Mr. WILLARD. And, as such, we do not get involved in the day-to-day policy decisions of the tribal government. Senator ABOUREZK. Do you prefer not to Mr. WILLARD. So I will yield. Senator ABOUREZK. I want to thank both of you for your time. Mr. WILLARD. I might just, while I have a couple of minutes, I will be presenting prepared testimony. We did file a letter dated August 20 to Morris Thompson, object to his March 3d letter pursuant to the Buy Indian Act in which he states for the purpose of the administration of the act, an Indian economic enterprise must be 100 percent home for purposes of implementing and negotiating authority under contracting authority of the act. This contravenes the Bureau's own memorandum of August 22, 1968, which the then commissioner by memorandum and solicitor's opinion related that 51 percent was adequate. The reason I bring this out is because as the village corporations venture into business activities, there will be oftentimes we'll go under a partnership basis. We have one such entity now that I am very familiar with wherein we went into a joint venture with a substantial partner for the purpose of their expertise. Our little village corporation controlled 80 percent of the stock. By the interpretation of the March 3d letter of Commissioner Thompson, our business enterprise would be exempt from being included in the special provisions of the act itself. These are just some of the areas that I wanted to allude to that will become more specific in the written testimony. Senator STEVENS. May I inquire, Mr. Chairman? Is that a result of a statutory provision applied in Alaska, or is that a national thing as far as the Indian ownership? Mr. WILLARD. This is a memorandum put out by the Commissioner Thompson to all Bureau of Indian Affairs and manual holders. Senator STEVENS. In other words, it was a national decision? Mr. WILLARD. It was a national-type thing. If I'm not mistaken, it was not the intent of the act when it was passed in 1910 and amended in 1934 or 1936. Senator ABOUREZK. Are you going to submit that testimony for the record? Mr. WILLARD. Yes. Senator ABOUREZK. I want to express my thanks to you, both of you. [The prepared statements of Mr. Baines and Mr. Willard follows:] SOUTHEAST ALASKA GOLDSTEIN BUILDING, ROOM 414 130 SOUTH SEWARD STREET September 1, 1976 The Honorable James Abourezk Dear Senator Abourezk: I would like to thank the American Indian Policy Review Commission for permitting me to present my testimony. My name is Conrad P. Baines, Jr.; I am the executive director of the Southeast Alaska Regional Health Corporation. The corporation covers the same geographical area as SEALASKA Corporation and the Central Council of Tlingit and Haida Indians of Alaska. The health corporation serves the Tlingit, Haida and Tsimpshian Indians of Southeast Alaska with the mandate to be a strong advocate and to improve their health status to the highest degree with as much community involvement as possible. My statements have not been approved by our board of directors and should not be construed as policy. I am speaking personally and drawing from my experience of the past year as an executive director. Although the intent and thrust of the hearing is to obtain testimony on Public Law 93-638 and contracting, I would like to offer testimony on other related and pertinent areas in manpower, facilities, program areas that need funding, PL 93-641 problem areas and the Indian Health Care Improvement Act. CONTRACTING SEARHC is a private non-profit health corporation. For the period July 1, 1975 to September 30, 1976, SEARHC was awarded three contracts from the Indian Health Service area office in Anchorage. The contracts were as follows: 1) Contract #243-75-0552, a cost reimbursement contract to Senator James Abourezk -2 September 1, 1976 develop the administrative capabilities of the health corporation; 2) Contract #243-76-0032, a fixed price contract to provide primary health care through our health aides in the Native communities where little or no primary health care exists; and, 3) Contract #243-76-0164, for purposes of training our employees in contract administration and finance. The amounts of the contracts were as follows: $214,240 Community Development Community Health Aide Program TOTAL IHS FUNDS There are several problem areas in the contracting process that we find objectionable and should be considered by the policy review commission. For the coming year, the above contracts will be combined into one reimbursement contract. The areas that I wish to bring to your attention are as follows: 1) Cost Reimbursement Contracts with No Cash Advance. We find this objectionable for obvious reasons. SEARHC must rely upon Central Council for daily cash flow. 2) Paternalistic Attitude of Contract and Project Officers. The "would be" contractor has very little voice in the negotiation proceedings. A legal contract advisor (lawyer) is not an allowable cost. When a tribe negotiates for a contract, legal counsel should be made available at no cost so negotiations with the contract officer can be made on equal footing. In the past, all contract requirements were virtually spelled out by the contract officer with little regard to tribal input. This attitude is clearly documented by the Alaska Federation of Natives (AFN) and the Association of Regional Health Directors (ARHD). The Association is composed of the directors of 12 Native health corporations. The August 30 letter from Carl Jack, Director of AFN Health Affairs, to Gerald Ivey, Area Director of Alaska Area Native Health Service (AANHS), is submitted as documentation of the contracting situation. 3) Treatment of Indirect Costs. Whenever we negotiate a contract amount, indirect costs must come from the negotiated amount therefore decreasing the amount of services that is to be performed in the contract. Many contracts have no provision for indirect costs as an allowable cost. The Indian Health Service requires strict accounting of all funds; but to allow little or no indirect costs is a conflict of interest. Senator James Abourezk -3 September 1, 1976 4) Budget Revision. The contracts that IHS initiates require a five percent (5%) or $5,000 allowable transfer of line items. Any variance from the 5% flexibility is an unallowable cost. In order to get a budget amended, the contract allows the contract officer 30 days to respond to the proposed budget amendment. We find this 30 days clearly objectionable and unworkable. This response time must be reduced to a much shorter workable time, such as five (5) working days. INDIAN HEALTH CARE IMPROVEMENT ACT Testimony would also like to be provided on the Indian Health Care Improvement Act. First of all, we would like to reaffirm our support for the act and would like to emphasize the need for the bill to be passed in the $2 billion magnitude. The projected estimated unmet needs for the Indian health services in Southeastern Alaska is in the vicinity of $5.5 million. The documentation of this figure is presented within the Mt. Edgecumbe Service Unit Operating Plan. This plan has been obtained from Arthur Willman, Service Unit Director. The Indian Health Care Improvement Act provides for Indian manpower development. This provision is needed in order to truly fulfill goals of Indian Self-Determination. Since the inception of SEARHC April 1975, one of the main problems we have had is finding Indian manpower with formal education and experience in the health field. Indian people with administrative and/or clinical background are virtually nonexistent. To provide an example, since the inception of SEARHC, as the executive director, I have been the only staff member having a masters degree in a health related field. Information drawn from the Association of American Indian Physicians, shows that there exists no Tlingit physicians anywhere in the United States; however, there is a fourth year dental student who is a Tlingit presently working in Anchorage at this time. It is common knowledge from IHS printouts that most deaths among Southeast Alaska Indians are related to alcohol abuse and accidents. However, at this time, there exists no alcoholism treatment or injury control programs at the community levels. Most Indian communities in Southeast Alaska have either inadequate clinics or none at all. Although it is known and documented what the Indian health problems are, there exists no manpower, facilities or programs to combat the problems. The Indian Health Care Improvement Act can help remedy some of the problems. SEARHC has been corresponding with staff of the Secretary of Senator James Abourezk -4 September 1, 1976 Correspondence from David Matthews indicates that he recognizes the need for improvement of health services; but, it is the opinion of the Secretary that the services should be improved through Titles XVIII and XXof the Social Security Act. SEARHC would like to state our as to the idea of using Medicare and Medicaid as the sole agents for improving health services to the American Indians. The Indian Health Service definitely is the mechanism to improve the services. PL 93-641 There is another area that SEARHC would like to make comments on. These comments pertain to Public Law 93-641. The law is the National Health Planning and Resources Development Act of 1974. Even though the rural medically underserved are the number one priority, in Southeast Alaska these are Indian. There are no travel funds for the people from the area to participate in SEAHSA activities. The importance of PL 93-641 to the Indian community cannot be overlooked. While the HSA will have only review and comment authority where Indian projects are concerned, the HSA, in performing their function, can defer forwarding Indian project proposals to the Secretary of HEW up to 60 days. Such delay could interrupt services supported by various grants and/or contracts. Further, a negative comment concerning Indian proposals could influence the Secretary's decision to fund or not to fund an Indian health proposal. Personally, I feel this seems to be an infringement upon the American Indians special relationship with the United States federal government. We would like to thank you, Mr. Chairman, for coming to Southeast Alaska and hope you return again. Sincerely Correlp. Bain). Conrad P. Baines, Jr. CPB/rp Enclosures |