Indian health care resources fall far short of delivering decent but urgently needed help. This is just one factor involved in the suicide epidemic among young Native Americans –- an outrageous and avoidable national shame -- and it is just one longstanding blot on the federal government’s credibility in relations with Indians. (See documentation below.)
Consider that in mid-October, Sen. Byron Dorgan (D-S.D., at left), chairman of the Senate Committee on Indian Affairs (SCIA), was once again introducing legislation to re-authorize (permanently) health care for nearly 2 million American Indians and Alaska Natives via the Indian Health Care Improvement Reauthorization and Extension Act of 2009 –- a reauthorization step that hasn’t been taken in 20 years, according to Sen. Lisa Murkowski (R-Alaska, at left), a co-sponsor of the measure and SCIA member.
“Our First Americans suffer the highest mortality rates from diabetes, tuberculosis, alcoholism and suicide,” Murkowski said. “Indian Country has waited far too long for a bill to arrive at the President’s desk. We have failed our trust responsibility for far too long. Let’s embark on a new course to make America’s Native people the healthiest people in the world.” Amen.
Now, I want to share with you some highly compelling views that Sen. Dorgan expressed in October 2007 when he introduced legislation that would have re-authorized Indian health care. I urge you to read his comments that were published in the Congressional Record and posted on the Friends Committee on National Legislation Web site.
Dorgan’s words are powerful. I’m sharing them in full -– a violation, I know, of short-form blog practice -- for those of you who may want to read every word. As I journalist, I’m not in the business of withholding information. But for those who want a quick read, I’m boldfacing key parts.
Please take special note of Sen. Dorgan’s anecdotal documentation of some cases of suicide. I’ve never read stronger human-interest stories. They boggled my mind. Here are Dorgan's comments, and bless him, Sen. Murkowski and every advocate of decent health care for American Indians and Canadian First People:
From the Congressional Record October 19, 2007
"I wish to talk about children's health care, but I want to focus mostly on Indian children, and I am going to talk about Indian health care, generally. The reason I am doing this, I am chairman of the Indian Affairs Committee in the Senate, and Senator Reid indicated we will have on the floor of the Senate, perhaps in a week or perhaps 2 weeks, for the Indian Health Care Improvement Act. It has been 15 years since that Act has been debated on the floor of the Senate, the Indian Health Care Improvement Act.
Why separate categories, Indian health care? Why separate? We have a trust responsibility. This country promised through treaty, through other obligations, this country said to the Indian people: We have a trust responsibility to provide for your health care. It is not something that the Native Americans, the first Americans, said: We want you to give this to us; we insist upon it. It was an agreement, a treaty agreement by this country to say--in many cases, a treaty, in other cases, just a solemn promise--we will provide health care coverage to American Indians as part of our trust responsibility.
The Indian Health Care Improvement Act expired in the year 2000 and has not been reauthorized. It is 7 years later. It doesn't mean there is no Indian health care. There is some, but it is horribly inadequate. In any event, we should reauthorize that Act and modernize it. With respect to Native Americans, we have fallen tragically short of what our responsibilities insist we do.
Let me describe what we are spending and how well we are doing with respect to health care. With Medicare, we spend $6,700 per Medicare patient; Indian health care, $2,100 per capita. We spend twice as much on health care for Federal prisoners whom we incarcerate as we do for American Indians for whom we have a trust responsibility for health care.
Someone incarcerated gets twice as much spent on their health care as American Indians for whom we have a responsibility. I am talking about children, I am talking about elders, and I will talk about some of them in just a moment. We can see ranging from Medicare to the VA to Medicaid to Federal prisons, all the way down, and here is the lowest, and the lowest is the per capita expenditure of health care for American Indians for whom we have a trust responsibility.
American Indians die at a much higher rate than other Americans from tuberculosis, a 600-percent higher rate from tuberculosis; diabetes, 189 percent, but in some parts of the country, it is 400 percent and 800 percent higher than Americans. Alcoholism, 500 percent higher. The fact is, we have grim statistics coming from Indian reservations with respect to the health of the first Americans. The rate of sudden infant death syndrome among Native Americans is the highest of any population group in the United States and more than double of non- Indians. Indian youth suicide on the Northern Great Plains, where I am from, is 10 times the national average.
Last night, I received a letter from a constituent on an Indian reservation. This constituent has had diabetes since she was 11 years old. Earlier this year, she received a kidney and pancreas transplant. She needs an anti-rejection medication to stay alive. When she went to the reservation clinic to get her medicine yesterday, she was told by the doctor: There goes our budget. There are two other tribal members who receive this medication, and when the funding is gone, there will be no more medication.
The stories are pretty unbelievable. This is a picture of a young girl named Avis Little Wind. I have described the tragedy of this young girl previously. Avis Little Wind is 14 years old. Avis is dead. She took her own life. Mental health treatment wasn't available for Avis. She lay in her bed in a fetal position for 3 months, and no one seemed alarmed by that, before she finally took her life. She wasn't in school, though she was supposed to have been. Her sister committed suicide, her father died by his own hands, and this 14-year-old girl is gone because, I presume, she felt that she was hopeless and helpless.
Those on the Indian reservation dealing with mental health issues, including suicide. For suicide prevention, they have virtually no resources. A young lady on this Indian reservation, who testified at a hearing I held once, said she had a stack of files on the floor of her office dealing with abuse and health issues. She said: ``We don't have any resources to even investigate the files. We would have to beg to borrow a car to take one of these kids to a clinic someplace.'' Then she broke down weeping. About a month later, she resigned.
The fact is people are dying. Avis Little Wind died of suicide because mental health treatment wasn't available on that Indian reservation. I was in Montana recently with Senator Tester, and a grandmother held up a picture of this beautiful young girl. She is 5 years old. Her grandmother described the picture of her granddaughter, named Ta'Shon Rain Littlelight. Ta'Shon Rain Littlelight loved to dance, and she danced in this regalia at all the pow-wows from the time she was able to walk a beautiful little girl with a sparkle in her eye. Well, Ta'Shon is gone. Ta'Shon lost her battle, as well. Between May and August of last year, she was taken many times to the Crow Indian Health Service Clinic for health services. They diagnosed the problem and they began to treat it. They said it was depression. A 5-year-old was depressed.
Well, during one of the clinic visits her grandfather said: ``But there is something else going on. Take a look at the condition of her fingertips and her toes. There is something happening in this little girl's body.'' It suggests, the grandfather said, a lack of oxygen. Something is going on. But that concern was dismissed, and finally the grandmother asked a doctor to try to eliminate the possibility of cancer or leukemia, or something of that nature. But those concerns were dismissed.
In August, this young girl was rushed from the Crow clinic to St. Vincent Hospital in Billings, MT. They airlifted her to Denver Children's Hospital where she was diagnosed with incurable, untreatable cancer. She lived for another 3 months after the tumor was discovered, in unmedicated pain. She died in September. The grandmother asked at our field hearing if Ta'Shon's cancer had been detected earlier, would it have made a difference? Would this little 5-year-old girl be alive? None of us knows, but the question of the quality of health care is a life-or-death issue.
It was for Ta'Shon.
Recently, on a Wednesday morning in my State, a young child on an Indian reservation was burned, severely burned, and rushed by the mother to the Indian Health Service clinic on the reservation, only to be told that the clinic was closed for the morning for administrative purposes. Even after the frantic pleas by the mother, this boy was refused care. So in her desperation, she contacted a doctor from another town outside of the reservation for assistance. They directed her to bring her young son immediately. She did. Thankfully, that young boy received treatment and has survived those severe burns.
She didn't get the needed health care for him at the Indian Health Service clinic. Following the treatment she did receive off the reservation, after a frantic drive in an automobile, the Indian Health Service clinic refused to cover the costs of the young boy's treatment. So the mother is now faced with a substantial medical bill, a mother who should never have been placed in this situation and a mother who doesn't have the resources to pay it.
When we held a hearing in the Indian Affairs Committee about methamphetamine, the intersection of methamphetamine and health care was pretty obvious. It was a courageous tribal leader who came to our hearing, Kathy Wesley-Kitcheyan, the chairwoman of the San Carlos Apache Tribe in Arizona. She said she was embarrassed to talk about some of the things on her reservation, because they are not very positive and she said it was like airing her family's dirty laundry but, she said, I must.
She talked about her 22-year-old son and her warning to him about the catastrophic effect of alcoholism and substance abuse. And she talked about losing her grandson. She broke down talking about her wonderful grandson, a rodeo champion who had won 26 belt buckles and 6 saddles as a rodeo rider, who made the wrong choices with drugs and drinking and lost his life. She talked about the methamphetamine problem. That is where it intersects so quickly, in a devastating way, with health care.
She said on their reservation, in 1 year, out of 256 babies born on that Indian reservation, 64 out of 256 babies were born addicted to methamphetamine. Let me say that again. Of 256 children born on that Indian reservation, 64 were born addicted to methamphetamine. At the San Carlos emergency room, in 1 year, 25 percent of the patients who came to the emergency room tested positive for methamphetamine. And on it goes.
I am describing circumstances that one would perhaps attribute to a Third World country, where health care doesn't exist. Yet these stories, in many ways, are even more heartbreaking because they happen here in this country. They happen too often to people who are living in Third World conditions on Indian reservations with inadequate health care--health care which was promised to them as a trust responsibility, but nonetheless inadequate health care.
I recently learned of a young boy named Nicholas from the Menominee Tribe of Wisconsin, who had a very rough start. He, like a high percentage of American Indian babies, was born premature--3 months premature. He weighed 21/2 pounds. For the first 3 months of his life, he struggled in intensive care to stay alive. As part of a significant effort by his family, his doctors at the IHS facility and traditional health care practices, he persevered. As a young man, he was forced to face another health care challenge: adult onset diabetes. While this type of diabetes usually strikes Americans in mid life, it is showing up now in American Indians and Alaska Native youth at an increasingly younger age. In fact, there is a 77-percent increase in diabetes in Native children and youth under 15 years of age.
Fortunately, this young man from the Menominee Tribe is receiving services from the tribal health facility and early screening at the tribal school, and has been able to control his blood sugar, which will prevent complications, one hopes.
David Whitetail, with the Three Affiliated Tribes in North Dakota, was not so fortunate. He was diagnosed with type II diabetes at 17. He didn't receive the necessary care, and now he is 39 years old and a dialysis patient awaiting a kidney transplant, but is finally, at long last, beginning to get the care he needs.
A couple of years back, a young woman--I guess she would like me to call her a young woman; she probably is a bit above a young woman in age--whose name is Lida Bearstail, went to the clinic in Mandaree, ND, because of knee pain. The cartilage had worn away and bone was rubbing against bone, causing her great, great pain. If that were to happen in this Chamber to any one of us or our families, we would, of course, get a knee transplant or get a new knee. But Mrs. Bearstail was denied this treatment because it was not deemed ``priority 1''--life or limb. If it is not life or limb, and you have run out of contract health money, you are out of luck. In fact, what happened to this woman, Ardel Hale Baker, is that she had chest pain that wouldn't end, and her blood pressure was very high, and so she was diagnosed at the IHS clinic as having a heart attack. She needed to be hospitalized immediately.
They stuck her in an ambulance and rushed her to a hospital off the reservation, but they didn't have any contract health care money left to pay for anything, so the Indian Health Service taped an envelope to this woman's leg with a piece of tape. She was hauled in on a gurney to the hospital with an envelope taped with masking tape to her thigh, and as they unloaded her in the emergency room, the folks who unloaded her took a look at what was taped to her leg. They opened it up and it said--and I have a chart, I believe, of what it said. It said this patient is not going to be covered because there is no contract health money available. What they were saying was this patient is having a heart attack. They were saying to the patient and to the hospital, if this patient is admitted, understand there is no money. There is no money here. So they admitted her, she survived, but it is kind of a tragic thing to tell a story about a woman who is hauled into a hospital with a piece of paper taped to her leg that says, by the way, if you admit this woman, you are on your own because Indian Health Service contract care is out of money.
I have had tribes tell me that contract health care was out of money after the first 3 months of the year. On one reservation they say: Don't get sick after June, because there is no contract health care money. If you are going to get sick, it has to be before June, otherwise this may happen to you. If you have a heart attack and go to a hospital, they might haul you in and there might be a note attached to your arm or leg that says, by the way, if you admit this patient, you might have some difficulty because there is no money available. This last woman, Ms. Baker, survived and then received a bill for $10,000. She doesn't have $10,000.
So what happens when they run out of contract health care, they warn the hospital you are on your own if you take them. Then when the patient is released from the hospital, their credit rating is ruined because they get a bill they can't pay. This is the result of our failure to meet our trust responsibility.
That is a long description of why we need to reauthorize the Indian Health Care Improvement Act. That Act will come to the floor in the next week or two, according to Senator Reid. We have written that bill in the Indian Affairs Committee. The vice chair of the Committee, Senator Murkowski from Alaska, and I, and many other members of the Committee have written a bill we think advances the interests of Indian health care. My colleague from Oklahoma, Senator Coburn, who is on the Indian Affairs Committee with us, is a valuable member and a constructive member. He is a doctor, and that is extraordinarily helpful in terms of his knowledge. He will make the point that we need much broader reform, and I will agree with him when we have this discussion.
We need much broader reform, and this is a step, a step in the right direction. Is it a step as broad as I would like to make? No. There is a reform step that is much broader that we need to take, and we will. And I will work for that when we move this bill, but at least we ought to move this legislation. I will work with Senator Coburn and others for much more substantial reform, but at least we need to start. This is since 2000, and 7 years later we need at least to move this legislation, but it has been 15 years since we last debated the issue of Indian health care on the floor of the Senate. So it is long past the time for us to do what we are required and have promised to do, and that is meet our responsibilities for health care for American Indians.
I want us to do this in a way that makes us proud. After all, it is our responsibility. We made this promise long ago, and we need to keep it. We are a good country and a good society. We spend a lot of time on the floor of the Senate talking about what doesn't work. There is a lot that works in this country. We are blessed to live here and blessed to be a part of this great place. But we continue as a country to always look to find out what we can do to fix things that are broken, to improve things that don't work quite as well as we would like. That is what we are trying to do with this issue of Indian health care.
I have described the failures. There are successes. There are folks working in Indian health care around the country who get up every day and work long hours and do a remarkable job. There are others who do not. I can tell you about a woman who has excruciating knee pain and goes to a doctor at the Indian Health Service, and she is told to wrap your knee in cabbage leaves for 4 days and it will be fine. It is unbelievable, but that sort of thing happens. I can tell you of other patients who go to an Indian Health Service doctor and get very good care. There are not enough resources. We need to respond, as we have done, to the issue of the cluster of teen suicides that exist on Indian reservations. There are so many things we need to do. Let me make the final point. These are the first Americans. These are not visitors. They were here first. Around the culture of Native Americans we have built quite a country. But Native Americans need to share in the great benefits bestowed upon the American people, and that includes opportunities for health care, opportunities for good jobs, opportunities for housing, and a decent education. We fall short in many of those areas.
We fall short in many of them. I have not spoken about education today or housing, but those issues themselves are pretty unbelievable when you take a look at the conditions on many American Indian reservations. I look forward, in the next week or two, to having an opportunity to debate the Indian Health Care Improvement Act. It is long past the time for us to do this. This will advance the interests of Indian health care, and then, in addition, we will not be completed. We will need to do reform, reform in a significant way beyond this bill. But this bill is an awfully good first start in the right direction.