Don Lounder
RAPID CITY, SOUTH DAKOTA -- Native Americans have served in the armed forces in higher numbers per capita than any other ethnic group in the nation. Yet they have, more often than not, received inadequate services from both Department of Veterans Affairs (VA) and Indian Health Service facilities, if they receive services at all. U.S. Sen. Tim Johnson (D-SD), Chairman of the Military Construction and Veterans Affairs Appropriations Subcommittee, held a field hearing at the Journey Museum in Rapid City last week to broach the subject of underfunded Native American veteran health care. More specifically, the hearing was an attempt to examine how the VA and IHS can work together more effectively to provide quality care for the country’s approximately 45,000 Native veterans. “With the current fiscal situation in Washington, we are going to be asked to do more with less,” Johnson said. “The VA and IHS will need to be more innovative and collaborative than ever before in order to provide services in this environment.” Tuesday’s hearing is a protraction of the memorandum of understanding (MOU) compact that was signed by the VA and IHS last November. The MOU outlines a plan for coordination, collaboration, and resource-sharing between the two agencies with an ultimate objective of improving the health status of American Indian and Alaska Native veterans. According to one of the hearing witnesses, Randy Grinnell, IHS deputy director, the VA and IHS “have a long history of partnering.” Yet this lengthy partnership seemingly has yet to manifest greater-than-average, or even minimally satisfactory, results for the Native American veterans targeted for assistance. “It is the bureaucratic red tape that Native American veterans must go through which results in ultimately poor services,” said Donald Loudner, an enrolled member of the Crow Creek Sioux Tribe and national commander of National American Indian Veterans Inc., who provided further testimony at the hearing. Loudner referred to individualized Native veteran care through both the VA and the IHS as an “option and a right” that is not being met by either agency. Last month, the Senate passed Johnson’s VA Appropriations Subcommittee’s spending measure, the only fiscal year 2012 spending bill to be approved by the Senate. The bill included $52 million for collaborative efforts and sharing arrangements with the IHS to ensure that Native American veterans receive the care that they have earned. Testifying on behalf of the Veterans Health Administration was Dr. Robert Jesse, the agency’s principal deputy undersecretary for health. “Coordination of health care services for Native American veterans with IHS has been difficult,” said Jesse. “There is a need to ensure that the often isolated Native American veteran as a patient is visible to both the VA and IHS,” he said. One of the ways the VA and IHS are attempting to increase patient visibility is through the implementation of “novel” methods of care, according to Jesse; the most salient new method being the creation of purportedly far-reaching telehealth and telemedicine systems of remote access for Native veterans. Telehealth is a system of health care based on consultation by telephone, and telemedicine, a somewhat more advanced system, is the diagnosis and treatment of patients in remote areas using medical information, as x-rays or television pictures, transmitted over long distances, especially by satellite. “More and more, however, we are finding that many Native Americans living in rural areas do not have landline telephones, nor do these isolated areas have the wireless broadband access necessary for two-way telemedicine transmissions,” Jesse said. This remoteness is virtually impossible to surmount, no matter what the solution, indicated Loudner. “Few, if any, (Native American) veterans can overcome the vast distances encountered in receiving (health care) services,” he said. “These proud veterans in some instances use their very last dollar to travel to a facility for care.” Further compounding the issue is the pervasive reluctance, due to a lack of funding, of both the VA and the IHS to consistently and uniformly provide medical services to Native veterans. The two agencies have been accused by many Native American veterans of continually shifting responsibility for care back and forth. This shuffling of patients underscores the urgent need for increased meaningful communication and coordination of services between the VA and IHS. Whether each agency is “woefully underfunded” or not, it is of dire importance for Native veterans that the MOU stipulations be speedily realized, Loudner further indicated. “The VA and the IHS need to be more proactive in the approach to coordinate efforts to provide quality medical care for our nation’s deserving Native American veteran population,” said Johnson. “The question that needs to be answered is ‘Will IHS treat veterans or will they be referred to the VA?’” he asked. “The IHS must exhaust all other avenues before providing primary health care services, including veteran care,” Grinnell said. The VA is one of these “other avenues” of referral for the IHS. But the VA’s stance on the issue is apparently the reversal: IHS is oftentimes the outside referral source for Native veterans seeking care from the VA. Stephanie Birdwell, member of the Cherokee Nation of Oklahoma and director of the Office of Tribal Government Relations for the VA, testified that the OTGR strives to “engage the voice and perspective of the tribal communities served” through an ongoing series of consultation and listening sessions throughout the nation. Birdwell’s specified priority at the time of the hearing was Alaska. In addition to the longstanding issues of lack of adequate and available services and outright denial of services by the VA and IHS, Iva Good Voice Flute, Oglala Sioux Tribe member and Air Force veteran, provided testimony on the status of female Native American veterans. “Though many female Native veterans are reluctant to come forward for health care services, the VA and IHS are having to undergo a culture change with the increased numbers of female Native vets seeking services,” said Good Voice Flute. “And there are not enough OB-GYNs to go around for female medical issues in a culture that was traditionally male-dominated.” As Chairman of the Military Construction and VA Appropriations Subcommittee, Johnson has worked to reduce the gap in care that often exists for veterans in rural areas, particularly Native American veterans. Building on the Rural Health Outreach and Delivery Initiative he launched in fiscal year 2009 to close gaps in VA service in rural and remote areas, the spending measure approved last month by the Senate included $250 million for medical care, including telehealth and mobile clinics, for veterans in rural areas, inclusive of Native American populations. Johnson’s rural health initiative explores new ways of better serving this population with the ability to fund new programs based on the unique needs of rural veterans and applies to veterans covered by IHS. “American Indian and Alaska Native veterans have many problems in common with other veterans. But because of geographic remoteness, weak tribal economies, and a host of related pathologies, they face challenges that are in many ways unique,” Loudner said in his testimony. “This is exactly why it is high time for the VA and the IHS, as well, to play ball with us.” (Contact Jesse Abernathy at staffwriter@nsweekly.com)
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