is now under control, but we believe that the Choctaw people deserve to have a water supply that meets minimum environmental health standards. The quality of services at the Choctaw Health Center have improved significantly in the last 10 years. During this time period the Choctaw Tribal Government has become increasingly involved in formulating local Indian Health Service policies. Currently, the Health Committee of the Choctaw Tribal Council is completing the Tribal Specific Health Plan and the strategy for tribal control of all health services. When these are implemented, the tribe will have resumed the responsibility and will have the means to provide health services to all its people. These tribal efforts to design the mechanism for tribal control have been possible through grants from P.L. 93-638, the Indian Self-Determination Act. It is difficult to believe that the continued funding of these grants is in jeopardy when they have proven invaluable to Tribal Governments attempting to maintain their independence from the Indian Health Service and attempting to exert local control of health services. We are requesting an allocation in Fiscal Year 1980 of $150,000. The Indian Self-Determination Act, a remarkable piece of lesgislation, must continue, assuring our Tribal Government of the financial base to allow the tribe to continue the progress it has made up to now. The last concern of the Choctaw Tribe is the obligations imposed on us by the recently enacted Indian Child Welfare Act. This remarkable piece of legislation will allow the Choctaws to control the destiny of children who are left homeless. However, it will place tremendous burdens, financial and administrative, on tribal courts, social workers, and legal staff. The Choctaw estimate that our tribe will need approximately $350,000 to make this legislation a reality for our people. Mr. Chairman and members of this committee, I appreciate the opportunity to appear before this committee and to provide this committee with information on the needs of our people. Thank you very much. ARNOLD HEADLEY, JOINT BUSINESS COUNCIL OF WIND RIVER INDIAN RESERVATION, WYOMING Senator DECONCINI. We are happy to have Senator Wallop take the time to come down here and it leaves us with an idea of how important this is. Senator WALLOP. I will be as brief as possible in the interest of giving the next two witnesses the time they need to explain the priorities which they have. It is with considerable pleasure that I introduce to you my friends, Ben Snyder and Arnold Headley, members of the Joint Business Council of the Shoshone Arapahoe Tribes of the Wind River Indian Reservation in Wyoming. They will be testifying before the committee on the real and human needs of dental health care and contract health care on the reservation. These needs are something that has to be seen to be believed, and I don't believe that their requests are exorbitant or out of line. I will turn it over to Ben Snyder. Mr. SNYDER. We have two problems on the reservation. One is in dental care and the other is in contract health care. The dental is provided by the IHS clinics. The facility is now being expanded to a five-chair clinic, but we do not have enough staff. Last year we only met 21 percent of the total need in dental. So we are asking for one more dentist, one receptionist, three dental assistants, and supplies for them to be used. The cost would be $71,600. And the contract held, we have IHS outpatient clinics on the reservation. We have no hospitals. We must buy all of our hospital care from outside the reservation in the local areas. We depend on contract budgets for all hospital care. Hospital rates are going up. We are chronically short of dollars for hospital care. Last year, we ran out of money before the year was over, even though you gave us a $240,000 supplemental last year. This year there will even be less hospital care because hospital rates are going up. We need a total of $1,407,300, more than the IHS budget for the Wind River contract health care in fiscal year 1980. This River contract will also help the local economy in the area because it will go mostly to the local hospital for the care of the Indian people. In summarizing, we are asking Congress for $1,478,900 over and above the fiscal year 1980 budget for dental and contract health on the Wind River Reservation in Wyoming. Thank you. Senator DECONCINI. Thank you. Does Mr. Headley have any testimony? Mr. HEADLEY. NO. Senator DECONCINI. What was your contract health care last year, including the supplement? Mr. SNYDER. $1.8 million, I believe. Senator DECONCINI. $1.8 million? Mr. SNYDER. Yes. That was in the IHS budget. Senator DECONCINI. That was for 1979. And then you got a supplemental? Mr. SNYDER. $240,000, yes. Senator DECONCINI. That is a little over $2 million. Mr. SNYDER. Right. Senator DECONCINI. What is the major reason for the substantial increase in need for health care? Just hospital cost? Mr. SNYDER. It is hospital cost. This is mostly what we are out for is the hospital cost. It is in the local area in the two hospitals that we generally use. Senator DECONCINI. What have those cost increases been? Mr. SNYDER. We had a contract with the hospitals in that area. And last February, the contract ran out and our costs were running right at $250 per day. Senator DECONCINI. That is up from what? Do you know? [The statement follows:] STATEMENT OF BEN SNYDER Honorable Chairman and distinguished members of the committee, I a am Ben Snyder, member of the Shoshone Business Council, representing the Joint Business Council of the Shoshone and Arapahoe Tribes, Wind River Indian Reservation, Wyoming. With me is Mr. Arnold Headley, Chairman, Arapahoe Business Council. Mr. Chairman, in the interest of time, I will limit my testimony to the highlights of our unmet health needs. I do request that my testimony and written supplement be entered into the record. The Shoshone and Arapahoe Tribes in Wyoming thank the Congress of the United States for your previous support concerning renovation and staffing of our outpatient clinics, and for last year's additional Contract Health funds. We sincerely appreciate the assistance of Congress in helping raise the level of health care provided to our people. However, we continue to be faced with the problems of limited availability of dental care and of Contract Health Care because of inadequate health resources. Therefore, this testimony is a request for Congress to consider authorizing resources to the Indian Health Service for the purpose of expanding Contract Health Services and dental care available to the Shoshone and Arapahoe people living in Wyoming. On the Wind River Reservation in Wyoming, the Indian Health Service provides outpatient medical and dental services and field health services such as community health nursing, mental health, social services, health education, and environmental health services. These outpatient health services meet many of our health needs; but, we are not so fortunate with the Contract Health Services program. Contract Health Services includes all inpatient hospital care, specialty physician care and related services. All of these services must be purchased through contractual provid ers. Our two basic problem areas involve direct dental care and Contact Health Care: Direct dental care. The Fort Washakie Outpatient Health Center dental staff consists of one dental officer and two dental auxiliaries. In fiscal year 1978, they were able to meet only 21 percent of the actual needs of the residents of the Wind River Indian Reservation. Inasmuch as our present dental facility is being expanded, we need the following additional staff: one dentist, one dental receptionist and three dental auxilliaries. These additional staff are needed in order to insure maximum utilization of the five-chair dental clinic and at the same time upgrade and expand dental services available to our people. The additional funds needed to improve dental care total $71,600. Contract health care. Since we must purchase all of our contract health care, the availability of inpatient hospital care and specialty physician services are dependent upon the amount of Contract Health funds allocated to the Wind River Service Unit. This underfunded program is our biggest problem area. We simply do not have enough contract dollars available to meet our health care needs. For fiscal year 1980, we compute our deficit in Contract Health Care to be $1,407,300. In conclusion, Mr. Chairman, we respectfully ask the Congress of the United States to authorize an appropriation of $1,478,900, over and above the amount proposed by Indian Health Service for the Wind River Reservation for fiscal year 1980. These additional funds will enable Indian Health Service to provide for expanding Contract Health Care and dental needs of our people. The dollar amount requested is consistent with the recommended health care levels contained in the Indian Health Service Resource Allocation Criteria. We thank you for your time and your consideration. Senator DECONCINI. Our next witnesses will be Timm Williams, Dennis Hendricks, Margo Kerrigan, California Rural Indian Health Board. CALIFORNIA RURAL INDIAN HEALTH Board STATEMENTS OF: TIMM WILLIAMS, BARBARA KARSHMER, DENNIS HENDRICKS, MARGO KERRIGAN, DARRELL HOSTLER Senator DECONCINI. Mr. Williams, if you would introduce those who are with you, we will enter the statement into the record and then say what you want to say in addition. Mr. WILLIAMS. Thank you, Senator. My name is Timm Williams. I am the chairman of the California Rural Indian Health Board. To my right is Barbara Karshmer, legal counsel. To her right is Dennis Hendricks, the vice chairman to the Board. And to his right is Margo Kerrigan, the health planner for the California Rural Indian Health Board. And Darrell Hostler to her right, who is legislative committee chairman. I would like to start and then defer some of the time to the rest of the delegation. I would like to start by refreshing the Senator's memory in regard to the California Rural Indian Health Board, which was organized about 10 years ago. Ten years ago, the Indians in California, I think under the laws of 638 and 437 that were recently passed, the California Rural Indian Health Board organized by nine major tribal organizations in California or nine major reservations in California, were the first to develop a unique model-type health care delivery system to our Indians. We now are looking at a problem area that we are confronted with because we have been under contract for 10 years of delivering services and dealing with what 638 and 437 are pressing upon the tribes. It is found that in the history of the development of our organization that we are being bypassed through-and that will be brought out in further testimony from the rest of the delegatesbut we are being bypassed in the request for funds to continue the development of our programs of the self-determined rate of our people and its development. And we feel in this instance that we are historically being held back until others catch up to where we are in the system. And we realize that the other probable thing you will find in our testimony is that we are in dire need of funds to continue our program at the development rate at which we are developing in order to reach those that we wish to reach as we grow as a selfdetermined group. The California Rural Indian Health Board presently services the people within its project contract areas and reaches all of those Indians within that group that are tribes and Indian people out in the rural and reservation communities of the State of California. And our project is statewide. Our program is statewide and the delivery system is statewide. We are, of course, naturally very proud of the development of what we as Indians have developed. The other thing I would like to just say as a reference point is that the 15 projects in which we deliver health care services, the facilities within those projects are not Indian health service facilities. They are facilities which the Indians in those communities developed on their own by obtaining buildings and renovating those buildings into medical health care delivery systems. In some instances, some of the groups built their own with community support from the lumber companies and the private industries in that area who donated to the cause and helped us to build our clinic. So we feel also unique in that situation that we are one of the few Indian groups that I think in the Nation, own our own facilities and deliver health care services through our own facilities without the cost of tax dollars coming either from the State or the Federal Government. I would like to defer the rest of the testimony to Dennis Hendricks, vice chairman. Mr. HENDRICKS. Thank you. Mr. Chairman, what we are here for is we would like for this subcommittee to appropriate $5.5 million for fiscal year 1980. And this year we would hope would come through the existing health delivery care systems in California for facility improvement. And I would like to now defer to Margo Kerrigan, the planner. Ms. KERRIGAN. Mr. Chairman, at the present time, the budget that we are operating on in California is $2.2 million. Over the past 10 years, we have seen a growing need to expand on our existing services, to add new services, and to improve the facilities in which these services are delivered. We are faced with a new problem this year with the advent of the new Fort MacArthur service unit in the San Pedro area, which will be an IHS facility, a Government-run facility with a potential of duplicating services that are already being provided by CRIHB programs. We do not feel that new money coming into California for the purpose of IHS facilities is in the best interest of cost efficiency and that it duplicates the existing health system network that CRIHB has worked so long and hard to develop. Additionally, we feel that the structure of our CRIHB programs is unique. We feel that it serves as a model health delivery system that other Indian health programs might look to as we are a health system that is Indian self-determination in practice. Our board is made up of 30 members representing the 15 world health programs in remote areas scattered throughout California. Appended to the testimony are a number of charts and tables that demonstrate what our programs do and who we are. We would appreciate your attention to them at some point in time. The goal of our program is to continue to promote health services in California as provided by the local health programs. We would hope that your committee would give us the attention that we are asking in this testimony. Additionally, in January of 1979, in a Federal district court in northern California, in the suit, the Rincon Band of Mission Indians v. Joseph A. Califano, it was held that the present allocation of Indian Health Service funds in California is constitutionally inadequate and it discriminates against California Indians by not providing them with their fair share of Indian resources. We see the possibility of increased funding coming into California for Indian Health Services. If this is the case, we would ask that attention be given to the existing Indian health programs that are members of the CRIHB network. And we feel that this recommendation is in the best interest of not only preserving the Indian health programs, but additionally, hoping to reduce the high cost of Indian health care in California by not setting up a new governmental health delivery system. At this time, our panel would be happy to answer any questions that you might direct to us. Senator DECONCINI. What is the nature of the lawsuit? Has the decision been decided in the district court? Ms. KERRIGAN. Yes, this is correct. We have as a member of our panel Barbara Karshmer, the legal counsel, who will provide you with that information. Ms. KARSHMER. The lawsuit was filed back about 5 years ago to remedy the situation in California, as much as California has 10 percent of IHS service population but has never received more than 1 percent of IHS's fundings for health services. And the lawsuit went into the issues of allocation of funds and generally, the duties of the Government to provide services. And the court found that the Indian Health Service should be providing comparable levels of services in California to that that is provided elsewhere in the United States. And found that the California Indians' constitutional rights to equal protection under the laws had been violated by the Indian Health Service. |