IHS pressed to include tribes in reform efforts
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A proposed reorganization of the Indian Health Service has drawn growing concern from tribal leaders, who asked this week to be included in reforming a system they agree has numerous problems.

Efforts to change the way IHS serves American Indians and Alaska Natives have long been identified. But under the "one department" initiative outlined in President Bush's new federal budget, tribes are worried their needs will not be addressed.

At a conference the National Congress of American Indians in Washington, D.C., on Wednesday, tribal leaders made their complaints known. Dennis Charley, an Alaska Native leader, asked Dr. Michael Trujillo, director of the IHS, to set up a task force so that the process can be "tribally driven."

"We live it in our everyday lives," said Charley of the health care provided at the reservation, village and urban level.

According to Trujillo, who is set to leave his second four-year term this summer unless Bush acts to nominate him, there are several components to the new initiative. All focus to "streamline" and "downsize" the Department of Health and Human Services and not just the IHS, he said.

Acknowledging a very "tight" budget, Trujillo said reorganization could proceed on several fronts. Included are management reforms and consolidation of various offices including public affairs and information technology (IT).

But what has drawn debate from tribal leaders most is a proposal to shift all department facilities construction to one office under Secretary Tommy Thompson. Indian Country hospitals and clinics would be affected by this move, which Sen. Daniel Inouye (D-Hawaii) earlier this week challenged tribes to examine more closely.

Going by the fiscal year 2003 budget, the outlook doesn't look promising. IHS facilities construction has been cut by $14.3 million after seeing historic increases during the Clinton administration.

While most of the slash represents completion of ongoing projects, the reduction in funds means that high priority facilities will not be funded next year if Congress approves the budget as it is now stands. Also, Trujillo pointed out that changes are imminent, saying the department would be moving within the next "several months" on reorganizing.

Some tribal leaders appeared taken aback by the developments. Although they strained not to criticize Trujillo, whom many said they admire and respect, they pressed him for his personal views on the changes.

Trujillo was somewhat non-committal in his response. "There's always changes that are necessary," he said.

While not immediately supportive of a task force, Trujillo nonetheless agreed tribal participation in the debate was essential. "Indian tribes should be involved in policy and implementation," he said.

"Tribes have a major part in the process" in lobbying Congress for additional funds and programs, he added. "Your assistance is essential and critical."

Frank Paisano, an official from Sandia Pueblo in New Mexico, challenged Trujillo, who is from Laguna Pueblo, to "speak up for your Indian people" in improving the health and welfare. "If you're not inclusive and don't involve yourself, then I think we're going to fall further and further behind," he said.

Trujillo was also asked to move forward on an internal investigation of the way the Portland Area IHS handles services and care. He said the request, received in a letter last year, was still being evaluated.

Florence Chavez (Taos Pueblo / Sandia Pueblo) of the National Indian Council on Aging urged Trujillo to focus on issues affecting senior citizens. "I think we're neglecting them," she said, pointing out that she is among the growing elder population.

Trujillo said the majority of people who receive IHS care are the elderly. He said the agency is looking at the way it provides elder care

The IHS budget for fiscal year 2003 is $2.9 billion, an increase of $60 million over the current fiscal year. Most of the increase is due to higher costs of providing health care and not to increased spending on programs.

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