WASHINGTON - Shortly after Charles Grim, responding to the family needs of a large household in Oklahoma, unexpectedly withdrew as the prospective nominee to direct the IHS for at least another two years, speculation among IHS monitors in Washington was divided as to whether the George W. Bush administration would seek a longer-lasting influence by getting behind a new nominee to the four-year post; or, with plenty of issues already on its plate, avoid the time-consuming process by appointing an acting IHS director to serve out the president's term.
Indian country at large closed ranks around Grim to applaud his service. For instance, Brian Patterson, executive director of United South and Eastern Tribes and Bear Clan Representative of the Oneida Indian Nation of New York (which owns Four Directions Media, the parent company of Indian Country Today), said that despite any misgivings about Grim's experience with smaller tribes when he became the IHS director, the Oklahoma Cherokee had increased IHS resources for every Native person, from the oldest to the youngest. The executive director of the California Rural Indian Health Board, James Crouch, while keeping an advocate's eye on the distribution of resources, agreed that the IHS budget increased every year on Grim's watch, after years of flat appropriation levels.
The administration reacted almost as swiftly, elevating Robert McSwain as IHS acting director. McSwain, a citizen of the North Fork Rancheria of Mono Indians of California, is a widely experienced veteran of the IHS. He went to work there in 1976 after stints with Central Valley Indian Health in California, as well as with CRIHB in Crouch's current post. As IHS deputy director from early 2005, IHS stated on the occasion of his September appointment as acting director, McSwain contributed to the identification and definition of agency priorities, policies, strategic directions and budget justifications.
''Of course we love the current Acting Director Bob McSwain,'' Crouch wrote in an e-mail. As a Native Californian, he said in a separate interview, McSwain will understand the needs of contract health services-dependent regions within IHS, such as east of the Mississippi; Bemidji, Minn.; California and Portland, Ore.
Still, Crouch is sticking with his initial reaction: ''Maybe the time has come for the next nominee for the position of the IHS Director to be a woman.'' His choice is Dr. Kathleen Annette of the IHS Bemidji Area Office. The next nominee need not be a physician, ''but must be a good manager,'' he added.
With a steady hand like McSwain's at the helm for a year and some months, Crouch believes now is a good time to start thinking about an IHS transition at the tribal, organizational and political levels. The analysis at CRIHB, he said, is that IHS perspective has become ''increasingly focused on direct care,'' characterized by larger tribes, the result of a succession of directors drawn from the IHS Oklahoma and Southwest service areas. Smaller tribes that entered the IHS system through ''638 contracts'' (after Public Law 93-638, permitting tribes to assume IHS functions with federal funding), or Alaska Natives that came to it through self-governance structures, should get more of a resource emphasis than they have recently, he said. As an example, he pointed to the fiscal year 2008 budget justification for IHS, which calls for spending $1.2 billion on health care facilities in Indian country. ''Almost none of it in ... CHS-dependent areas,'' Crouch said.
In that context, he continued, the next nominated IHS director should focus on a global approach to equal resource improvement throughout the IHS system, working within Congress and the next presidential administration ''to greatly increase resources for distribution through the Indian Health Care Improvement Fund ... to implement resource equity across all components, all segments, of the health care delivery system.'' Large or small, tribally operated or IHS-operated health systems should benefit equally, Crouch said, because the IHS has an affirmative responsibility to distribute health services and resources equally. He said $1.4 billion is needed for that purpose, on top of the current approximately $4 billion congressionally enacted IHS budget.