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Friday, October 17, 2003
Tour Finds Indian Health Care Ailing
By Leslie Linthicum
Journal Staff Writer
GALLUP Members of the U.S. Commission on Civil Rights walked through the Indian Health Service Hospital here Thursday to see with their own eyes what health care that costs $800 a year per patient looks like.
It looked like this: Crowded. Disjointed. Lacking in beds, doctors and nurses. Too far from the populations that need to be served.
After walking through packed waiting rooms, narrow hallways and records rooms with files stacked to the ceiling, and after hearing about how patient loads have increased while numbers of beds have decreased and funding has stayed static, Commission Chairwoman Mary Frances Berry had one question.
"What do you have enough of here besides patients and diseases?" she asked.
The Commission on Civil Rights has already investigated disparities in how American Indians are treated around the nation. It released a report earlier this year describing the dire state of Indian health care, especially on the Navajo Nation.
It came to Gallup to learn more and scheduled a daylong hearing in Albuquerque today at the Doubletree Hotel. The all-day hearing, from 9:45 a.m. to 6 p.m., is open to the public and a public comment period is scheduled at 4:30 p.m.
When it leaves Albuquerque, the commission will return to Washington and make further recommendations about how Congress should repair some of the damage underfunding has done to Indian communities.
The commission is an independent agency established in 1957 to investigate discrimination in federal laws and policies on the basis of race, ethnicity, gender, age, religion or national origin. It has no legislative power, but it has been successful in making recommendations to Congress.
Its report about Native Americans, "The Quiet Crisis," included a recommendation that Indian Health Service funding be increased.
The commission estimated that the per-capita health expenditure for all Americans will be $5,775 this year. The IHS, the primary health provider for Native Americans, spends about $1,600 per person.
But, on the Navajo Nation, the IHS spends less than $800 per person.
At the same time, Indian people die from serious illnesses such as diabetes, tuberculosis and alcoholism at two to six times the rates other Americans do.
The only explanation for the $800 per person rate appears to be the great number of people needing services, spread over thousands of square miles, from Thoreau to Tuba City, on the Navajo Reservation, the largest and most populous in the nation.
The commission spent Thursday in Gallup because its members wanted to see what it had read about in reports from its staff, they said.
"I come from the Pine Ridge Indian Reservation, and we hear these stories again and again," said Elsie Meeks, the only tribal member on the panel. "What I'm concerned with is equality of health care."
They chose Gallup because it is part of the Navajo Service Area, a large area that serves nearly 300,000 people.
"It seemed that this would be an ideal place to get some feel for it rather than just look at the data," Berry said.
The Gallup Indian Medical Center sees 314,000 patients a year and has a $26 million a year budget.
The hospital's chief operating officer said the hospital staff does the best job it can with what the federal government provides. But he acknowledged that patients wait hours to see doctors and nurses and that they are discharged a day earlier on average than patients nationally.
The hospital struggles to find space and funding for programs and has trouble attracting doctors and nurses and keeping them, CEO Floyd Thompson said.
"The big thing we need to do is replace this facility," Thompson said. "We need more professional staff and support staff."
Berry said she was surprised to learn that rural roads, poverty, lack of electricity and telephones and long distances to travel combine to keep people from getting to doctors to be diagnosed, treated and to receive follow-up care.
"I was not even aware there were all these things that are barriers," Berry said. "It's clear that they have an overload of patients and that they have neither the facilities nor the resources."
A hearing after the tour attracted about 100 nurses, therapists, patients and government employees who work in Gallup or on the Navajo Reservation. Their complaints focused on a revolving door of doctors, long waits, insensitivity and centralized services that require long drives for care.
Dr. Jana Gunnell, who came to Gallup as an Indian Health Service physician and now works for the New Mexico Department of Health, said IHS doctors are overwhelmed by too many patients and medical problems that seem without end.
"I never worked harder in my life," Gunnell said of her IHS tenure. "You just have so many patients. You leave out of self-preservation. You burn out."