[Congressional Record (Bound Edition), Volume 152 (2006), Part 9]
[Senate]
[Pages 11538-11540]
[From the U.S. Government Publishing Office, www.gpo.gov]




                   INDIAN HEALTH CARE IMPROVEMENT ACT

  Mr. DORGAN. Mr. President, I have come to the floor today to talk 
about the Indian Health Care Improvement Act and some frustration--I 
should say enormous frustration--that I and Senator McCain have about 
what is happening with a piece of legislation that is so very 
important.
  In this country, we have responsibility for health care for two 
groups of people: Federal prisoners who are incarcerated in prison--we 
are responsible for their health care. If they get sick, they go to an 
infirmary, they go to a hospital, we are responsible. We provide health 
care for Federal prisoners. We also have trust responsibility

[[Page 11539]]

for providing health care for American Indians. That is our trust 
responsibility.
  It is interesting and enormously disappointing to me that we spend 
twice as much per person on health care for Federal prisoners as we do 
in providing health care, as is our obligation, for American Indians.
  I want to talk a little about that because we have written a piece of 
legislation called the Indian Health Care Improvement Act, which builds 
on a piece of legislation that was passed some while ago. I want to 
talk about what American Indians are facing out in the country with 
respect to health care.
  Let me describe it first with respect to a story. This is a very 
typical story about a member of the Mandan, Hidatsa, and Arikara 
Nation, which is called the Three Affiliated Tribes in North Dakota. It 
is a story about a fellow who had diabetes. By the way, I held a 
hearing some years ago on that reservation. On that reservation, the 
rate of diabetes is not double, triple, or quadruple the rate of 
diabetes elsewhere. At that reservation, at that point, it was 12 times 
the rate of diabetes that existed elsewhere.
  The person I am speaking about on the Three Affiliated Tribes or Fort 
Berthold Reservation is Laidmen Fox, Sr. He was a Native American who 
had struggled, as other members of his family had, with diabetes. He 
had his feet amputated. Later he had his knees amputated. Finally, his 
entire legs were amputated. He was on dialysis. And, finally, the 
doctors told him he would have to have his hands amputated. At that 
point, Mr. Fox said he wanted to be taken off of the dialysis machine 
and to be taken home to die. He died 2 years ago. He went home to be 
with family and friends, having lost his feet, his knees, then his 
legs, and then told he would lose his hands. He died, was taken off 
dialysis.
  Just this last February, his daughter--who was 41 years old, and 
blind from diabetes, and also on dialysis--chose do have herself taken 
off the machine and went home to die in a similar manner.
  We now have in this country something nobody wants to talk about. We 
ration health care for American Indians. Yes, there is health care 
rationing. There is something called contract health services. That 
means that when American Indians show up at a clinic or a hospital and, 
through the Indian Health Service, seek treatment for their problems, 
the only treatment they will get and the only reimbursement they will 
get for that medical condition is if it means ``life or limb,'' 
threatening ``life or limb.'' Otherwise, in most cases, under the 
contract health provisions, there is no health care available.
  Let me talk about some other examples, if I might.
  A member of the Turtle Mountain Band of Chippewa Indians in my State 
was suffering from cancer. He went through chemotherapy, and went 
through chemotherapy again for a number of years through referral from 
the Indian Health Service to the University of Minnesota. All of a 
sudden the Indian Health Service said to him: We don't have any more 
funding. And they refused to pay for any additional treatment, even 
after he had a number of relapses.
  This is not unusual for American Indians to face this sort of thing.
  Another American Indian fell as a result of insulin shock at his 
home. He hit his hip, and hurt his hip badly in the fall. He was taken 
to a hospital by ambulance, given a shot for the pain and told he was 
to be released. His father objected because he said: My son can't walk. 
You can't release him. And the father said: I can't carry him. He can't 
walk. He must stay here.
  The doctor said he could stay in the hospital for one night's 
observation. The next day, when the pain did not subside, they gave him 
an x-ray, found out his hip was broken, and referred him to another 
facility. And because so much time had elapsed since the accident, he 
had to have a full hip replacement.
  Another tribal member was a Vietnam veteran and should have had the 
services of both the Indian Health Service and the VA available to him. 
He died after the Indian Health Service denied his request for a 
referral for him to be seen by a lung specialist at the Mayo Clinic. 
The IHS told him they had no money to send him to a specialist, and 
this Vietnam veteran died as a result.
  In Montana, an Indian man went to the Indian Health Service clinic 
seeking assistance for gallstones. He was told it was not a ``life or 
limb'' situation, which would get him referred to a health provider off 
the reservation under the contract health provisions I have just 
described. Subsequent to that, his duct ruptured and he became 
infected. He had to have part of his pancreas removed, and now he is on 
dialysis.
  Several months ago, a 24-year-old man at the Spirit Lake Nation went 
to the IHS clinic complaining he had abdominal pain. He was given some 
medicine and was sent home because he was not considered a ``priority'' 
patient. He ended up in the emergency room in a nearby hospital, off 
the reservation, and then transported to a larger medical center 125 
miles away. His appendix had raptured. That was 3 months ago, and he is 
still in the hospital 3 months later, as they attempt to try to control 
his body temperature and other related matters.
  He was determined not to have a ``life or limb'' emergency medical 
need, and so his actual condition was overlooked, with the results of 
several months now of acute care in a hospital.
  Mr. President, I have spoken a number of times on the floor of the 
Senate about a young girl named Avis Little Wind. I brought her picture 
to the floor of the Senate. I did that with the permission of her 
relatives. She was 14 years old, and she hung herself. She killed 
herself 2 years after her sister had killed herself.
  I went to the reservation because we have had a cluster of suicides 
of young teenagers on Indian reservations. I talked to this young 
girl's teachers, school administrators, people in the mental health 
area, tribal council folks, to try to understand what is wrong here.
  What I discovered is this little 14-year-old girl, named Avis Little 
Wind, laid in a bed for 90 days in a fetal position. Clearly, something 
was seriously wrong with this young woman. Yet, it did not send a 
signal to anybody. Her father killed himself. Her mother was 
dysfunctional, a substance abuser. This young girl somehow just slipped 
through the system, and she got up one day out of that bed and took her 
own life.
  Avis Little Wind is one person, but a person whose future was stolen 
from her because she felt hopeless or helpless. And the fact is, on 
that Indian reservation--as is the case for most Indian reservations--
there is no mental health treatment available. There are not enough 
people available just for the diagnosis of serious problems. You would 
think someone who misses 90 days of school at age 14 would send alarm 
bells all over, but it did not. There is not enough money in the Indian 
Health System to deal with it.
  Senator McCain and I have passed some legislation recently dealing 
with the issue of Indian teen suicide and trying to begin to address 
that issue. But there is a serious lack of attention to the health care 
needs of Native Americans and, yes, teenagers like Avis Little Wind and 
the tragedy that resulted in her death.
  It is not uncommon to see 75 people stand in line waiting to have a 
prescription filled. It is not uncommon for them to stand in line only 
to find out they can't get the prescription filled because the medicine 
is not available there.
  I have been to a health care facility where one dentist is working in 
a small trailer house serving 5,000 people. Is that fair? Is that the 
right thing to do? We can do better than that as a country. Yet, 
somehow, this issue of the Indian Health Care Improvement Act is not a 
priority. The administration has dragged its feet, and dragged its feet 
for months and months. Senator McCain and I have just written the 
administration a letter saying: How about some help here? How about 
some cooperation? Let's find a way to solve this and fix it.

[[Page 11540]]

  While we talk and while we dither and while the administration 
decides to delay, we have people losing their lives, and we have people 
going to health care facilities with very serious problems being told: 
We don't have the money to refer you.
  Mr. President, I ask unanimous consent for 1 additional minute.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. The tribal chairman for the Three Affiliated Tribes in 
North Dakota says: Everybody up there on the reservation understands, 
don't get sick after June. Just don't get sick after June because the 
money has run out on contract health services. If you get sick after 
June, there is no money. They are not going to send you to a hospital. 
Or if you go to the hospital, the hospital will charge back to you 
because they won't get the money from the Indian Health Service. It 
will ruin your credit, and you will have to file for bankruptcy. But 
don't get sick after June because the money won't be there.
  What kind of message is that to the American people, especially the 
most vulnerable in our society? These reservations are where there is 
substantial poverty, great difficulty.
  I have not mentioned methamphetamine. We have had hearings about 
that. It is unbelievable what is happening with respect to these 
reservations and health care, and yet somehow there is no urgency here.
  Senator McCain and I are asking for a little cooperation from the 
administration and some cooperation here in the Senate to move this 
bill.
  We had a witness just the other day at a hearing about 
methamphetamine on reservations. Methamphetamine is a scourge all 
across this country.
  Mr. President, I ask unanimous consent for 2 additional minutes.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  Mr. DORGAN. One of the witnesses at that hearing on methamphetamine 
on reservations, who is the chairperson of an Indian tribe, lives on a 
rural reservation with 13,000 Native Americans who live on that 
reservation. She told us that one-half of the babies who have been born 
to tribal members on that reservation--one-half of the babies--have 
tested positive for alcohol or drugs, including methamphetamine. Think 
of that.
  I was in a hospital one day when they showed me a young baby that was 
born with a .12 blood alcohol content lying in the nursery. This baby 
was born with a .12 blood alcohol content, and the mother was down the 
hall and refused to see the baby because she did not want the baby. She 
checked into the hospital dead drunk.
  The fact is, we have serious problems with methamphetamine and 
substance abuse and teenage suicide, and all of these issues, and we 
have a health care system on Indian reservations that is a rationing 
system. When the chairman of the tribe in my State says, ``All the 
Indians know: don't get sick after June because the money is not there 
under contract health to help you,'' that is a serious problem.
  All I am asking for and all Senator McCain is asking for is a little 
help and a little cooperation from the administration and, yes, from 
our colleagues to move this legislation called the Indian Health Care 
Improvement Act. It is the right thing for this country to do. Mr. 
President, I see the chairman of the committee is here, and I will, at 
this point, yield the floor.
  I do have an amendment I wish to offer on the Defense authorization 
bill today, and I am available to do that when it is convenient. But 
the chairman and ranking Member are here, so at this point I yield the 
floor.
  The PRESIDING OFFICER. The Senator from Virginia.
  Mr. WARNER. Mr. President, I was much taken by the remarks of the 
Senator from North Dakota. I have great respect for the Senator from 
North Dakota. I tell you, you do a lot of homework. You do a lot of 
independent work. And while I do not have the expertise with regard to 
the reservations that you have, any of us listening to your comments 
would immediately come to the conclusion that we better step in to 
help. And I say to the Senator, you can count on me when the time 
comes. I think that matter should be addressed as quickly as we can by 
the Senate.
  I thank the Senator.

                          ____________________