An Ailing System
Health Care for urban Native Americans hits a crisis point. A unified group forms to seek a cure.
Greg Pohuma woke from receiving a kidney transplant in 2005 and discovered a problem. Though he had been told the medications ensuring his body wouldn't reject his new kidneys would be paid for by Indian Health Services, he found IHS wouldn't be able to cover the cost, he says. "The day I was getting out, they told me they weren't going to give it to me, because I wasn't from one of the area tribes here closer to Albuquerque. I was denied the transplant drugs for my kidney, which would have meant that I would have to go back on dialysis or lose the kidney."
Pohuma's tribe is Taos Pueblo, but he's lived in Albuquerque for close to 25 years. He's been using Indian Health Services (IHS) in Albuquerque since he was a child.
In 2005, IHS experienced huge budget shortfalls and closed its urgent health services at the end of that year. "That created a crisis in the delivery system because all of these people really had nowhere to go," says Roxane Spruce Bly, coordinator for the Native Health Care Council of New Mexico. "The issue is that if you're Native American, and you live off the reservation, it's increasingly difficult to access health care services."
Until the 2008 Legislative Session, a unified group didn't exist to represent urban Native Americans. A bill passed and was signed by the governor that would create a nine-member commission to represent urban-dwellers in Bernalillo County seeking health care. The goals of the commission are to make recommendations to state legislators, provide leadership and analyze the population. Bly says the U.S. Census significantly undercounts the Native American population.
Albuquerque ranks among the five cities with the largest percentage of urban Native American populations, according to a 2006 health summary. There are 46,833 Native Americans in the city, who make up 10.5 percent of the total population. That's according to census numbers. When Keith Franklin and Norman Ration had IHS pull up the patient list for the last three years, they found a total more like 51,818. "That's a lot of Indians," Franklin says. Franklin is the president of the Albuquerque Metro Native American Coalition, and Ration is the executive director of the National Indian Youth Council.
Ration and Franklin have been working on the health care issue for more than 10 years. A lack of unity among urban organizations often caused problems when talking with state or tribal governments, Ration says. "They would always ask us, Who elected you? Who's your president? They talk government to government to government. They have meetings that way. We don't have a representative." The off-reservation Native American population is often viewed as fractured, scattered, he says.
This is a federally funded hospital. But they still didn't see the facts that they're denying one of the people that their hospital was set up to serve.
Greg Pohuma, kidney-transplant patient
The first step, says Bly, is to figure out how the new commission will function. An interim working group made up of nonprofit members and stakeholders is making a plan so the commission will be ready to get to work on July 1, when the legislation takes effect. "We have to recognize, this is the first small step toward the future," says Bly. "We're not going to see change overnight. But the legislation itself is historical. We've never been able to mobilize and establish this level of cohesion."
After much haggling, Pohuma got his medication paid for. For the first month or so, he had to cover the cost out-of-pocket, about $600 or $700. "There are a lot of pills that you have to take," he says. "I had security or APD threatened to be called on me, because I was telling them, I'm a tribal member. This is a federally funded hospital," he says. "But they still didn't see the facts that they're denying one of the people that their hospital was set up to serve."
Why should Native Americans expect free health care? Health care to Native American people is the first pre-paid health insurance policy, says Bly, and health care services were guaranteed through the relinquishment of tribal land. "In exchange for millions and millions and millions of acres, the federal government obligated itself to provide health care services, education, housing—all kinds of social programs to Native Americans."
UNM Hospital was built with federal government money on tribal land and was originally called the Bernalillo County Indian Hospital. "It was a joint partnership between the county and the federal government to provide health care for Native American people," Bly says. Next door to UNMH is what was once called the "Old Indian Hospital," Bly adds, but that's a misnomer. In the '30s, it was a tuberculosis sanatorium. Later, it became known as the Albuquerque Indian Health Center.
Part of the lease agreement established in 1952 that allows UNMH to use that tribal land requires 100 beds for Native Americans. It also requires "perpetual general hospital care and medical, surgical and obstetrical care and treatment of the highest medical standard for Indians," according to a document assembled by the Community Affairs Advisory Council on Native American Health Services by UNMH. Ration, Franklin and Bly say UNMH is not in compliance with that contract. Ration and Franklin say the issue may have never come up before, because IHS was able to fill the need. "That's the question that needs to be asked," Franklin says. "Why since 1952 did the county commissioners not push the issue?"
When the urgent care closure happened at IHS, says Bly, Native Americans were told they would be able to go to UNM Hospital. But it was discovered that the contract had been altered over the years, and it wasn't clear-cut whether people would get free health care at the hospital, she says. "In the following months, people began to go home to the reservation for care," Bly adds. "There weren't urgent care services in Albuquerque any longer."
Maria Rickert, CEO of Indian Health Services, says in 2005 tribes chose to take some of the money IHS runs on, "their share of the pie, so to speak," she says. "We were left with less than half the pie to continue services for the same population." Rickert was forced to lose 65 members of her staff. "We're still trying to meet the demand, but that's very difficult."
Rickert says it isn't feasible for UNMH to provide 100 beds for Native Americans, and that's why the IHS Commission allowed a waiver in the contract. "It's not realistic anymore," Rickert says. "You don't have enough nurses right now to even staff the beds that they have, never mind 100 that are reserved for Native Americans."
There is simply no money in Indian Health Services, says Bly, and it leaves a lot of people vulnerable. "Sometimes people accuse us of being overly dramatic, but there is no doubt in my mind that there are people that die because of the lack of funding and their inability to access care and resources."
See next week’s Alibi for Part II