ALASKA NATIVES COMMISSION
JOINT FEDERAL-STATE COMMISSION
ON
POLICIES AND PROGRAMS AFFECTING
ALASKA NATIVES
4000 Old Seward Highway, Suite 100
Anchorage,
Alaska 99503
TABLE OF CONTENTS
Witness List | Exhibit
List
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Deposition
Exhibit #8 - Testimony of Mim Dixon
TESTIMONY TO THE ALASKA NATIVES COMMISSION
Presented
by Mim Dixon, Health Center Director, Chief Andrew Isaac Health
Center, 1638 Cowles St, Fairbanks, Alaska 99701, on July 18,
1992.
I appreciate the efforts of the Commission to gather
data from many sources to look at the status of Alaska Natives
and
to make
recommendations about how federal programs can be improved to
serve people in our region. Currently, Tanana Chiefs Conference,
Inc., (TCC) is undergoing a health planning process to develop
a health plan to the year 2000. We are looking at many of the
Year 2000 objectives for the nation that have been developed
by the U.S. Department of Health & Social Services and the
Indian Health Service (IHS). We are also looking at other sources
of information which the Commission is probably reviewing as
well. At the present time, we don't have many accurate, current
facts and figures to offer about morbidity and mortality among
Alaska Native people in Interior Alaska. What I would like to
offer instead is a summary of issues, needs and recommendations
identified by patients, staff, the TCC Health Board, and the
TCC Board of Directors. While these are admittedly impressions,
they nevertheless merit further attention from the Commission.
Cancer Prevention, Detection & Treatment. Often
we are so focused on treating emergencies, trauma, and other
urgent needs
that there simply are not enough resources to do the necessary
work of cancer prevention and detection. Once cancer has been
diagnosed/ the patients in our region do get very good treatment.
At issue is the availability of prevention and detection services.
Specifically the IHS beneficiaries in our region need more access
to sigmoidoscopy for detection of colon cancer and culposcopy
for detection and prevention of cervical cancer. At the present
time Chief Andrew Isaac Health Center cannot schedule more than
1 sigmoidoscopy per day because of limitations in space, equipment,
and staff. This means that the maximum number of sigmoidos-copies
we can offer in a year is 250. The National Foundation for Cancer
Research recommends that after age 50 adults receive sigmoidoscopy
every 3 to 5 years and after age 60 they receive it every year.
We have nearly 1000 patients over the age of 60, so less than
one-fourth can be served with our current limited resources.
With regard to prevention and detection of breast
cancer and cervical cancer, we do a relatively good job providing
Pap smears
and referrals for mammograms. However we have neither the space
nor the staff to do culposcopy, which is an important test for
the detection of cervical cancer.
You have probably reviewed
the book, "Cancer Mortality Among
Native Americans in the United States: Regional Differences in
Indian Health, 1984-1988, Trends of Our Time 1968-1987",
published by the Cancer Prevention and Control Program in the
IHS. After reviewing the findings in this report, Dr. Ann Lanier,
epidemiologist in the Alaska Area IHS, has recommended that smoking
cessation programs are probably the single most important thing
that we can do to prevent cancer among the population that we
serve. Here at TCC we have been planning a smoking cessation
program to begin, in August. However, our resources are limited
to hiring a single individual to serve Fairbanks and the entire
region. We are also working on an AIDS prevention campaign with
less than two individuals serving our entire region. This year
for the first time we helped join a community effort for a bone
marrow drive. Since that time three IHS beneficiaries residing
in our region have needed bone marrow trans-plants. In the future,
there will be an ongoing need to expand and maintain the bone
marrow registry for our region.
Birth Control. Teen pregnancy continues to be a problem
in our region. In the last three months, 9 babies were born to
girls
15-19 years old,
for an average of 3 babies per month. Currently residents of
our region are very interested in the new birth control technology
called Norplant. The Norplant device is implanted in a woman's
arm and lasts for approximately 5 years. The cost of the Norplant
is about $400. In addition to this expense, it requires a minor
surgical procedure which again takes space and time at the clinic.
At the present time we are unable to keep up with the demand
for Norplant. Additionally, sterilization is a growing method
of choice for birth control among the population we serve, as
well as in the rest: of the United States. A problem with the
IHS eligibility criteria is that married couples cannot obtain
sterilization for a non-Native spouse even though this is the
preferred method for birth control. THO failure to fund sterilization
for non-Native spouses leads to more unwanted children. higher
risks of FAS and other drug affected babies, and higher costs
for the IHS.
Alcohol and Mental Health. Many of the patients
who are hospitalized from our service unit suffer from complications
caused by chronic alcoholism. The costs
of their care are enormous and we have little to offer them to
prevent further on-going complications. Many of these patients
return to the hospital time after time. We need more psychiatrists
to provide inpatient care for these and other patients with mental
health problems. We also need more help from psychiatrists in
medication management for patients using narcotics and mood altering
drugs. At the present time the psychiatrists hired by TCC are
spread very thin trying to supervise programs all over the region.
Long Term Care. Currently the IHS does not
pay for nursing home care for patients in need of long term care.
People in our region would like to
bring their elders home to live as close to their families as
possible. There is a desire for facilities similar to the Tanana
Elders Home in various subregional centers in Interior Alaska.
Also there is a need for adult foster care; home health, homemaker
services, and nursing home care. The Greater Fairbanks Community
Hospital Foundation is building a new nursing home, Denali Center.
However there are no mechanisms in place for IHS to pay for beneficiaries
who do not qualify for Medicaid to use this facility.
P.L. 93-638
Contracting. Through a P.L. 93-638 Contract with the federal
government, TCC manages the Interior Service Unit of the Alaska
Area Native Health
Service in the Indian Health Service. This contract has been
in place since 1984. Chief Andrew Isaac Health Center(CAIHC)is
the main facility that serves about 12,000 Alaska Native people
living in Fairbanks and 28 villages in Interior Alaska. TCC management
of the Interior Service Unit has been characterized by creative
problem solving, courage, and excellence. Let me give an example
of each. With regard to excellence, CAIHC is the only IHS funded
facility in Alaska to have received a commendation from the Joint
Commission on Accreditation of Health Care Organizations. It
took courage for TCC to close the Service Unit Hospital in Tanana
in 1982. Instead of rebuilding the 40-year old, 95,000 square
foot facility, TCC used creative problemsolving to enter a somewhat
unique relationship with the private sector.
With planning and
guidance from TCC, in 1970 a P.L. 95-151 agreement was signed
between the IHS and the Greater Fairbanks Community
Hospital Foundation (GFCHF) which built and owns Fairbanks Memorial
Hospital (FMH) . Through this agreement IHS provided $1.8 million
to GFCHF to construct 18 inpatient beds and a 6,125 square foot
outpatient facililty. In return the GFCHF agreed to provide the
outpatient facility to the IHS for 20 years under a cost-free
lease, and to provide inpatient care to IHS beneficiaries at
a discounted rate negotiated to exclude the hospital's cost of
capital.
This creative partnership between TCC, IHS, and
GFCHF has had many benefits:
- It has given IHS beneficiaries
access to the best private medical care in Interior Alaska
and allowed them to be served
closer to home.
- It enabled FMH to develop better facilities
to serve all people in the region.
- The federal government
saved money. Only $1.8 million were spent by the federal
government to help build FMH and
CAIHC,
compared to an estimated $75 million which would have
been needed to replace the Tanana Hospital.
Health Facility Construction. Over the years,
TCC has saved the federal government money both by not replacing
the Tanana Hospital ($75 million saved), by
having a 20-year cost-free lease for CAIHC ($3.7 million saved)
and by obtaining discounted rates for hospital care at FMH
(currently 22% of charges, for a savings of $784,000 per year.)
Now
the cost-free lease has expired and it is time again for the
federal government to invest in health care for IHS beneficiaries
in Interior Alaska. CAIHC is 20 years old. It is crowded and
does not have enough room to meet current and future needs.
While IHS guidelines suggest that 60,000 square feet of space
are needed
for a free standing facility here, currently CAIHC has only
10,400 square feet. There are problems with heating and ventilation.
More exam rooms are needed to reduce waiting time for appointments
and walk-in care. More space is needed for cancer prevention
and detection activities and other needs already discussed.
Once again TCC is proposing a creative solution
which will help save the federal government money. Our plan is
to add
onto the
existing clinic and renovate the old space. This will create
a 40,000 square foot clinic attached to FMH. The total space
proposed has been reduced from 30% from 60,000 to about 40,000
square feet because laundry, x-ray, housekeeping, maintenance,
and other services will be shared with FMH. The estimated cost
is $12 million. GFCHF has agreed to finance the facility if
a government lease could be secured, however, a direct appropriation
would be the preferred method of financing.
Instead of embracing
this creative partnership and cost effective means of delivering
health services, the IHS relies on old
formulas which make this project too low a priority for funding.
The irony
of the situation is that, if TCC were seeking to replace the
Tanana Hospital, we would have a very high priority for $75
million worth of construction, while we have a very low priority
for
the alternative $12 million project. This leaves us to pursue
the political route for funding. However, our congressional
delegation has a hard time finding the funds for this project
because they
have already made substantial commitments to the new Alaska
Native Medical Center in Anchorage and the new IHS hospital
in Kotzebue.
We hope this will not turn out to be another case
of broken promises by the federal government to the Indian tribes.
Before
TCC decided
to close the Tanana Hospital we sought assurances from the
federal government that approach would not have long term negative
impacts
for the people we serve. In a letter from G. Ivey, AAMHS, to
William "Spud" C. Williams, President, TCC, dated
December 16, 1981 the federal government stated:
"This is
to provide you written assurances that in the event that
Tanana Hospital does close as an inpatient facility, the Interior
Service Unit budget will not be affected adversely simply
because
of this change and the method by which health services are
provided in the Interior Service Unit."
Nevertheless, it is
this very change which pubs us at a lower priority level for
the expansion of the clinic.
Several times in the past few
years, TCC has undertaken the construction and financing of
facilities without federal
support. In 1989,
we built a new dental clinic on the first floor of the
TCC Building, allowing the dental program to expand from
6 to
12 operatories.
The total project, from conception to completion, took
about 6 months and cost about $500,000. Similarly, in 1991
we financed
and constructed an eye clinic and in 1992 a mental health
facility. Without the constraints of the federal government,
TCC was
able to complete these projects very quickly and cost
effectively.
Once again we are proposing to do this with the
expansion of Chief Andrew Isaac Health Center. However, we
cannot finance this $12 million project from self-generated
funds. Before
we can go to the bank for financing, we need the assurances
of a
federal lease guarantee. While this seems like a simple
and straightforward process, we have already spent
two years
grinding
through the
bureaucracy and paperwork of the federal government.
Still, it seems we are no closer to our goal.
In closing
I would like to request, that the Commission consider the following
actions to help the Alaska Native
people residing
in Interior Alaska:
- Support funding for the Chief
Andrew Isaac Health Center expansion.
- Find ways that
the federal government can reward cost effective and creative
approaches to the delivery
of
health services,
rather than penalizing those programs which
have taken steps to be more
efficient.
- We need to assure that Alaska
Native Medical Center funding does not jeopardize funding
for construction
of other health
facilities around the state.
- Recognizing
that 638 Contractors can seek the advice of private architects
and
engineers,
we
should eliminate
the
requirements for lengthy, costly, and
bureaucratic reviews of building plans at the IHS Area
Offices and Headquarters. TCC asks the
Commission
to review the
IHS system for construction of
new facilities with the intent of streamlining
it and moving
funding from oversight to direct
funding of facilities and programs.
Thank you for the opportunity
to present these issues and suggestions.
This document was ocr scanned. We have made every attempt to
keep the online document the same as the original, including
the recorder's original misspellings or typos.
