough money to focus on preventive care. The main problem is a lack of federal money. American Indian programs are not a priority for Congress, which provided the health service with $3.6 billion this budget year.
Officials at the health service say they can't legally comment on specific cases such as Ta'Shon's. But they say they are doing the best they can with the money they have - about 54 cents on the dollar they need.
One of the main problems is that many clinics must "buy" health care from larger medical facilities outside the health service because the clinics are not equipped to handle more serious medical conditions. The money that Congress provides for those contract health care services is rarely sufficient, forcing many clinics to make "life or limb" decisions that leave lower-priority patients out in the cold.
"The picture is much bigger than what the Indian Health Service can do," says Doni Wilder, an official at the agency's headquarters in Rockville, Md., and the former director of the agency's Northwestern region. "Doctors every day in our organization are making decisions about people not getting cataracts removed, gall bladders fixed."
On the Standing Rock Reservation in North Dakota, Indian Health Service staff say they are trying to improve conditions. They point out recent improvements to their clinic, including a new ambulance bay. But in interviews on the reservation, residents were eager to share stories about substandard care.
Rhonda Sandland says she couldn't get help for her advanced frostbite until she threatened to kill herself because of the pain - several months after her first appointment. She says she was exposed to temperatures at more than 50 below, and her hands turned purple. She eventually couldn't dress herself, she says, and she visited the clinic over and over again, sometimes in tears.
"They still wouldn't help with the pain so I just told them that I had a plan," she said. "I was going to sleep in my car in the garage."
She says the clinic then decided to remove five of her fingers, but a visiting doctor from Bismarck, N.D., intervened, giving her drugs instead. She says she eventually lost the tops of her fingers and the top layer of skin.
The same clinic failed to diagnose Victor Brave Thunder with congestive heart failure, giving him Tylenol and cough syrup when he told a doctor he was uncomfortable and had not slept for several days. He eventually went to a hospital in Bismarck, which immediately admitted him. But he had permanent damage to his heart, which he attributed to delays in treatment. Brave Thunder, 54, died in April while waiting for a heart transplant.
"You can talk to anyone on the reservation and they all have a story," says Tracey Castaway, whose sister, Marcella Buckley, said she was in $40,000 of debt because of treatment for stomach cancer.
Buckley says she visited the clinic for four years with stomach pains and was given a variety of diagnoses, including the possibility of a tapeworm and stress-related stomachaches. She was eventually told she had Stage 4 cancer that had spread throughout her body.
Ron His Horse is Thunder, chairman of the Standing Rock tribe, says his remote reservation on the border between North Dakota and South Dakota can't attract or maintain doctors who know what they are doing. Instead, he says, "We get old doctors that no one else wants or new doctors who need to be trained."
His Horse is Thunder often travels to Washington to lobby for more money and attention, but he acknowledges that improvements are tough to come by.
"We are not one congruent voting bloc in any one state or area," he said. "So we don't have the political clout."
On another reservation 200 miles north of Standing Rock, Ardel Baker, a member of North Dakota's Three Affiliated Tribes, knows all too well the truth behind the joke about money running out.
Baker went to her local clinic with severe chest pains and was sent by ambulance to a hospital more than an hour away. It wasn't until she got there that she noticed she had a note attached to her, written on U.S. Department of Health and Human Services letterhead.
"Understand that Priority 1 care cannot be paid for at this time due to funding issues," the letter read. "A formal denial letter has been issued."
She lived, but she says she later received a bill for more than $5,000.
"That really epitomizes the conflict that we have," says Robert McSwain, deputy director of the Indian Health Service. "We have to move the patient out, it's an emergency. We need to get them care."
It was too late for Harriet Archambault, according to the chairman of the Senate Indian Affairs Committee, Democratic Sen. Byron Dorgan of North Dakota, who has told her story more than once in the Senate.
Dorgan says Archambault died in 2007 after her medicine for hypertension ran out and she couldn't get an appointment to refill it at the nearest clinic, 18 miles away. She drove to the clinic five times and failed to get an appointment before she died.
Dorgan's swath of the country is the hardest hit in terms of Indian health care. Many reservations there are poor, isolated, devoid of economic development opportunities and subject to long, harsh winters - making it harder for the health service to recruit doctors to practice there.
While the agency overall has an 18 percent vacancy rate for doctors, that rate jumps to 38 percent for the region that includes the Dakotas. That region also has a 29 percent vacancy rate for dentists, and officials and patients report there is almost no preventive dental care. Routine procedures such as root canals are rarely seen here. If there's a problem with a tooth, it is simply pulled.
Dorgan has led efforts in Congress to bring attention to the issue. After many years of talking to frustrated patients at home in North Dakota, he says he believes the problems are systemic within the embattled agency: incompetent staffers are transferred instead of fired; there are few staff to handle complaints; and, in some cases, he says, there is a culture of intimidation within field offices charged with overseeing individual clinics.
The senator has also probed waste at the agency.
A 2008 GAO report, along with a follow-up report this year, accused the Indian Health Service of losing almost $20 million in equipment, including vehicles, X-ray and ultrasound equipment and numerous laptops. The agency says some of the items were later found.
Dorgan persuaded Senate Majority Leader Harry Reid, D-Nev., to consider an American Indian health improvement bill last year, and the bill passed in the Senate. It would have directed Congress to provide about $35 billion for health programs over the next 10 years, including better access to health care services, screening and mental health programs. A similar bill died in the House, though, after it became entangled in an abortion dispute.
The growing political clout of some remote reservations may bring some attention to health care woes. Last year's Democratic presidential primary played out in part in the Dakotas and Montana, where both Obama and Democrat Hillary Rodham Clinton became the first presidential candidates to aggressively campaign on American Indian reservations there. Both politicians promised better health care.
Obama's budget for 2010 includes an increase of $454 million, or about 13 percent, over this year. Also, the stimulus bill he signed this year provided for construction and improvements to clinics.
Back in Montana, Ta'Shon's parents are doing what they can to bring awareness to the issue. They have prepared a slideshow with pictures of her brief life; she is seen dressed up in traditional regalia she wore for dance competitions with a bright smile on her face. Family members approached Dorgan at a Senate field hearing on American Indian health care after her death in 2006, hoping to get the little girl's story out.
"She was a gift, so bright and comforting," says Ada White of her niece, whom she calls her granddaughter according to Crow tradition. "I figure she was brought here for a reason."
Nearby, the clinic on the Crow reservation seems mostly empty, aside from the crowded waiting room. The hospital is down several doctors, a shortage that management attributes recruitment difficulties and the remote location.
Diane Wetsit, a clinical coordinator, said she finds it difficult to think about the congressional bailout for Wall Street.
"I have a hard time with that when I walk down the hallway and see what happens here," she says.