5. 6. 7. needed diagnostic and treatment services presently not available. To treat surgical conditions. Patients with surgical problems To offer Renal Dialysis treatment. More than six renal To wait until FY 1981 to fund for housing would make it To assure that the people whom the hospital will serve will have the Services of the Comprehensive Health Care Facility available to them upon its completion, staff housing should be funded simultaneously with hospital construction; thus, staffing for the new facility would dovetail with the hospital project. This is why we are requesting that design, site planning, utilities provision and an initial 25 units of staff housing be built in FY 1980 and the remaining 248 houses be built in FY 1981. APPRECIATION We the members of the Chinle Hospital Steering Committee and the residents of the Chinle Service Unit area wish to express our sincere appreciation to the Committee for your past support and request your continued efforts to see that the appropriations for the completion of the Chinle Comprehensive Health Care Facility are included in the FY 1980 "add ons". This will then assure in-patient care for our people in Chinle. STATEMENT OF THE FORT BERTHOLD TRIBAL COUNCIL Ar. Chairman and committee members, my name is Austin Gillette, the Tribal Chairman of the Three Affiliated Tribes composed of the Hidatsa, Arikara, and Mandan tribes of the Fort Berthold Reservation located in north western North Dakota. In 1951, Currently the tribal enrolled membership of the Three Affiliated Tribes is 6,055. The Fort Berthold Reservation has a land base of 980,000 acres. 155,000 acres located in the center of the reservation were inundated by the Army Corps of Engineers to formthe Garrison Dam. As a result, reservation communities were geographically isolated from each other and from major market towns. In addition to geographic isolation the inundation of the fertile river bottom land caused the destruction of an agricultural economy among the Three Tribes. The relocation of the tribal membership following the building of the Garrison Dam contributed to the destruction of cohesiveness among community members, a breakdown of extended family relationships and dependence on a cash economy. As residents of rural communities the enrolled members of the Fort Berthold Reservation experience poor health care services from the Indian Health Services and contract care facilities. The inadequate service can be attributed to an insufficient budget which limits proper medical care and allows no provision for training of health care staff. is Currently, the Fort Berthold Indian Health Service Budget allocation so minimal that it allows for the coverage of emergency medical care rather than elective health care. Also budget increases have covered inflationary costs only. Therefore no allowance is provided for improving the health care delivery system in areas of greatest need such as alcoholism, mental health and tribal staff training. The training of our tribal employees who are in health programs is crucial to assure the development and improvement of our medical service delivery system. This becomes even more evident when the realities of the staffing available to us from the Indian Health Service, Aberdeen Area office is considered. We are aware that statistically the Indian Health Service, Aberdeen Area, has only 18 commissioned officers out of an employee total of 1,100, while the Phoenix area has a similar number of personnel but have 78 commissioned officers. Statistics indicate that the Aberdeen Area has significantly fewer Indian Health Service experienced professional staff than other areas of the same size. Nationally the focus of the Indian Health Service has been to assist Oklahoma and the southwest to meet their medical needs, therefore, bypassing the important medical needs of the Aberdeen area. At this point it is essential that funding be secured for a career mobility program to be developed through the Fort Berthold Community College located near New Town, North Dakota. The career mobility program would assist the Community Health Representatives and Alcoholism Program stapps. The Community Health Representative Program has been in existence for a number of years and they do receive training from the Indian Health Service, which does not provide for career mobility. The training program currently offered to the Community Health Representative's is not cost effective since it des require that staff training be obtained for short periods of time at training sites in Arizona and South Dakota. A local training program would benefit more staff and enable the Community Health Representative Program an opportunity to contribute to the development of a curriculum which will reflect reservation health needs. The training of the Community Health Representative's will enable better utilization of physician time, the early detection of health problems in the reservation communities and the continuation of health care at a quality level. On the Fort Berthold Reservation the major medical expenditure has been created by alcohol related accidents. Presently, there are no training programs for the Alcoholism Program staff and workshops that are held do not meet their needs. Therefore, it is extremely important that a Community Mental Health arts degree program be funded to meet their on-site training needs. associate os The Indian Health Service has a limited number of staff. The major portion of the Indian Health Service budget goes to contract health care and long-term care patients are sent to government health facilities in Washington, California, Colorado, and Texas. This process contributes to the breakdown of the patients' healing process since it eliminates family contact and support. Although there are two physician positions available for the Fort Berthold Reservation, they remain vacant. When the draft ended, it became more difficult for Indian Health Service to place physicians in rural areas. Although there are clinic days set for the communities when a physician is to be present, this has been sporatic because of the limited physician time. Two Public Health Nurses now make weekly visits into the outlying communities, and a Physician's Assistant is to be placed at Twin Buttes. Because of the problem in getting physicians in rural areas, the Three Affiliated Tribes must look to finding alternatives in meeting rural health needs. We are proposing the addition of physician extender staff for two of the outlying communities White Shield and Mandaree and are requesting the establishment of two Nurse Practioner positions and two clerks for the clinics. The addition of field staff will create more work for the Minne Tone Clinic staff, and to assist we request an addition of a Contract Health Services Clerk position and medical supplies. The proposed additions of staff to Indian Health Service unit at Fort Berthold will more adequately meet the health needs of the outlying communities on the Fort Berthold Reservation to provide services in the communities. The Three Affiliated Tribes proposes to explore during the next year the mental hearth needs of the Fort Berthold Reservation population and indentify areas on which work can begin. Consultation is needed in dealing with mental health problems from specialists knowledgeable on needs of children, and adults, drug and alcohol problems, self-concept/self image, the realities of the lack Of employment on the Fort Berthold Reservation to work toward community based services and activities to deal with these problems. The Tribal Business Council has requested a recreation therapist position to be established by the Indian Health Service, and there is currently a Psychiatric Social Worker on the staff of Indian Health Service. With these Indian Health Service staff and tribal community Health Representative, Alcoholism Program, and Child Welfare, law and order and tribal court staffs, the team approach will be used with the assistance of mental health specialists to develop methods of dealing with the mental health problems such as one-car accidents, alcoholism, the growing problems of child neglect, unemployment and identification of program budget needs. The Three Affiliated Tribes requests diagnostic services of a consulting psychiatrist to work with children, teachers, parent groups, as well as the tribal Alcoholism Program and Child Welfare program staffs. A psychiatrist would best meet the needs because of the medical and mental health back ground. The communities on the Fort Berthold Reservation are isolated. Public housing is built in clusters and has created problems for families accustomed to living in the country and leaves considerable idle time for children. The Three Affiliated Tribes is in need of funding for a master plan, design and development study for a Hospital, a detoxification and rehabilitation center, and an extended care facility. The need for funding approval is imperative since it will assist us in planning for a health facility that will meet our needs. Reservation residents in need of hospitalization travel long distances in severe weather to obtain treatment. Patients are transported to rehabilitation centers located two to four hundred miles away. They return to an unchanged environment which encourages negative progress. An alcoholism treatment center located on the reservation would contribute greatly to patient sobriety. The Three Affiliated Tribes requests a waiver of regulations to implement a pilot project of medicare premium payment by Indian Health Service. Although Medicare has been available to the Indian elderly, few participate in the program because of cost. With limited income and demands in their income, it is difficult to pay quarterly premiums. The elderly then become victims of the Indian Health Service contract services when funds are depleted each Spring and their illness must be timed to coincide with Indian Health Service funding. Although emergency cases may be cared for, the time lapse becomes critical. With the passage of recent legislation, it is now possible for Indian Health Service to receive Medicare payments; however, this will be limited because of the few elderly who take part in Medicare. The Tribal Business Council has gone on record to request payment of the premiums for Medicare by Indian Health Service (see attached resolution no. 79-37), for the elderly on the Fort Berthold Reservation. This payment would provide for better health care for the elderly, making possible a choice of physician and hospital care, and a sa savings in contract health care payments. There are approximately 134 members of the Three Affiliated Tribes over age 65. The premiums for Medicare are approximately $50 per quarter (134 x $200 per year $26,800). A long illness of several elderly would exceed the Medicare premium payment for the total number of enrolled members over age 65. = STATEMENT OF THE CITY OF MESA, ARIZ. Good morning Mr. Chairman, members of the subcommittee....I'm J. LaMar Shelley, City Attorney, City of Mesa, I greatly appreciate the chance to speak before you today regarding the City of Mesa's feelings on Public Law 95-399. Although this bill was passed, the Department of Interior, Bureau of Indian Affairs did not request the funding necessary to carry out the specifics of the new law. Therefore, we request that this subcommittee recommend to the Department of Interior, Bureau of Indian Affairs an appropriation in the sum of $3,916,260 pursuant to the authorization of Public Law 95-399. The passage of this law by Congress was, we feel, a satisfactory resolution to a long-standing boundary dispute between the Salt River Pima-Maricopa Indian Tribe, the City of Mesa and some private parties. Because of the conflict of claims between the above parties, all of which are based on governmental documents and actions, it was decided that the fairest and most appropriate resolution of this matter would be to establish a boundary which would be fixed from the date of the legislation forward, and to then compensate the interested parties for the properties they would be losing. After many months of negotiation and work with Congressman John J. Rhodes' office, we arrived at House Bill 12344. Senate Bill 3002, an identical bill, was introduced by Senator Goldwater. The bills were enacted as Public Law 95-399. According to the terms and provision of the law, the south boundary of the Salt River Pima-Maricopa reservation is established as a non-ambulatory line which will in many areas assume the location established by a Bureau of Land Management survey in 1972. In other areas it will exclude the private properties and City property which have been held for many years. In those areas where the boundary will assume the location established in 1972 by the Bureau of Land Management, the City of Mesa and private parties which will be losing land will be compensated; in those areas where the boundary will exclude lands lying north of the 1972 BLM boundary, the Indian community will be compensated. This arrangement and agreement is the result of negotiation among all the involved parties, and is supported by those parties as a necessary action to reach a satisfactory conclusion in this matter. Under provisions of Public Law 95-399, the U.S. government will reimburse the City and the Indians for their lost property, at the rate of $18,000 an acre (Price determined by computing the potential value of unmined sand and gravel on the lands in question). City of Mesa would get $1,490,760; other private parties agreeing to give up land would receive and additional $460,980, bringing public/ private compensation to a total of $1,951,740 for 108.43 acres. Indians would give the City of Mesa 60 acres, and would vacate claim to an additional 49.14 acres, for a total of 109.14 acres for which they would be compensated $1,964,520 by the U.S. government. This law also states that pending its passage by the Congress of the United States, the Indians would drop all further litigation against the City and private parties, as would the City. Adding $3,916,260 to the Department of Interior, Bureau of Indian Affairs appropriation request for Fiscal Year 1979-1980 will once and for all settle this dispute. As mentioned, all parties feel that it is equitable. I personally believe that this agreement marks the start of a new relationship which in the future will produce tangible and intangible benefits for the Indians, the City of Mesa and all others involved here. Mr. Chairman and members of the subcommittee, I again want you to know I appreciate this opportunity to be here and talk with you on this subject. I respectfully request that you consider adding the necessary appropriation pursuant to Public Law 95-399. Thank you very much. |