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Testimony

Submitted to the
Alaska Natives Commission
in connection with a hearing at

Fairbanks, Alaska
July 18, 1992

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 | PDF Version

 

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:

  1. It has given IHS beneficiaries access to the best private medical care in Interior Alaska and allowed them to be served closer to home.
  2. It enabled FMH to develop better facilities to serve all people in the region.
  3. 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:

  1. Support funding for the Chief Andrew Isaac Health Center expansion.
  2. 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.
  3. We need to assure that Alaska Native Medical Center funding does not jeopardize funding for construction of other health facilities around the state.
  4. 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.

 

 
 

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