are children with great needs in Indian country, and some of them preventable, some not. There's FAS, fetal alcohol syndrome, and the effects, but there's also other developmental disabilities. There's chronic illness from ear infections to whatever.

One of the problems is, we don't even know what a lot of the issues are. There has been so little done with children with chronic conditions under reservations that we don't even know. As far as I know, Indian Health Service has no record of tracking system for these children. So that's my one issue.

The other one is-and that's another problem area, I guess. Another one is a much more positive thing.

Senator WELLSTONE. Can I interrupt you? No tracking system meaning what? That we're not

Mr. JONES. Well, we don't know how many children there are with chronic conditions. We don't know whether there are more or less. I believe, some of us believe, there are many more children with chronic conditions because of the risk factor in Indian country. Poverty, unemployment, isolation, things like that.

But as far as I know there's never been any attempt by Indian Health Service to actually look into how many children there are, what conditions there are, to specifically see how they compare to the general population.

Senator WELLSTONE. Sometimes we don't know what we don't want to know.

Mr. JONES. Right. Yeah.

As I say, the next point I want to make is a much more positive one. Although there is a word of caution that goes along with that, and here I speak as a newly retained consultant to the Mayo Clinic.

I think what we're beginning to see is some entities like the Mayo Clinic bringing its prestige and reputation and its experience to say, "How can we become partners with Indian tribes to bring what we have, our knowledge, our expertise to tribal communities?"

I think that's a very exciting thing that's happening. I guess my word of caution there is, I would hope in health care reform, that that becomes a catalyst to that kind of a partnership and not a barrier to it. Whatever happens to national health care reform enables these kind of new partnerships.

Let me just give some examples. Mayo Clinic has already-it's already a leader in what's called telemedicine, which is like satellite downlinks. They've become experts at that, because they opened their Scottsdale, AZ, clinic and their Jacksonville, FL. The doctors in Mayo can now instantaneously do actual consultations by satellite. So that they can look at an x ray. They can talk to a doctor, even talk to a patient.

One of the things I noted throughout the morning was comments about the isolation. "We lose the doctors. They don't stick around." I think these kind of things can connect those doctors to experts, to some specialists, and help support them so that they stay in rural areas, stay in tribes.

My fear is, I think technology has often gotten in the way with the the expensive technology is often a barrier, itself.

A person commented on the dialysis machine. "We don't-we only have one because we can't afford it." That's going to be one of the barriers, and we have to think about that.

The other one, is they're looking at things like diabetes tracking. Some things like that, I think, would be very simple, cost effective, and people of the expertise at Mayo have to work with tribal communities to develop systems like that. So I just hope that a national plan can support that.

Senator WELLSTONE. I think these are some excellent suggestions. I went beyond our 2-minute time limit because Mr. Jones came all the way up here from Rochester. Thank you very much. Ms. SEEGER. Giles Hart.

STATEMENT OF GILES HART, RED LAKE TRIBAL SUBSTANCE ABUSE PROGRAM

Mr. HART. Senator Wellstone. My name is Giles Hart. I'm with the Red Lake Tribal Substance Abuse Program.

And I'm going to be talking about 2 minutes on substance abuse, how it affects us and how it affects other Indian tribes in the State of Minnesota.

Red Lake Alcohol Rehab Program and Indian Treatment Drug Program have been in operation since 1969 and 1972, respectively. Red Lake Alcohol Program received its funding through the State of Minnesota and Indian Health Service, like all the others to reservations and tribes in the State. Through the national health care plans, both of these major funding sources could be lost to our tribes, or greatly reduced.

We don't know what the future holds for our residential programs, currently, which are funded through the Indian Health Services. And the rest of the funding is from the State Chemical Dependency Consolidated Treatment Fund, which consists of all treatment dollars in the State of Minnesota.

The State doesn't know what effect the State of Minnesota doesn't know what effect the reductions will have with us. They know it is going, you know, to affect us deeply. And it could be especially costly to our tribe, our Red Lake Tribe, in the residential treatment centers, to our youth homes, to our halfway houses, and to our primary residential treatment centers. And also to our outpatient programs, which almost all of our reservations have. And in the event that funding is lost through budget cuts through Indian Health Service and also through the State-through the health care, this would set the tribes of Minnesota back about 15 years prior to the changeover to Indian Health Service.

Thank you.

Senator WELLSTONE. Thank you. Thank you very much. I appreciate your comments. They're important.

Ms. SEEGER. Mark Abrahamson.

STATEMENT OF MARK ABRAHAMSON, NURSE

Mr. ABRAHAMSON. My name is Mark Abrahamson. I've been a nurse for 18 years, and a public health nurse for 10 years, and those 10 years I've served the Grant Portage Reservation as their health director.

I want to thank you, first, for your inspiring speech to the Eighth Congressional District on Saturday. It was great.

One of the questions that you asked fairly early on, is how to improve communications between Indian Health Service and their tribal program. And I think one of the keys there is what happens to us practitioners, nurses and doctors, and other medical practice people, is we get pulled into all sorts of administrative duties that really become burdensome.

Sometimes I'll spend more time writing a grant for a $1,000 AIDS project than I'll actually spend-than we actually spend time providing the project. It's extremely burdensome, and, unfortunately, one of the problems there, again, is funding. And you hear that over and over today, but one of the cruel jokes that I've learned over the 10 years as the health administrator is that I was led to believe that increasing my numbers, documenting our services, documenting the patients that we served would somehow feed the dollars that we get. That has not happened.

Health costs increased 15 percent or more a year. Two- to threepercent mandatories, at the most. So at this point, that's already been pointed out. We're tribal council is subsidizing our program by about 70 percent for our total programs there.

The other thing I wanted to just mention is prevention programs, again. We're all talking prevention. We've been real fortunate in Portage because of our nurses, because of our CHR's. We have a 100-percent immunization rate in many of our quarters. And that's a real rate. We know everybody. We're fairly small, and we're able to attain that.

Our breast and cervical cancergram program, too, for women, we've been able to screen almost 100 percent of our age-eligible women for those programs. But the sad part is in the areas like ours, with rural populations and not many physicians-we are supposed to have four physicians in our county. We're down to two. We may lose another. We don't have practitioners right now. And because of that, we're not able to do other primary prevention things involving men's cancer and men's screening right now. We're all set to start a men's cancer screening program, but we had to pull back because we lost another doctor. And so those primary prevention things, again, are tied to funding.

And I wanted to give you that message. So, thank you.

Senator WELLSTONE. It's a really important message, Mark. Thank you very much. Thanks for your work.

Ms. SEEGER. Bill Lawrence, please.

Senator WELLSTONE. Did Bill have to leave? He was here forhe left something in writing. Do you have that from Bill?

Mr. ANDERSON. Yeah.

Senator WELLSTONE. Okay.

Ms. SEEGER. Monte Hammitt. And, Monte, please give a little bit of your background.

Monte was telling me that he coached up at Red Lake, and he was telling me the number of the guys that were on his football team that were Vietnam veterans and had gone to Vietnam. So I shared that with Paul once.

STATEMENT OF MONTE HAMMITT

Mr. HAMMITT. It might take a little while, because I don't think I can do it in 2 minutes.

Yes, it was a great pleasure. I served since 1961. I was gone 4 years out of that from 1990. But it was 28 years or something like that, up at Red Lake.

I've been involved with the health care-Indian Health Care Services basically since that time. And currently, we're now doing some private consultant work, including Red Lake, in 1990, working with various other tribes across the country.

And we want to thank you, Senator, for the help that you've given investing your time with other issues of the tribe regarding this.

Right now I'd like to make some comments. As I heard here this morning, it ties into the same statements that were said. And I can't help but applaud all of the previous speakers for the concern on the issues, and I hope that these issues and concerns are heard in Washington very, very vividly.

Back in just in belief, I know Dan Milbridge mentioned this, you know, maybe Eli mentioned this-but back on April 1, 1992, the hearings before the your committee with Chairman Inouye, comments about what is the health care of the American Indian peoples, the right, the obligation, where the U.S. Government stands, what they've done. More importantly, what they have not done. We acknowledged that there has been tremendous progress with Indian Health Service. We acknowledge that there's been a lot of great things that have happened over the years. But we're still a long ways behind.

And just a couple of comments. They talked about the prevention. In the 1992 amendments, the Indian Health Care Improvement Act, there were like 62 preventative health care amendments objectives that were added, but there has not been a dime added to the base of the budget. Instead they want to cut the dollars and take staff away.

How can they talk about a national health insurance program out here when you got one of the only governmental, if you will, public health programs in this country. The armed services program doesn't provide what the American Indian health program provides. It's a ration program. This ration program, now you're talking about derationing it and taking away the substance and the basis of health care for every American Indian person across the country. We can't build health care reform and preventative health programs on the basis of deregulating the budgets and taking away from the budgets.

One of the things that I submitted for you-just briefly, Senator. I appreciate it-is a draft mission statement that I was asked to put together last December by some of the members of the NCAI and National Indian Health Board, some of the other tribes. And in essence I'll just get down to what the goal basis of that it.

The Indian Health Service has been looking at national health insurance. One, that shouldn't be-national health insurance shouldn't be derived on the basis of-paid for on the backs of the American Indian people. We need to shift-and American Indian

health care programs should all be shifted now-over to an entitlement program.

If these statements of Senator Inouye and the rest that are making across the country which are true, it is very important. We need to make sure that when we put these programs in, we cement them into an entitlement program, so that you don't have to hear the tribe-you don't have to hear the headaches and the concern these tribal leaders have to go through and these health directors and nurses and the physicians as the provider.

The basic-we got four bullets in the statement. It says we raise the health status of every federally recognized American Indian from Alaskan aid to its highest possible as part of the current mission statement. Provide us an entitlement, a comprehensive health care delivery system that is developed with all federally recognized Indian tribes that delivers health care programs, services, functions, activities, access, and health facilities for all American Indians and Alaska Natives. Provide 100-percent funding for entitled comprehensive health care delivery system. Provide for tribes and optional self-governments with the entitlement of the U.S. Government's comprehensive health care delivery system for American Indian and Alaska Natives.

And I would like to-I've used up about my 2 minutes.

One other thing on behalf

Senator WELLSTONE. You have to be brief, Monte, because my fear is that I will leave and cut people off. There are some other people who want to speak.

Mr. HAMMITT. I thank you very kindly.

Senator WELLSTONE. Thank you very much.

I love it the way-I love it the way you said that you just about used up your 2 minutes. But-because--because you went more. But the reason is you have some important things to say. I mean, this is a very-and so I just

Mr. HAMMITT. Do you want me to continue?

Senator WELLSTONE [continuing]. Just apologize to everyone.

No; I'm just apologizing to you and everyone because I think what you have to say is so important.

Mr. HAMMITT. Thank you.

Ms. SEEGER. It looks like Willa Morris. Is that correct? Willa?

STATEMENT OF WILLA MORRIS, PROGRAM COORDINATOR, WHITE EARTH MENTAL HEALTH PROGRAM

Ms. MORRIS. I'm the program coordinator for the White Earth mental health program. And I just wanted to issue-bring up the issue of mental health because I think it's also very important to what we're talking about here today.

We kind of talked around about it with prevention, stress, and some of those other issues. I've worked primarily with children and adolescents, and I see an incredibly high rate of depression among those kids. And that's very frightening to me, that I'm seeing 4-, 5-, 6-year olds who are very depressed because of the poverty, because of the isolation, because of some of the things we've been talking about.

I just wanted to encourage you to include issues of mental health in anything that you're going to be bringing up, because I think