Senators find health care funding inadequate, call for changes

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CROW AGENCY, Mont. - From their comments at a recent Senate Committee on Indian Affairs field hearing on health care, it would appear that at least two of the committee's senators have run out of patience with excuses for failure in the Indian health care system.

Sens. Byron Dorgan, D-N.D., and Jon Tester, D-Mont., unleashed their collective frustrations on the IHS director of medical services, Dr. Charles North, and any other IHS official in the room, claiming they were not doing enough to ensure adequate health care for Indian country.

''This is not an option; it's a trust responsibility, we need to own up to our responsibility,'' Dorgan said.

The senators were told that the IHS is funded at 60 percent of what should be adequate. Funding for the Crow Nation, host of the field hearing, is at 50 percent, according to Pete Conway, director of the Billings Area Office of the IHS.

''We are $4.8 million in the red in this region and there are 28 positions not filled in this [Crow] hospital,'' Tester said.

Dorgan said when most Americans are ill, they can go to a doctor. In Indian country, he said, people are asked to wait.

''Nobody in this system wants to come to the public and tell it like it is; we are not where we need to be,'' Dorgan said.

''I have heard Native Americans say they have run out of contract dollars in January and former Chairman Tex Hall [of the Mandan, Hidatsa and Arikara Nation] used to say everybody understood - don't get sick after June because there is no contract health care.

''If that's the case, is it a fact then that we are rationing health care to Native Americans?'' Dorgan asked.

North responded by saying that IHS was the payer of last resort when it comes to referrals. All other alternative resources, such as Medicare, Medicaid, workers compensation, private insurance, Veterans Administration and other programs must be dispersed.

''We are not the only care out there for Native Americans; there are other options,'' he said.

Dorgan acknowledged that other payers were in place, but he said the IHS, represented by the federal government, is responsible.

''We have these hearings in Washington, D.C., and elsewhere and what we always hear are that we are doing pretty good, or we are doing the best we can; we've made a couple percentage improvements here or there.

''Dr. Charles Grim [director of the IHS] has admitted to me a couple of times that the amount of health care that is required for American Indians is being funded at 60 percent. That leaves 40 percent of the health care that is needed is not available; that means there is rationing of health care.

''I think it ought to be on the front page of every newspaper because I think it is scandalous,'' he said.

''Isn't it a fact that you have to tell somebody, and they may be pretty sick but it's not about life or limb, and you have to tell them they will have to wait, that we are sorry about the pain but you will have to wait?'' Dorgan said.

North said they had to live with the reality of medical care every day.

''I have been in direct health care for 30 years with the Indian Health Service and I understand exactly what you are saying. We struggle to find the best resources for our patients, the best referral sources and the best methods to diagnose, treat and cure,'' North said

When asked if he was frustrated, North responded by saying, ''I find the struggle to be a good struggle and one worth fighting.''

Dr. Joseph Erpelding, an orthopedic surgeon from Billings, Mont., said he was frustrated because access to care is limited to referral service when patients have to wait anywhere from two weeks to a year in a clinic.

''I've had a patient wait for six years,'' Erpelding said.

He said he had scheduled a patient for surgery during the week of Crow Fair, when most Crow members attended for cultural reasons.

''I shouldn't be offering surgery on a week that is very important to this nation,'' he said to applause.

That person had waited 13 months for surgery.