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Congressman Morris Udall

May 2, 1980
Page Five

IHS as being solely responsible for the health care of Indian people. As a result, the State or county offices refuse to enroll Indians in their programs or to reimburse them for health care services; reimbursement for which they would otherwise be eligible if they were not Indian. Specific cases include:

a.

b.

c.

d.

The most blatant example, which is still ongoing, has occurred
in Arizona. The State sponsors something called a "Preemie"
program, under which the State will pay certain of the health
costs involved in providing care to high-risk newborns. The
State has refused to pay for qualified Indian babies on the
grounds that Indians are IHS's responsibility. The Assistant
Secretary for Health has submitted several requests to the Office
for Civil Rights in HEW (OCR) to investigate the problem. OCR
has still failed to respond.

OCR has also been negligent in investigating the refusal by the Arizona State Mental Hospital to accept involuntary commitments where the committing court is a tribal Indian court. This has made it difficult for tribes and Indian people to obtain adequate care for mentally disturbed Indians.

In North Dakota several medical specialists refuse to treat
Indians. Several persons familiar with the case said that when
OCR sent down an investigator, the physicians simply refused to
talk to her and that OCR's response was to just drop action on
the case.
It still has not been resolved.

In South Dakota the State Mental Hospital refused to accept Indians who were involuntarily committed to the hospital unless IHS agreed to pay for their care, even though indigent nonIndians received care at no cost. The Office for Civil Rights pledged support and asked IHS and the tribes to send specific cases. Initially two cases were sent, and OCR said that was not enough. Then a dozen cases were sent, and OCR still took no action. Eventually one of the complaining Indians was forced to file suit in federal court against both IHS and the State.

I hope this information satisfactorily answers the Committee's questions and provides information that is useful to you. We will continue to forward information on these issues to you as it becomes available to us. Thank you for your continuing effort on behalf of improved health services for Indian people.

Sincerely yours,

Jake Whitenow

Jake Whitecrow
Executive Director

JW/mm

CC: Congressman Kogovsek

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Statements

Our Referance: AD

Congressman Pat Williams
Attention: Judy Chapman
1233 Longworth Building
Washington, D.C. 20515

Dear His. Chapman:

what is the
Total cost of
This project

Fer your request to Mr. William Fandersee, Area Facilities Manager, Billings Area Indian Health Service, we are listing the recommendations we havo given. to administrators of our Indian Health Service Hospital at Browing, Montana.

1.

Next year winterize the hospital before winter sets in..

2. Give preventative maintenance, maintenance, and safety in the boiler
room high priority.

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3. Develop an operating plan for the heating system, identify training needs of the staff, develop procedures to be followed in operating the boiler plant, and constantly monitor the status of the heating system.

4. Monitor the existing system continuously to insure water is added and
air is vented from the heating system piping. This will be required
until the contract has been completed to change over the piping and
replace boiler #1.

5. Retaia part-time help to augment the staff until the heating system
Change over contract is completed.

The heating problem at the Browning Indian Health Service Hospital is the ... result of deterioration over a number of years and lack of adequate maintenanco. Because of limited staffing, maintenance personnel are used daily to drivé ambulances and deliver patients to Great Falls hospitals and other hospitals to receive care not available at the Browning Hospital.

Our expectation has been the replacement of the hospital at Browning and adequate staffing; however, Congressional funding has not been forthcoming. We are constantly in the position of letting tarorrow's needs slide to meet today's priorities in giving immediate health care to patients with limited resources.

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DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Congressman Pat Williams

Attention: Judy Chapman

2

For your information, I have attached a copy of Lir. Wandersee's trip report and a request for help by Charles Thomas, Facility Manager, Browning Indian Health Servico liospital.

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REPORT TO THE CONGRESS

Project REFLEX
(Resource Flexibility)

--A Demonstration Of Management
Through Use Of Fiscal Controls
Without Personnel Ceilings

Department of Defense

B-165959

BY THE COMPTROLLER GENERAL
OF THE UNITED STATES

COMPTROLLEY

B-165959

COMPTROLLER GENERAL OF THE UNITED STATES

WASHINGTON, D.C. 20540

To the President of the Senate and the
Speaker of the House of Representatives

We have reviewed the Department of Defense's Project REFLEX (Resource Flexibility)--a demonstration of management through use of fiscal controls without personnel ceilings.

We made our review pursuant to the Budget and Accounting Act, 1921 (31 U.S.C. 53), and the Accounting and Auditing Act of 1950 (31 U.S.C. 67).

Copies of this report are being sent to the Director, Office of Management and Budget, and to the Secretaries of Defense, the Army, Navy, and Air Force.

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