CBC Chair calls work with IHS “a success story” but highlights how COVID-19 underscored many challenges

WASHINGTON D.C. - Testifying remotely, March 23, to the U.S. House Subcommittee for Indigenous Peoples of the United States in a hearing titled, “A year in review: The State of COVID-19 in American Indian, Alaska Native and Native Hawaiian communities,” Colville Business Council Chair Rodney Cawston issued a review of the Colville Tribes’ year-long fight against COVID-19.

“On the one hand, by working with the Indian Health Service early in the pandemic, the CCT was able to implement protocols on the Colville Reservation that we believe helped prevent the virus from spreading,” said Cawston, reading from a prepared statement. “In other ways, however, the pandemic made certain longstanding tribal needs, such as health facility needs, resources to reduce wildfires, and communications infrastructure, even more pressing.”

The Colville Tribes are one of a relatively small number of direct services tribes in the country, meaning the Indian Health Service provides direct services to the tribal membership through the Colville Service Unit, which has clinics in Nespelem and Omak, and Cawston noted early in the pandemic, the Colville Tribes worked closely with the CSU to “provide strategic planning to assist the Tribes in making decisions to control transmission.”

Cawston highlighted the closure of the reservation as one of these early public health measure that helped curb the spread of COVID-19 on the reservation, and the tribal chair further highlighted the fact “the combined efforts of 

both IHS and the Colville Tribes’ staff have resulted in the vaccination of 40 percent of the CCT’s vulnerable patient population.”

Although he called the tribes’ work with IHS “a success story,” Cawston noted the pandemic had highlighted the understaffed health care system on the reservation, the lack of public transportation and inadequate facilities.

“None of the clinical facilities on the Colville Reservation had negative pressure rooms to keep patients suspected of having COVID-19 isolated from other patients or clinic staff,” said Cawston. “IHS and the CCT erected temporary yurt  structures outside of the facilities that allowed for testing while patients remained in their vehicles. IHS and tribal staff have maintained this system in extreme weather conditions in the summer and winter months.”

While the COVID-19 pandemic underscored the Colville Reservation’s needs for more health facilities, it also impacted the tribes’ ability to address those needs, said Cawston, who noted in May 2020 IHS picked the Colville Tribes for a Joint Venture Facility Construction program.

“Under the Joint Venture program, an applicant agrees to construct and, in most cases, equip a health facility in exchange for IHS paying for a portion of recurring staffing costs,” explained Cawston. “When it applied, a significant portion of the Colville Tribes’ business plan to repay the funds needed to build the Omak clinic hinged on collection of third-party revenue, most notably Medicaid.

“The pandemic has reduced third party revenue and has threatened the viability of the Tribes’ business plan. For the Colville Tribes’ Omak clinic project, any reduction in the number of Medicaid eligible patients or services will affect the Tribes’ revenue forecasts and its ability to service debt for the construction of the clinic. This is coupled with the COVID-19 related decreases in third party revenue in the Indian health system generally. We understand that other JV project awardees, specifically the projects in Alaska, are facing similar challenges to the viability of their construction plans.”

As a fix, Cawston suggested that “at least some of the $600 million that Congress recently appropriated to IHS for Health Facility Construction in the American Rescue Plan Act should be utilized to assist those Joint Venture projects…”

Cawston further noted the pandemic had highlighted the Colville Tribes’ needs for active forest management and communication infrastructure.

“The most recent wildfires also highlighted the lack of communications infrastructure for rural tribes like the Colville Tribes, both for emergency management and distance learning,” said Cawston. “Ninety percent of the Colville Tribes’ 1.4-million-acre land base lacks broadband access. A contributing factor to the fatality that occurred in the Cold Springs Fire was the communications facilities such as (cell towers) that were rendered inoperable by the fire. 

“The lack of broadband has particularly affected rural reservation communities like the Colville Tribes. Schools on or near the Coville Reservation reported higher rates of absenteeism, homework being turned in late (or not at all), and even losing contact with tribal member students because of this lack of broadband access.”

Cawston testified alongside tribal leaders from across the country including Carmen Hulu Lindsey, Chair of the Office of Hawaiian Affairs, William Smith, Chair of the National Indian Health Board, Francis Crevier, CEO of the National Council of Urban Indian Health, Larry Curley, Executive Director of the National Indian Council on Aging, Adrian Stevens, Chair of the Board of Directors for the National American Indian Housing Council and Dr. Charles Grim, Secretary of the Chickasaw Nation Department of Health.

A press release issued from the National Indian Health Board following the hearing noted, “According to IHS, as of March 21, 2021, there was 189,231 positive COVID-19 cases reported across all 12 IHS Areas. The Centers for Disease Control and Prevention reported on March 12, 2021, that American Indians and Alaska Natives were 3.7 times more likely than non-Hispanic white people to be hospitalized and 2.4 times more likely to die from COVID-19 infection.”

The NIHB press release further outlined tribal priorities in the testimony, including

1. Provide full funding and mandatory appropriations for the Indian Health Service

2. Prioritize Tribal water and sanitation infrastructure

3. Increase support for Tribal mental and behavioral health

4. Provide greater health care access and financial support for IHS, Tribal, and urban (I/T/U) facilities

5. Create a sustainable Tribal health workforce

6. Increase telehealth capacity in Indian Country while expanding broadband access

7. Establish a 21st century Health Information Technology (HIT) system at IHS

8. Expand and strengthen the government-to-government relationship with the federal government and the Tribes and expand self-governance.

In response to the testimony of tribal leaders, ranking member Don Young (R-Alaska) suggested a “celebrity bill so we can really get it out in front and even if you don’t get it in one bite at least it’s out there and we get people talking about it.”

“As I have said in the past in my 48 years, we do a lot of talking and not much acting,” said Young. “I would like to suggest we do that and have a bipartisan bill addressing the indigenous people of America and solutions of problems that they’re facing, funding, housing, the whole bit, water, education, transportation. You name it. We can do that I believe if we get our heads together and do a good job.”

In response, subcommittee Chair Teresa Leger Fernandez (D-New Mexico) noted the virtual room was full of nodding in agreement to Young’s suggestion.

“This hearing was all I would have hoped it to be,” said Leger Fernandez. “You couldn’t tell who was a Republican and who was a Democrat for the most part in the questions, because all you heard was committee members asking what’s the problem and what can we do to help solve it so we do not have this continued devastation in our Indigenous communities.”

Leger Fernandez further noted she will take up Congressman Young’s call to have a subcommittee address history, comprehensive legislation: “We must fulfill the trust obligation,” said Leger Fernandez.

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