Facing federal backlog, Oklahoma tribes step up health investments
Several tribes in Oklahoma are planning major investments in health care, including a Cherokee project that will be the largest joint venture in Indian Health Service’s history.
The Cherokee, Muscogee and Osage nations all are expanding their health facilities and planning to hire more providers. Several of the projects are joint ventures where a tribe pays to build and equip new facilities, but the federal government agrees to pay some of the operations costs. Others, such as the Chickasaw Nation, are investing in offering more services within their current footprint.
The U.S. government committed to provide health services to American Indians under a series of treaties and federal laws, but the Indian Health Service has been underfunded for years. Tribes have identified at least $14 billion worth of work needed to build or upgrade health facilities, and at the current rate of funding, a project might not move forward for decades, or even centuries, said Dr. Charles Grim, interim executive director of health services for the Cherokee Nation.
“The need out there is far outstripping the money they’re making available,” he said. “Depending where you are on a list, it could be 300 years until they get to you.”
The Cherokee project includes building a new, 490,000-square-foot facility in Tahlequah for outpatient services like primary care, dentistry, optometry, physical therapy and some surgeries that don’t require an overnight stay. Currently, those services are provided in the same building as inpatient care, Grim said. Separating them will give both the hospital and the outpatient offices room to serve more patients, he said.
“Every single service is expanding in size,” he said.
The Cherokee Nation will spend about $200 million on the new building, and at least $75 million on equipment and information technology systems. The facility is scheduled to open in 2019, and will create about 800 new jobs. It will be the largest project in the joint venture program’s history, Grim said.
The investment is part of a larger effort to prioritize health, which included raising pay for some doctors, committing more money to pay for care at non-Cherokee facilities, building two new facilities and expanding two others, Grim said. In those cases, the tribe funded the projects without federal help, he said.
Cherokee Nation Principal Chief Bill John Baker said improving health care lays the foundation for the tribe’s future.
“For many years Native people, including Cherokees, have faced the worst health disparities in our country,” he said. “Through planning, focus and partnerships, we have an opportunity to change that history and truly make the health of our people a priority. I’m proud that tangible changes are taking shape to improve health care access for Native people across northeast Oklahoma.”
To get funding through a joint venture, tribes have to compete by showing their members need access to certain services, and that they have the funds and expertise to complete the project, Grim said. Less than 30 projects have been approved since the early 1990s, and Oklahoma applications have been unusually successful. The current project is the third for the Cherokee Nation, and the Chickasaw and Choctaw nations also have secured joint ventures, he said.
The Muscogee Nation also has a joint venture in the works to replace an outpatient facility in Eufaula by this summer. A second project, financed by the tribe, recently created a combination inpatient and outpatient facility in Okemah, said Shawn Terry, secretary of the health for the Muscogee Nation. The outpatient side is open, and the inpatient side will open after the state finishes inspections and licensing, he said.
Both projects replace facilities from the 1970s, which didn’t have enough space for the number of providers and patients they have now, Terry said. The new facilities will be able to handle at least 2,000 more patients than they currently have, he said.
“They were badly dilapidated, in bad need of replacement,” Terry said.
Other tribes’ projects, plans
The Osage Nation also found it had outgrown its health facilities, and plans to spend at least $15 million on new construction. A new clinic will nearly triple the space available in the current facility, which is about 12,500 square feet.
Dr. Ron Shaw, chief executive officer of Osage Nation Health Services, said the current building couldn’t accommodate services they wanted to add, like mammograms and physical therapy.
“We are limited in space to provide more patient encounters and a wider scope of services,” he said.
New facilities aren’t always necessary, however. The Chickasaw Nation is planning to invest in hiring pediatricians for its existing clinics as part of a push to emphasize prevention, said Dr. Judy Goforth Parker, the nation’s secretary of health. Recruiting physicians is a challenge in rural areas, she said, but they have found a group of doctors and nurse practitioners who want to work in-depth with a smaller number of children.
“While our family medicine services have served our patients well for years, we believe adding providers who are specifically trained to connect and interact with our children will offer the opportunity to begin even earlier developing lifelong habits and choices that promote wellness and overall health,” she said.
An artist’s rendering shows a planned health facility in Okemah. The Muscogee Nation is constructing two new facilities as part of its investments in health.
An artist’s rendering of a planned outpatient care facility in Tahlequah. The facility is the latest Cherokee Nation project to improve access to health care.