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Some health clinics deny care to urban Indians

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By Garance Burke -- Associated Press

FRESNO, Calif. (AP) - After tribal elder Vera Quiroga was turned away from the very clinic she helped found, she had little choice but to drive to a far-off reservation for her dental work.

The reason, she said, is that the BIA doesn't recognize her as a Yaqui, even though her children and grandchildren have tribal documentation.

''They said if you don't have federal paperwork, you can't get service anymore,'' said Quiroga, 82.

While federal law requires taxpayer-funded tribal clinics to serve all patients of Indian ancestry, some have recently stopped admitting those who can't document their federal tribal status, patients and clinic officials told The Associated Press.

Federal officials deny that qualified patients are being turned away and say they're doing all they can to ensure a health program for urban Indians isn't shut down entirely. The IHS oversees 33 clinics nationwide that provide free or discounted medical services to city-dwelling Indians.

But Martin Young, chairman of the board of the Santa Barbara clinic where Quiroga was turned away, said it received a letter last fall from the BIA instructing it to stop offering free health services to patients from unrecognized tribes or who don't have a bureau identification card.

It has since turned away about 200 patients, including Janet Darlene Garcia, 50, a member of the Coastal Band of the Chumash Nation, which does not have federal status. She relied on the clinic for her diabetes counseling sessions.

An IHS spokesman said the letter explained who was eligible for care, but denied that the agency instructed Santa Barbara to withhold services. However, clinic managers in Tucson, Ariz.; Wichita, Kan.; and Boston reported getting similar directives.

''IHS is suddenly saying that you can't serve this Indian even though he looks Indian, and his family says he's Indian and has all of this history of being Indian, but he doesn't have this piece of paper,'' said Susette Schwartz, director of the Hunter Health Clinic in Wichita. ''We need some consistency.''

Under the Indian Health Care Improvement Act of 1976, Congress funds health care programs for members of tribes recognized by states or the federal government, as well as their descendants. Many states recognize tribes the federal government does not.

In California, the right to government-supported medical care is extended a step further, to those whose ancestors lived here in 1852 and are ''regarded as an Indian by the community.''

Phyllis Wolfe, who oversees urban Indian programs at the U.S. Department of Health and Human Services, said clinics that are granted federal dollars must follow federal guidelines.

Wolfe could not explain why the clinics would have changed their policies. ''I don't believe they would do that, but I can't say that that's not been done,'' she said.

Sen. Byron Dorgan, D-N.D., chairman of the Senate Committee on Indian Affairs, said tribal members who lack federal documentation should still be treated at urban clinics. The committee held a hearing March 8 on amending the IHCIA, and Dorgan said afterward the law doesn't need to be changed to ensure care for patients like Garcia and Quiroga.

''We shouldn't be having people turned away from these health clinics because they don't have a piece of paper,'' said Dorgan, who also has heard reports of patients being denied care because they lacked proper paperwork.

''I'm very frustrated with what's going on,'' he said. ''This is a matter of life or death for American Indians, particularly children and the elderly.''

But a Justice Department official told the committee there could be constitutional concerns about providing health benefits to people who are not members of federally recognized tribes.

''Under the Supreme Court's decisions, there is a substantial likelihood that legislation providing special benefits based on something other than membership or equivalent affiliation with a federally recognized tribe might be regarded by the courts as a racial classification subject to strict constitutional scrutiny,'' said Deputy Assistant Attorney General C. Frederick Beckner III.

Beckner didn't discuss whether clinics currently are being instructed to not help people who don't belong to federally recognized tribes. He said after the hearing that he knows nothing about that.

Nationwide, more than 60 percent of American Indians and Alaska Natives live in urban areas, according to the U.S. Census. For the poorest of them, the clinics are a lifeline, a place to get diabetes treatment or alcohol counseling delivered by doctors well-versed in Native culture.

The urban clinics are managed by local contractors with funding from IHS. President Bush's 2008 budget proposal would eliminate the program's $32.7 million annual allocation altogether.

Under the circumstances, federal officials said the cash-strapped clinics are doing everything they can to care for all patients in need.

''We recognize that the urban Indian population is in need of care and we don't want to disenfranchise any Native Americans who are living in urban areas,'' said Paul Redeagle, deputy director of the IHS office in Sacramento. ''We're currently working with the urban programs in California to resolve their problems.''

Redeagle said his office had looked into questions about the management of the Santa Barbara clinic and had found no proof of wrongdoing.

That's no consolation to Quiroga, who helped start the clinic in the 1970s. She said her already limited finances are taxed by regular 40-mile trips to the tribal lands of the Santa Ynez Band of Mission Indians.

In Boston, workers at the North American Indian Center said they were told not to treat the Mashpee Wampanoag of Cape Cod, whose ancestors shared Thanksgiving dinner with the Pilgrims. But they were allowed to keep offering free health services to the tribe's members after they read the text of the 1976 law to their federal funders.

''We actually got requests from IHS to deny service to the Mashpees,'' said Barbara Namias, who oversees community health programs at the Boston clinic. ''We had to refer them back to the legislation.''

But Lisa Flores, an environmental planner and documented Pascua Yaqui member who attended diabetes counseling classes at a now-defunct Fresno clinic, has given up on getting Native-focused care in her area.

''From a tribal perspective, we're all supposed to take care of each other,'' she said. ''Now that they closed it, the question then becomes: Are you unworthy of health care?''