STATEMENT OF WILLIAM P. RAGSDALE, ACTING ASSISTANT SECRETARY FOR INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR

Mr. RAGSDALE. Good morning, Mr. Chairman.

Mr. Chairman, thank you. We are pleased to be here this morning. I have with me some staff and representatives from the Department, but I will defer introducing them at this time.

I would ask that my statement be entered into the record, Mr. Chairman.

The CHAIRMAN. It will be included immediately following your oral presentation.

Mr. RAGSDALE. I will try not to be redundant. I believe it adequately represents our position regarding the development of the rules and the implementation of this most important legislation.

First of all, I'd like to set the record straight. The Bureau of Indian Affairs, to the very best of my knowledge, never contemplated vetoing the amendments to the Indian Self-Determination and Educational Assistance Act. I have been serving as the Deputy for Bureau Operations for the last 2 years, and neither myself nor anyone else in the Indian Bureau, including the former Assistant Secretary, to the best of my knowledge ever contemplated recommending a veto by the President.

First of all, I'd like to say about the Public Law 93-638 amendments that we are challenged and devoted to implementing this most important legislation which provides a framework for carrying out of the government-to-government and trust relationships. It is important to note, however, that much substantive law, treaty, court decisions, and so on, provide the foundation for our obligations to maintain both the trust and government-to-government funding arrangements that differ from tribe to tribe.

When I finish, I would appreciate it if the chairman would ask me the same questions he asked of the tribal chairmen with respect to tribal sovereignty, and I would be most happy to respond on the record for the committee. But first let me talk about a couple of other things.

Let me talk to the heart of the matter, and that is the important policy that the Congress of the United States and the executive entered into when this legislation was first enacted regarding the exercise of self-determination, and that is the commitment that the United States gave to the Indian tribes across the Nation to provide a unique contracting relationship between the United States and the Indian tribes in the most direct manner.

Also, under this commitment it was reaffirmed that the exercise of Indian rights, which had been assured as a matter of Federal law, including court decisions, etc., would not be affected.

The next aspect of policy and the commitment of the unique and continuing relationship of the United States of America with Indian tribes has dealt with the policy of the trust relationship and the way the United States of America would execute both the government-to-government and trust relationship.

Last week I spent 1 week in the State of Wisconsin. I was asked on a number of occasions by State officials and, in particular, by State legislators, about the U.S. Government's policy.

Essentially what I said was that I believe that, number one, treaty rights are somewhat like the Constitutional rights of all citizens of this country in that they are both solemn commitments to Indian and non-Indian people, alike, that should be carried out and you could expect this as a part of the American system.

Second, that tribal governments have fully joined in the process of being recognized as having full status in the American system of government and should be welcomed into that system under the U.S. framework.

Third, that the abrogation, abolition, or termination of rights of Indians is not on the table for serious discussion or negotiation by those responsible for keeping this public policy in both the Congress of the United States and the executive branch, to the best of my knowledge.

I know this committee has an enlightened attitude in this regard, and I know the chairman-and hopefully the committee, as well-will do all that they can to better educate the American public in this regard.

Finally, I want to emphasize that I do not consider the employees of this agency, the Bureau of Indian Affairs, in an adversary role in terms of this guarantee and commitment of the United States to further the relationships I have just talked about.

I have been in this Indian Bureau for 20 years and I am a career Indian Affairs employee. It has been my personal witness that the majority of the employees in the Indian Bureau fight for Indian rights, and we do that with a great amount of vigor, against a lot of adversaries in some instances. You don't do that and have an adversarial relationship, overall, with the clients and your beneficiaries.

I am prepared to respond to your questions, Mr. Chairman. [Prepared statement of Mr. Ragsdale appears in appendix.]

The CHAIRMAN. Mr. Secretary, I thank you for your statement. It is very encouraging-especially your emphasis upon your policy on treaty rights. I think we coincide completely in that respect. I am also pleased to learn that you do not believe that the relationship that exists is an adversarial one, but I am certain you will have to agree that the perception in many parts of this land-Indian country and otherwise-would seem to lead one to conclude that the relationship is an adversarial one, unfortunately.

I should point out at this juncture that I do not intend to ask any questions for the record other than a couple for the IHS, which does not relate to the subject matter here, because, instead, I will be submitting questions. I don't want the exchange between us to be construed by anyone as being an exercise of an adversarial relationship.

I thank you very much, sir.

Mr. RAGSDALE. Thank you, Mr. Chairman.

The CHAIRMAN. Dr. Rhoades.

STATEMENT OF DR. EVERETT J. RHOADES, DIRECTOR, IHS,

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Dr. RHOADES. Thank you very much, Mr. Chairman.

My name is Everett Rhoades. I am the Director of the Indian Health Service. I am accompanied by several officials of the Indian Health Service and the Department, and with your permission, I would ask that my formal statement be entered into the record.

I would add my endorsement to the positive statements I have heard this morning, because I feel as strongly about that and Indian Health Service supports.

Second, I have often commented in my speeches around_the country that although there are a number of adversaries that I encounter from time to time, due to the sincere concern that I have for the Indian people who are dying but should not be dying, this has never been reflected adversely in my relationships with tribal representatives or their other legal representatives.

Perhaps if I might just summarize the progress to date in this new phenomenon that we are involved in with the tribes that is no longer called "consultation," but, I believe, is appropriately called "participation." I would just like to review for the committee that in the 14 years since the original landmark piece of legislation was passed, a considerable amount of progress has been made toward tribal assumption of control of their own health programs.

For example, of the 127 service units in the Indian Health Service, 52 are now operated by the tribes; 7 of the 50 hospitals are operated by the tribes; 73 of 139 of our health centers are operated by the tribes; 2 of the 7 school health centers and approximately 250 smaller stations and satellite clinics are operated by the tribes. We currently have about 350 contracts for a variety of services funded at approximately $180 million. These are solely for services.

In addition to that, we have approximately $30 million in contracts for architectural and engineering construction services.

If I could just call your attention to the chart here on my right, I think I can remain seated and point out the major steps that have taken place since the amendments were signed into law on October 5, 1988.

Within a very few weeks, joint meetings were held between BIA and the Indian Health Service in several areas of the country involving a total of over 1,300 participants. The purpose for this was orientation, to ensure that the law was understood and to begin an education process for the Indian Health Service. This was followed very quickly by Indian Health Service Area Director tribal meetings in each of the 12 Indian Health Service areas which were held by December 1988. At this time I established four major work groups representing the major divisions that we believe are encompassed in the amendments to the 638 process-that is, administrative, construction, program, and resource provisions.

These four work groups were made up of approximately 66 percent Indian tribal participants selected by the tribes, representing those tribes from within each of the 12 areas. This included representatives from the National Indian Health Board and other national Indian organizations. This also involved over 400 other participants.

The purpose of these work groups was basically to begin laying out the rulemaking specifications that the law called for, as a first step in the preparation of notice of proposed rulemaking.

There were joint area meetings then held to review the work of these work groups; "joint" reflecting BIA and Indian Health Service and tribal participation taking place the first month of this year.

I established a steering committee to advise me about the mechanism of securing participation by the Indian tribes, and also the process to be followed in carrying out the intent of the law. All of our efforts have been designed to carry out the intent of the law, as we have understood it.

This group is to make recommendations to me. I made a commitment to this group that I will not make decisions of a substantive nature relating to regulations until I have reviewed them with the Steering Committee.

I might just point out, Mr. Chairman, that all of the groups that I have in the Indian Health Service, whether it is work groups or steering committee or the chairmanship of the regulation drafting, workshops have been chaired by either an Indian person, tribal person, or co-chaired between Indian Health Service and the tribes.

This led to what was called the Nashville Regulation Drafting Workshop, attended by approximately 260 participants. These participants went through the documents prepared by the working groups, line by line, with probably some of the most comprehensive and finest discussions taking place between Indian Health Service, BIA officials, and the tribes as to precisely the point in this law. This proved to be a much more formidable undertaking than I think most of us had anticipated going into that workshop. It required that a second workshop be held, and which was attended by over 300 participants who continued developing a document which would largely reflect the point of view of the tribal participants and the Federal agencies. This document would then form the basis for continued development of these regulations. That is approximately where we are at this point.

I have been extremely impressed by the level of medical, health, clinical, and professional input into these activities by the tribes. I might just point out, parenthetically, that both Lionel John and the representative from the Northwest have served, and continue to serve, on the steering committee for the Indian Health Service. I believe the process has been largely successful. I think it is easy to see that it is a time-consuming process. I think your own remarks earlier this morning about the profound importance of this process suggests to me that one should approach the development of regulations quite deliberately-and I do not say this in order to delay the implementation of the regulations. There is no benefit to be derived by the Indian Health Service for delaying the implementation of these regulations.

In fact, I have a group working together in consultation with tribal participants looking at every aspect of the existing regulations and the language that is now appearing in the proposed language to see what can, in fact, be implemented in contracts prior to publication of these regulations. I believe that a modest to a moderate amount of progress can be made in this direction.

Mr. Chairman, this would serve to summarize the major point that I really wanted to bring before this committee. I am available to answer any questions you might have.

[Prepared statement of Dr. Rhoades appears in appendix.]

The CHAIRMAN. I thank you very much. I will be submitting several questions to which I hope you can respond. I would very much hope that you will go through the testimony of the witnesses who proceeded you and respond to their questions. I think it would be extremely helpful.

Doctor Rhoades, we all know that there is going to be a $45 million shortfall, and several Indian tribes have approached the committee expressing their concern about what will happen to health care in their reservation.

In this audience we have tribal leaders from the Pueblo of Isleta, and they have advised me that, as a result of this shortfall, their operations would have to end. Their contract health care program will be terminated at the end of June, which would mean that services such as obstetric care, dialysis, and other acute care will be terminated in their area.

The other one comes from the Navajos in the Albuquerque area-concern that with this budget shortfall it would mean that their health care program will be ending about June the 23rd.

In both cases, they consider—and I concur—that they are emergencies. I hope you will respond to them.

In the spirit of amity and comity, I would like to announce that on June 20 at 11 a.m., this committee will convene to consider the nomination of Dr. Edward Brown, who has been nominated to serve as Assistant Secretary and Director of the BIA. At that time we will have as witnesses two Senators from Arizona and possibly a Member of the House delegation. In addition, the senior leader of Dr. Brown's tribe has been invited to testify, if he so wishes. In order to accommodate all those who may wish to testify, we are inviting them to submit statements. These statements, subject to our study, will be made part of the record.

We intend, at the end of the hearing, to immediately vote upon the nomination and hopefully report it out that day, unless something should come up that we don't anticipate at this moment.

And so those of you who may be interested in submitting statements are welcome to do so, but the speaking witnesses will be the two Senators, a Member of the House, and a leader of the tribe and, obviously, the nominee, himself.

At this time I would like to call upon my very distinguished colleague, Senator Conrad.

Senator CONRAD. Thank you, Mr. Chairman.

I will be brief, given the lateness of the hour. But there are several questions that were raised by Twila Martin-Kekahbah, the chairperson of the Turtle Mountain Band, that I think deserve a review.

I'd very much like to know, Mr. Ragsdale, if you could tell me why the IPS dollar per person for Turtle Mountain in fiscal year 1989 was $320, when the high in the area was $1,100. How is that arrived at? There seems to be some confusion in terms of what formula is used to come up with a result like that.

Mr. RAGSDALE. Well, I agree there is some confusion. I can't speak to the dollar amounts. The fact of the matter is that we had a meeting scheduled at 11 o'clock this morning to meet with Congressman Dorgan, I believe, with some of my staff to go over their