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I think there needs to be some sort of dialog created so that we can have a better understanding of that decision, because I know that there has been no one from our program that has ever been consulted regarding this decision.

Mr. KOGOVSEK. I appreciate your pointing that out to us. Is there anything-yes, Mr. Wilson?

Mr. WILSON. I have another point. It may be that the committee might look at investment in the manpower program as an investment by virtue of the fact that we know if the person down in the grades is taught reading, communication skills and math that he will probably do well anywhere. The only thing he needs different is science to become a health professional.

But the point is that we can get the program with the investment that we are talking about. These people then become producers within the economy and hopefully, as opposed to many of the people being on welfare, dropping out, or things of this nature. And if they do continue on and become a health professional, I think they will pay back the money many times over in taxes, because the majority of our physicians I think pay lots of money in taxes.

Mr. KOGOVSEK. Any questions by minority staff?

Mr. JACKSON. Mr. Wilson, I just have one quick question. I have been looking through the materials that you submitted here, and I was just wondering, what sort of assumptions were made to arrive at the $229 million recommendation?

Mr. WILSON. The Indian Health Service put out a Tribal Specific Health Plan. Are you familiar with that? And they-the Tribal Specific Health Plan is how we arrived at that figure; totaled the needs up. This is the known unmet needs over the next 4 years. So that is a total of title I Tribal Specific Health Care.

Mr. KAHRAHRAH. Dr. Steele has a comment on section 106.

Dr. STEELE. I would just like to push for 106. Earlier this morning you asked which sections could be best cut out and nobody has spoken to 106, which is continuing medical education. And there has not been a great need for it up until now, because nobody has been really interested in what is happening right in the clinic. But I spent a month as part of my residency program at Standing Rock in North Dakota, Fort Yates, and we are not training doctors to work out in the boonies out in the rural areas. They are being trained in suburban hospitals to work when you have that backup, 106 would give us the flexibility to get that training that is really sorely needed by the doctors that are working on reservations, and if that section is cut out it could eventually have to, yes.

Right now, no, we are not doing a lot, but we really have intentions this year of doing that.

Mr. KOGOVSEK. Thank you for making that point, and on behalf of the committee, we appreciate that you have a lot of patience in waiting for us to get around for your testimony. Once again, we apologize for that delay, but thank you for being with us this morning and afternoon.

Is Mr. Raymond Paddock in the audience?

Mr. PADDOCK. Thank you, Mr. Chairman.

Mr. KOGOVSEK. Mr. Paddock, if you would identify yourself for the record, please. I see that you have some testimony here that goes

for several pages. We are in a situation here that I feel badly about. Mr. PADDOCK. I am ready to summarize it.

Mr. KOGOVSEK. At that point, then we will take your prepared testimony, and we will make it part of the record, without objection. [Prepared statement of Raymond E. Paddock may be found in the appendix.]


Mr. PADDOCK. I would like to thank Mr. Wilson, I think he stole a lot of my points here, but I would like to turn to page 2 of my testimony, just to raise an issue that I would like to hit on a little bit more.

As you know, I am a tribal chairman for an Indian tribe in Alaska, and I am also representing the board of directors of the Alaska Federation of Natives. So I am here wearing two hats.

In section 103, I state that health professions preparatory scholarships, there were no funds allocated for Alaska, and I am only speaking for Alaska now. Currently the Tlingit and Haida are attempting to attract some people into the medical professions through its BIA funded education program. However, we are not recruiting specifically in that category.

What I am getting at here is what Mr. Wilson pointed to, is that there are a number of federally funded education programs that can be related to health careers of one kind or another. And we do help people through our BIA education programs, getting to careers of their choice. We are now working specifically with the IHS and health careers, and with the Department of Labor, CETA manpower division, and they are also helping people get training in health programs. The point I wanted to make in this little dialog here is that as a tribal government, we have an opportunity to be innovative. It is something that cannot be done with a specific Federal agency. And I would like to see somewhere in the preamble, or in the purpose of the legislation that would encourage tribal governments to be innovative in getting the various Federal programs into working together. We know we are facing a crunch in terms of money that will be coming in to us and in terms of trying to use the funds that we get more efficiently. We hold a weekly staff meeting in our tribal council, bringing in the various divisions of our tribal government. That includes community services and human services. And in each case, they all interrelate, where there would be physical facilities, water and sewer; or human resources such as health and education and welfare programs, and so on.

They all interrelate and they all have to work together. If we have that authority and that blessing to be innovative, without having to bicker with every one of the contracts that we attempt to deal with, then I think we are going to find the tax dollars better spent, and the money spent more efficiently.

Mr. Wilson also pointed out that the rural school systerns are not adequately preparing young people in the physical and biological sciences. I wish Mr. Young were here at the moment because he was a school teacher in one of those remote Indian villages for a time in his life so he can relate specifically just how well prepared these young people are when they get out of school.

If we want to get young people into the medical profession they have to understand some of the very basics of math; they have to understand how to write a simple report; they have to know the metric system. If they are going to calibrate instruments in the field, in the village somewhere to get it back into working order they have to know some basic physics; they have to know some chemistry, some biology, and in most cases, our kids are not prepared. I think this is a national problem.

Turn to page 5, or to page 4 in my report. Our experience in dealing with Federal agencies is one of buck passing. Indian Health Service passes the buck to the State government, NIAAA, and the regional health corporations. Each in turn is unequipped through their own funding sources to attack the problem head on. Our hope is that through the Indian Health Care Improvement Act we can bring these forces together in a meaningful manner.

And again this goes back to the structure of the tribal government itself, in that I am hopeful that we can find ways to be more innovative in bringing these funds into a more efficient use.

On page 5, I refer to the last two paragraphs. And this is something that is a little alarming to some people, particularly in the Department of Labor.

We have attempted over the last 2 fiscal years to subsidize the demands of the villages for additional health services through CETA programs. In 1979-I am speaking of our tribe only, now in 1979 we subsidized $494,388 through CETA. In 1980 the figure is $312,000 for a grand total of $806,640. Recently the Congress has seen fit to change the thrust of the CETA program and move toward funding the private sector. This means that the health delivery systems in our regions will have to find other funding sources just to maintain their current level of programs.

We do not know where these other sources might be, unless it might be within the Indian Health Care Improvement Act.

Now this is a dangerous precedent we are setting, because the CETA program is a training program in itself. And the very structure of the villages of Alaska is such that most of them lack a tax base and most of them are dependent on CETA just to get by the very basics of municipal government in community survival. And that includes firemen, policemen, health workers, a number cf the basic things that people take for granted through local taxes. This does not happen up there in too many of our villages.

What is happening in this vicious circle is that by training people under CETA, they become CETA-trained, and then they have to go out into the community to try to find work. And of course, there is no tax base to pay them. So we go out and we try to find somebody else who is CETA-eligible, which means that he has to be unemployed for a certain number of weeks, and the vicious cycle starts all over again, so we are really not getting anywhere.

So we are hoping that somehow through this Indian Health Care Improvement Act, we can put a stop to this kind of wasteful training, is what it amounts to, and get on with the job.

If there are any questions, I will be glad to answer them.

The CHAIRMAN. This is an important hearing and important legislation, and you have made some very good points. I went through

your entire statement. This will give us help when we start trying to write a bill here in the next few weeks.

Mr, PADDOCK. Thank you.

Mr. JACKSON. Mr. Paddock, I note on page 3 of your statement that under title II, section 201, Alaska receives $172,400 for alcoholism, and all of those funds go to one single village. Are you aware of what other funding is going to Alaska for alcoholism programs through NIAAA?

Mr. PADDOCK. Yes; there are a number of State run programs and also NIAAA is funded through IHS. But the Indian Health Care Improvement Act only has this one source of funding. And this in fact is a carryover from funding that existed prior to the passage of this act.

Mr. JACKSON. What do the specific health plans for Alaska provide to meet the needs for alcoholism treatment?

Mr. PADDOCK. Of the 12 regions that submitted health plans, alcoholism was rated top priority in every one of the regions.

Mr. JACKSON. Is there a dollar amount?

Mr. PADDOCK. There is, but I do not have it with me. We had such a short time to prepare this, I did not have all the data available. Mr. JACKSON. Could you supply that for us?

Mr. PADDOCK. Yes; I could.

[EDITOR'S NOTE.-The information requested had not been submitted at time of printing. When received it will be placed in the committee's files.]

The CHAIRMAN. All right. Thank you very much.

Our last witness is Mr. Leo Watchman, from the Navaho Health Authority Board.

Sorry to keep you here all day and into the afternoon, but last is best sometimes.

[Prepared statement of Leo Watchman may be found in the appendix.]


Mr. WATCHMAN. Thank you, Mr. Chairman. First of all I'd like to express my appreciation for the opportunity to appear before you today. I have provided copies of written testimony, and I'll summarize it.


Mr. WATCHMAN. However, this has been condensed already from a substantial amount of work that we can also provide in addition. We would like to go on record as supporting H.R. 6629, the reauthorization of the Indian Health Care Improvement Act. And I also would like to introduce myself as being the executive director for the Navaho Health Authority; I have been recently appointed to that position, although I have been with the program for about 7 some odd years.

The Navaho Health Authority wishes to talk about two particular issues. One, of course, is that we strongly support the reauthorization, of the Public Law 94-437 And also we have some recommended changes which could see the intent of the act become a realization as it was intended by Congress for the benefit of the Indian people.

We have criticized the Indian Health Service in their refusal to transfer the scholarship programs under sections 103 and 104 of 437 to Indian tribes for the tribes themselves to administer.

You are familiar with the two sections; section 103 establishes the health professions preparatory scholarship program for Indians. Section 104 establishes a health professions scholarship program for persons who will provide their professional services to Indians.

We feel that Congress meant that the Indian people would be involved in the development of health manpower to serve Indians. We feel that this can only happen if the Indian Health Service will allow these programs to be transferred to the tribes through contracts or grants.

The Navaho Health Authority is an agency of the Navaho tribal government which is particularly charged with the health manpower development, and to do all things necessary to raise the health levels of the Navaho people.

So we are particularly concerned with some of these situations, as we see it from the Navaho. The programs of the Navaho Area Índian Health Service under sections 103 and 104 could be appropriately handled, in this case by the Navaho Health Authority.

We feel that the Navajo Health Authority has had outstanding success in administering scholarships in the health professions with funds that we have received from the Kellogg Foundation under the Rural Health Education Centers, normally referred to as AHECS.

We feel that one way that these scholarship programs can be transferred to tribal organizations is through contracts under the Indian Self-Determination Act. We feel that section 103 of that act authorizes the Secretary to contract with tribal organizations for them to carry out the Secretary's functions, authorities, and responsibilities under the 1954 Transfer Act.

The Transfer Act, transferred to the Indian Health Service functions formerly performed by the Bureau of Indian Affairs. It transferred not only hospitals and health facilities, but also the responsibility for the conservation of the health of Indians.

In enacting Public Law 94-437, we feel that Congress contemplated that the programs under that law could be managed by the tribes themselves by contracting with the Indian Health Service.

In my testimony there are certain references to the act, and in deference to time, Mr. Chairman, I will-I am trying to summarize it as rapidly as I can here.

The Indian Health Service has refused to contract the scholarship programs to Indian tribes. We feel that the intent of the initial legislation if you would refer to some of the quotations out of the Senate Interior and Insular Committee's report on Public Law 94-437.

I quote: "Contracting is the principal method by which the tribes participate directly in Indian Health Service programs." Also, this was introduced, as you know, by Senator Jackson in S. 1017, and on February 26, 1973, there is a quotation, "which would provide the Indian Health Service a new contracting authority tailored to meet Indian needs and to further the goal of Indian self-determination."

We feel that this was the intent of Congress. However. the Indian Health Service has chosen a position which really is relying on the Assistant General Counsel for Public Health opinion says the Secretary cannot contract these scholarship programs to the tribes under the Indian Self-Determination Act.

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