I was wondering how the Indian reservations ran their free health care
programs paid for by us the taxpayers and found this.  Ignore it if you
want, but it's the cold stark disgusting truth about how the government
screws up every single program they get their hands on.

We have kept the Native Americans "reserved" and drunk for generations and
then given them health care that pales in comparison to that given to
federal prisoners. The alcoholism rates, drug abuse, obesity, diabetes,
heart disease rates in the native American populations are staggering–yet
they get the tylenol treatment. THIS is a national tragedy.

This is inevitable when you depend on the government for your healthcare, or
anything else, for that matter Sure as the sun rises in the east,
politicians are going to promise things they can't and, in most cases, have
no intention of delivering.

cookie
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Indian Health Care's Broken Promises
June 15, 2009
By Mary Clare Jalonick of the Associated Press

CROW AGENCY, Mont. (AP) — 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.

'Don't get Sick After June' a Sad Joke

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.

A 222-Year-Old Promise Is Not Being Kept

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.

Indian Health Care Statistics are Staggering
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.

Lack of Access to Medicare and Medicaid

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.

Forced To Make 'Life or Limb' Decisions

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.

Tylenol and Cough Syrup for Congestive Heart Failure

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."

A Note, Diminished Care, a Bill

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.

One Woman's Medicine Ran Out; So Did Her Life

"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.

Vacancy Rates Can Vary Widely by State, Specialty

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.

Little Girl's Death has Become a Cause

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.

http://www.reznetnews.org/article/indian-health-cares-broken-promises-35270




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