Post by Okwes on Jul 7, 2007 11:32:55 GMT -5
AP Enterprise: Some health clinics deny care to urban Indians
By Garance Burke, Associated Press Writer | March 7, 2007
www.boston.com/news/local/massachusetts/articles/2007/03/07/ap_en\
terprise_some_health_clinics_deny_care_to_urban_indians/?page=1
<http://www.boston.com/news/local/massachusetts/articles/2007/03/07/ap_e\
nterprise_some_health_clinics_deny_care_to_urban_indians/?page=1>
FRESNO, Calif. --American Indians say they are being illegally denied
care at taxpayer-funded clinics that have long served all people of
native ancestry but recently began excluding members of tribes that lack
formal recognition by the U.S. government.
Federal officials deny that qualified patients are being turned away and
say they're doing all they can to ensure a health program for urban
Indians isn't shut down entirely. The Indian Health Service oversees 33
clinics nationwide that provide free or discounted, culturally sensitive
medical services to city-dwelling Indians.
Native groups say federal law requires the clinics to serve all patients
of Indian ancestry, but some have recently stopped admitting those who
can't document their federal tribal status, patients and clinic
officials told The Associated Press.
"They said if you don't have federal paperwork you can't get service
anymore," said Vera Quiroga, a Yaqui elder who was turned away from a
clinic she helped found in Santa Barbara and now has to drive to a
far-off reservation to get her teeth cleaned.
The U.S. Bureau of Indian Affairs doesn't recognize the 82-year-old as
Yaqui, even though her children and grandchildren have tribal
documentation.
Another former Santa Barbara patient, Janet Darlene Garcia, 50, is a
member of the Coastal Band of the Chumash Nation, which does not have
federal status. She relied on the clinic for her diabetes counseling
sessions.
Martin Young, chairman of the clinic's board, says it received a letter
last fall from the IHS regional office in Sacramento instructing it to
stop offering free health services to patients from unrecognized tribes
or who don't have a BIA identification card.
It has since turned away about 200 patients, he said.
An IHS spokesman said the letter explained who was eligible for care,
but denied the agency instructed Santa Barbara to withhold services.
However, clinic managers in Tucson, Ariz., Wichita, Kan., and Boston
reported getting similar directives.
"IHS is suddenly saying that you can't serve this Indian even though he
looks Indian, and his family says he's Indian and has all of this
history of being Indian, but he doesn't have this piece of paper," said
Susette Schwartz, director of the Hunter Health Clinic in Wichita. "We
need some consistency."
The question of who is entitled to free health care will likely be
discussed Thursday during a hearing of the Senate Indian Affairs
Committee.
Under the American Indian Health Care Improvement Act of 1976, Congress
funds health care programs for members of tribes recognized by states or
the federal government, as well as their descendants. Many states
recognize tribes the federal government does not.
In California, the right to government-sanctioned medical care is
extended a step further, to those whose ancestors lived here in 1852 and
are "regarded as an Indian by the community."
Phyllis Wolfe, who oversees urban Indian programs at the U.S. Department
of Health and Human Services, said clinics that are granted federal
dollars must follow those guidelines. Program officials did not answer
requests to clarify any possible exceptions.
Wolfe could not explain why the clinics would have changed their
policies.
"I don't believe they would do that, but I can't say that that's not
been done," Wolfe said.
Nationwide, more than 60 percent of American Indians and Alaska natives
live in urban areas, according to the U.S. Census. For the poorest of
them, the clinics are a lifeline, a place to get diabetes treatment or
alcohol counseling delivered by doctors well-versed in native culture.
Urban Indians have higher rates of infant mortality and deaths
attributed to diabetes and alcohol consumption than city dwellers of all
other races, according to a 2006 report in the American Journal of
Public Health.
The urban clinics are managed by local contractors with funding from
IHS, a division of Health and Human Services. But President Bush's 2008
budget proposal would eliminate the program's $32.7 million annual
allocation altogether.
Under the circumstances, federal officials say, the cash-strapped
clinics are doing everything they can to care for all patients in need.
"We recognize that the urban Indian population is in need of care and we
don't want to disenfranchise any native Americans who are living in
urban areas," said Paul Redeagle, deputy director of the IHS office in
Sacramento. "We're currently working with the urban programs in
California to resolve their problems."
Another California clinic, the Fresno Native American Health Center,
closed its doors in January. Clinic officials there said they were asked
why they were treating patients from tribes the BIA didn't recognize.
Redeagle said the Fresno clinic was closed because it was seeing too few
patients and did not hire qualified staff, violations of its contract
with the federal government.
In Boston, workers at the North American Indian Center said they were
told not to treat the Mashpee Wampanoag of Cape Cod, whose ancestors
shared Thanksgiving dinner with the Pilgrims. But they were allowed to
keep offering free health services to the tribe's members after they
read the text of the 1976 law to their federal funders.
"We actually got requests from IHS to deny service to the Mashpees,"
said Barbara Namias, who oversees community health programs at the
Boston clinic. "We had to refer them back to the legislation."
Throughout American history, defining who is Indian -- through tracing
family trees or calculating a person's percentage of Indian blood -- has
always been political.
Each tribe defines its membership differently. In California, just 12
percent of the state's 433,000 American Indians belong to BIA-recognized
tribes.
The Santa Barbara clinic removed most of its board members in September
and replaced them with members of federally recognized tribes. Nonnative
staffers who were let go the year before are suing over the alleged
bias.
Redeagle said his office had looked into questions about the management
of the Santa Barbara clinic and had found no proof of wrongdoing.
But that's no consolation to Vera Quiroga, who helped start the clinic
in the 1970s, long before it moved to its current home in a shopping
center. She said her already limited finances are taxed by regular
40-mile trips to the tribal lands of the Santa Ynez Band of Mission
Indians.
"Now I have to go up to the rez to get seen," said Quiroga, who lives on
$1,600 a month from her pension and social security checks.
The clinic where she now receives dental work is run by a federally
recognized tribe whose members each get sizable checks in casino
revenue, but they still qualify for free care from the Santa Barbara
facility.
Many urban clinics are already trying to make do with less by following
the example set by Oakland's Native American Health Center. The clinic
has applied for grants from other funders and opened its doors to all
urban dwellers to bring in new sources of revenue.
"We just want to do what we're here for, which is to help the working
poor," executive director Martin Waukazoo said.
But Lisa Flores, an environmental planner and documented Pascua-Yaqui
member who attended diabetes counseling classes at the now-defunct
Fresno clinic, has given up on getting native-focused care in her area.
"From a tribal perspective we're all supposed to take care of each
other," she said. "Now that they closed it, the question then becomes:
Are you unworthy of health care?"
By Garance Burke, Associated Press Writer | March 7, 2007
www.boston.com/news/local/massachusetts/articles/2007/03/07/ap_en\
terprise_some_health_clinics_deny_care_to_urban_indians/?page=1
<http://www.boston.com/news/local/massachusetts/articles/2007/03/07/ap_e\
nterprise_some_health_clinics_deny_care_to_urban_indians/?page=1>
FRESNO, Calif. --American Indians say they are being illegally denied
care at taxpayer-funded clinics that have long served all people of
native ancestry but recently began excluding members of tribes that lack
formal recognition by the U.S. government.
Federal officials deny that qualified patients are being turned away and
say they're doing all they can to ensure a health program for urban
Indians isn't shut down entirely. The Indian Health Service oversees 33
clinics nationwide that provide free or discounted, culturally sensitive
medical services to city-dwelling Indians.
Native groups say federal law requires the clinics to serve all patients
of Indian ancestry, but some have recently stopped admitting those who
can't document their federal tribal status, patients and clinic
officials told The Associated Press.
"They said if you don't have federal paperwork you can't get service
anymore," said Vera Quiroga, a Yaqui elder who was turned away from a
clinic she helped found in Santa Barbara and now has to drive to a
far-off reservation to get her teeth cleaned.
The U.S. Bureau of Indian Affairs doesn't recognize the 82-year-old as
Yaqui, even though her children and grandchildren have tribal
documentation.
Another former Santa Barbara patient, Janet Darlene Garcia, 50, is a
member of the Coastal Band of the Chumash Nation, which does not have
federal status. She relied on the clinic for her diabetes counseling
sessions.
Martin Young, chairman of the clinic's board, says it received a letter
last fall from the IHS regional office in Sacramento instructing it to
stop offering free health services to patients from unrecognized tribes
or who don't have a BIA identification card.
It has since turned away about 200 patients, he said.
An IHS spokesman said the letter explained who was eligible for care,
but denied the agency instructed Santa Barbara to withhold services.
However, clinic managers in Tucson, Ariz., Wichita, Kan., and Boston
reported getting similar directives.
"IHS is suddenly saying that you can't serve this Indian even though he
looks Indian, and his family says he's Indian and has all of this
history of being Indian, but he doesn't have this piece of paper," said
Susette Schwartz, director of the Hunter Health Clinic in Wichita. "We
need some consistency."
The question of who is entitled to free health care will likely be
discussed Thursday during a hearing of the Senate Indian Affairs
Committee.
Under the American Indian Health Care Improvement Act of 1976, Congress
funds health care programs for members of tribes recognized by states or
the federal government, as well as their descendants. Many states
recognize tribes the federal government does not.
In California, the right to government-sanctioned medical care is
extended a step further, to those whose ancestors lived here in 1852 and
are "regarded as an Indian by the community."
Phyllis Wolfe, who oversees urban Indian programs at the U.S. Department
of Health and Human Services, said clinics that are granted federal
dollars must follow those guidelines. Program officials did not answer
requests to clarify any possible exceptions.
Wolfe could not explain why the clinics would have changed their
policies.
"I don't believe they would do that, but I can't say that that's not
been done," Wolfe said.
Nationwide, more than 60 percent of American Indians and Alaska natives
live in urban areas, according to the U.S. Census. For the poorest of
them, the clinics are a lifeline, a place to get diabetes treatment or
alcohol counseling delivered by doctors well-versed in native culture.
Urban Indians have higher rates of infant mortality and deaths
attributed to diabetes and alcohol consumption than city dwellers of all
other races, according to a 2006 report in the American Journal of
Public Health.
The urban clinics are managed by local contractors with funding from
IHS, a division of Health and Human Services. But President Bush's 2008
budget proposal would eliminate the program's $32.7 million annual
allocation altogether.
Under the circumstances, federal officials say, the cash-strapped
clinics are doing everything they can to care for all patients in need.
"We recognize that the urban Indian population is in need of care and we
don't want to disenfranchise any native Americans who are living in
urban areas," said Paul Redeagle, deputy director of the IHS office in
Sacramento. "We're currently working with the urban programs in
California to resolve their problems."
Another California clinic, the Fresno Native American Health Center,
closed its doors in January. Clinic officials there said they were asked
why they were treating patients from tribes the BIA didn't recognize.
Redeagle said the Fresno clinic was closed because it was seeing too few
patients and did not hire qualified staff, violations of its contract
with the federal government.
In Boston, workers at the North American Indian Center said they were
told not to treat the Mashpee Wampanoag of Cape Cod, whose ancestors
shared Thanksgiving dinner with the Pilgrims. But they were allowed to
keep offering free health services to the tribe's members after they
read the text of the 1976 law to their federal funders.
"We actually got requests from IHS to deny service to the Mashpees,"
said Barbara Namias, who oversees community health programs at the
Boston clinic. "We had to refer them back to the legislation."
Throughout American history, defining who is Indian -- through tracing
family trees or calculating a person's percentage of Indian blood -- has
always been political.
Each tribe defines its membership differently. In California, just 12
percent of the state's 433,000 American Indians belong to BIA-recognized
tribes.
The Santa Barbara clinic removed most of its board members in September
and replaced them with members of federally recognized tribes. Nonnative
staffers who were let go the year before are suing over the alleged
bias.
Redeagle said his office had looked into questions about the management
of the Santa Barbara clinic and had found no proof of wrongdoing.
But that's no consolation to Vera Quiroga, who helped start the clinic
in the 1970s, long before it moved to its current home in a shopping
center. She said her already limited finances are taxed by regular
40-mile trips to the tribal lands of the Santa Ynez Band of Mission
Indians.
"Now I have to go up to the rez to get seen," said Quiroga, who lives on
$1,600 a month from her pension and social security checks.
The clinic where she now receives dental work is run by a federally
recognized tribe whose members each get sizable checks in casino
revenue, but they still qualify for free care from the Santa Barbara
facility.
Many urban clinics are already trying to make do with less by following
the example set by Oakland's Native American Health Center. The clinic
has applied for grants from other funders and opened its doors to all
urban dwellers to bring in new sources of revenue.
"We just want to do what we're here for, which is to help the working
poor," executive director Martin Waukazoo said.
But Lisa Flores, an environmental planner and documented Pascua-Yaqui
member who attended diabetes counseling classes at the now-defunct
Fresno clinic, has given up on getting native-focused care in her area.
"From a tribal perspective we're all supposed to take care of each
other," she said. "Now that they closed it, the question then becomes:
Are you unworthy of health care?"