[Congressional Record (Bound Edition), Volume 152 (2006), Part 13]
[Senate]
[Pages 18387-18389]
[From the U.S. Government Publishing Office, www.gpo.gov]




                           INDIAN HEALTH CARE

  Mr. DORGAN. Mr. President, I want to speak about a subject that is 
very important dealing with Indian health. I believe there will be an 
attempt to move legislation by consent in the Senate dealing with the 
reauthorization of the Indian Health Care Improvement Act. We have had 
difficulty moving that legislation. Senator McCain and I and others 
worked on completing the legislation. It has not yet moved. My hope is 
that it can move through the Senate without objection today.
  I want to describe why it is important because in this country, there 
is a lot of noise about a lot of issues. People often talk about the 
noise of democracy. Sometimes that noise of democracy is a very welcome 
noise and wonderful sound, but there are other times when it is shrill 
and partisan and the noise of democracy is not such a comfortable 
noise.

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  In the midst of all the discussions about all of these issues, there 
are day-to-day issues that affect peoples' lives, especially health 
care. On Indian reservations in this country, there is a very special 
challenge with respect to health care. We have a trust responsibility 
for Indians and their health care. We don't meet that responsibility 
very well.
  There is wholesale rationing going on with respect to health care for 
American Indians. Nobody likes to talk about it. Around 60 percent of 
health care needs of American Indians are being met, and about 40 
percent of the needs are unmet. That estimate comes from the Indian 
Health Service. It is not one they advertise, but it is one you can pry 
out of them if you are persistent enough.
  We spent twice as much money per person on health care for Federal 
prisoners than we do to support our trust responsibility of health care 
for American Indians.
  Let me say that again. We have a responsibility for the health care 
of Federal prisoners because they are incarcerated. We spend twice as 
much per person for their health care than we do to provide the health 
care that we are responsible to provide to American Indians. That ought 
not be a source of pride for anybody in this Chamber or the other 
Chamber who is involved in the discussions about these issues.
  Let me describe, if I might, through the stories of a couple of 
Native Americans, what they face with respect to health care and why 
there is such an urgency to pass the Indian Health Care Improvement 
Act. That reauthorization is long overdue, and I hope it will be 
accomplished today in the Senate.
  Let me tell you about an 80-year-old elder who is a diabetic and 
living on an Indian reservation. This 80-year-old diabetic fell while 
tending to her garden and broke her leg in two places. The break was so 
severe that there was a bone sticking out of her ankle. This 80-year-
old woman went to the hospital. The doctor sent her home with 
painkillers.
  She then went to another hospital and was told the condition was not 
priority 1, which means ``life or limb,'' and, therefore, she was not 
able to get care.
  She went to a third hospital, limped in, and finally received some 
care--the third stop, with a bone sticking out of her leg.
  What is this ``life or limb''? It means that under what is called 
contract care for American Indians--one tribal chairman on a 
reservation in my State said, we understand: Don't get sick after June. 
If you do, there is not any money available to you. If it is not ``life 
or limb,'' if it doesn't threaten your life or limb, we are sorry, you 
are out of luck; no health care service for you.
  Another American Indian with diabetes called in for a prescription 
drug refill for insulin. He was told he should come in and get blood 
work done first. It was 2 weeks before he could get that blood work. So 
he was without the insulin he needed for almost 2 weeks. As a result, 
this person will likely require dialysis because he couldn't get his 
prescription filled in a timely manner.
  This is a picture of a woman who said it was all right for me to use 
her picture. Her name is Lida Bearstail. Lida Bearstail went to a 
clinic because of knee pain. Her condition was one in which the 
cartilage had worn away in her knee so that the bones in her knee were 
rubbing against each other, causing her great pain and great 
discomfort.
  If that happened to us or one of our families with our health care 
system, my guess is a doctor would recommend knee replacement surgery, 
and we would go in and have some knee replacement surgery. But her pain 
and her limb and the cartilage being gone and bone rubbing against bone 
was not deemed life or limb or a ``priority 1'' medical condition. She 
was just given pain medication. She tried a second time. Again denied.
  The question is: What would happen with us? We would get knee 
surgery. What happens to Lida Bearstail? She limps, has trouble 
walking, and probably someday will not be able to walk. Knee surgery is 
not in her future. It is not life or limb, not a priority, not a 
priority for Lida.
  Let me describe the circumstances of another woman. And she also has 
given me permission to use her picture. This is Ardel Hale Baker. I 
want to tell you about Ardel Hale Baker. A couple of months ago, she 
had chest pain--very serious chest pain--that wouldn't quit. Her blood 
pressure was very high. So she went to the Indian Health Service 
clinic, and she was diagnosed as having a heart attack. She needed to 
be sent immediately to the nearest major hospital.
  They said: You need to go in an ambulance.
  She said: Is there a chance I can go in something other than an 
ambulance? She was thinking--she was having a heart attack, but she was 
thinking: ``I am going to get billed for this and I don't have any 
money,'' because if you are not ``priority 1,'' you may end up having 
to pay the bill. And if you don't have the money, it ruins your credit 
rating and credit companies come after you.
  Anyway, she said: I would not like to go in an ambulance. Can I go in 
a private vehicle?
  They said: No, you have to go in an ambulance.
  When she arrived at the hospital, the nursing staff was lifting her 
off the gurney and putting her on a hospital bed. As they lifted Ardel 
Hale Baker off the gurney, they found something taped to her leg. This 
woman was having a heart attack, and they found a piece of paper--this 
piece of paper--taped to her leg.
  It had her name on it. It says: Hale, Ardel. Then it says: ``You have 
received outpatient medical services. This letter is to inform you your 
priority 1 care cannot be paid for due to funding issues.''
  So this woman is taken off a gurney to be placed on a hospital bed, 
having a heart attack, and a hospital worker finds a piece of paper 
taped to her leg saying: Oh, by the way, this isn't ``priority 1.'' 
This won't be paid for.
  This sort of incident is unbelievable, and it is going on in this 
country in Third World conditions on Indian reservations because the 
health care that is available--or should be available--is not available 
under the circumstances in which it is needed. Again, we have a tribal 
chairman that has said in public hearings in the Congress: ``On our 
reservation, we understand. Don't get sick after June because the money 
has run out and you are not going to get health care.'' So we have a 
woman going into a hospital with a paper taped to her leg, having a 
heart attack, that says, ``We are sorry, this won't be paid for.''
  If ever there is an understanding of the need for fast 
reauthorization of the Indian Health Care Improvement Act, that ought 
to be it.
  I expect Senator McCain and I and others who have worked for months 
on this piece of legislation--in fact, for several years on this piece 
of legislation--I expect all of us share the same hope today: that the 
Senate will have advanced this measure and given some hope to people 
who are waiting for improvement in health care on Indian reservations. 
In too many cases, there are people who feel left out, left behind. 
They feel hopeless and helpless.
  I have spoken on this floor about a young girl named Avis Littlewind. 
Avis Littlewind was 14 years old when she killed herself. She, like 
others, as we find clusters of teenage suicides on reservations, 
apparently felt there was no hope. She laid in her bed for 90 days, 
missing 90 days of school. Her sister committed suicide 2 years prior 
to that.
  The fact is, when you go talk to these kids--and I have, I talked to 
Avis Littlewind's classmates. I went to the Standing Rock Reservation 
and talked to a group of kids with no other adults present. They were 
high school kids, and I talked to them about their lives. There was a 
cluster of teenage suicides on that reservation. We understand that 
just the basics we expect don't exist for them--the basic mental health 
treatment. When they reach out, there is no one there. One woman was in 
tears as she said: We don't have proper mental health treatment. We 
don't have enough of it here. In order to transport a kid who needs to 
see a professional, I would need to borrow a

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car. I would need to beg somebody to give me a car to take them to 
someone who can see them.
  That is what is going on. This country can do better than that. We 
have a responsibility to do better than that. We have a trust 
responsibility for these health care needs. My hope is that today the 
Senate will agree by unanimous consent to pass the Indian Health Care 
Improvement Act, the reauthorization that is so long overdue.
  Mr. President, I yield the floor.

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