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Cherokee gets Congressional nod for IHS post

WASHINGTON - The Senate has unanimously confirmed Charles Grim as director of the Indian Health Service.

The 20-year IHS veteran, a Cherokee tribal member and dentist by training, received plaudits on all sides, from Cherokee Nation of Oklahoma Chairman Chad Smith to Tommy Thompson, Secretary of the Department of Health and Human Services (DHHS).

Dr. Grim's tenure is sure to be momentous. He takes up his post at a time when the Indian Health Service is in transition, facing consolidation under Secretary Thompson's "One Department" initiative - that is, in future the IHS will lose some of its "Indian" profile and get folded instead into its parent department, DHHS, if Thompson gets his way. But the stated hope is that it will also gain access to the greater resources, including financial resources that are currently untapped by tribes, of DHHS.

Beyond that administrative challenge, health care is well into a transition from response to infectious disease to a pre-emptive emphasis on health promotion and disease prevention - phrases that have become a regular mantra of Grim's public appearances.

But in fact, the IHS will lack flexibility in moving to health promotion and disease prevention until the Indian Health Care Improvement Act is reauthorized by Congress. Since the last reauthorization expired, the IHS has functioned under continuing resolutions. But an agency that operates on a long-past reauthorization is confined by its provisions, meaning it may not respond well to "unauthorized" challenges, so to speak.

But perhaps one should minimize the alarmism at this point. Grim is greatly favored within the administration of President George W. Bush, who nominated him to the IHS post. And on domestic matters anyway, Bush has occasionally demonstrated a reasoned reluctance to move forward until the elements of success are in place.

With Dr. Grim's confirmation the IHS given its high efficiency ratings among all government agencies, is looking more and more as if the elements may be in place.

As IHS director, Grim will administer a nationwide multi-billion dollar health care delivery program comprised of 12 administrative areas, overseeing local hospitals and clinics, a work force of more than 15,000 employees, and a nationwide network of 49 hospitals, 269 health centers, 176 Alaska Native village clinics, and 133 health stations.

His previous experience has been centered in the IHS Oklahoma area office, the second-busiest in the IHS system.