Tribal clinics refusing care to some Indians

[Okwes]

Tribal clinics refusing care to some Indians
By Garance Burke
The Associated Press
Tucson, Arizona

FRESNO, Calif. — After tribal elder Vera Quiroga was turned away from the very clinic she helped to found, she had little choice but to drive to a far-off reservation for her dental work.
The reason, she said, is that the U.S. Bureau of Indian Affairs doesn't recognize her as a Yaqui, even though her children and grandchildren have tribal documentation.
"They said if you don't have federal paperwork you can't get service anymore," said Quiroga, 82.
While federal law requires taxpayer-funded tribal clinics to serve all patients of Indian ancestry, some have recently stopped admitting those who can't document their federal tribal status, patients and clinic officials tell The Associated Press.
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 medical services to city-dwelling Indians.
But Martin Young, chairman of the board of the Santa Barbara clinic where Quiroga was turned away, said it received a letter last fall from the Bureau of Indian Affairs instructing it to stop offering free health services to patients from unrecognized tribes or who don't have a bureau identification card.
It has since turned away about 200 patients, including Janet Darlene Garcia, 50, 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.
An Indian Health Service spokesman said the letter explained who was eligible for care, but denied that the agency instructed Santa Barbara to withhold services. However, clinic managers in Tucson, 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."
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-supported 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 federal guidelines.
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," she said.
U.S. Sen. Byron Dorgan, D-N.D., chairman of the Senate Indian Affairs Committee, said tribal members who lack federal documentation should still be treated at urban clinics. The committee held a hearing Thursday on amending the Indian Health Care Improvement Act, and Dorgan said afterward the law doesn't need to be changed to ensure care for patients like Garcia and Quiroga.
"We shouldn't be having people turned away from these health clinics because they don't have a piece of paper," said Dorgan, who also has heard reports of patients being denied care because they lacked proper paperwork.
"I'm very frustrated with what's going on," he said. "This is a matter of life or death for American Indians, particularly children and the elderly."
But a Justice Department official told the committee there could be constitutional concerns about providing health benefits to people who are not members of federally recognized tribes.
"Under the Supreme Court's decisions, there is a substantial likelihood that legislation providing special benefits based on something other than membership or equivalent affiliation with a federally recognized tribe might be regarded by the courts as a racial classification subject to strict constitutional scrutiny," said Deputy Assistant Attorney General C. Frederick Beckner III.
Beckner didn't discuss whether clinics currently are being instructed not to help people who don't belong to federally recognized tribes. He said after the hearing that he knows nothing about that.
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.
The urban clinics are managed by local contractors with funding from the Indian Health Service. 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.

[Okwes]

Some health clinics deny care to urban Indians
by Garance Burke
The Associated Press



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?"