<DOC>
[110 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:41320.wais]
S. Hrg. 110-393
THE STATE OF FACILITIES IN INDIAN COUNTRY: JAILS, SCHOOLS, AND HEALTH
FACILITIES
=======================================================================
HEARING
before the
COMMITTEE ON INDIAN AFFAIRS
UNITED STATES SENATE
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
MARCH 6, 2008
__________
Printed for the use of the Committee on Indian Affairs
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41-320 PDF WASHINGTON DC: 2008
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COMMITTEE ON INDIAN AFFAIRS
BYRON L. DORGAN, North Dakota, Chairman
LISA MURKOWSKI, Alaska, Vice Chairman
DANIEL K. INOUYE, Hawaii JOHN McCAIN, Arizona
KENT CONRAD, North Dakota TOM COBURN, M.D., Oklahoma
DANIEL K. AKAKA, Hawaii JOHN BARRASSO, Wyoming
TIM JOHNSON, South Dakota PETE V. DOMENICI, New Mexico
MARIA CANTWELL, Washington GORDON H. SMITH, Oregon
CLAIRE McCASKILL, Missouri RICHARD BURR, North Carolina
JON TESTER, Montana
Allison Binney, Majority Staff Director and Chief Counsel
David A. Mullon Jr. Minority Staff Director and Chief Counsel
C O N T E N T S
----------
Page
Hearing held on March 6, 2008.................................... 1
Statement of Senator Barrasso.................................... 10
Statement of Senator Dorgan...................................... 1
Statement of Senator Johnson..................................... 10
Prepared statement........................................... 10
Statement of Senator Murkowski................................... 26
Statement of Senator Tester...................................... 30
Witnesses
Davidson, Valerie, Senior Director, Legal and Inter-Governmental
Affairs, Alaska Native Tribal Health Consortium; accompanied by
Rick Boyce, Director, Health Facilities Support................ 52
Prepared statement with attachment........................... 55
Grinnell, Randy, Deputy Director, Management Operations, Indian
Health Service, U.S. Department of Health and Human Services;
accompanied by Gary Hartz, Director, Office of Environmental
Health and Engineering, and Rick Olson, Director, Clinical and
Prevention Services............................................ 16
Prepared statement........................................... 17
Herraiz, Domingo S., Director, Bureau of Justice Assistance, U.S.
Department of Justice.......................................... 18
Prepared statement........................................... 20
Nosie, Wendsler, Chairman, San Carlos Apache Tribe............... 37
Prepared statement........................................... 39
Ragsdale, W. Patrick, Director, Office of Law Enforcement
Services, Bureau of Indian Affairs, U.S. Department of the
Interior; accompanied by Jack Rever, Director of Facilities.... 11
Prepared statement........................................... 14
Roessel, Charles Monty, Superintendent, Rough Rock Community
School......................................................... 46
Prepared statement........................................... 48
Appendix
His Horse Is Thunder, Ron, Chairman, Standing Rock Sioux Tribe,
prepared statement............................................. 103
Holt, Linda, Chairperson, Northwest Portland Area Indian Health
Board; Suquamish Tribal Council Member, prepared statement..... 99
National Indian Education Association (NIEA), prepared statement. 109
Prior, Kyle, Chairman, Shoshone-Paiute Tribes of the Duck Valley
Reservation, prepared statement................................ 106
Response to written questions submitted to Domingo S. Herraiz by:
Hon. Maria Cantwell.......................................... 111
Hon. Byron L. Dorgan......................................... 110
Written questions submitted to Jack Rever and W. Patrick Ragsdale
by:............................................................
Hon. John Barrasso........................................... 113
Hon. Byron L. Dorgan......................................... 112
Hon. Tim Johnson............................................. 113
Written questions submitted to Randy Grinnell by Hon. Maria
Cantwell....................................................... 114
THE STATE OF FACILITIES IN INDIAN
COUNTRY: JAILS, SCHOOLS, AND HEALTH
FACILITIES
----------
THURSDAY, MARCH 6, 2008
U.S. Senate,
Committee on Indian Affairs,
Washington, D.C.
The Committee met, pursuant to notice, at 10:00 a.m. in
room 628, Dirksen Senate Office Building, Hon. Byron L. Dorgan,
Chairman of the Committee, presiding.
OPENING STATEMENT OF HON. BYRON L. DORGAN,
U.S. SENATOR FROM NORTH DAKOTA
The Chairman. We are going to begin the hearing. This is an
oversight hearing on the state of facilities in Indian Country:
jails, schools and health facilities by the Senate Committee on
Indian Affairs here in the United States Senate.
My colleagues will join me shortly, but because of time
constraints, we need to begin. We will likely have a Senate
vote at about 10:45 this morning. We will have to have a brief
recess when that occurs.
Today, the Committee will examine the current state of
health facilities, schools, detention facilities and more in
Indian Country. We will receive testimony from the agencies
responsible for administering the programs to build new and to
repair existing facilities. We will also hear about the
obstacles they face in trying to complete these facilities.
Early in the Federal Government's relationships with Indian
tribes, the Government itself owned and operated facilities for
health care, education and, to a lesser extent, for detention.
Over the past 33 years, however, many tribes have contracted or
compacted with the United States to take control of these
facilities and their operations.
Nevertheless, the primary source of funds for the
construction of and the operation of these facilities still
remains the Federal Government.
Before touching on the three areas--schools, health care
and detention facilities--that are the subject of this hearing,
I want to highlight the erratic and insufficient funding and
the nature of Federal spending in dealing with these issues.
Taking health care as an example with chart 1--I am going to
show a number of charts this morning--over the last 25 years,
annual Federal spending has ranged from under $15 million to
almost $140 million for health care facilities.
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The Administration's budget request for the 2009 fiscal
year is extremely low, at the low end of this at the $15.8
million range, yet the amount necessary to fund the facilities
on the current priority list of the Indian Health Service for
Fiscal Year 2009 through the out years is an estimated $2.6
billion. Let me repeat, the funding needed for the facilities
on the current priority list is $2.6 billion, yet in 2009, the
Administration is requesting little more than one half of 1
percent of that amount. At that rate, final funds for
facilities on the current priority list would be available at
the end of 165 years.
With respect to schools, the Bureau of Indian Affairs funds
approximately 4,500 schools or school facilities in Indian
Country. Most of these are found at 184 Indian schools and 27
tribal colleges. What I meant to say was 4,500 buildings or
facilities that are attached to those schools.
These facilities provide more than 60,000 students with
facilities for education. The greatest concentration of Bureau
schools is in the Southwest, the Great Plains, and the
Northwest. As of the year 2000, half of the school facilities
in the BIA's inventory exceeded their useful lives of 30 years,
and more than 20 percent were over 50 years old.
The Interior Department's Inspector General recently
visited 13 BIA schools located just in the State of Arizona.
The Inspector General found severe deterioration that directly
affects the safety and the health of Indian children.
Deterioration ranged from leaking roofs to classroom walls
buckling and separating from their foundation. The Inspector
General warned, in issuing a flash report in May of 2007, that
the failure to mitigate these conditions will likely cause
injury or death to children and/or to school employees.
Here are some examples of the conditions of schools in
Indian Country taken from the Inspector General's report. Chart
2 is a montage of deterioration--a broken cinder block in a
wall, a corroded sink, a buckled sidewall, an abandoned
dormitory seen through a broken window. The Keams Canyon School
in Keams Canyon, Arizona was constructed in 1928. On the
grounds are condemned buildings that have not been properly
boarded up, which is seen now in chart 3. Those are buildings
that have not been boarded up that have been condemned.
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In chart 4, you will see that leaking water has
significantly damaged ceilings. In both chart 4 and chart 5,
you will see in this case damaged ceilings from water. In chart
5, you will see that the main boiler has been leaking. The
boiler was last inspected in 2002. It failed inspection and
still displayed the ``failed'' tag, but it is still in
operation.
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The boarding school in Many Farms, Arizona, has a crumbling
foundation. You will see that in chart 6. And the crumbling
foundation has actually resulted in a moving wall, which is
chart 7. If you look at the bottom, you will see that the
entire wall has moved in this particular building. Note the
widening gap between the vertical side of the box and the
slanting wall.
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At the Kayenta Boarding School, mold covered an office
wall. That is chart 8. These are from the Inspector General's
report. That same school with mold on the wall had water leaks
near electrical outlets and buckled sidewalls.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Well, I don't need to go through more of those charts that
show these problems, but we have very serious facility problems
in health care, in education, in juvenile detention and jails.
The detention facilities are a longstanding problem. Let me
talk about them just for a moment. Back in 1998, the Attorney
General testified before this Committee that the 73 small jails
that exist in Indian Country are severely inadequate and
antiquated. Most Indian Country jails are in such poor
condition they are completely out of compliance with building
codes and professional jail standards.
The Interior Inspector General reported this to the
Committee in June of 2004. He said the condition of Indian
jails was in desperate shape. He deemed the state of Indian
jails a ``national disgrace.'' That problem remains unsolved,
and we will hear from tribal officials today about that. One
tribe that will testify today says they have a new detention
facility and it is only staffed now at minimum capacity, which
is another problem and an issue.
I am going to, when we discuss this later, ask Mr. Ragsdale
who is with us, and Mr. Rever, questions about a consulting
study that has been done that has not been made available to
this Committee. There was a consulting study that follow on the
Inspector General's report given to this Committee in 2004. The
report was, ``Neither safe nor secure in assessment of Indian
detention facilities.'' In February, 2006, two years ago, the
BIA contracted with Shubnam Strategic Management Applications
to visit 38 Indian jails and assess the conditions, and provide
a cost analysis.
In March of last year, Mr. Rivera testified before the
Prison Rape Elimination Commission about the state of Indian
Country jails. He indicated that the Shubnam report is in
preliminary stages. Once it has gone through Director Ragsdale,
it will be open for public information. I think it will be a
month or two months, that was March of 2007.
The Committee staff met with Mr. Ragsdale to discuss this
issue. He stated the report should be ready by December. That
report is not ready. It has not been made available to this
Committee. My understanding is it is 1,000 pages. Interior now
says it was just made available to them, which contradicts what
we heard last year.
So I talked to the Interior Secretary personally to ask
that it be made available to this Committee. It seems to me
when you are holding a hearing on the very subject, the
taxpayers have paid for the consulting report, and the report
was described to us last March as awaiting Mr. Ragsdale's
review, and would be done in a matter of months. Mr. Ragsdale
said it would be done in December.
I don't understand why this Committee does not have that
information today. I think it is arrogant and it is wrong. This
Committee should have been provided that information. I will
give Mr. Ragsdale and others a chance to respond to that and
answer some questions about it.
My colleagues have joined me. Mr. Barrasso, do you have an
opening statement? I indicated we are going to have a vote I
think at 10:45 a.m., so we will proceed with opening
statements, and then have the witnesses begin, and we will have
to take a short recess.
STATEMENT OF HON. JOHN BARRASSO,
U.S. SENATOR FROM WYOMING
Senator Barrasso. Thank you very much, Mr. Chairman. Yes, I
would, and I want to follow up on some of the examples that you
have given because that is exactly what I have seen in Wyoming
as well, Mr. Chairman.
On the Wind River Reservation in Wyoming, different
buildings sit condemned, vacant due to gas leaks, due to fires,
general maintenance issues. Meanwhile, our law enforcement
department already is stretched to the maximum: short staff,
large areas to cover. It operates out of a building that is
shared with four other offices.
The Fort Washakie Health Center operates today for 11,000
users out of a building that was built in 1877 for the cavalry.
So what is happening there is absolutely unacceptable and I am
thankful, Mr. Chairman, that you have scheduled this hearing
and I look forward to working with you and making sure we can
revamp those broken programs.
With that, Mr. Chairman, I will reserve for questions.
The Chairman. Senator Barrasso, thank you very much.
Let me call on Senator Johnson.
STATEMENT OF HON. TIM JOHNSON,
U.S. SENATOR FROM SOUTH DAKOTA
Senator Johnson. Thank you, Mr. Chairman.
In light of the 10:45 vote, I will submit my statement for
the record.
[The prepared statement of Senator Johnson follows:]
Prepared Statement of Hon. Tim Johnson, U.S. Senator from South Dakota
Thank you Chairman Dorgan and Vice-Chairwoman Murkowski for holding
this hearing. The provision of adequate educational, health and law
enforcement facilities are essential to upholding our treaty and trust
responsibilities to American Indians. It is also a moral obligation.
There are nine BIA schools in my state that have been found to be in
need of ``Major Repairs or Replacement.'' The conditions at these
schools are shocking; they include inadequate fire protection, outdated
electrical systems, improperly maintained furnaces and condemned
buildings.
The affects of these conditions on tribal children are even more
shocking. This past December school had to be canceled at Cheyenne
River-Eagle Butte because temperatures in the building had dropped to
48 degrees due to problems with the heating system and the increased
costs of heating fuel. At the Crow Creek School, children are living
and taking classes in trailers because the lack of resources has
prevented construction of a new dormitory to replace the one lost in a
fire. Simply put, the health and education of tribal children are at
risk because their schools are literally crumbling down around them.
To try to address these challenges I, along with Representative
Pomeroy, have introduced the Indian School Construction Act. This bill
has passed the Senate before and would create a tax credit bonding
program for tribal schools, similar to the Qualified Zone Academy
Bonds, to allow an additional funding mechanism for the construction of
BIA schools. The tribes in my state are not asking for much, only a
safe and productive place for their children to learn, which we are
obligated to provide by treaty, trust and moral obligations. While the
Indian School Construction Act is not under the jurisdiction of Indian
Affairs, I hope the members of this Committee will support the bill and
help take this important step to improve education facilities in Indian
Country. Thank you.
The Chairman. Senator Johnson, thank you very much.
We are joined today by a number of witnesses. I want to
begin to call on them in the following order. First, Mr. Pat
Ragsdale, Director of the Office of Law Enforcement Services,
accompanied by Mr. Jack Rever, Director of Facilities at the
Department of Interior.
Then, I will call on Mr. Randy Grinnell, Indian Health
Service Deputy Director of Management Operations, accompanied
by Gary Hartz, the Director of the Office of Environmental
Health and Engineering, and Dr. Rick Olson, Director of
Clinical and Prevention Services. And finally, we will call on
Mr. Domingo Herraiz, Director of the Bureau of Justice
Assistance, United States Department of Justice. Mr. Herraiz
will discuss the Indian jail construction program.
Mr. Ragsdale, you may proceed.
STATEMENT OF W. PATRICK RAGSDALE, DIRECTOR, OFFICE OF LAW
ENFORCEMENT SERVICES, BUREAU OF INDIAN
AFFAIRS, U.S. DEPARTMENT OF THE INTERIOR;
ACCOMPANIED BY JACK REVER, DIRECTOR OF FACILITIES
Mr. Ragsdale. Good morning, Mr. Chairman. If I may, I will
defer to Mr. Rever to provide the Administration's statement.
The Chairman. Mr. Rever?
Mr. Rever. Good morning, Mr. Chairman and members of the
Committee. My name is Jack Rever and I am the Director of
Facilities, Environmental, Cultural Resources, Safety and a
couple of other things within the Bureau of Indian Affairs.
The Bureau owns or provides funding for a broad range of
buildings and other facilities across this Nation. The Bureau's
construction and maintenance program is multifaceted and the
operation is challenged with meeting facility needs in the
areas of education, public safety and justice, dams and
irrigation projects, and general administration.
I am here today to discuss the status of the education and
justice facilities in Indian Country.
Bureau-owned to funded education facilities serve 184
schools and dormitories that provide educational opportunities
for approximately 44,000 students, including almost 1,600
resident-only boarders. From 2002 through 2008, the
Administration invested more than $1.7 billion in the
maintenance, repair and construction of education facilities
across Indian Country.
The Bureau operates or funds detention and law enforcement
facilities throughout Indian Country to support Bureau and
tribal law enforcement programs. There are currently 84
detention facilities across Indian Country. Of these, 38 are
owned and operated by the Federal Government, five are owned by
the tribes and operated by the Federal Government, and 41 are
owned and operated by tribes.
Through its appropriations, the Department of Justice from
Fiscal Year 1997 to Fiscal Year 2002 provided funds to tribes
on a cost-sharing basis for major projects. This funding has
enabled various tribes to build 21 new detention centers. The
construction center is responsible for correcting identified
code and standard deficiencies at BIA facilities.
In order to accomplish this, the BIA has established a
facility condition index--we call it an FCI--to track and
report the status of facilities. The FCI is a Government-wide
performance measure to describe the condition of a facility or
group of facilities and it is calculated by dividing the cost
of correcting the deferred maintenance work by the cost of
replacing the facility at its current size and capacity.
The FCI is used to develop and revise the BIA five year
deferred maintenance and construction plan and monitor
performance in maintaining assets. The plan provides the Bureau
with a clear strategy for addressing facilities with the
greatest needs. Each fiscal year plan reflects the projects in
priority ranking order based on critical health and safety
requirements.
Over the past seven years, there has been significant
progress in improving the condition of Bureau Indian education
schools. In 2001, 120 of the 184 schools and dormitories were
ranked as being in poor condition as measured by the FCI. When
all of the construction work authorized by Congress through the
Fiscal Year 2008 and proposed by the President for 2009 is
completed, 50 schools will have been improved from fair to good
condition, or a total of 114 schools of the 184 schools.
The BIA prioritizes education construction projects
separately for replacement of the entire campus, replacement of
separate facilities on that campus, and projects to improve and
repair buildings. The priority in each category is given to the
facility with the most critical fire and life safety issues.
The replacement school priority list was established in the
year 2004 and includes the replacement of 14 schools. The
replacement facilities construction list is prioritized every
year, with a two year projection. Improvement and repair
projects are prioritized annually.
In September, 2003, as you have mentioned, sir, the
Inspector General found that the BIA's process for forecasting
future student enrollments was not adequate, resulting in new
construction with excess space and unwarranted cost. As a
result, BIA has adopted an enrollment projection methodology in
2004 to right-size school projects.
This methodology uses the past 10 year enrollment history
to predict future enrollments. This new methodology provides
realistic assessments of the future enrollment for BIA schools
to prevent schools from being over- or under-built.
Indian Affairs has also taken steps to create consistent
and efficient school designs for construction. In 2005, the BIA
revised the space guidelines that define the needs of schools
based on academic curriculum and projected student enrollment,
and in 2006 Indian Affairs published the first architectural
and engineering standards for design and construction to
establish common design elements for classrooms, cafeterias,
gymnasiums, heating and cooling systems, and other operating
systems.
In addition, Indian Affairs adopted the U.S. Green Building
Council's leadership in energy and environmental design,
commonly called LEED, as goals for energy-efficient design in
our schools. In fact, Indian Affairs schools were the first
ones built in both Arizona and in New Mexico to achieve
designation as LEED-compliant schools, criteria now adopted by
those States in their education construction programs.
Beginning in 2006, Indian Affairs adopted new procedures
and methods of school construction programming. Indian Affairs
started a plan to design projects in the two years prior to
requesting of funds for construction, with the goal of
beginning construction on major projects in the year of
appropriation.
This strategy has multiple benefits. Projects have been
completed. Planning and design are ready to begin construction
when funds are available. And projects that start on time
minimize the construction cost and the cost of inflation. The
new procedures have already increased the annual obligation
rate for our funds from 44 percent to 87 percent, thereby
significantly reducing the carryover and therefore the cost of
our program.
Many of the school construction projects funded since 2001
have been delayed for a variety of reasons. That created the
need for additional funding due to inflation. In 2007, Indian
Affairs created a shortfall recovery plan to permit the
construction of all school projects at their authorized scope
of work as specified in the revised space guidelines. The plan
proposed delaying the start of a few schools in construction
and reprogramming those funds to address the shortfalls.
We are pleased and grateful that the Fiscal Year 2008
appropriation bill authorized the execution of our shortfall
recovery plan. We are even more pleased to report that the plan
continues on schedule to eliminate the shortfall by the end of
the current fiscal year. We anticipate that we will achieve our
mutual objective to build schools at scopes of work necessary
to meet educational objectives.
In the area of public safety and justice facility
construction, recently the BIA concluded a two year master
planning effort to accomplish three objectives regarding the
needs of justice systems across Indian Country: one, assess the
condition and current operating standards of the Indian Country
justice system; two, prepare a comprehensive plan of justice
facilities including size, estimated construction cost, and
estimated cost to operate the facilities, including staffing
and preferred location of justice system facilities; and three,
establish standards for the operation, design and
organizational structure of the justice system.
The effort took two years and we visited 38 justice system
facilities including law enforcement, detention and tribal
courts, both tribally and federally-owned, and we conducted
telephone interviews with law enforcement and detention staffs
from both Indian Affairs and tribal programs. Based on the
demographic and facility information collected, BIA formulated
a comprehensive solution to address justice facilities in
Indian Country, and it is under review at the present time.
Those results will be provided to the Committee at a later
date.
We will work with the tribes and in consultation with the
Department of Justice to ensure that any future construction or
renovation of justice system facilities meets the needs of the
tribes for an efficient and effective law enforcement court and
incarceration program.
Mr. Chairman, thank you for the opportunity to appear
before you today. I will be happy to answer any questions you
may have.
[The prepared statement of Mr. Rever follows:]
Prepared Statement of Jack Rever, Director of Facilities, Bureau of
Indian Affairs, U.S. Department of the Interior
Good morning, Mr. Chairman, Ms. Murkowski, and Members of the
Committee. My name is Jack Rever. I am the Director of Facilities,
Environmental, Safety, and Cultural Resources Management in the Bureau
of Indian Affairs in the Department of the Interior. The Bureau owns or
provides funding for a broad variety of buildings and other facilities
across the nation. The Bureau's construction and maintenance program is
a multifaceted operation challenged with meeting facility needs in the
areas of Education, Public Safety and Justice, Dams and Irrigation
Projects, and General Administration. I am here today to discuss the
status of education and justice facilities in Indian Country.
Bureau-owned or funded education facilities serve 184 schools and
dormitories that provide educational opportunities for approximately
44,000 students, including almost 1,600 resident only boarders. From
2002 through 2008, the Administration invested more than $1.7 billion
in the maintenance, repair and construction of education facilities
across Indian Country.
The Bureau operates or funds detention and law enforcement
facilities throughout Indian Country to support Bureau and Tribal law
enforcement programs. There are currently 84 detention facilities
across Indian Country. Of these, 38 are owned and operated by the
Federal Government, 5 are owned by Tribes and operated by the Federal
Government, and 41 are owned and operated by Tribes. Through its
appropriations, the Department of Justice from FY 1997 to FY 2002
provided funds to Tribes on a cost sharing basis for major projects.
This funding enabled various Tribes to build 21 detention facilities.
The construction program is responsible for correcting identified
code and standard deficiencies at BIA facilities. In order to
accomplish this, the BIA has established a Facilities Condition Index
(FCI) to track and report the status of facilities. The FCI is a
Government-wide performance measure to describe the condition of a
facility or group of facilities. It is calculated by dividing the cost
of correcting deferred maintenance work by the cost of replacing the
facility at its current size and capacity.
The FCI is used to develop and revise the BIA Five-Year Deferred
Maintenance and Construction Plan and monitor performance in
maintaining assets. The plan provides the Bureau with a clear strategy
for addressing facilities with the greatest need. Each fiscal year plan
reflects the projects in priority ranking order based on critical
health and safety requirements.
Education Construction
Over the past seven years, there has been significant progress in
improving the condition of Bureau of Indian Education (BIE) schools. In
2001, 120 of the 184 schools and dormitories were rated as being in
poor condition as measured by the FCI. When all of the construction
work authorized by Congress through FY 2008 and proposed by the
President for FY 2009 is complete, 50 schools will have improved to
fair or good condition, for a total of 114 schools.
The BIA prioritizes education construction projects separately for
replacement of an entire campus, replacement of separate facilities and
projects to improve and repair buildings. Priority in each category is
given to facilities with critical fire and life safety issues. The
Replacement School Construction priority list was established in 2004
and included replacement of 14 schools. The Replacement Facilities
Construction list is prioritized every year with a two year projection.
Improvement and repair projects are prioritized annually.
In September 2003, the Inspector General found that BIA's process
for forecasting future student enrollments was not adequate, resulting
in new construction with excess space and unwarranted costs. As a
result, BIA adopted an enrollment projection methodology in 2004 to
right size school projects. This methodology uses the past ten year
enrollment history to project future enrollments. The new methodology
provides realistic assessment of the future enrollment for the BIE
schools to prevent schools from being over- or under-built.
Indian Affairs has also taken steps to create consistency and
efficiency in school design and construction. In 2005, the BIA revised
the Space Guidelines that define the needs of the school based on
academic curriculum and projected student enrollment and in 2006,
Indian Affairs published the first architectural and engineering
standards for design and construction that established common design
elements for classrooms, cafeterias, gymnasiums, heating and cooling
systems, and other operating systems. In addition, Indian Affairs
adopted the U.S. Green Building Council's Leadership in Energy and
Environmental Design (LEED) goals for energy efficient design. In fact,
Indian Affairs schools were the first ones built in Arizona and New
Mexico to achieve designation as LEED compliant schools, criteria now
adopted by those states in their education construction programs.
Beginning in 2006, Indian Affairs adopted new procedures and
methods of school construction programming. Indian Affairs started to
plan and design projects in the two years prior to requesting funds for
construction with the goal of beginning construction on major projects
in the year of appropriation. This strategy has multiple benefits.
Projects that have completed planning and design are ready to begin
when funds become available and projects that start on time minimize
the impacts of inflation. The new procedures have already increased the
annual obligation rate from 44 percent 87 percent thereby significantly
reducing carryover.
Many of the school construction projects funded since 2001 have
been delayed for a variety of reasons, which created a need for
additional funding due to inflation. In 2007, Indian Affairs created a
shortfall recovery plan to permit the construction of all school
projects at their authorized scope of work as specified in the revised
space guidelines. The plan proposed delaying the start of a few school
construction projects and reprogramming project funding to address
project shortfalls. We are pleased and grateful that the Fiscal Year
2008 appropriation bill authorized the execution of our shortfall
recovery plan. We are even more pleased to report that the plan
continues on schedule to eliminate the shortfall by the end of Fiscal
Year 2008. We anticipate that we will achieve our mutual objective to
build schools at scopes of work necessary to meet education objectives.
Public Safety and Justice Facility Construction
Recently, the BIA concluded a two year master planning effort to
accomplish three objectives regarding the needs of justice systems in
Indian Country:
1. Assess the condition and current operating standards of the
Indian Country Justice System;
2. Prepare a comprehensive plan of justice facilities,
including size, estimated construction cost, the estimated cost
to operate the facilities including staffing and preferred
location of justice system facilities; and
3. Establish standards of operation, design and organizational
structure of the justice system.
The effort took two years as we visited 38 justice system
facilities, including law enforcement, detention facilities and tribal
courts, both tribally and federally owned and conducted telephone
interviews with law enforcement and detention staffs of both Indian
Affairs and tribal programs. Based on the demographic and facility
information collected, BIA formulated a comprehensive solution to
address justice system facility requirements in Indian Country. A draft
Master Plan for justice facilities in Indian Country is under review,
and the results will be provided to the Committee at a later date.
We will work with the Tribes, in consultation with the Department
of Justice, to ensure that any future construction or renovation of
justice system facilities meets the needs of the Tribes for an
efficient and effective law enforcement, court, and incarceration
program.
Mr. Chairman, thank you for the opportunity to appear before you
today. I will be happy to answer any questions you may have.
The Chairman. Mr. Rever, thank you very much.
Next, we will hear from Mr. Randy Grinnell from the Indian
Health Service, who is accompanied by Gary Hartz, the Director
of the Office of Environmental Health and Engineering, and Dr.
Rick Olson, Director of Clinical and Prevention Services.
Mr. Grinnell, you may proceed.
STATEMENT OF RANDY GRINNELL, DEPUTY DIRECTOR,
MANAGEMENT OPERATIONS, INDIAN HEALTH SERVICE,
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES;
ACCOMPANIED BY GARY HARTZ, DIRECTOR, OFFICE OF
ENVIRONMENTAL HEALTH AND ENGINEERING, AND RICK OLSON, DIRECTOR,
CLINICAL AND PREVENTION SERVICES
Mr. Grinnell. Good morning. I am Randy Grinnell, Deputy
Director for Management Operations in the Indian Health
Service.
As you mentioned, today I am accompanied by Dr. Rick Olson,
Acting Director of the Office of Clinical and Preventive
Service; and Mr. Gary Hartz, Director, Office of Environmental
Health and Engineering.
We are pleased to have the opportunity to testify on the
state of health facilities in Indian Country. The mission of
the Indian Health Service, in partnership with American Indian
and Alaska Native people, is to raise their physical, mental,
social and spiritual health to the highest level. In supporting
that goal, IHS and tribes provide optimum availability to
functional, well-maintained and accredited health care
facilities and staff housing.
Collectively, the IHS and tribes currently provide access
to health care services for American Indians and Alaska Natives
through a total of 679 facilities, including 48 hospitals, 304
ambulatory health centers, 166 Alaska village clinics, 143
health stations, and 20 school health centers. During regular
reviews of IHS and tribal hospitals by the Joint Commission on
Accreditation of Health Care Organizations, the Accreditation
Association for Ambulatory Health Care and the Centers for
Medicare and Medicaid Services to ensure the provision of
quality patient care, the area most frequently cited for
improvement relates to physical structure and efficiency.
The average age of these facilities is 33 years old, as
compared to 9 years old for health care facilities in the
United States. The Indian Health Service has identified a
backlog of deferred maintenance of approximately $370 million
to maintain these facilities within their current footprint.
Issues such as modernization or expansion due to population
growth are addressed through the health care facilities
construction priority system and the priority list it
established.
The IHS currently estimates that completing the 22
facilities on the current priority list totals $2.6 billion. To
expand access, tribes have successfully partnered with IHS
under the joint venture program and small ambulatory program.
These programs complement the health care facilities
construction priority list by providing mechanisms for tribes
to become involved in the acquisition of facilities.
From 1998 to present, seven tribes have entered into joint
venture program agreements to construct facilities and lease
them to the IHS at no cost. In exchange the IHS agreed to
equip, staff and operate these facilities. Five of these
facilities have been completed, and 27 tribes have received
funding through the small ambulatory program to provide
improved facilities space for health care programs.
Mr. Chairman, this concludes my statement and I would be
happy to answer any questions that you may have.
Thank you.
[The prepared statement of Mr. Grinnell follows:]
Prepared Statement of Randy Grinnell, Deputy Director, Management
Operations, Indian Health Service, U.S. Department of Health and Human
Services
Good Morning. I am Randy Grinnell, Deputy Director for Management
Operations in the Indian Health Service. Today I am accompanied by Dr.
Richard Olson, Acting Director of the Office of Clinical and Preventive
Services, and Mr. Gary Hartz, Director, Office of Environmental Health
and Engineering. We are pleased to have the opportunity to testify on
the state of health facilities in Indian Country.
The mission of the Indian Health Service, in partnership with
American Indian and Alaska Native people, is to raise their physical,
mental, social, and spiritual health to the highest level. In
supporting that goal the IHS and Tribes provide optimum availability to
functional, well maintained and accredited health care facilities and
staff housing. Currently the IHS provides access to healthcare services
for American Indians and Alaska Natives through 31 Hospitals, 50 health
centers, 31 health stations and 2 school health centers. Tribes also
provide healthcare access through an additional 15 hospitals, 254
health centers, 166 Alaska Village Clinics, 112 health stations and 18
school health centers.
The Joint Commission on Accreditation of Healthcare Organizations,
the Accreditation Association for Ambulatory Health Care, and the
Centers for Medicare and Medicaid Services regularly conduct in-depth
quality reviews of IHS and Tribal hospitals. IHS has consistently
maintained 100 percent accreditation of all hospitals and facilities
and expects to continue to do so in FY 2009. This is an ambitious goal
but one that IHS considers critical to ensuring that high quality
patient care is being provided.
During these reviews, the area most frequently cited for
improvement is related to the physical structure and efficiency. The
average age of IHS facilities is 33 years as compared to 9 years for
healthcare facilities in the United States; many are overcrowded and
were not designed in a manner that permits them to be utilized in the
most efficient manner in the context of modern healthcare delivery. The
condition of these facilities varies greatly depending on age and other
factors. Some are in need of maintenance. In addition to maintenance,
there is a need for modernization or expansion to address population
growth, to accommodate modern equipment, or to meet the needs of
rapidly changing health care delivery protocols. The process that the
IHS has used since 1991 to evaluate healthcare facilities need and
prioritize projects for funding is the Healthcare Facilities Priority
System (HFCPS) and the Priority List it established. The IHS currently
estimates that completing the new or replacement facilities on the
current Priority List totals $2.6 billion. The 22 facilities on this
Priority List are those facilities with the greatest need.
The IHS continues to improve access to services by replacing old
facilities or constructing new ones. In FY 2007, the IHS opened three
Federally-owned healthcare facilities to increase access to services at
Clinton, Oklahoma, Sisseton, South Dakota, and Red Mesa, Arizona. The
IHS also increased access to substance abuse treatment with a new
regional youth treatment center in Wadsworth, Nevada. These new health
facilities are designed to serve 22,100 American Indian and Alaska
Natives, which is an increase of 50 percent in access to health care in
those communities.
We have also partnered with Tribes to expand access under the Joint
Venture Program and the Small Ambulatory Program. These programs
complement the Healthcare Facilities Construction Priority List by
providing mechanisms for Tribes to become involved in the construction
of facilities. Since 1998 under the Joint Venture Program, 7 Tribes
have entered into agreements to construct facilities and lease them to
the IHS at no cost; in exchange, the IHS agreed to equip, staff, and
operate these facilities. Five of these facilities have been completed.
Under the Small Ambulatory Program, 27 Tribes have received funding to
provide improved facility space for healthcare programs since 1998.
In the House Report accompanying the FY 2000 Appropriations Act,
Congress directed the IHS, in consultation with the Tribes and the
Administration, to review and revise the existing HFCPS. IHS has been
working with Tribes and the Department on a revised system.
We anticipate this revision would provide an assessment of health
services and facilities needs today and would rank those facilities
needs based upon contemporary criteria developed through extensive
consultation of IHS and the Tribes.
Mr. Chairman, this concludes my statement and I would be happy to
answer any questions you may have. Thank you.
The Chairman. And you are Mr. Hartz?
Mr. Hartz. Yes.
The Chairman. Mr. Grinnell, thank you.
Mr. Hartz has been with us before. I am sorry about that.
Thank you.
Mr. Hartz. No problem. I am not in uniform today.
[Laughter.]
The Chairman. And Mr. Domingo Herraiz, the Director of the
Bureau of Justice Assistance at the U.S. Department of Justice.
Mr. Herraiz, you will be discussing the Department's Indian
jails construction program.
STATEMENT OF DOMINGO S. HERRAIZ, DIRECTOR, BUREAU OF JUSTICE
ASSISTANCE, U.S. DEPARTMENT OF JUSTICE
Mr. Herraiz. Chairman Dorgan, Vice Chairwoman Murkowski and
members of the Committee, the Department of Justice appreciates
the opportunity to testify before this Committee regarding
priorities for correctional facilities in Indian Country.
The Department recognizes the critical role of planning to
ensure the construction and renovation of tribal correctional
facilities are appropriate for the intended population,
supportive of cultural and traditional values, safe and secure
when completed, and adhere to the Bureau of Indian Affairs'
standards regarding correctional operations programs and
design.
The Attorney General and the Department remain committed to
partnering with tribes to cost-effectively plan for and
renovate facilities associated with incarceration and
restoration of juvenile and adult offenders subject to tribal
jurisdiction.
My name is Domingo Herraiz and I am the Director of the
Bureau of Justice Assistance. BJA has the privilege of
administering tribal programs to help reduce and prevent crime
and violence in Indian Country. Based on BJA's involvement in
these vital initiatives, I would like to provide you an update
on four key areas: cooperation with tribes and related
partners; the state of tribal correctional facilities; factors
considered for funding tribal correctional facilities; and
strategies to maximize the effectiveness of tribal correctional
facilities.
The President and the Attorney General remain committed to
addressing the most serious criminal justice problems in Indian
Country and to ensure the federally-recognized Indian tribes
are full partners in this effort. It is in the spirit of
partnership that BJA has been a principal supporter of the
Office of Justice Programs in departmental tribal consultation,
training and technical assistance sessions. These sessions have
expanded to include five Federal departments.
At each of these sessions, BJA, OJP, and our Federal
partners have offered expertise to participants for training
workshops and technical assistance. Through tribal consultation
sessions, we have solicited priorities for detention and
corrections in their communities. After consulting with tribes
about challenges and barriers to accessing OJP grant resources,
BJA and OJP implemented a new tribal grant policy. The new
policy will help Native communities seeking OJP resources
through our competitive grant solicitation process.
BJA has also had an active role in the Justice Programs
Council on Native American Affairs, which includes all senior-
level OJP leadership and representatives from other Department
of Justice agencies.
Partnerships also provide the foundation for BJA's
administration of the Department's construction of correctional
facilities on tribal lands discretionary grant program. BJA
staff meet regularly with the OJP Senior Advisor for Tribal
Affairs, Department of Health and Human Services' Indian health
representatives, the Office of Juvenile Justice and delinquency
prevention tribal staff, and Substance Abuse and Mental Health
Services Administration representatives to discuss the wide
range of issues impacting Indian Country, including
correctional facilities and construction projects.
Equally as important is the partnership these agencies have
with tribal organizations and tribal grantees who share
invaluable information through focus groups and other forums
regarding ways to better support criminal justice systems in
Indian Country.
This information reflects the criminal justice system in
Indian Country's clear need of better management. In 2004, the
Department of Interior's Office of Inspector General issued a
report, Neither Safe Nor Secure: An Assessment of Indian
Detention Facilities, indicating that many of the more than 72
tribal detention and correctional facilities in Indian Country
were outdated and unsafe for both staff and inmates, serving
only as detention facilities and providing little in the way of
rehabilitation or programming services.
Simply replacing all correctional facilities is not the
answer. Other cost-effective strategies for construction of
tribal correctional facilities must be examined. We are looking
closely at these issues, including the use of correctional
alternatives or non-custody programs, renovating existing
buildings for correctional-related functions, and the provision
of less expensive lower security beds.
Joint county, tribal and regional tribal solutions should
also be considered when sites are in close proximity to
strengthen services and save resources. DOJ's Tribal
Construction Grant Program has provided resources to 26
American Indian and Alaska Native communities between 1998 to
the present. Of these awards, 22 have gone to communities for
new correctional facilities. Four awards have been made for
renovation of existing facilities.
By April 2007, 17 tribes had completed construction of
their new facilities, five were actively engaged in design and
construction, and four tribes were renovating existing
structures to achieve Federal compliance and become fully
operational. Today, DOJ is in the process of awarding 25 grants
to tribes to facilitate construction efforts, while eight
tribes will receive funding for the renovation of existing
structures and another 17 tribes will receive awards for
construction planning.
Key elements of the application process for each new
construction grants includes tribes must demonstrate a capacity
need, provide a development plan to help prevent overcrowding,
discuss the involvement of an executive level planning team,
including the tribe's capacity to oversee the project and
manage costs, and submit a reasonable budget for the proposed
design.
Likewise, applicants for DOJ's renovation of tribal
correctional facilities funding are required to provide details
regarding BIA's assessment supporting the renovation request
and a cost-effective design for completion within a rigorous 18
month time frame, thus demonstrating that the renovation will
lead to continued BIA support for operation and maintenance of
the facility, and the tribe's capacity to successfully sustain
the facility in the future.
The comprehensive planning process is also well established
with the construction of correctional facilities of the tribal
lands discretionary grant program. To support planning efforts,
BJA provides training and technical assistance from experts
dedicated to correctional issues tribes face to maximize the
cost-effectiveness of construction projects and to plan for the
long-term effectiveness of the tribal justice system.
We are constantly listening and learning from our tribal
partners. Best practices emerge from lessons learned. Knowing
what one tribe has discovered does work allows us to share that
knowledge with others experiencing similar issues to save
critical time and resources. Offering locally based training to
correctional officer staff and engaging a wide range of tribal
partners to develop policies and procedures for tribal
correctional facilities will also serve to strengthen related
services in Indian Country.
Community-based alternatives to help reduce the burden of
overcrowding while offering many offenders a hopeful solution
to breaking the cycle of alcohol and substance abuse, and
linking efforts to results, the Department will continue to
seek ways to improve its programs in practical ways that tribes
themselves have helped to identify and design.
This concludes my statement, Mr. Chairman. I welcome the
opportunity to answer any questions from you or the Committee.
[The prepared statement of Mr. Herraiz follows:]
Prepared Statement of Domingo S. Herraiz, Director, Bureau of Justice
Assistance, U.S. Department of Justice
Chairman Dorgan, Vice-Chairman Murkowski, and Members of the
Committee: The Department of Justice (DOJ) appreciates the opportunity
to testify before the Committee regarding priorities for correctional
facilities in Indian Country. The Department recognizes the critical
role of planning to ensure that the construction and renovation of
Tribal correctional facilities are appropriate for the intended
population, supportive of cultural and traditional values, safe and
secure when completed, and adhere to Bureau of Indian Affairs (BIA)
standards regarding correctional operations, programs, and design. The
Attorney General and Department remain committed to partnering with
Tribes to cost effectively plan for and renovate facilities associated
with the incarceration--and restoration--of juvenile and adult
offenders subject to Tribal jurisdiction.
My name is Domingo S. Herraiz, and I am the Director of the Office
of Justice Programs' (OJP) Bureau of Justice Assistance (BJA). BJA is
committed to preventing and controlling crime, violence, and substance
abuse, and improving the functioning of the criminal justice system.
BJA has the privilege of administering Tribal programs to help reduce
and prevent crime and violence in Indian Country. Based on BJA's
involvement with these vital initiatives, I would like to provide you
an update in four key areas:
1) Cooperation with Tribes and related partners;
2) The state of Tribal correctional facilities;
3) Factors considered for funding Tribal correctional
facilities; and
4) Strategies to maximize the effectiveness of Tribal
correctional facilities and improve planning, construction, and
renovation programs.
The President and the Attorney General remain committed to
addressing the most serious criminal justice problems in Indian country
and to ensuring that federally recognized Indian tribes are full
partners in this effort. It is in this spirit of partnership that BJA
has been a principal supporter of OJP's Interdepartmental Tribal
Consultation, Training and Technical Assistance Sessions held in FY
2007 and FY 2008. These sessions have expanded to include five federal
departments and ten of their agencies, several of which, have direct
responsibility or touch on this area. At each of these sessions, BJA,
OJP and our federal partners have offered our expertise to all
participants for training workshops, technical assistance, general
session panels demonstrating challenges as well as cooperative
opportunities available, and through tribal consultation sessions, we
have solicited tribal priorities for detention and corrections in their
communities. Our latest session began yesterday in Washington, D.C. and
will conclude tomorrow.
After consulting with tribes about challenges and barriers to
accessing OJP grant resources, in September 2007, BJA and OJP
implemented a new Tribal Grants Policy. The new policy will help Native
communities seeking OJP resources through our competitive grant
solicitation process. We are implementing the policy starting with the
Fiscal Year 2008 grants solicitations.
BJA also has an active role in the Justice Programs Council on
Native American Affairs, which includes all senior-level OJP leadership
and representatives from other Department of Justice offices and
agencies. The council coordinates OJP's efforts on behalf of tribes and
serves as a liaison with other Department of Justice components on
Tribal issues.
Another important outcome from our Council efforts and Tribal
consultations has been our establishing a Tribal Justice Advisory Group
(TJAG). The TJAG provides advice and assistance to me and other OJP
leadership on Tribal justice and safety issues. It convened its initial
meeting in November and will meet again tomorrow.
Partnerships also provide the foundation for BJA's administration
of the Department's Construction of Correctional Facilities on Tribal
Lands Discretionary Grant Program. BJA staff meet regularly with the
Senior Advisor for Tribal Affairs from the Office of Justice Programs'
Office of the Assistant Attorney General; Department of Health and
Human Services' Indian Health representatives, Office of Juvenile
Justice and Delinquency Prevention (OJJDP) tribal staff, and Substance
Abuse & Mental Health Services Administration (SAMSHA) representatives
to discuss the wide range of issues impacting Indian Country, including
correctional facilities and construction projects. Equally as important
are the partnerships these agencies have with Tribal organizations and
Tribal grantees, who share invaluable information through focus groups
and other forums regarding ways to better support the criminal justice
system in Indian Country.
This information reflects that the criminal justice system in
Indian Country is clearly in need of better management. In 2004, DOI's
Office of the Inspector General issued a report, ``Neither Safe Nor
Secure: An Assessment of Indian Detention Facilities,'' indicating that
many of the more than 72 Tribal detention and correctional facilities
in Indian Country were outdated and unsafe for both staff and inmates,
serving only as detention facilities and providing little in the way of
rehabilitation or programming services. Underscoring these concerns,
BIA shared information indicating that many of the Tribal detention and
corrections facilities are in disrepair.
Simply replacing all correctional facilities is not the answer.
Other cost effective strategies for construction of Tribal correctional
facilities must be examined. We are looking closely at these, including
the use of correctional alternatives, or non-custody programs;
renovating existing buildings for correctional-related functions; and
provision of less expensive, lower security beds. This last strategy
can be very cost effective, and relies heavily on thorough needs
assessments and population profiles. Finally, joint county-Tribal and
regional Tribal solutions should be considered when sites are in close
proximity to strengthen services and save resources. In addition, the
Department has worked closely with the Tribes to expand the scope of
its Tribal programs to include training and technical assistance to
Indian Country.
DOJ's Tribal construction grant program has provided resources to
26 American Indian and Alaska Native communities, between 1998 to the
present. Of these, 22 awards have gone to communities for new
correctional facilities, and 4 awards have been made for renovation of
existing facilities. By April 2007, 17 Tribes had completed
construction of their new facilities; were actively engaged in design
and construction; and 4 Tribes were renovating existing structures to
achieve federal compliance and become fully operational.
Today, DOJ is in the process of awarding grants to 25 additional
Tribes to facilitate construction efforts. While 8 Tribes will receive
funding for the renovation of existing structures, another 17 Tribes
will receive awards for construction planning. BJA anticipates these
awards will be made in April 2008.
The following are key elements of the application process for each
new construction grant: Tribes must demonstrate a capacity need for the
new facility; provide a developed plan to help prevent overcrowding of
the projected facility by tapping into community-based alternatives;
discuss the existence and involvement of an executive-level planning
team--including the Tribe's capacity to oversee the project and manage
costs; and submit a reasonable budget for the proposed design.
Likewise, applicants for DOJ's renovation of Tribal correctional
facilities funding are required to provide details regarding a BIA
assessment supporting the renovation request and a cost-effective
design for completion within a rigorous 18 month timeframe, thus
demonstrating the renovation will lead to continued BIA support for
operation and maintenance of the facility and the Tribe's capacity to
successfully sustain the facility in the future.
A comprehensive planning process is well established with the
Construction of Correctional Facilities on Tribal Lands Discretionary
Grant Program. Tribes must: (1) examine population projections; (2)
demonstrate a need for the facility, determine operational costs, and
the ability to cover these costs; (3) determine the ability to recruit,
train, and retain qualified staff; (4) explore the use of alternatives
such as sanction programs, pre-trial release, day reporting,treatment,
and electronic monitoring; (5) determine the availability of treatment
and other services such as substance abuse, health, mental health,
education, employment, and housing; and (6) demonstrate that Tribal
leaders and other community stakeholders have fully participated in the
planning and needs assessment process.
To support planning efforts, BJA provides training and technical
assistance at no cost from experts dedicated to the correctional issues
Tribes face to maximize the cost effectiveness of construction projects
and to plan for the long-term effectiveness of the Tribal justice
system. For example, more than a dozen Tribal Construction of
Correctional Facilities Project Guides, from ``Selecting an
Architect,'' to ``Site Selection,'' and ``Population Profiles,
Population Projections and Bed Needs Projections,'' have been published
and distributed to Tribes to guide them throughout their planning,
construction, and renovation efforts.
To ensure our programs remain relevant to the needs of Indian
County, the Department continues to seek ways to improve and enhance
its Tribal grant initiatives. For example, the President's proposed
Fiscal Year 2009 budget consolidates multiple funding streams and
burdensome requirements to create four new competitive grant programs
that will provide states, localities, and Indian Tribes with the
flexibility they need to address their most critical criminal justice
needs. A total of $200 million is requested for the Byrne Public Safety
and Protection Program in Fiscal Year 2009. Another new initiative in
the President's proposed budget is the Violent Crime Reduction
Partnership Program to help communities suffering from high rates of
violent crime form law task forces including local state, Tribal, and
federal agencies. A total of $200 million is requested for this program
in Fiscal Year 2009. The Department has taken other steps, as well. In
the past two years alone, training and technical assistance to Tribes
has increased and further collaborations have been built toward
regional and multi-service facility exploration and development.
We are constantly listening and learning from our Tribal partners.
Best practices emerge from lessons learned. Knowing what one Tribe has
discovered does not work allows us to share that knowledge with others
experiencing similar issues to save critical time and resources.
Offering locally-based training to correctional officer staff, and
engaging a wide range of Tribal partners to develop policies and
procedures for Tribal correctional facilities will also serve to
strengthen related services in Indian Country. Community-based
alternatives help to reduce the burden of overcrowding while offering
many offenders a hopeful solution to breaking the cycle of alcohol and
substance abuse. Linking efforts to results, the Department will
continue to seek ways to improve its programs in practical ways that
the Tribes themselves have helped to identify and design.
This concludes my statement Mr. Chairman. I would welcome the
opportunity to answer any questions you or other Members of the
Committee may have. Thank you.
The Chairman. Mr. Herraiz, thank you very much.
I thank the entire panel. We have testimony from the BIA,
from the Indian Health Service, and the Department of Justice.
I am trying to understand. I have looked at the President's
budget on these issues and you all have painted a pretty
optimistic picture. I think, frankly, the picture is pretty
pessimistic. So I want to ask a few questions about that.
Mr. Rever, the replacement school construction program went
from $83 million down to $46 million, now down to the
President's budget request of $22 million. We have a $1.8
billion backlog and we cut it in half and cut it in half again,
and you are telling me that, gee, things are pretty optimistic
here. I don't understand that. Why is this funding being cut in
half when the need is so great?
Mr. Rever. Mr. Chairman, if I may answer. The entire
program of 184 schools are being addressed in accordance with
our priority list of facility conditions. We certainly have
made huge progress in correcting those in the most serious
condition. That is where we concentrated our budgets in the
first few years of this program.
As we have moved forward and as we have assessed the
facilities themselves, and as we have gone back and taken a
look at do we really need to replace every school in the entire
campus because there is a question here on do we really need to
replace the entire campus. I personally have toured a number of
schools and facilities, and it is my personal professional
opinion, having been in this business a long time, is that
maybe we don't have to replace the entire campus. Maybe we can
take some of the buildings that are made out of concrete block
and they have adequate roof structures and the design is
current, that we ought to take a look at the way we are
programming the replacement or replacement of individual
facilities, and repair and upgrade of the existing facilities.
The Chairman. I understand what you are saying, but did you
recommend these budgets be cut? Notwithstanding what you just
said, we still have replacement requirements. In the context of
that question, the flash report by the Inspector Report of your
department on May 31, 10 months ago, went out and looked at a
number of schools and said these are severe deficiencies that
have the potential to seriously injure or kill students and
faculty, and require immediate attention to mitigate the
problems.
We have very serious problems, and it takes an Inspector
General to go find them? I don't understand that. Why would you
not have found these and corrected them?
Mr. Rever. Well, in fact, Mr. Chairman and members of the
Committee, I personally have found publication of that report
by the Inspector General addressing those 14 schools, led a
team of investigators, including safety officials and
engineers, on a tour of every one of those facilities to take a
look at the findings of the Inspector General. I will be more
than happy to provide the Committee of our response to the
Inspector General, including my trip report from that event.
What I found was that we have what I would call a
satisfactory process to identify all of the deficiencies listed
in that report. In fact, when I went back and checked to make
sure that we had identified and had corrective action plans in
place for all of those facilities, that is what we found. Our
database, and if I may, sir, the one that comes to mine
immediately is the Chin-Lee Boarding School. I visited the
Chin-Lee Boarding School because that was the one that the
Inspector General pointed out as having the greatest life-
threatening deficiencies.
What I found when I arrived on site were two structural
engineering reports assessing the deterioration of the
facility, making recommendations for repair and arrest of the
subsidence that was evidenced in the foundations, and
establishing a risk factor that was satisfactory to their
professional judgment and opinion that were good enough to last
for at least seven years, from five years to seven years, and
the design and engineering contract to accomplish those
corrective actions was already in place.
So in fact, sir, we did know exactly what the condition of
those facilities were. So we did the thing that all engineers
do. We did a risk assessment. We relieved that risk. We have
now programmed the replacement of that facility in our
replacement facility construction program, and in the Fiscal
Year 2009 budget it is in our program.
The Chairman. I understand your answer. I don't understand,
you come to us and you speak in positive terms after you have
cut in half and cut in half again the school replacement
program for Indian schools that have a requirement of $1.8
billion backlog. We have Inspector General reports. I have been
to these schools. All of us have been to these schools. The
fact is, Indian kids are going to schools that are in
disrepair. There is a big backlog, and you come to us
suggesting we cut the budget in half last year, suggesting we
cut it in half again with the President's budget, and you are
happy with that.
I understand you are paid to represent the President's
budget, but I am telling you I think it shortchanges kids in
these schools.
Now, well, just let me go through this again. The Indian
Health Service, all of us understand the backlog here. The
suggest in the President's budget is let's cut that in half.
Let's cut the funding in half for the facilities construction
program in Indian health. That stands logic on its head.
BIA jails repair and renovation program, let's cut that by
30 percent. Department of Justice Tribal Jails program, let's
zero that out. Let's not do anything. I mean, the fact is this
makes no sense to me.
Now, let me go back to this issue of jails, if I might. I
have been to an Indian jail and seen a young teenage kid
intoxicated laying on the floor of that jail in which adults
are moving around incarcerated as well. We all understand what
is going on. We have enough reports that will fill a library
telling us what is going on.
Now, Mr. Ragsdale, I said when I started, the fact is we
had the Inspector General report. Then the Americans taxpayers
have paid for a consulting study. In testimony, one of the BIA
employees said that was going to be done, this was last March.
Mr. Rivera testified before the Prison Rape Elimination
Commission. He said the consultant report, the Shubnam
Strategic Management Application report, which the taxpayers
paid for, he said that is going to be ready. It is going
through Director Pat Ragsdale, and then it will be open for
public information I think in a month or two. That was a year
ago. That was March a year ago.
Now, my Committee staff met with you in August of last year
to discuss these issues. We asked you about the Shubnam report.
You said it would be ready by December. I called Carl Artman
and talked to the Interior Secretary in preparation for this
hearing, saying I want that released for this hearing. I want
to find out what that consulting company found about the 38
Indian jails that they assessed. Both said it is not going to
be made available.
I think that is arrogant. We paid for that report, and I
don't understand why, if in March of last year you were
apparently in possession of the report and your BIA folks said
it was going to be released in a couple of months, and then you
tell us it is going to be released in December, why are we
sitting here in March of this year not able to access
information about 38 different Indian detention centers?
Mr. Ragsdale. First, Mr. Chairman, I will tell you that my
projection that the report would be completed by December was
my best estimate at the time. It has taken longer than that to
fully review the report.
With respect to Mr. Rivera's, not to be confused with Mr.
Rever, statement before the commission, I think what Mr. Rivera
was referring to--he was the head of corrections at the time,
and I was the Director of the Bureau at the time and had been
kept informed about the progress of the report--I think what
Mr. Rivera was referring to was the first part of the report,
the phase one part of the report.
But I have been kept apprised of the progress of the
report. We took our first look at the preliminary report, which
was fairly complete----
The Chairman. When was the report contracted?
Mr. Rever. Mr. Chairman, the report was contracted in the
year 2006.
The Chairman. What did the contract require with respect to
completion?
Mr. Rever. The contract was modified several times.
The Chairman. What did it require originally as a
completion date?
Mr. Rever. One year, sir.
The Chairman. And so, when would it have been done?
Mr. Rever. It would have been done in 2007, but if I may,
sir, what happened was that it was two-phased and always
planned to be a two phase report. One was a condition
assessment of existing detention centers across Indian Country.
We wanted to know what the condition was, not only the
condition, but the operation concepts that were going on on
tribally owned and BIA-owned and operated jails because we
wanted to confirm what we knew, but expand the concept.
We then took a look at what was being discovered as our
consultant visited these jails. For the first time, we have had
a chance to look at the combination of facilities and their
condition, and the condition of those, and unfortunately the
deteriorated condition of those facilities, had on the
operation of the detention centers.
We don't have heliports. We don't have adequate detention
facilities. We have looked at the fact that we are putting more
offenders in jail than we ever have before and we are letting
some go. The statistics that we were getting for what the need
was was much greater than what we anticipated because we didn't
know, and now we do know.
So in addition to that, it became very apparent to us that
we can't just address the detention aspect of a justice system.
That is why I talk about justice systems. It is the law
enforcement and policing. It is the court system and then
eventually the incarceration.
The Chairman. Mr. Rever, I am sorry to interrupt you. All
of us understand that. We understand that. I am asking you
about a 1,000 page report that the taxpayers have paid for, and
you have decided you would not share with this Committee
because someone hasn't yet reviewed it. I am so tired of the
bureaucracy and I am especially tired of the bureaucracy in the
BIA. The fact is, we ought to have access to find out what did
they discover about those 38 facilities. We paid money to
discover that. We were told it was going to be available, and
when we scheduled this hearing we expected it to be made
available to us and it has not been. As you can tell, I am not
happy about it because I think it is arrogant.
Now, the fact is you come to us, all of you come to us, and
say things are really swimmingly good. You know that they are
depressing with respect to facilities in Indian Country on
jails, health care and education. And you are recommending
budget cuts--I don't know if you believe in them or not--but
you come here and defend them. I mean, it is unbelievable to
me.
Well, I have taken more time. I have more questions, but we
will have a second round.
Senator Murkowski?
STATEMENT OF HON. LISA MURKOWSKI,
U.S. SENATOR FROM ALASKA
Senator Murkowski. Thank you, Mr. Chairman.
To continue with the Chairman's line of questioning on the
report, recognizing that the report isn't here, I would agree
with Chairman Dorgan, you have to question why. I think it is
unacceptable that this many months after the fact we still
don't have the report.
But Mr. Rever, you have indicated that the assessment that
you have made, or that you have been part of, recognizes that
these facilities in, your word was ``deteriorating'' condition.
So I think we can all assume that when we get this report, it
is not going to be a pretty report. It is going to tell us what
we know, and that is that these facilities are in deteriorated
condition. They are completely inadequate. They were built for
an era that has passed many decades ago. These inadequacies
lead to a potential public safety crisis in Indian Country.
I am not convinced that we are going to find anything in
this report that is going to be a positive. I think we are
going to learn that it is, as you say, a deteriorated condition
and perhaps even worse. We know that.
So the question then is, if you know that it is bad and is
getting worse, why has the Administration asked for so little
funding to make is work? Now, the Chairman has indicated in his
comments that I think you said it was a 30 percent decrease in
detention funding. I have just asked, and apparently there is
some discrepancy in terms of the numbers, but whether it is a
30 percent decrease or whether it is a $600,000 increase over
last year, the question is why has the Administration not
sought adequate funding, whether it is in this year's budget or
beginning seven years ago when we recognized that we were going
to be faced with this really terrible problem?
Mr. Rever. I would like to take the opportunity to answer
that, Senator.
First of all, I have to clear up the purpose of the report.
The purpose of the report was not to discover the condition of
the facilities. We know what the condition of the facilities
are. We do an annual inspection to determine what the condition
of those facilities are. What the purpose of the report is is
to identify the need. Nobody that I am aware of, that we have
spoken to, has ever been able to quantify the deficiencies in
detention facilities, law enforcement facilities, and tribal
facilities across this great Nation of ours.
We took the opportunity to do a master plan. What this is
is a plan to correct what is this deficiency. We start out by
determining what is the existing condition, and that took a
year.
Senator Murkowski. So are you saying that until you have a
plan that recognizes the full extent of the situation that you
are in, you are not willing to start work on some of the most
clearly deficient facilities and increase that budget to allow
for correction of that? That you are going to hold off until
you know entirely what the full analysis is of all these
facilities?
Mr. Rever. Not at all, Senator. What we are looking at is a
plan to integrate across Indian Country a cost-effective
solution to the justice problem we have to address the rising
crime rate on Indian reservations. It is a monumental task to
be able to do that.
We believe, and I think we are supported consistently by
the Department of Justice, that we can't just solve individual
problems. This is such a big problem that we have to look at
the way the justice system works along Indian Country. Until we
know what the need is and come up with a cost-effective
solution--for instance, we know as a result of our study, that
we are only incarcerating about 50 percent of the offenders
that truly should have been incarcerated.
Now, that number will not be reflected in any report that I
see or Mr. Ragsdale sees because until you go out and actually
visit the detention center and the law enforcement center and
see that they take in offenders in the morning and release them
before dawn to keep the count down because of health and other
considerations, when we put four times and five times as many
offenders in a jail than it was built for--until we knew that
we wouldn't be able to identify the need.
Now, this plan simply identifies the need. It identifies
where we should have detention centers, and we created tiers,
what should be locally----
Senator Murkowski. But recognizing that you are waiting for
a plan that clearly identifies the need without allowing for
increases in the budget to take on what you know you are going
to be faced with, I think is closing your eyes to the reality
of your own report. You are going to get this report in a month
or two or maybe more, and will be dealing with a budget that is
hopefully not what the President has recommended, but it will
have been your recommendation that we don't need to increase
the budget at this point in time. So you basically put yourself
yet another year behind.
I want to ask one quick question of Mr. Herraiz, if I may.
This is to the budget request that would, again, eliminate the
tribal set asides for the grant allocations for detention
construction, and instead would require that tribes basically
compete with States and local governments for construction
funding.
I understand that there is a new tribal grant policy, but I
am not quite sure what it says or what it does. What is this
policy and what is the Department doing to make sure that the
tribes can compete on an equal footing with the States and
local governments as they go after these facilities
construction funds?
Mr. Herraiz. Senator Murkowski, members of the Committee, I
became Director of the Bureau of Justice Assistance in 2004. I
came from a background of working at the State level doing
exactly what I do now in Washington for the Department of
Justice, overseeing grant administration, linking the public
policy.
One of the experiences I have had has been recognizing that
many times grant application processes are very cumbersome,
require a lot of red tape solicitations that have way too much
information and are confusing to the average person at the
local level in tribal communities as well. So in 2005, I
sponsored, with the Department, a listening tour if you will.
We held a session in Alaska. We held two in the Lower 48, to
focus on tribal issues, to figure out what are some of the
concerns they had with the Indian Alcohol Substance Abuse
Initiative that we had, Tribal Courts program that
administered, as well as tribal construction.
Within that context, a lot of the feedback we received was
burdensome, the cumbersome process, not unlike I had heard
before in my career. So working with the OJP tribal policy, the
tribal initiative, the first piece that we were able to address
is just that issue, to streamline the grant process and to make
sure that burdensome requirements are not in there.
Certainly, we have the requirements to partnership with BIA
and make sure that those requirements are met, but in
particular as it relates to the requirements of other things
that we absolutely have in control that may be guidelines on
our end, but are not regulations and are not statute that you
all have created, we bypass that.
So within that context, we have also created since I have
been at BJA a tribal justice unit, as well as we have a tribal
justice unit in the Office of Justice Programs, to oversee
specifically those requests. What that means to you is that we
can concentrate our effort, not diminish the results of other
corrections programming that we have in BJA or other law
enforcement initiatives, but absolutely concentrate
specifically on tribal communities, so that we can address
whatever planning issues, whatever construction issues,
whatever translates.
Drug courts, we have found in this time period, don't work
the same, but healing to wellness courts do. So we need to
tailor to the needs and conditions of the tribes to make sure
that those resources are spent effectively.
Senator Murkowski. Thank you.
Thank you, Mr. Chairman.
The Chairman. Senator Johnson?
Senator Johnson. Between high schools, jails and schools, I
don't know where to begin. But Mr. Rever, a specific example of
the Lower Brule Indian Tribe is an excellent jail facility
built by the Department of Justice, and it is woefully
understaffed. The problem is there are no women, no juveniles,
and a small amount of males allowed in the jail. The BIA police
aren't even allowed to move their offices to the facility.
Do you ever talk to the Department of Justice about that?
How do you explain that?
Mr. Ragsdale. Thank you, Senator.
With regard to Lower Brule, let me first of all say that
Chairman Jandreau, the leader of the Lower Brule Tribe, has
exercised a lot of forbearance, and we do have a schedule to
make the facilities fully operational, including moving the
police department into the facility, which the tribe wants us
to do.
We have had difficulty fully staffing the facility. In the
report that we talked about that has not been released, we
address some of the other ancillary problems that we have in
staffing when we have a lack of housing and so forth. I regret
that we have not been able to fully staff the facility, but we
do have a plan and a schedule to do that that we have shared
with your staff, and we have made significant progress.
With regard to the police department being allowed to move
into the facility, we have had some difficulty with GSA, who is
the responsible office to authorize leasing of space for
Federal agencies. We have not been granted a delegation of
authority from GSA to lease the space, even though the Chairman
has graciously offered to give us a $1 lease or a no-cost lease
to staff the facility. We are anxious to move our police
department in there, but have not been able to do so thus far.
Senator Johnson. What is your estimation of the time line
to get the police department folks in there?
Mr. Ragsdale. Well, I believe that we do have the staffing
for the adults, and we just have so many different schedules
for facilities and operations. I don't recall the specifics,
but we did provide that to your assistant just this week. We
had a full meeting and gave him a progress report, so I would
rather defer.
Senator Johnson. Do you understand the terrible
inefficiency of hauling prisoners hundreds of miles away,
utilizing the police for to transport the prisoners? The police
force is already understaffed in too many cases.
Mr. Ragsdale. Yes, sir. I totally agree with you. It is
inefficient, and it does put a strain on the limited law
enforcement personnel that we have to have to transport not
only for Lower Brule, but for many other tribes, inmates and
juveniles for hundreds of miles.
Senator Johnson. Mr. Chairman, I have no other questions.
The Chairman. Thank you.
Senator Barrasso.
Senator Barrasso. Thank you, Mr. Chairman.
I share the concerns and we have problems in Wyoming with
health facilities, with schools, with the same things we are
talking about in terms of law enforcement, and continue to ask
questions, and I will continue to ask questions about that.
We look at our two health care facilities and our centers
in Wyoming. The Fort Washakie Health Center, as I mentioned
earlier, was built in 1877 to house cavalry units. Tribal
leaders tell me that it was renovated in the late 1990s, but
just with the addition of some exam rooms. This is not
adequate. The conditions that we have really don't meet the
needs of our 11,000 users of the reservation's health system so
it can operate.
Mr. Grinnell, could you explain to me how the Indian Health
Service is working to provide a fair system to make sure that
the Indian health care facilities in Wyoming are updated to
meet a reasonable standard of care?
Mr. Grinnell. I would like to defer to my colleague, Mr.
Hartz, please.
Mr. Hartz. Thank you, Senator.
The facilities are in good shape from a maintenance
standpoint, we look at the supportable space, the health space
that the tribes run as well as what we run, and we distribute
resources based on the space identified in each of the
locations.
As far as addressing the needs of facilities to be replaced
or to build new, we have direction from the Congress to develop
a priority system to take a look at all of the health services
and facilities needs across Indian Country. First looking at
what the health service requirements are, health services
needs, and then from that determination, whether in fact there
is a need for replacement of a health facility or a new one or
some other means by which the health services would be
addressed. But it is a comprehensive effort that is underway
per congressional direction, sir.
Senator Barrasso. Mr. Chairman, I have additional
questions. Maybe I could submit those, because I know the vote
has been called and Senator Tester hasn't had a chance yet. So
with your permission, I would defer.
The Chairman. Senator Barrasso, thank you.
Senator Tester?
STATEMENT OF HON. JON TESTER,
U.S. SENATOR FROM MONTANA
Senator Tester. Senator Barrasso, you are too kind.
Thank you, Mr. Chairman. I really appreciate it.
Just to recap real quick, Mr. Rever, you are facilities for
jails and schools, correct?
Mr. Rever. Yes, sir.
Senator Tester. And Mr. Grinnell, you are IHS facilities
for medical facilities, right?
Mr. Grinnell. Yes, sir.
Senator Tester. How many years have you been on the job,
Mr. Rever?
Mr. Rever. I have been on this job two and a half years.
Senator Tester. Two and a half years?
Mr. Rever. Yes, sir.
Senator Tester. Mr. Grinnell?
Mr. Grinnell. Six months in this position.
Senator Tester. Six months in this position.
Can you give me any idea, Mr. Rever, how many dollars have
been spent on construction during your two and a half year
tenure?
Mr. Rever. Yes, sir. We have put in the ground upwards of
$300,000 a month. So I would say over the last two years, we
have been able to, about $280 million.
Senator Tester. At $300,000 a month, that correlates to
$280 million?
Mr. Rever. I am extrapolating to cover other items as well.
We spend a lot of money on architect, engineer, design studies.
Senator Tester. I am talking about building facilities, not
architecture, not design, none of the stuff--actually building
a facility. How many dollars have been spent?
Mr. Rever. Sir, I may ask----
Senator Tester. Bricks and mortar.
Mr. Rever. Schools only?
Senator Tester. Schools and jails.
Mr. Rever. Schools and jails. I haven't built any jails
since 1993. That is not part of our purview, but we are putting
$8 million a year into improvements and repairs over the last
two years.
Senator Tester. Okay. And this isn't architectural stuff;
this is actually hiring the people to lay the foundations and
build?
Mr. Rever. Yes, sir. And probably over the last two years,
put about $300 million in the ground.
Senator Tester. Okay, $300 million you have spent on bricks
and mortar?
Mr. Rever. Yes, sir.
Senator Tester. What was the $8 million for?
Mr. Rever. The $8 million was improvement and repairs to
detention facilities, sir.
Senator Tester. Improvement. How many dollars have been
spent on studies?
Mr. Rever. Just on the study that we have completed,
probably $40,000 or $50,000 all together.
Senator Tester. About $40,000 or $50,000 all together.
Mr. Rever. Yes, sir.
The Chairman. Senator Tester, if you would yield, what was
the cost of the Shubnam Report?
Mr. Rever. I don't know, sir, in exact dollars. I will have
to provide that to you.
The Chairman. That can't be included in your estimate.
Mr. Rever. No, sir, it was not.
The Chairman. That would be a very large contract, I
assume, or a significant contract. This is a California
consulting company that worked for you. So that is not a part
of your answer, right?
Mr. Rever. No, sir. It was a very reasonably cost study,
sir.
Senator Tester. And that $300 million you spent is over
your two and a half years in this job?
Mr. Rever. Yes, sir.
Senator Tester. Could I get a list of those projects?
Mr. Rever. Yes, sir. You certainly may.
Senator Tester. Okay.
How about you, Mr. Grinnell? Can you give me an idea on
what you spent? I don't know. It has been six months, so it is
kind of a null and void. Let me get to my point, because we do
have a vote going.
It appears to me just from the limited testimony that I
have seen here today, and I want to tell you something. I come
out of the Montana legislature, and the last people I want to
attack are people who work for the government. Truthfully, I
appreciate your being here and I appreciate the job you do.
But, and this is a big ``but,'' when you get out of bed in the
morning you have to ask yourself how you are going to make
things better in Indian Country because there are a lot of
things that need to be made better.
In your particular area, it is about construction of
schools and medical facilities and jails. I am going to focus
on schools and medical facilities, although jails are probably
equally as important. If we don't have adequate medical
facilities, it doesn't matter how much money we pump into
Indian health care. It is not going to improve.
The same thing with schools. In Montana, every at-risk kid
in the State of Montana is Native American. That is the one
thing No Child Left Behind has done that is good. And part of
that is the people in the classroom, but the other part of it
is the classroom.
And so when you get out of bed in the morning, I would hope
you say to yourself, if somebody above you is saying, you know
what, we are going to cut school reconditioning from $83
million to $46 million to $22 million, that you protest
violently. Because I think every one of you people have skills
and if they fire you for that reason, that is a reason to get
fired. And it is the same thing for health care facilities.
I don't mean to lecture anybody here, but we have seven
reservations in the State of Montana. I am sure it applies in
North Dakota. I am sure it applies to Wyoming. Alaska's got a
little different thing going, but it probably applies to
Alaska, too. We have major problems. And when we send dollars
out and they are spent on study after study after study and
nothing is done, that is almost criminal and it is certainly
not what I would anticipate from the people who are in the
positions you are in. Because we can do all the policy-making
we can here, and if you don't carry it out on the ground, it is
all for nought. You guys make it happen.
With that, I do have some questions. We do have a vote. I
do have some questions I will submit for the record.
Thanks you folks for being here. I want the next time we
come together to meet to be positive and talk about the things
we have going and talk about the future and what the long-term
plan is, and how we can move forward to make things better. But
the truth is, the Chairman pointed it out, you can't be
positive about this budget and there is no harm in saying that,
because it is a wreck in Indian Country. It honest to God is a
wreck. And we have to fix it and we will. With your help, we
will fix it right.
The Chairman. Senator Tester, they would lose their job if
they said it was a wreck. That is the problem. I mean they come
here representing the Administration's budget, but the Bureau
of Indian Affairs education construction account, that is not
the replacement for schools. That is the go in and repair. It
is to respond to what the Inspector General says in their flash
warning. Kids could die, very serious problems.
The proposal, you know, we used to be $250 million a year.
In 2007, it went from $205 million down to $142 million. Now,
they request it down to $115 million. You are presiding over a
substantial reduction in the amount of money available to meet
a dramatic need. I described earlier the school replacement
program cut in half and cut in half again. I mean, it just
doesn't work.
I understand how you answer these questions, but I am very
disappointed because we are faced with responsibilities, trust
responsibilities, treaty responsibilities. And then we see
these budgets and you are trying to suggest that, you know
what, things are going pretty well. And frankly, they are not.
Senator Domenici last year, a year ago, asked both Justice
and BIA whether you have responded. The Inspector General
recommended that there be a strategic plan between Justice and
BIA with respect to this issue of jail replacement and
renovation. He asked for a response from you, and we would like
as well a response. Have you done a strategic plan between the
two? If so, what is it? Can you submit it to this Committee?
Because there is a vote ongoing, if you will just think
about that. We will take a 10 minute recess, go vote and be
back. We appreciate your indulgence.
[Recess.]
The Chairman. The Committee will come back to order.
Senator Murkowski?
Senator Murkowski. Thank you, Mr. Chairman.
I just had one very quick question for you, Mr. Grinnell.
This is on the status of the Barrow Hospital up north. Under
the current facilities priority system, we have approximately
five in-patient facilities. Barrow and Nome are at the top of
that. The question is when do you anticipate that you will be
able to finish the final stage of construction for the Barrow
Hospital?
Mr. Grinnell. Mr. Hartz, he has the specifics on that
project.
Senator Murkowski. Okay.
Mr. Hartz. Thank you, Senator Murkowski.
We are pleased, as you probably well know, to announce that
construction is underway with the participation of the Denali
Commission. They started laying rock on the pad that IHS
purchased for the new site. Our five year plan that outlines
the schedule for completion of the project is obviously
dependent upon the level of appropriations. The $15.8 million
that we are asking for in the current fiscal year, 2009, will
permit us to continue that process of moving forward on the
construction of the facility.
Senator Murkowski. So you haven't told me when you
anticipate construction to be complete.
Mr. Hartz. I have all this stuff here and I do have it.
Senator Murkowski. If you could just provide that.
Mr. Hartz. Here we go. No, we have it right here. I am
sorry. We had so much fun at the break that I mislaid some of
my papers. Here we go.
Based on our projections of how the project could proceed
forward and where we have identified the mid-point of
construction, we would look at the completion of the funding in
Fiscal Year 2011. So we would be looking at completion of the
project probably in Fiscal Year 2012, late 2012.
Senator Murkowski. As you know, we are anxiously awaiting
not only completion of that facility, but the one up in Nome.
Mr. Hartz. Yes, we understand that. We are anxious, too.
Senator Murkowski. Thank you, Mr. Chairman.
The Chairman. Mr. Grinnell, describe for me again the
justification for an Indian Health Services construction
program being reduced from what used to be $90 million four
years ago, down to last year at $30 million, and this year at
half of that, down to $15 million. Describe the rationale for
that.
Mr. Grinnell. Yes, Mr. Chairman. I would like again to
defer to Mr. Hartz, as he has the specifics on that.
Mr. Hartz. Thank you, Senator.
As we all recognize, we are in tight budget times, but I
would like to highlight the fact that even the facility at Fort
Washakie that Senator Barrasso identified, as aged as it is, we
did make major efforts to maintain accreditation of these
facilities and to ensure that they qualify for Medicare/
Medicaid reimbursements, et cetera. And that is really critical
to the business that we are in, namely health care delivery.
Other than the fact that we are in severely tight budget
times and the priorities that the agency puts on the delivery
of much-needed health care, I don't have a better answer than
that today, sir.
The Chairman. Could you tell me what was requested from
your agency going up through the budget process? Did you
request a reduction by 50 percent in Indian Health Service
facility construction?
Mr. Hartz. The agency per congressional request develops
and provides a five year plan to the Congress. It is a public
document that we provide. It is from that I responded to
Senator Murkowski's question about what the projections are in
the out years for keeping these projects moving off the
priority list. As these projects develop, the designs develop,
and they come ready for construction, you folks fund
construction, and we get ready to identify the next phase,
trying not to delay the mid-point of construction which is
critical to these cost estimates. We actually do identify a
could use column on our chart that is part of the public
record.
The Chairman. And what does it suggest ``could use'' for
Fiscal Year 2009?
Mr. Hartz. For the facilities on the priority list that we
have discussed over many years with the staff and the
congressional delegation runs about $260 million.
The Chairman. About $260 million.
Mr. Hartz. That is a public document that relates to
priority projects.
The Chairman. I understand. That is in Fiscal Year 2009?
Mr. Hartz. That is not a request. That is a ``could use.''
The Chairman. I understand.
Mr. Hartz. Okay.
The Chairman. Well, what is it, then? I understand it is
not a request, but tell me what the line is?
Mr. Hartz. It is approximately $260 million.
The Chairman. You said it is not a request. So what is it?
Mr. Hartz. It is a ``could use,'' because projects
progress.
The Chairman. I understand.
Mr. Hartz. They go through varying stages and as we get
closer in the development of the need, we deal with it in
``could use'' amounts.
The Chairman. So first of all, we have a need that we have
identified. We have a total backlog of about $9 billion,
regrettably. You have identified that you could use in this
fiscal year $260 million and you request $15 million. Is that
accurate?
Mr. Hartz. We request the priority for the health delivery.
Facilities in IHS, HHS and across Government facilities are not
the priority need as other services.
The Chairman. I understand. First of all, we asked you to
be here. I appreciate your coming. You serve in public service.
I appreciate your service in public service. But I hope you
understand that when I say I am terribly disappointed with this
budget, and I would not want to be in your position, to come to
a committee and try to paint this as something that is good
news. It is not good news. It is not in my judgment an accurate
reflection of where our responsibilities are. We are moving
backwards, not forwards, on things that deal with life and
death, especially with respect to health care issues.
I can tell you that I went to a facility recently that is
in disrepair and crowded and so on, and they said, well, this
is the space we are going to get the new x-ray machine, which
is going to be a dramatic improvement for us. They said they
have not been able to get it. It has been two years now since
we have been able to get the request in and get it responded
to.
And I said, why is that? Well, we don't know. The money was
available, but it just took a long, long time to get it through
the area office and the regional office. And I walked away
thinking again, so we have people out in the waiting room, a
full waiting room, and they don't get the access to a brand new
machine, an x-ray machine that should have been there, because
of the bureaucracy. It just drives me--well, I am very
disappointed.
These numbers reflect in my judgment a lack of progress and
a lack of recognition of the urgency and the need. I wish that
you would come to us with better news. I understand and wish
that you could answer my questions. Dr. Grim never would
because he said he never could. But my question would be, what
did you request? And if you could answer it and would, you
would probably be fired for answering it on the record, but if
you could answer it and told me you requested a cut by 50
percent in this Indian health care account, I would say you
should not be in this job, either of you.
But I don't think that is what you requested. I think you
would have requested some additional funds because you know
they are needed and that it goes through the machinations and
up through the crawl spaces in Government and through the
Office of Management and Budget and it turns out they want to
cut that particular account in half, and they send you up here
to put a necktie on and a suit on to justify it. And that can't
be very comfortable if you feel as I think you probably feel.
So I don't mean to lecture, but I am not happy.
Mr. Ragsdale, I would tell you I am not happy at all with
how this has worked out with the Shubnam report. I understand
it is a two-phase report and almost a year ago you got the
preliminary report, at least in the first phase. The first
phase is the most important phase for us. The first phase is
the most important. Let's understand what they found in those
38 facilities. You have had that for a long period of time, and
I am going to get to the bottom of that and I hope you have
testified accurately about it.
Mr. Ragsdale. Mr. Chairman, if I may. We are anxious, and I
know that the Assistant Secretary is anxious to release this
report. I believe this report will provide the executive and
legislative bodies of this Government a blueprint of where we
need to go in the future. It is a very comprehensive report. It
has been reviewed internally within the Bureau of Indian
Affairs, that in fairness we want to share that with the
Department of Justice and go through the report, it is a very
detailed report, and make it available to the Committee and to
the Indian tribes as soon as possible.
I regret that it has taken longer than I thought it would,
but that is just part of our process.
The Chairman. Well, the Department of Justice is no more
important than this Committee, and to the extent that you are
sharing things, you ought to share it with this Committee as
well as the Department of Justice. I have people calling the
consulting company to find out, (A) what it would cost, and (B)
when did you get the two phases. And I believe you have had the
first phase for a long period of time. That first phase should
have been made available to this Committee for this hearing.
There is no excuse for it not being made available. I spoke to
the Secretary specifically and personally. I spoke to the head
of the BIA personally. And we have been informed, you informed
us, that it had been available last December. You informed our
Committee of that, Mr. Ragsdale.
So I am a pretty unhappy guy about this because I think the
BIA has stiffed this Committee. We will see.
Let me with that happy note, thank you for being here. At
our request, you have come today to give us your description of
where we are. I will ask if the Committee members have
additional written questions they wish to submit to you that
you would respond to those written questions and give us the
opportunity to inquire further.
Let me thank you for being here and we will release you and
ask if we can have the final set of witnesses come forward.
I would like to call up the second panel, the Honorable
Wendsler Nosie, Chairman of the San Carlos Apache Tribe. From
the Navajo Nation, we have Mr. Monty Roessel, Executive
Director of the Rough Rock Community School in Chinle, Arizona.
We have Ms. Valerie Davidson, Senior Director of Legal and
Government Affairs at the Alaska Native Tribal Health
Consortium located in Anchorage, Alaska. Ms. Davidson is
accompanied by Mr. Rick Boyce, the Director of Health
Facilities at the Consortium.
We appreciate very much you coming, and we are sorry that
we have been delayed some, first by a vote and then a lengthier
stay with the first panel. But you have traveled in many cases
long distances to be with us to provide some of your testimony.
We will ask that you summarize your testimony. Your entire
testimony will be made a part of the record. So if you would do
us the service of summarizing it, we would appreciate that.
We will call first on the Honorable Wendsler Nosie, the
Chairman of the San Carlos Apache Tribe. Mr. Chairman, thank
you very much. You may proceed.
STATEMENT OF WENDSLER NOSIE, CHAIRMAN, SAN CARLOS APACHE TRIBE
Mr. Nosie. Thank you, Mr. Chairman and the Committee.
First of all, I just want to again say my name is Wendsler
Nosie, Sr., the San Carlos Apache Tribal Chairman in Arizona. I
have with me Councilwoman Bernadette Goode and also I have
Ollie Benaly, who is the Chief of Police, Todd Winger, who is
the Construction Director for the new health care facility, and
Paul Nosie, who is with the detention center.
What I would like to express deeply is to be very frank. I
am very honored to be here, and with the chosen words of the
Committee, with the amount of feeling that was put into it. At
one point in your discussion, I wish I was sitting at your
panel and asking questions as well, because there are many
reports that we do for the Federal Government, the BIA, that
are submitted, and also with IHS, which outlines the total
needs of Indian problems in Indian Country. I come to wonder
where do those reports go and who is reading them? Because in
those reports, it outlines the great needs.
What I would like to discuss is the health care issue. The
health care with the facility has been a great need, like any
other tribe. I have been with the Tribal Council as a
councilman for seven and a half years and served as the Tribal
Chairman for one and a half years. As I travel around Indian
Country, the voices are the same. The cries are the same. The
great need of more funding and appropriations, that if
Washington could only earmark more money to the tribes, then we
would become--well, two things will actually happen. The care
of our people will be taken care of, and in the future we would
have a better vision of where we are going as a tribe.
It is important that all agencies understand that. One of
the things that we also talk about is the government-to-
government relationship, the partnership. That actually should
be exercised to the fullest. As I have learned and come to
understand the reports that are given here to Washington are
very crucial because they tell you of Indian Country and the
great needs.
Now, we can relate back to our elders to where they had
discussed to us, the younger people, waiting for the time that
things will be better and still waiting for health care. We
have many of our elders who have passed away because of the
type of services we are getting, based on lack of funding for
staff. The hospital is obsolete. Just like in any other
community, the numbers are rising. We are up to more than
13,000 people, and that does not include other people from
other nations that live within the tribe. So it seems that
funding-wise, it is never being planned for the future, for the
increase in numbers.
So now we are at a point with our health facility of taking
on self-determination. We have pictures here that you can see
our health care what it looks like. It is important for us to
become self-governing. I think in 1975, it was once passed and
talked about that self-governance is a very important policy.
At this time and age, the tribes have taken that initiative to
become self-governing. Why? Because if IHS was giving the
services that we needed, we won't going that route, if it was
acceptable.
At this point, we know that we have to establish our own
destiny of where we are going to go, but it has to be in a
partnership in the agreements of the long treaties that have
set between the Apaches and here in Washington, but also with
all tribes. So it is important that we understand, that the
agencies understand, that self-governance is very important to
us, to create a future for our unborn children so that we know
what our greatest needs are. We know what our greatest health
care should be, but we need the cooperation in order to get it
done.
An example is the detention center. I can honestly say that
with the funding, the agencies were able to listen, listen to
the needs of what was needed for the tribe. And so building,
the facility was built with a lot of cultural input, so that we
can not only have it as incarceration, but also have it as a
healing place as Native people, because these people here are
our community members, our friends and neighbors, our children.
It is important that this type of process is taking place so
that we can work in a unified effort in the better need of our
people.
But we have that information. That is why I go back to the
very first thing I said. I kind of wonder. I see monthly
reports from our 628 programs that are submitted to the BIA
agency. Now, where does it go from there? Those reports outline
the great needs. I have been here, as I was saying, a year and
a half as the tribal chairman, and have been here several times
lobbying for more funds, that your appropriation would be
higher so that it could benefit all tribes across this Country.
Mr. Dorgan, I want to thank you for the bill that was
passed last week. It is very important for us to know that
there is people here in Washington that know the living
conditions, the education conditions and the environment that
we're living in is very important. Because if those issues are
not addressed, it is very harming to our people, because
actually what are we teaching them? What are we teaching them
through the detention center. What are we teaching them through
health care and education? If the Indian people have a future,
then it is very, very important that the United States
Government relates back to its trust responsibility.
That is basically just listening, hearing the great needs
of the tribes. I realize that I sit here probably representing
all of the nations that are not able to be here. I know that
that is one thing that I would really stress is the
appropriation of funds.
We can't live this way. We can't continue this way. We need
a true partnership, a true government-to-government
relationship. Because I like to see those in our community that
only have so many years to live to know that the Federal
Government is finally exercising the true trust responsibility
that they had mentioned years and years ago.
Mr. Dorgan, again I want to thank you. I appreciate this
opportunity and this hearing because it is very vital. We are
talking about lives. We are talking about souls. And we are
talking about the future for Indian Country. I know we have a
rightful place in this Country if we are given that
opportunity.
So Mr. Dorgan and your Committee, I thank you for this
opportunity and we do have our written testimony submitted.
[The prepared statement of Mr. Nosie follows:]
Prepared Statement of Wendsler Nosie, Chairman, San Carlos Apache Tribe
Introduction
Thank you, Chairman Dorgan, Vice-Chair Murkowski, and other Members
of the Senate Indian Affairs Committee, for allowing me the opportunity
to testify today. My name is Wendsler Nosie, Chairman of the San Carlos
Apache Tribe, based in San Carlos, Arizona. We commend the Committee
for holding this important hearing on the state of facilities in Indian
Country so that we can shine a light on this very serious problem. The
backlog for jails, schools, and health facilities is staggering. Like
other tribal communities, the needs on my Reservation for adequate
facilities to provide the health care, law enforcement, and educational
services that my people deserve far exceed the level of support
provided by the Federal Government.
My testimony primarily focuses on our experiences and struggles to
build a new IHS outpatient clinic replacement facility and our recently
built Adult and Juvenile Detention and Rehabilitation Center. But I
would be remiss if I did not mention that I recently received
information from the BIA that it plans to condemn San Carlos' police
building, which houses the San Carlos Police Department, Tribal Courts,
and the BIA criminal office, because of its poor condition without
offering any assistance to find resources to construct a new building
even though Secretary Kempthorne and the Department of the Interior
have used San Carlos and its violent crime and serious methamphetamine
problem as an example in its budgets in brief and press conferences
over the past few years to justify increases to law enforcement.
Indeed, two years ago, San Carlos testified before this Committee about
the devastating effects of meth on its community. The Tribe has a self-
determination contract for police services, but the BIA owns the
facility and is responsible for its maintenance and operations. Due to
its poor condition, the BIA wants the Tribe to assume ownership of the
building.
Failure of the Federal Government to Provide Adequate Facilities
The Federal Government has failed in its trust responsibility to
provide adequate facilities to the San Carlos Apache Tribe and to other
tribes across the country. The agencies, the White House, the Office of
Management and Budget, and the Congress, have all shirked their
responsibilities to provide adequate resources to Indian Country so
that we can rebuild and provide for our communities.
The condition of facilities on my Reservation and in the rest of
Indian Country is unacceptable in this great country of ours. Let me be
clear that the San Carlos Apache Tribe supports our troops in Iraq,
Afghanistan, and other parts of the world. The Apaches have many
decorated war veterans that have served with distinction in the United
States military throughout this country's history. However, I wonder
about some of the priorities of the United States when my community
needs to be rebuilt, my people need decent health care, my people need
safe communities, and my people need infrastructure. When I hear about
the billions and billions of dollars the United States is spending to
rebuild Iraq, to build homes, jails, governmental buildings, hospitals,
and schools for the Iraqi people, I wonder why the United States will
do these things for the Iraqi people but not for its own citizens in
the United States.
The solution to this problem is obvious. The Administration and the
Congress must dramatically increase funding to construct new facilities
as well as funding to operate and maintain these facilities when they
go on-line. Because of the Federal Government's failure to provide
adequate funding over the past decade, we are seeing astronomical
backlogs. In the area of health facilities, there is an avalanche
effect where tribes with unmet health facilities needs in certain parts
of the country are seeking to redistribute funding for health
facilities that could adversely impact other tribes, such as San
Carlos, who have equally, if not more pressing, unmet health facilities
needs. This unfortunate situation played out on the floor of the Senate
during passage of S. 1200, the Indian Health Care Improvement Act.
For example, the appropriations for IHS health facilities over the
past 9 years have been stark as illustrated by the chart below:
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The President's budget requests and as well as the budget requests
under the Clinton Administration for facilities construction have been
deplorable. In FY 2005, the President's budget requested a moratorium
on IHS facilities construction using the rationale that steel prices
were too expensive. Needless to say, this explanation does not make
sense when construction is going on all around us and all over the
world. Unfortunately, the President's budgets' utter lack of support
for IHS facilities construction has set a tone that Congress has
followed over the years as the Congress has only provided minimal
funding for health facilities. For example, for FY 2008, $32.6 million
was allocated for facilities construction even though there are at
least 24 facilities on the construction priority list ready for
planning, design, or construction dollars. If you are familiar with
construction, then you know $32.6 million does not go far when building
new health facilities that must be able to serve the community for at
least the next 60 years.
Our hope is that all of our efforts within Indian Country, in the
Administration, and in the Congress can be used in a positive direction
to significantly increase appropriations. We must work together and,
through our collective strength, address the facilities backlog. The
San Carlos Apache Tribe urges a Call to Action of the Congress from
Indian Country to increase appropriations. We understand that other
tribes and tribal organizations are also discussing this same idea. We
stand ready to assist in this effort.
I believe that this hearing will help jumpstart the efforts to
secure badly needed appropriations for facilities in Indian Country.
Also, I believe it would be helpful if the Committee could hold some
field hearings or listening sessions in Indian Country on this issue,
so that Members could see for themselves the conditions that families,
community leaders, health care personnel, social services staff,
detention personnel, police officers, school administrators, teachers,
and students in Indian Country must grapple with every day due to poor
facilities.
In addition to improving the bleak appropriations situation, we are
hopeful that this hearing and subsequent hearings and meetings will
spur action within the agencies to reform their current processes to
provide us and other tribes with increased flexibility, greater self-
determination, less administrative burden, and greater control over the
construction and operations of new health care facilities. For example,
the Tribe's experience working with DOJ in constructing its Adult and
Juvenile Detention and Rehabilitation Center in the late 1990's is a
true success story and illustrates what tribes can achieve when given
sufficient funding and flexibility. The Tribe has had, unfortunately, a
less than optimal experience with the IHS in its struggle to build a
new outpatient clinic due to limited funding and an overreaching
construction process. The current process at IHS is not
institutionalized and allows the goal post to be moved. This is
problematic as it indicates to us that the sovereignty of tribes is not
truly understood and that the principle of government-to-government
transfer of control to tribes in the construction and operation of
health care facilities is paid little heed.
Background on the San Carlos Apache Indian Reservation
To better understand the needs on the San Carlos Apache Indian
Reservation as well as the Unites States' trust responsibility to the
San Carlos Apache Tribe, it is helpful to know about the Reservation
itself as well as the history of the Apache people. The aboriginal
territory of the Apache Nation included the western part of Texas, the
current states of Arizona and New Mexico, and part of the country of
Mexico. The Apache Treaty of Santa Fe in 1852 was executed by Mangus
Colorado and others on behalf of the Apaches. Pursuant to the Treaty,
lands within the aboriginal territories of the Apache Nation were to be
set aside for a permanent Tribal homeland and the United States
promised to provide for the ``humane'' needs of the Apache people. In
exchange, the Apache Nation agreed to the end of hostilities between
the two nations.
The San Carlos Apache Indian Reservation was established by an
executive order of President Grant on November 9, 1871. Through the
concentration policies of the United States, various bands of Apaches
were forcibly removed to the San Carlos Apache Indian Reservation.
These bands included the Coyoteros, Mimbrenos, Mongollon, Aravaipa,
Yavapai, San Carlos, Chiricahua, Warm Springs, and Tonto Apaches.
Famous Apache leaders who were located at San Carlos included Geronimo,
Cochise, Loco, Eskiminzin, Nachie, Chatto, and others. Throughout
history, the United States in 1873, 1874, 1876, 1877, 1893, and 1902
diminished the size of the Reservation several times by executive order
due to the discovery of silver, copper, coal, water, and other minerals
and natural resources.
The San Carlos Apache Reservation is located 2 hours by car from
Phoenix. Our land base is 1.8 million acres, but only a small
percentage of the Reservation can be used for building purposes. The
remainder of the Reservation is comprised of some of the most rugged
terrain in the Southwest, including deep stands of timber, jagged
outcroppings, and rocky canyons. As a result, the Reservation lacks
infrastructure in all but two general areas. On the western edge of the
Reservation, the Tribe has 3 districts: 7-Mile Wash, Gilson Wash, and
Peridot. Located on the eastern edge of the Reservation is the District
of Bylas. All together, these 4 districts are home to 13,456 tribal
members. Approximately 84 percent of our tribal members live on the
Reservation. Although we have worked hard to develop our Reservation
economy, 76 percent of our population is unemployed, and the poverty
rate on the Reservation is 77 percent. The population of the Tribe
continues to increase and more than 30 percent of the population is now
under the age of 18 years. New young families are in desperate need of
decent health care, education, and safe communities.
Struggle to Build IHS Replacement Health Facility
Antiquated Current Facility
Our existing facility is located in San Carlos in Gila County. It
was built 48 years ago in 1962. It has 8 beds and its limited services
include ambulatory care, emergency room, community health programs,
dental, and administration. Patients requiring surgical procedures and
complex medical cases are referred to the Phoenix Indian Medical Center
in Phoenix or to contract health care hospitals. This means that
helicopters frequently go back and forth between Phoenix and San Carlos
to rush urgent care and trauma patients to hospitals in the valley.
IHS has documented numerous deficiencies at our current health care
facility rendering it inadequate for present operations. The current
health care facility is being used beyond its full capacity. The
facility is severely understaffed and lacks adequate equipment, program
services, and physical space to adequately meet the medical and other
healthcare needs of tribal members. To give an idea of the space
deficiencies in the clinic, IHS, based upon workloads at the current
clinic, has determined that the new clinic needs 31 examination rooms.
The current clinic only has 13 examination rooms. Due to lack of space,
sick and elderly patients currently have to wait a long time to be
examined or to get prescriptions filled. The current clinic sees on
average 200 patients a day with a total of over 6,000 patients per
month. The Tribe over the years has heard frequently from IHS staff
that the current San Carlos health clinic is one of the worst
facilities in the IHS system.
Long Road To a Project Justification Document for a New Facility
The project plan for the new clinic would allow the Tribe to bring
some fundamental healthcare services back home to the Reservation as
well as address unmet medical needs of the Tribe. For example, as part
of the project plan, the new outpatient clinic would have a low risk
birthing unit. The current clinic is not equipped for labor and
delivery services even though there are a high number of births of San
Carlos tribal members each year (the 2001 figures of IHS show 234
births per year of San Carlos tribal members). Currently, the women of
San Carlos must travel off the Reservation and often to locations far
from their homes to deliver their babies. The closest delivery service
from San Carlos is 40 minutes away at Cobre Valley Community Hospital
while the Bylas community is an hour from Cobre Valley and 50 minutes
from Mt. Graham Community Hospital. The women of San Carlos are eager
to deliver their babies at home on the Reservation and the new clinic
would allow them to do so. Also, the new clinic would be equipped and
staffed to provide the following new services, which are badly needed
on the Reservation: telemedicine, diagnostic imaging, expanded
specialty care such as ambulatory surgery and endoscopy, physical
therapy, and expanded diabetes treatment. The new facility would
provide for more than 3 times the staff at the current facility. The
existing facility has 118 staff and the new facility would have 358.2
staff. The size of the current facility is 3,580 square meters. The
size of the new facility is proposed to be 18,767 square meters. The
cost for the new facility and staff quarters, according to IHS, is
approximately $110 million (but this cost will only increase as costs
go up over time and given site circumstances that IHS did not factor in
its initial estimates).
Our struggle for a replacement health care facility began over 20
years ago. In and around 1988, IHS evaluated IHS health care delivery
programs nationwide. The proposal to construct a replacement facility
to provide health care services space at San Carlos was among those
selected for further evaluation. IHS assessed the health care needs of
the Indian population at San Carlos and evaluated the ability of the
existing health care delivery system to meet those needs. The major
factors that IHS considered were the use of the existing system, the
size and condition of existing space, the ability of the existing space
to support an accessible, modern health care delivery system, and the
proximity of other health care facilities. The findings of this
evaluation concluded that the existing San Carlos Indian Hospital was
inadequate and required a complete replacement.
IHS placed the San Carlos facility on its list of facilities in
need of replacement in the early 1990s. It is now 2008 and we still do
not have a new health care facility. For over a decade, IHS and the
Tribe went round and round ``negotiating'' the Project Justification
Document (PJD), which is the project plan that IHS must approve before
a facility can be placed on IHS's health care facilities priority
construction list. IHS and the Tribe could not come to an agreement
over the size of the facility and the level and types of services that
could be provided at the facility. The main issue was whether an
inpatient or outpatient health care facility should be built. Even
though the user population at San Carlos supported such a facility and
San Carlos previously had an inpatient facility, IHS was firm in its
position that it would not support an inpatient facility due to IHS's
limited budget and because it was trending away from building inpatient
facilities. Inpatient facilities offer more types of services on site
than do outpatient facilities. Many tribes navigating the IHS
construction process are having this same issue with IHS. Many tribes
have been in the ``PJD preparation'' phase for many years because they
are being asked to compromise on the health care needs of their people
even before the shovel breaks ground.
Further, IHS informed the Tribe that, if the Tribe sought an
inpatient facility, then it would be practically impossible to
construct the facility in the foreseeable future due to the scarce
appropriations for inpatient facilities. IHS pointed to the proposed
inpatient facility at Whiteriver, AZ, for the White Mountain Apache,
our sister tribe, and indicated that it would be very long time before
Whiteriver would receive construction funding. The Whiteriver inpatient
clinic has been on the priority construction list from the beginning,
like San Carlos, and has yet to receive any appropriations to start its
project.
In 2003, the Tribe, after intensive internal discussions,
determined that it would consent to an outpatient facility instead of
an inpatient facility. This was a very difficult decision for the Tribe
because an outpatient facility will not meet all of the health care
needs of its people but would certainly allow for better services and a
much better facility. Even after the Tribe decided to pursue an
outpatient facility, the negotiations were difficult. The Tribe felt
that it had to capitulate on issue after issue because IHS, at each
step, would inform the Tribe that it would not approve the PJD if the
Tribe did not consent to the reduced services to be provided at the new
facility. For example, the Tribe sought cardio-rehabilitation, case
management, and patient advocacy services, but IHS informed the Tribe
that it would have to ``start all over'' in the process if it continued
to seek such services. IHS rejected these service requests on the basis
that, even though these services are reasonable services to offer at a
non-IHS facility, IHS had not developed national templates for the
services and, therefore, would not allow any tribe to provide these
services at their facilities.
Another example was a difference in views over the number of beds
at the new facility. The Tribe sought 23 beds for the new facility.
Previously, the service area had 26 beds between the 1960s and 1980s
but these services were lost when the facility underwent patchwork
renovations. IHS will only allow for 8 beds (the number of beds in the
current facility) in the new facility due to budgetary constraints.
Even with the compromises of the Tribe, IHS still was reluctant to
approve the PJD because we believe it knew in 2003-2004 that the
Administration was going to propose a moratorium on funding for health
facilities construction in FY 2005. As perceived by the Tribe, IHS's
plan was to stagger the PJD approval process so that only a few PJD's
would be approved every few years. Due to congressional pressure, IHS
approved the San Carlos outpatient replacement facility PJD in 2004 and
placed the facility on IHS's priority outpatient construction list.
Even with the approval of the PJD and the placement of the San
Carlos outpatient replacement facility on the priority construction
list, the process has been extremely difficult at every turn. Without
the strong commitment of the Tribe to this project and the tremendous
support for this project by the Tribe's Congressman and Appropriators,
this project would have languished without any funding. The Tribe
received planning and design funding from FY 2005 to FY 2007 (FY 2005
Interior appropriations bill specified $555,000 for San Carlos for
planning and design, the FY 2006 Interior appropriations bill specified
$6.139 million for planning for San Carlos, and IHS allocated $2
million to San Carlos under the FY 2007 Continuing Resolution).
Currently, for FY 2008, the Tribe is not slated to receive any funding
at this point in FY 2008 from the facilities construction account as
this funding was appropriated in a lump sum amount without allocations
for specific facilities and IHS has determined that it will allocate
this funding to Barrow, Cheyenne River, and Ft. Yuma ($36.6 million in
FY 2008). IHS has indicated to the Tribe that it is looking for funding
in other IHS accounts to keep the project moving along and we are
hopeful that IHS can find this funding for us.
Even with funding that was allocated to the Tribe for FY 2007 in
the amount of $2 million, the Tribe has had difficulties drawing down
this funding. At one point, the IHS construction office stated that it
would not release these funds to the Tribe until it ``has a certain
comfort level'' with the Tribe's designs and plans. It would be more
helpful if IHS could provide us with consistent, concrete guidelines
and criteria to which they want us to adhere to draw down funds. When
the Tribe has requested the procedures for drawing down its funds, the
IHS construction office responded in an email, ``Yea right.'' There
should be consistency, transparency, and cooperation in the agency
process.
Previously, the Tribe entered into a self-determination contract
under P.L. 93-638 for the construction of the contract and recently
submitted a notice of intent to IHS that it plans to submit a self-
determination contact for the operations of the facility. We believe
that IHS could improve upon its appreciation for the purpose of a self-
determination agreement to provide for the government-to-government
transfer of responsibility. It is our belief that the IHS construction
office tends to micromanages the project contrary to the government-to-
government transfer of responsibility. The self-determination agreement
states that ``tribal preferences will be honored,'' but sometimes we do
not feel that this is the case. For example, we have registered design
architects and engineers as part of the Tribe's project team but IHS
second guesses their work and pressures us to do things their way.
Another example is the Program of Requirements (POR). The POR for
the project was created by IHS for the Tribe, even though P.L. 93-638
states that the Tribe has the right to generate its own POR.
Essentially, these facilities are designed as IHS wants them designed
and do not necessarily reflect the true health care needs in the
community. We believe that there should be a mechanism to update the
POR so that the up-to-date health care needs in the community are
addressed.
We recently were told by the construction branch at IHS that IHS is
a ``bottom up'' organization and that, unless the project manger from
engineering services has a personal level of comfort with what the
Tribe is doing, then the project will not be supported by anyone in
Washington. We have been told that we can talk to anyone we want to in
Washington; but, unless the Dallas Project Manager is satisfied with
the direction of the project, the project will receive no support and
no funding. We have had individuals from IHS threaten not to approve
the design package from the Tribe at the next approval phase, unless
things are done their way. We have had the IHS project managers show up
at tribal meetings with Service Unit staff uninvited, totally disrupt
the meeting, insult our medical staff, and have had our meeting delayed
for over an hour while we calmed them down enough so that they could
sit in on the meeting without interruption.
Further, IHS recently informed us that we must alter our design to
shift the burden of maintenance responsibility to the Tribe instead of
IHS. IHS wants all utility systems developed for the health facility to
be operated and maintained by the Tribe even though there are no funds
provided for this. We believe that IHS should be responsible to
maintain systems designed to exclusively support the hospital.
Suggestions for Improving the Construction Process at IHS
In addition to dramatically increased appropriations, IHS needs to
be pro-active in introducing funding into the projects on the priority
list, and they need to get the message ``from the top down'' that the
reason IHS exists is to provide better health care and new facilities
for the Tribe. IHS should work to improve their construction process to
fulfill the purpose of their self-determination agreements, which is to
provide for the government-to-government transfer of responsibility for
the construction and operations of the facility.
The IHS system needs to be re-organized to streamline the design
and construction process. The projects are originated in the Phoenix
area office, then are transferred to Dallas for the construction phase,
then the maintenance and operations are transferred back to the Phoenix
area office after the project is completed. This is extremely
inefficient. There should be continuity throughout the construction
process from conceptual development through design, construction, and
maintenance and operations. The Dallas project managers travel to
Arizona to oversee projects that the Phoenix Area Engineering staff
could easily oversee. It would be most cost effective and much more
efficient to originate, design, and construct these projects at the
Area Office level. We find that the area office engineering staff have
a high level of understanding of these projects, are very professional,
and have a vested interest in providing the best buildings possible as
they will be responsible for the maintenance and operation of the
facility once it is built.
We understand that questions have been raised about the seeming
high cost of IHS facilities construction projects. However, according
to our project team that has extensive experience in hospital
construction, these projects are lower in cost compared to what is
spent in the private sector on hospital construction. Our budget was
conceptualized before all the engineering challenges on our site were
identified; and, as a result, our budget does not accurately reflect
the actual project cost. There are many glaring omissions in our
proposed budget as provided by IHS. These budgets need to be accurately
updated in cooperation with the Tribe.
Experience Constructing and Operating New Adult and Juvenile Detention
and Rehabilitation Facility
Construction of Adult and Juvenile Detention and Rehabilitation Center
San Carlos was in dire need of a juvenile detention facility and a
new adult jail for many years. From 1994 until 1999, the Tribe pushed
for a new facility and was placed on the BIA's ``waiting list.'' In
1999, San Carlos attended a conference in Albuquerque sponsored by DOJ.
With technical assistance from DOJ, Office of Justice Programs (OJP),
the Tribe prepared an application and received funding approval for a
Juvenile Detention/ Rehabilitation Center for $2,153,550.00.
While the Tribe was pleased that the juvenile project was approved
for funding, the need for a new adult detention center still existed.
Determined to obtain funding, the Tribe expressed its concerns about
the condition of the adult facility to OJP. This effort led to San
Carlos preparing a second application for both an adult and juvenile
complex. On September 29, 1999, this application was approved,
resulting in the Tribe obtaining a combined total of $10,787,272.00 in
a lump sum to construct an Adult and Juvenile Detention and
Rehabilitation Complex. From a funding perspective, the response from
OJP, DOJ, was remarkable. DOJ listened to Tribal representatives,
recognized the Tribe's problems and needs, and addressed them
immediately. The Tribe entered into a self-determination contract to
construct the facility and then later entered into a self-determination
contract to operate and maintain the facility. The program at OJP back
in the late 1990's should be a model for most other Federal agencies.
We understand that this program is not now the program that it once
was.
The next step involved the construction phase. The Tribal Planning
Department took the lead in grant management and development. The first
action involved preparing a Request for Proposals (RFP) for
Architectural and Engineering services. The Tribe evaluated and hired a
firm from Phoenix. One of the keys to success was the fact that DOJ
authorized hiring a project manager from the overall budget so that the
design and construction phases could go forward without any major
glitches or delays. Reimbursements and advances from DOJ were timely
and DOJ was very responsive to any questions posed or modifications
needed. Overall, the design and engineering phase went very well. The
construction of the facility was completed in 2003. The principle of
self-determination worked well in the self-determination contract for
construction with DOJ. The Center is an example of the timely and
positive effects that can occur when tribes have flexibility and
control over the construction of their facilities and they do not have
to navigate a bureaucratic maze.
Obtaining funding and completing the design and construction of
this complex were tremendous accomplishments, but another major
obstacle needed to be addressed. Even though DOJ was responsible for
the construction side of the new facility, BIA was and remains
responsible for the operations and maintenance for the new facility.
Here, the right hand did not know what the left hand was doing.
Although the Tribe had requested that the BIA include funding for the
operation of the facility because the facility was ready to go on-line,
the Tribe learned that the President's budget in FY 2003 did not
contain funding to operate and maintain the new facility. The Interior
appropriations bill for that fiscal year did not contain operations and
maintenance funding for the new facility, so we had a situation where
the Federal Government had constructed a multi-million dollar facility
that could not be used. The Tribe did not and does not have the
resources to hire staff, operate the facility, and maintain it.
Fortunately, after intense lobbying by the Tribe and other tribes
across the country through the formation of a coalition, the BIA agreed
to reprogram FY 2003 funds so that the facilities that had completed
construction could hire and train staff and furnish and equip their
facilities.
For FY 2004, the coalition of tribes, including San Carlos,
advocated strongly for funding for operations and maintenance in the
Interior appropriations bill. The effort was successful, and the
appropriations bills for FY 2004 and going forward contained funding
for operations and maintenance for San Carlos new detention and
rehabilitation center. However, the funding that the Tribe receives is
not enough.
The annual amount the Tribe receives is inadequate to support
administrative functions, basic operational costs, and the
``detention'' staff. For the short term, the Center is managing at a
minimal level. The Tribe is able to manage at the minimum level due to
the fact that the program has some carry over funding to supplement the
annual budget. However, these funds will be exhausted shortly even
though the Center is not operating at the recommended staffing level.
If the base level of funding is not increased by the BIA, continued
operation of the Detention/Rehabilitation Center will be seriously
jeopardized, as the Tribe simply does not have the financial resources
to supplement the estimated $1.5 to 2 million annual deficit. Even with
the shortfalls in funding, the BIA honors the government-to-government
transfer of control to the Tribe for operations and maintenance as
contemplated in the self-determination contract, and we appreciate
that.
At the present, the FY 2008 budget for the operations of the
detention center is less than the budget of its employees' salaries.
The current salary budget is $3.1 million; however, the budget from the
BIA for the total operations for FY 2008 is $ 2.6 million. Our total
budget need is $4,047,353. We are short $1,434,011 of what is needed to
operate the detention center efficiently. We are not at full capacity
in filling the positions that are needed and are presently short
staffed. Presently, we have a total of 42 permanent employees, 22 are
adult correctional officers and 11 are juvenile correctional officers.
Our projected staffing needs in the beginning indicated a staffing of
64. Taking this into account, we are 22 positions short.
It should be noted that the discussion above does not include the
costs associated with the rehabilitation component of the Center. In
the initial planning stages, the Tribe felt very strongly, especially
its elders, that it did not want a detention facility that was simply a
jail, especially for juveniles. It believed that incarceration does not
help individuals become healthy, happy, productive members of the
community, and they wanted to ensure that rehabilitation services were
an integral part of the overall program for both adults and juveniles.
Most of the offenses at San Carlos are related to alcohol and substance
abuse. With effective rehabilitation and re-entry programs, these
offenders have a chance at leading productive lives.
San Carlos is very fortunate to have the opportunity to design,
construct, and operate the San Carlos Detention and Rehabilitation
Center serving both adults and juveniles. While the Tribe now has a
modern, clean, and functional facility, at the present time, the
reality is that it is functioning as little more than a jail. This fact
is discouraging to the Tribe. As stated above, the original intent of
the Center was to be a place where troubled youth, adults, and affected
family members could receive the services and support they need to
become productive and positive members of their community.
The Detention Center staff is doing a commendable job in
maintaining the facility, providing a clean and safe environment, and
treating all residents with dignity and respect. However, with the
exception of limited education programming and emergency medical and
dental services, there is minimal on-going treatment programming taking
place. The staff at the Center is extremely dedicated and spend their
personal resources and time to develop programming for mentorships for
the detainees, especially the juveniles. For example, with personal
funds from donations, Center staff have taken the juveniles over the
past few years to participate in a 300-mile sacred run, which is a
relay race from Whiteriver to Mt. Graham. I help to organize in the run
and run in it myself with my family. This 3-day experience focuses on
teamwork, relationship building, and fun. The juveniles tell me they
cherish their experience because they feel that they are part of
something bigger than themselves. Our juvenile staff do such an
excellent job (all of it on a shoestring with little federal support)
that they are asked to give presentations in other parts of the country
and in Arizona about their innovative juvenile program.
Issues related to this situation are identified and briefly
described below:
<bullet> The Tribe simply does not have the financial resources to
provide the funds needed and the BIA is funding the contract at
a level that meets minimal ``detention'' staffing and operating
levels only.
<bullet> IHS has demonstrated only a willingness for finding reasons
why they can not provide services to detainees rather than
making an earnest effort to find solutions.
<bullet> Some grants under SAMHSA like the Tribal Capacity Expansion
(TCE) grant and other federal grants that could provide at
least a portion of the funding necessary to start providing
treatment services require a minimum of two years experience
providing treatment services to be eligible for funding
consideration. As a result, it puts the Tribe in a no-win
situation as they need funding to get their treatment services
started but they can't obtain funding unless they have been
providing treatment services for at least two years.
<bullet> Programs, such as the Arizona Health Care Cost Containment
System (AHCCCS) and the SAMHSA ATR programs, could assist the
Tribe greatly; but it is our understanding that they both have
prohibitions regarding serving individuals in detention.
<bullet> The State of Arizona is one of a few states that allocates
funding for education for juveniles in detention, but all of
the funds are distributed to County detention facilities. The
Detention Center is attempting to work with the local school
district and the Gila County Superintendent of Schools, but
what is really needed is that Tribes should receive separate,
direct funding from the State.
It seems that the BIA, IHS, SAMHSA, OJJDP, and other federal
agencies have the opportunity to showcase the San Carlos Detention/
Rehabilitation Center and use it as a model program that other tribes
can use as the foundation for designing and developing their facilities
and programming. San Carlos has an excellent facility, but the
provision of comprehensive, substantive programming (treatment) is a
real and frustrating challenge for the Tribe. It would seem that rather
than putting tribes in a position where they have to ``piece-meal'' a
program together, some type of block grant format could be established
where tribes could obtain the services (operational and treatment) they
need through one proposal/application.
Conclusion
We appreciate your efforts to help us address the facilities crisis
in Indian Country, and we look forward to working with you to ensure
that the Apache people and other Indian people across the country have
the tools that they need to help their communities become strong and
vibrant.
The Chairman. Chairman Nosie, thank you very much.
This Committee will be holding a hearing in Phoenix,
Arizona I believe it is two weeks from next Monday. Senator
John Kyl will be joining me in Arizona. We will be holding a
hearing specifically on law enforcement issues. I hope perhaps
you might be there as well. I know that you come from that
area.
Next, we will hear from Mr. Monty Roessel, Superintendent
of the Rough Rock Community School in Chinle, Arizona, from the
Navajo Nation. Thank you very much for being here. You may
proceed.
STATEMENT OF CHARLES MONTY ROESSEL, SUPERINTENDENT, ROUGH ROCK
COMMUNITY SCHOOL
Mr. Roessel. Thank you, Mr. Chairman and members of the
Committee, for the invitation to speak before this Committee,
not as an elected official or an issues advocate, but as a
person who is directly responsible for the safety and education
of more than 500 Navajo students.
My name is Charles Monty Roessel. I am Superintendent of
Rough Rock Community School. Rough Rock is a K-12 residential
school located in the northeast part of Arizona on the Navajo
Nation. To say that the Rough Rock Community School is in need
of adequate school facilities is an understatement. Rough Rock
was originally built in 1965 and opened its doors in 1966.
We were a leader in bilingual-bicultural education then and
we continue to be today. Despite our substandard condition of
our facilities, parents nonetheless continue to enroll their
children at Rough Rock. Recent research has confirmed what many
educators have always held as common sense: the quality of a
school's facility has an impact on the student's academic
achievement. The research on school building conditions and
student outcomes finds a consistent relationship between poor
facilities and poor performance.
Here are some of the facilities-related hardships we
routinely face at Rough Rock. Sometimes our students wake up at
4:30 in the morning just so they can take a shower because the
pipes under our two dorms have corroded to such a level that
only half of the shower heads work in each dorm wing. Our
middle and high school students have to share a cafeteria that
was originally built for 75 students and today must accommodate
more than 300. When it rains and snows or when the wind blows,
as it often does, they must stand outside and wait their time
to eat and sit down.
Our high school does not have a biology or chemistry lab
and this puts them at a disadvantage if they want to attend
college. Even worse, the quality of water is severely
compromised. It is high in arsenic because the pipes are old
and not compatible with the water filtering system. We must
choose between high arsenic or high chlorine levels. Our school
must operate its own water system, which was also built in
1965. Yes, there is a great need for adequate and safe
facilities at Rough Rock.
A recent study has shown that students attending schools in
newer and better facilities score 5 to 17 points higher on
standardized tests. If a classroom is cold, noisy or dark,
students are losing instructional time. At Rough Rock, we have
classrooms and dorms that are cold because of outdated
mechanical systems, dark because of old lighting systems and
little daylight, and noisy from thin walls and deteriorating
structures. They were built to code in 1965. The codes have
changed, but the buildings haven't. Just imagine how many
Bureau-funded schools could make AYP if our facilities were
only adequate.
In March of 2004, the Rough Rock Community School was
listed as number eight on the school construction priority
list. Yet construction dollars will not be requested until
2011. It will take at least seven years before a shovel hits
the ground just for the first phase of construction. This cost
of inaction and slow action is hurting Indian children all
across this Country. This is unacceptable and our Indian
children deserve better.
Some might think that being placed on a priority ranking
list for a new school is a good thing. Well, it is, but it also
comes at a heavy price. Because we are now slated for a new
school, many of the safety repairs I mentioned are declined by
the OFMC. For example, in some buildings our high school and
vocational classes do not have a fire alarm system installed.
The dorm's plumbing problem cannot be fixed because the pipes
have asbestos. In both cases, we are told to wait for new
construction.
Every time a hear a fire alarm in the buildings that have
one, my heart skips a beat. I understand the logic. Why would
you put money into something that you are going to tear down?
But is it right? No. We are tired of band-aid solutions and
alarmed at the hazards to which our students and children are
exposed.
Since our elementary school was constructed in 1965, a
revolution has taken place in education. Computers have
replaced and supplemented books. The internet has replaced the
encyclopedia. And what was adequate 40 years ago is not anymore
today.
We all know the answer is more money, and I understand that
money is scarce. But rather than look at facilities as an
expenditure, we need to look at them as an investment--an
investment in our future and in our children. Without a
commitment to our future, we will never have the willpower to
ensure that every Indian child has the same opportunity as any
other child in this Country. At the very least, this is an
issue of fairness, and at the very most, it is a moral issue.
It is time that we offer our students the best facilities
possible that are safe, dependable and adequate to ensure that
no Bureau-funded school student is left behind.
I was taught by my dad that you can't complain about a
situation unless you at least are willing to recommend some
changes to that. So I have some recommendations to streamline
the process so that from start to finish it takes three years
and not eight years. Right now, we are looking at 10 years
passing before our school would even be open. That is almost an
entire set of grades that are losing out on the brand new
school. In order to speed up the process and reduce the
backlog, I believe it would be beneficial to allow schools that
are ready, such as Rough Rock, to jump up on the priority list.
Also, encourage standard designs. There is no reasons to
continually redesign and redesign and redesign new dorms. A
dorm is a dorm and the process could be streamlined and save
money if people would use standardized designs. I think to
create the capacity for Bureau-funded schools to utilize
bonding to build new facilities and to encourage that projects
be funded in phases like we are trying to do at Rough Rock to
proceed at a faster rate.
On behalf of all Indian children, I thank you for looking
into these troublesome construction matters, and I am happy to
answer any questions the Committee might have.
[The prepared statement of Mr. Roessel follows:]
Prepared Statement of Charles Monty Roessel, Superintendent, Rough Rock
Community School
Thank you, Mr. Chairman and members of the Committee for the
invitation to speak before this Committee. I would like to briefly go
over my written testimony and touch on a few points.
My name is Charles Monty Roessel. I am a Navajo from Round Rock,
Arizona working as superintendent of Rough Rock Community School. I
have held this position for eight years. Rough Rock is a K-12 North
Central Association accredited residential school located in the
northeast part of Arizona on the Navajo Nation. Our enrollment is
around 500 with one-half of the student population staying in an
elementary and high school dorm during the week. Our students come from
throughout the Navajo Nation. We operate the school under a Tribally
Controlled Schools Act grant (P.L. 100-297) from the Bureau of Indian
Education.
To say that the Rough Rock Community School is in need of adequate
school facilities is an understatement. Rough Rock was originally built
in 1965 and opened its doors in 1966, as the Rough Rock Demonstration
School, the first Indian community-controlled school in the country. In
fact, community control of our school pre-dated the enactment of the
Indian Self-Determination Act by nine years.
Bilingual and Bicultural Focus
Rough Rock was a leader in bilingual and bicultural education then
and continues to be today. The philosophy is simple and it is backed by
research. If students know their culture and are proud of who they are,
they are more likely to have academic success. Therefore, at the
elementary school we have implemented a Navajo language immersion
program. And at the high school, in order to graduate a student must
take four (4) credits of Navajo history, language and culture. At the
time it was a revolutionary idea to think that Indians could control
their own education. Well to say the least, we have demonstrated and
proven that Indian people can and are able to control their own
education.
Despite the sub-standard condition of our facilities, parents
nonetheless continue to enroll their children at Rough Rock because
they highly value the benefits of our bilingual/bicultural curriculum
and our focus on encouraging our students to be proud to be Navajos.
Impact of Facilities on Learning and Achievement
It would be naive to say that the quality of school facilities does
not matter. Of course it does. At Rough Rock, we lack what most schools
all across this country take for granted--a safe and habitable
environment that enables students to enjoy learning and to achieve.
Recent research has confirmed what many educators have always held
as common sense--the quality of a school facility has an impact on
students' experiences and ultimately on their educational achievement.
The research on school building conditions and student outcomes finds a
consistent relationship between poor facilities and poor performance:
When school facilities are clean, in good repair, and designed to
support high academic standards, there will be higher student
achievement, independent of student socioeconomic status. (AFT, 2006)
Here are some of the facilities-related hardships we routinely face
at Rough Rock:
<bullet> Sometimes our students wake up at 4:30 am just so they can
take a shower because the pipes under our two dorms have
corroded to such a level that sometimes only half of the shower
heads work in each dorm wing.
<bullet> Our middle and high school students have to share a
cafeteria that was originally built for 75 students and today
must accommodate more than 300. And, when it rains or snows or
when the wind blows as it often does, they have to stand
outside and wait for their time to sit and eat.
<bullet> Our high school does not have a biology or chemistry
laboratory so that students who take these science courses
learn only through books; they do not get exposure to hands-on
learning. This puts them at a disadvantage if they want to
attend college.
<bullet> Our students quickly learn that ceiling tiles might fall at
any moment because of leaky ceilings and wind damaged roofs.
<bullet> Even worse, the quality of water is severely compromised; is
high in arsenic because the pipes are old and not compatible
with the water filtering system. We must choose between high
arsenic or high chlorine levels. Our School must operate its
own water system--which also dates back to 1965.
Yes, there is a great need for safe and adequate facilities.
A study in Tennessee has shown that students ``attending school in
newer, better facilities score five to seventeen points higher on
standardized tests than those attending in substandard buildings''
(Young, Green, Roehrich-Patrick, Joseph & Gibson, 2003). Inadequate
facilities have the biggest impact on time on task. If a classroom is
cold, dark or noisy, students are losing instructional time. At Rough
Rock, we have classrooms and dorms that are cold because of outdated
mechanical systems, dark because of old lighting systems and no
daylight, and noisy from thin walls and deteriorating structures. They
were built to code in 1965 but the codes have changed while our
buildings have not.
Safe and modem facilities also have a huge impact on the
recruitment and retention of highly qualified teachers. A study by
Boston College found that the correlation between facility improvement
and retention of teachers can be greater than pay increases. (Buckley,
Schneider & Shang, 2004)
It is also important to note that because of Rough Rock's location,
we must provide housing for our teachers, as there is no off-
reservation town with a private housing market within commuting
distance. Our campus housing, too, is plagued by safety issues and
inadequacies.
Rough Rock School thus has to act in several critical capacities--
as the local educational agency, as the municipality responsible for
the water/sewer system, as the landlord for our employees and as the
transportation department fixing potholes within our school compound.
Replacement School Priority List
In March, 2004, Rough Rock Community School was listed as number
eight on the school construction priority list as ranked by the Bureau
of Indian Affairs, Office of Facilities Maintenance and Construction
(OFMC). Our project has four elements: construction of a new high
school dormitory (grades 9-12) with cafeteria; construction of an
elementary dorm to house students in grades 1-8; construction of a new
elementary/middle school (K-8); and renovations to our existing high
school building to up-grade its capabilities, repair building systems,
and add wings for essential educational spaces such as science labs. We
proposed to OFMC that our project--now estimated at about $30 million
but originally projected at $16M in 2001--be funded and constructed in
phases for maximum economy and efficiency. The dorms would be built
first; then the elementary/middle school; then we will pursue the high
school renovations.
In the four years since achieving our priority list ranking we
inched our way up to the planning phase. Within seven months after
receiving planning funds, we had that phase completed, including the
identification of acreage for construction of the new buildings. Now we
are poised to begin the design phase next month--April 2008.
However, our school was notified that funds for the construction
phase will not be requested until, at the earliest, the budget request
for Fiscal Year 2011. Even if this expectation is met and Congress
appropriates the requested funds, it means from the time BIA approved
the priority ranking list it will have taken 7 years before a shovel
hits the ground--just for the first phase of our construction.
Completion of that first phase will take about 2 years before students
can occupy. The next phases will follow after that. Thus, it will be 12
or 13 years, if all goes well, before our full project is completed.
Inaction has a cost. In 2001, our project was originally projected to
cost $16M, today it is projected to be around $30M. At this rate, our
project might cost $40M in 2011. This is unacceptable. Our Indian
children deserve better.
Repairs on Existing Facilities Have Ceased
Some might think that being placed on the priority ranking list for
new school construction is a good thing. It is. But, it comes at a
heavy price. Because we are now slated for a new school, many of the
safety repairs I mentioned that need to be addressed are declined by
the OFMC. For example, some buildings--such as our high school
gymnasium and vocational education classrooms--do not have fire alarm
systems installed. The dorm plumbing problems cannot be fixed because
the pipes have asbestos. In both cases, we are told to wait for new
construction.
In other words, our students and parents and staff are told to
endure these unsafe conditions based on the promise of being number 8
on a priority ranking list. Every night we pray that nothing happens.
Every time I hear the fire alarm go off, my heart skips a beat. I
cannot believe that parents in Scottsdale or Boston would allow such
safety hazards to persist. And yet, this is business as usual in
Bureau-funded schools. I understand the logic; why would you put money
into something that you are going to tear down? But, is it right? No.
We are tired of band aid solutions and alarmed at the hazards to which
our children are exposed.
Poor Facilities Thwart NCLBA Mandates
Our school is being held accountable under the No Child Left Behind
Act, but who is holding the BIA accountable to provide the facilities
to adequately provide an education for our students? Every year new
standards of accountability seem to be imposed but we must make do with
the same old tools we always have had. Our accreditation is mandated by
the Bureau of Indian Education and yet, our facilities do not allow us
to offer the full academic programs required of us.
We all know the answer is more money. I understand that money is
scarce but rather than look at our facilities as an expenditure we need
to look at them as investments--investments in our future and in our
children. Without a commitment to our future we will never have the
willpower to ensure that every Indian child has the same opportunity as
any other child in this country. At the very least, this is an issue of
fairness and at the very most it is a moral issue.
Our staff is getting very adept at making do with less. It would be
nice if we didn't have to. About a week ago, after ceiling tiles
crashed to the floor (thankfully no child was injured), I was
inspecting the facility with our maintenance director. When I peered
through the hole I was appalled. My maintenance director just chuckled
and said ``old Indian trick.'' He was referring to pipes being held
together with duct tape and bailing wire. It is sad to think that this
is not the exception but the norm in Indian Country. By the Bureau's
own criteria only 39 percent of its school facilities are acceptable.
Since our elementary school was constructed 1965, a revolution has
taken place in education: Computers have replaced/supplemented books;
the Internet has replaced the encyclopedia. What was adequate 40 years
ago is not today. These old buildings were built when there were no
computers and as such, their electrical systems can not handle
computers in classrooms and computer labs in classrooms. Plus, adding
cabling to these old buildings runs the risk of disturbing the asbestos
that infests them.
Sometimes you just can't wait for your name and number to come up
on the school construction priority list. This January, Rough Rock
opened the doors to our new high school library. I want to thank OFMC
and Congress for providing us with this much needed educational
facility. They recognized the drastic need for our high school students
and somehow found the money to build this essential education facility.
We no longer are one of the few, if not only, high schools that did not
have a library. It makes me very sad to think of how many high school
students have passed through Rough Rock School over the past 42 years
without the benefit of a library--a very basic educational support
tool.
In Arizona, the public school system has invested millions upon
millions to improve the state of their facilities. All around Rough
Rock, public schools are building two story schools with gymnasiums
bigger than those at many colleges. And yet, parents still choose to
send their child to Rough Rock because they want their child to receive
the type of educational program we offer. It is time that we offer our
students the best facilities possible--not the largest gymnasiums--but
the most up to date classrooms that are safe, dependable and adequate
to ensure that no Bureau-funded school student is left behind.
My Recommendations
<bullet> Streamline the process so from start to finish it takes 3
years and not 8 years or more just to get funding appropriated,
and 10 years before a facility can be constructed and occupied.
Ten years means ten graduating classes!
<bullet> In order to speed up the process and reduce the backlog, I
believe it would be beneficial to allow schools that are
ready--such as Rough Rock--to move ahead of schools that are
not. This would be an incentive for schools to move rapidly to
complete a project in a timely manner, and also enable a school
which is ready to benefits its students sooner rather than make
them wait for a project higher on the priority list but slower
on the progress scale.
<bullet> Encourage the use of standardized designs to speed up the
construction process and more economically use the funds that
are available. For example, we plan to use standardized plans
for our dorm construction--with some ``tweaking'' to
accommodate our local needs. Not only do we believe this is a
sensible way to save money on design costs, it will also enable
us to get the dorms built and occupied more quickly.
<bullet> Create the capacity for bureau-funded school to utilize
bonding to build new facilities.
<bullet> Encourage that high-cost projects be funded in more than one
phase--like Rough Rock is proposing in order to proceed at a
faster rate.
Conclusion
On behalf of all Indian students, I thank you for looking into
these troublesome construction backlog matters. I am happy to answer
any questions the Committee has.
The Chairman. Mr. Roessel, thank you very much.
Now, we will hear from Ms. Valerie Davidson, the Senior
Director of Legal and Governmental Services at the Alaska
Native Tribal Health Consortium in Anchorage, Nebraska. She is
accompanied by Mr. Rick Boyce.
STATEMENT OF VALERIE DAVIDSON, SENIOR DIRECTOR, LEGAL AND
INTER-GOVERNMENTAL AFFAIRS, ALASKA
NATIVE TRIBAL HEALTH CONSORTIUM; ACCOMPANIED BY RICK BOYCE,
DIRECTOR, HEALTH FACILITIES SUPPORT
Ms. Davidson. Thank you and good morning. We really
appreciate this Committee's attention to the deplorable health
positions as clearly evidenced by your great work in the
passage of the Indian Health Care Improvement Act not only out
of this Committee, but also shepherding it through the Senate
and its transmittal over to the House.
Clearly, this Committee understands the deplorable health
conditions, and we appreciate the attention that this Committee
is giving to the status of the health facilities.
Today, I would like to be able to cover five topics very
briefly: first, the state of Indian health facilities; second,
the opportunities or innovation that are before us today;
third, the other support needs that go into maintaining
existing facilities; fourth, the impact of the lack of funding
of health facilities that they have on health disparities; and
finally, fifth, the new prioritization system.
This Committee, of course, is very well aware from your
questions earlier and your statements about the unmet need for
health facilities. As you indicated earlier, if you add the
$6.5 billion unmet need for primary care health facilities to
the IHS's $2.65 billion, that is of course over $9 billion just
for primary health care facilities.
You asked the question earlier, how much would an
appropriate amount be? And clearly, if the unmet need is almost
$10 billion, anything less than $1 billion a year is simply
unacceptable.
The average age of the IHS facility as indicated earlier is
about 33 years, but some facilities we know are over 40 years
to 66 years. Even a really new hospital like the Alaska Native
Medical Center in Anchorage is over 10 years old and it is
considered one of the brand new facilities in Indian Country.
But the typical IHS facilities are old. They are dilapidated.
They are in very, very poor condition. The Nome Hospital, for
example, was constructed in 1948 with an addition in the 1970s.
The replacement for that facility has been on the IHS priority
list since 1991. Another facility in Barrow was constructed
with wood frame construction in 1964 and it has also been on
the priority list since 1991.
In addition, though, to the simple inpatient facilities,
there is also a great need in other parts of the Country that
don't even have hospitals at all. For example, the Portland
area, which represents Washington, Oregon and Idaho, and the
California area, there are no inpatient hospital facilities at
all. None. And necessarily, they are contract health-dependent.
Even though we have seen a shift in population to the west
coast and the east coast of the United States, there are
virtually no inpatient hospital facilities on either coast.
With regard to health clinics, there are some examples of
health clinics that are, for one, on the Colville reservation
that is over 70 years old. Also on page six of the written
testimony that we have provided, you can see an example of the
clinic in Nukduk, also known as Newtok, which has no running
water, and you can imagine providing health care in a facility
where you may have an emergency blood and there is no running
water. You can imagine the sanitation problems and the health
issues that that causes.
The other, though, is that so clearly there is a huge unmet
need across Indian Country, and I think you are well aware of
those. That said, there tremendous opportunities for innovation
development, specifically with regard to the Joint Venture
Program, the Small Ambulatory Clinic Program, and a new
recommendation from the Facilities Appropriations Advisory
Board which is the Area Distribution Program.
You are familiar probably with the Joint Venture Program
and the Small Ambulatory Program. With regard to the Area
Distribution Program, though it was recommended by the FAB, it
provides a methodology for allocating funds to each area office
to address the highest priority projects in each area. The
great thing about that program is it can also be used to match
other local, State and private funds to complete a project that
would take many more years if only IHS funds were used.
Now, that said, there is some disagreement across Indian
Country with regard to that program, and some areas have
expressed concern about projects identified back in 1991 that
remain on the priority list. They question whether the area
distribution fund may dilute the facilities appropriation and
further delay funding for those existing projects.
What we do know, though, is that the Joint Venture and
Small Ambulatory Clinic Program funding lines have been in
place on the facilities appropriation and Congress has
continued to provide funding for other facilities, along with
the funding of individual projects on the priority list. We
would ask Congress to continue that practice with the Area
Distribution Program.
So that gives you a little bit of the opportunities for
innovation. However, one of the things that we would be remiss
is if Congress and tribes and the IHS spend all of these
resources to getting these facilities built. That is only half
the equation. The other half is all of the efforts that need to
be undertaken to be able to make sure that those facilities
continue to be viable. Those includes funds for medical
equipment replacement, facility and environmental support
funding, maintenance improvements, and the Village Built Clinic
Program.
As one example, the medical equipment replacement fund,
medical equipment should be replaced every six years. Right now
with the current funding mechanism, the only funding that is
provided would mean that that medical equipment couldn't be
replaced for 18 years. So a baby born into the hospital has the
prospect of coming back as an 18 year old adult and seeing that
same medical equipment. Clearly, that is a health safety issue
that cannot be tolerated.
Unfortunately, what happens is that tribes are often forced
to divert direct patient care dollars into upgrading that
medical equipment. It just doesn't make any sense.
The facility and environmental support funding obviously
pays for maintenance staff and basic operation of health
facilities including utilities. We are at a time in many parts
of the Country and Alaska in particular, we are paying over $5
a gallon for heating oil. The line item for this amount has
remained flat, and in fact we are actually taking a back step
in the proposed 2009 budget.
One of the things that happened is that although in Fiscal
Year 2009, the President's budget proposes no change from 2008,
what it actually does, if you look into the details, is it
allocates $25 million out of the base funding for staffing and
operational cost of new facilities that are coming online in
2009. So in addition, what that really means is that we have
experienced, even though the budget shows flatline, we have
experienced a $25 million net loss.
The other is of course maintenance and improvement funds.
There is a $371 million maintenance and improvement backlog. It
is embarrassing and quite simply it is unacceptable. The
Village Built Clinic Lease Program has seen no significant
improvement since the program was authorized. We estimate that
it takes at least another $5.8 million to be able to meet the
need.
Now, once you have that unfortunate bleak picture, let's
talk about the real life impact on health disparities. The
biggest impact obviously, as you identified earlier, is the
decrease in access to care, which of course exacerbates already
the health disparities that know exist. The things that we
haven't even talked about are the needs for long-term care,
including skilled nursing in assisted living facilities,
residential alcohol and substance abuse facilities, and the
huge unmet sanitation facilities.
Right now, we know that American Indians and Alaska Natives
suffer from alcoholism and substance abuse challenges more than
any other population. Right now, we have people who are lucky
if they only have to wait for six months to be able to get into
a residential treatment program. Using Alaska as an example,
one in eleven Alaska Native deaths is alcohol induced. Alcohol
contributed to 85 percent of reported domestic violence cases,
80 percent of reported sexual assault cases between 2000 and
2003, and suicide among Alaska Natives remains at two times the
national average. These are almost all alcohol-related. We have
people who are ready to get help, who are ready to get into
treatment programs and there are not sufficient facilities to
be able to meet that need.
We know that also on the inpatient side when facilities are
unavailable, entire areas become dependent upon contract
health. When facilities are not adequately funded, these funds
will necessarily come out of funds that were originally
intended for direct patient care, which we know is already
grossly under-funded by about 50 percent, like the replacement
of medical equipment. Chronic lack of funding also contributes
to the lack of facilities, overburdening of other budget line
items, and rationed health care on a systemic level.
But finally, I wanted to congratulate the Facilities
Advisory Appropriations Board, as well as the IHS, who have
worked over the last eight years on developing a new facility
priority system that was sent out numerous times through
extensive consultation. You can read the last about seven or
eight pages of my written testimony to get more detail there.
In conclusion, we just wanted to let this Committee know
that we know from experience, unfortunately, that as resources
get tighter, individual American Indians and Alaska Natives and
the facilities that provide their care, are going to feel the
impact more than any other.
As I said before, the funding really should remain in the
billions. The real life task that we have to ask ourselves is
not how much we do and how much the need is, but at the end of
the day if individual American Indians and Alaska Natives don't
get the access to the care they need, then we have collectively
failed them miserably. Alaska Natives and American Indians
deserve so much more than that.
We appreciate the attention that this Committee has
provided to highlight some of those issues.
Thank you.
[The prepared statement of Ms. Davidson follows:]
Prepared Statement of Valerie Davidson, Senior Director, Legal and
Inter-Governmental Affairs, Alaska Native Tribal Health Consortium;
accompanied by Rick Boyce, Director, Health Facilities Support
Good morning, Chairman Dorgan, Vice-Chair Murkowski and Members of
the Committee. Quyana (thank you) for the opportunity to testify today
about the state of Indian health facilities.
I was privileged to work for seven years for the Yukon-Kuskokwim
Health Corporation, the tribal health program that serves 58 federally-
recognized tribes in a region roughly the size of Oregon, of which
Bethel is the hub. I am now honored to work for over 2 years for the
Alaska Native Tribal Health Consortium, a statewide tribal health
program that serves all 229 tribes in Alaska, co-manages with
Southcentral Foundation the Alaska Native Medical Center (ANMC), the
tertiary care hospital for all American Indians and Alaska Natives (AI/
ANs) in Alaska, and carries out all non-residual Area Office functions
of the IHS that were not already being carried out by Tribal health
programs as of 1997. With me today is Rick Boyce, Director of Health
Facility Support, for the Alaska Native Tribal Health Consortium. Mr.
Boyce also serves as the Alternate Alaska Representative to the
Facilities Appropriations Advisory Board.
The deplorable health status of AI/ANs is clearly understood by
this Committee as evidenced by your commitment to modernizing the
Indian Health System through your recent efforts to advance the Indian
Health Care Improvement Act (IHCIA). We thank the Committee for your
efforts in highlighting the unmet needs in Indian Country and
congratulate you on your successful passage of the bill in the Senate
and its transmittal to the House.
We look forward to the day when we can take advantage of these
modern advances. In the meantime, we know that in order to make headway
on health disparities, we need to put adequate resources toward
improving access to care. In addition to providing resources for direct
care, we also need to focus our efforts and resources on building
facilities where they do not exist, and improving facilities that are
in disrepair because the maintenance and improvement needs have not
been sufficiently funded.
For those of you who have not visited Indian country or seen a
tribal health facility first hand, I will try to paint a picture. It
will be incomplete. It is impossible to understand the diversity and
challenges faced by Tribes without visiting a number of them. However,
not everyone can visit. So today, I hope to help you understand why
adequate health facilities are so important to the Indian health
system.
The stories I will tell you come from my experience in Alaska, and
from the experience of other tribes across the country, where tribal
members experience the same difficulties accessing health care, and
tribal governments and clinics experience the same pain of having to
deny health care to people in need because there just isn't enough
money to pay for it, and because there are just not enough resources to
provide adequate facilities.
We specifically recommend that Congress adequately fund the full
range of facility construction and operational needs, including primary
health care needs, Long-Term Care Skilled Nursing and assisted living
facilities, residential alcohol and substance abuse facilities, and our
huge unmet sanitation facilities needs.
I. The Indian Health Service System
The Federal Government has a duty--acknowledged in treaties,
statutes, court decisions and Executive Orders--to provide for the
health and welfare of Indian Tribes and their members. \1\ In order to
fulfill this legal obligation to Tribes, it has long been the policy of
the United States to provide health care to American Indians and Alaska
Natives through a network made up of the Indian Health Service
programs, tribal health programs and urban clinics.
---------------------------------------------------------------------------
\1\ See Federal Basis for Health Services, January 2007
(info.ihs.gov/Files/BasisForServices-Jan2007.doc).
---------------------------------------------------------------------------
The Indian Health Service (IHS), directly and through tribal health
programs carrying out IHS programs under the Indian Self-Determination
and Education Assistance Act, Pub. L. 93-638, as amended (ISDEAA),
provides health services to more than 1.9 million American Indians and
Alaska Natives. We are members of 562 federally-recognized tribes in
the United States, located in 35 different states. According to the
IHS, these services are offered from the following facilities: \2\
---------------------------------------------------------------------------
\2\ Indian Health Service Fact Sheet, IHS/OD/PAS January 2007
(info.ihs.gov/Files/IHSFacts-Jan2007.doc).
------------------------------------------------------------------------
IHS Directly Tribally
Operated Operated
------------------------------------------------------------------------
Hospitals 33 15
Health centers 54 229
Health stations 38 116
Alaska Community Health Aide (CHA) clinics 0 162
------------------------------------------------------------------------
There are also 34 urban Indian health programs funded by IHS under
Title V of the IHCIA that provide care to approximately 600,000 AI/ANs.
\3\ When health care cannot be provided through these facilities, IHS
and tribal programs use funding to purchase ``Contract Health
Services'' from providers outside of the IHS system.
---------------------------------------------------------------------------
\3\ Indian Health Service Year 2007 Profile, January 2007
(info.ihs.gov/Files/ProfileSheet-Jan2007.doc).
---------------------------------------------------------------------------
The number of facilities does not really tell the story though. The
Indian health system is a real system of care. It is reflected in the
IHCIA, which addresses health provider workforce issues, and a full
range of health care services from preventive health care services to
critical inpatient care, from prenatal care and deliveries to services
needed at the end of one's life.
The IHCIA also encompasses services that have been woefully
inadequate or simply unavailable like nursing home services and
behavioral health, including a continuum of mental health and substance
abuse services. In addition, the IHCIA addresses those critical
infrastructure issues that are so easily overlooked when a suffering
patient and her family require immediate attention--the facilities that
are needed to provide this vast array of services and basic public
health services like safe water and sanitation.
There is a desperate need for additional resources even with
reliance on supplemental funding through Medicaid, Medicare and SCHIP.
The system simply cannot remain viable without adequate facilities.
II. State of Indian Health Facilities
The unmet need for health facilities for the IHS and tribal health
system is $6.5 billion. This includes only the highest priority need
for inpatient hospitals, health centers, staff quarters, and youth
regional treatment centers. It does not include adult treatment
centers, residential long-term care facilities, nor sanitation
facilities, which are sorely needed.
Currently, the average age of an IHS facility is 32 years. Even
more startling is that there are 17 installations throughout the IHS
where the facility age is between 40 and 66 years.
The state of individual health facilities in Indian Country varies
greatly. They range from a few ``newer'' health facilities to the more
common old, poorly maintained facilities that are in desperate need of
repair. Even more striking is that entire IHS Areas do not have certain
kinds of health facilities at all.
An example of a newer inpatient hospital facility is the Alaska
Native Medical Center (ANMC), jointly operated by Southcentral
Foundation and ANTHC. Although it was constructed over ten years ago,
it is considered a very new facility in the Indian Health System. The
planning documents for this facility were completed 10 years before the
facility was constructed. In the meantime, it languished on a very long
``facilities list'' along with other crucial but unfunded projects. The
ANMC facility is a significant improvement over the previous hospital
that was constructed in 1953, but it is clear that the facility is not
large enough to keep up with population growth. This is a common
occurrence when limited construction funds are available to meet the
need for facilities that have been sitting for years on the IHS
facility list.
The more typical IHS inpatient hospital is old and dilapidated. For
example, the Nome hospital was constructed in 1948 with an addition in
the 1970s. A replacement facility has been on the IHS priority list
since 1991. Another Alaskan facility, the Samuel Simmonds Memorial
Hospital in Barrow was constructed with wood frame construction in
1964. Although wood framed buildings are short-lived, the Barrow
hospital has been on the IHS priority list since 1991.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Some areas, like the Portland Area (representing Washington,
Oregon, and Idaho) and the California Area, have no inpatient hospital
facilities at all. Because there is no hospital for AI/AN patients in
their respective IHS Area, these facilities depend on Contract Health
Services (CHS) funds. In fact, despite the population shifts to the
west and east coasts of the United States, there are very few IHS
inpatient hospitals in the western United States. Likewise, there are
very few IHS inpatient hospitals located on the east coast. There is
clearly a need for additional inpatient hospitals.
Like inpatient hospitals, health centers are also in various
stages. For example, health clinics in the Portland Area are an average
of 40-50 years old. One clinic on the Colville Indian Reservation is
over 70 years old. Other clinics in the Portland Area make do with
mobile homes. \4\
---------------------------------------------------------------------------
\4\ Testimony of Linda Holt, Chairperson, Northwest Portland Area
Indian Health Board, before the Senate Finance Committee, March 22,
2007.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The continuing ``pause'' on facility construction has delayed
attempts to address the aging health care facilities within the IHS
system. We strongly recommend that Congress appropriate more resources
for the construction of desperately needed health facilities and to
take advantage of other opportunities for innovation. At a minimum, we
recommend that the 2010 budget restore funding to $93.6 million,
allowing the IHS to replace its high priority healthcare facilities
with modern facilities, and to significantly expand capacity at its
most overcrowded sites.
III. Innovations in Facility Development
We have seen the benefit of pursuing and leveraging additional
resources in the construction of sanitation facilities. Between 1986
and 1990 project contributions from other sources to IHS sanitation
facilities construction projects averaged $55.7 million annually. After
the Sanitation Deficiency System (SDS) was established, annual average
contributions for the five years following (1991-1995) averaged $105.6
million. \5\ This resulted in a $50 million annual increase in
contributions from other sources. Thus, contributions almost doubled as
a result of SDS.
---------------------------------------------------------------------------
\5\ The Indian Sanitation Facilities Act, P.L. 86-121, authorizes
the IHS to provide essential sanitation facilities, such as safe
drinking water and adequate sewerage systems, to Indian homes and
communities.
---------------------------------------------------------------------------
We anticipate that these same opportunities can be replicated in
making additional resources available to address the unmet need for
health facilities by increasing appropriations for two successful
programs and providing additional resources to implement the FAAB
recommendations. Because of the limited amount of funds available for
health facility construction, tribes worked with Congress to develop
two innovative programs, the Joint Venture Program (JV) and the Small
Ambulatory Program (SAP), to leverage other funds to get projects
completed. Another opportunity yet to be realized is the FAAB's
recommendation for the Area Distribution Program.
Tribes have built approximately three times more health care space
than the IHS has been able to with limited funds through the Joint
Venture Program and the Small Ambulatory Program.
The Joint Venture program was developed to help assist tribes with
their unmet facilities needs. This competitive program provides the
medical equipment funds and the complete staffing package for a
selected facility that is constructed with tribal resources so long as
it meets IHS planning requirements. \6\
---------------------------------------------------------------------------
\6\ The Joint Venture program was enacted as an amendment to the
IHCIA under Section 818 and authorizes Congress to appropriate
recurring funds for increased staffing, operation and equipment for new
or replacement facilities constructed with non-IHS funding acquired by
tribes.
---------------------------------------------------------------------------
The Small Ambulatory Program (SAP) also assists tribes with their
unmet facilities needs. This competitive program provides the
construction funds, facility maintenance costs, and medical equipment
costs, while the tribe provides the staffing package. \7\
---------------------------------------------------------------------------
\7\ The Small Ambulatory Program is only available to tribes who
contract or compact to operate a facility under the Indian Self-
Determination and Education Assistance Act, Pub.L. 93-638.
---------------------------------------------------------------------------
One recommendation from the FAAB is the creation of an Area
Distribution Program (ADP). The ADP is intended to provide funds to
each IHS area to fund projects on the national priority list that are
high priorities for the Area but don't rank high enough to receive
direct Congressional funding in the near future. Thus, it provides a
methodology for allocating funds to Area Offices to address the highest
priority projects within the Area. These funds can be used to match
other local, state, and federal funds to complete a project that would
take many more years to complete if they were limited to using IHS
funds.
The ADP would be initiated only when Congress appropriates funds
for this purpose, the fund would be another line item in the facilities
appropriation just as Joint Venture, Small Ambulatory Clinic, Dental,
and Priority List Construction are separate line items now.
The ADP proposal would require these funds to be distributed to the
highest priority Area Office facilities where the Area and Tribes agree
that only limited new staffing is required. Upon completion of ADP
projects, the facility will be allocated only about 40 percent of the
additional staffing and operational funds usually allocated to new
facilities. As proposed by the FAAB, the ADP funds would be allocated
as follows:
<bullet> In a given year, the Area Offices may not participate in the
ADP if the line-item amount in the Facilities Appropriation
exceeds 20 percent of the total appropriations for facilities
construction.
<bullet> Those Areas that receive 20 percent or less of the annual
line-item facilities appropriation are allocated a portion of
the Area Distribution Program funds using a formula based on
Area user population and location cost adjustments.
The benefit of this process is every IHS Area is able to
participate. Other matching funds can be used to build, renovate, and
expand a facility; and some staffing is provided. Each Area can
complete a high area priority project, and M&I funds can now be used
for code and infrastructure type projects like boilers, chillers,
pumps, air handlers and life-safety code issues. More projects
addressing the overall unmet needs are completed more quickly and at a
lower costs since non-IHS partners like private foundations and other
granting agencies contribute funding for some of the staffing and/or
construction costs.
Some Areas have expressed concern about projects identified back in
1991 that are now on the national priority list. They question whether
the Area Distribution Funds may dilute the facilities appropriation and
further delay funding for their projects. However, the Joint Venture
and SAP funding lines are already in place on the facilities
appropriation and Congress has continued to provide funding to these
programs along with funding individual projects on the priority list.
We ask that Congress continue this practice with the Area Distribution
Program so that it provides another option for Congress to allow more
tribes to participate in what has been a closed priority system since
1991.
There have been 7 Joint Venture projects and 27 Small Ambulatory
Program projects awarded since 1998. The JV program and the SAP are
examples of the best available opportunities to leverage funds to get
desperately needed facilities constructed in Indian Country, but the
funds available have been very limited. We recommend that Congress
increase Joint Venture funding and Small Ambulatory Program funding and
add new appropriations for the Area Distribution Program to accelerate
the completion of needed facilities.
IV. Facility Operational Needs
When addressing facility needs, it is important to look beyond new
construction. In order for existing facilities to remain functional and
provide maximum use, it is also important to adequately fund Medical
Equipment Replacement, Facility and Environmental Support Funding,
Maintenance & Improvement and the Village Built Clinic Lease Program.
Adequate funding for these programs will ensure that the facilities we
build today will be available for continued use into the future. Thus,
we recommend adequate funding for these needs as more specifically
described below.
A. Medical Equipment Replacement
In order to assure patient safety, medical equipment should be
replaced on an average of every 6 years. Unfortunately, current funding
levels cover only one-third of the level of need. Thus, equipment that
should have been replaced after 6 years may continue to be used for 18
years or longer. Medical equipment maintenance and replacement presents
obvious patient safety issues, and some tribes may divert funds from
direct patient care to make up this gap.
The annual medical equipment funding is $21.3 million, when the
annual need is actually $64 million. We urge Congress to increase IHS
appropriations to this line item to ensure that neither patient safety
nor direct patient care is compromised.
B. Facility and Environmental Support Funding
Facility and Environmental Support (FES) funding provides for the
maintenance staff and basic operations of health facilities, including
utilities. These funds also pay for Area office programs, like core
staffing for health facilities, environmental health, and sanitation
construction.
The level of funding has stayed relatively flat or received small
increases (less than 2 percent). With the rising cost of salaries and
double digit annual increases in energy costs, this funding line is not
keeping pace. In fact, the FY09 President's budget proposes no change
from FY08 even though it allocates $25 million out of the base funding
for staffing and operational costs for new facilities opening in FY09.
Historically, new funds were made available to meet these additional
FES costs for new facilities in addition to any necessary nationwide
programmatic increases. However, the effect of the President's FY09
budget recommendation is that new facility needs are being funded at
the expense of existing programs.
We recommend that Congress increase this appropriation by $4.2
million annually to meet the current national need. We also recommend
that Congress appropriate an additional $25 million recurring need for
new staffing requirements associated with new facilities opening in
FY09.
C. Maintenance & Improvement
Maintenance & Improvement (M&I) funds are used to maintain
facilities so they can continue to be used in the future.
Unfortunately, the level of M&I funding is substantially lower than
what is needed. It is estimated that the base M&I funding needed to
just sustain the facilities in their current condition should be funded
at $80 million annually. Because funds have not kept pace with the
need, there is a tremendous backlog of maintenance needs. The IHS
estimates $371 million is needed just to get caught up. The FY08 M&I
funding level of $52.9 million is grossly insufficient to sustain the
facilities. It fell far short of the estimated $120 million needed to
address the backlog.
Failing to maintain existing facilities will only hasten the need
for new construction. Health programs with existing facilities have
tremendous and growing maintenance and improvement needs especially
those with older facilities. We recommend that the Maintenance and
Improvement appropriation be substantially increased to sustain
existing facilities and to address the $371 million backlog of
maintenance and improvement issues.
D. Village Built Clinic Lease Program
The Village Built Clinic (VBC) Lease Program funds rent, utilities,
insurance, janitorial, and maintenance costs of healthcare facilities
in rural Alaska communities. \8\ Despite an increase in the number and
size of clinics throughout Alaska as well as the rapidly increasing
fuel costs, funding for the VBC Lease Program has barely increased
since 1996. Village clinics have also incurred more costs in recent
years due to increases in the scope and level of medical services
provided, expanded village healthcare programming, new technology, and
accreditation standards. Current lease funding covers only
approximately 55 percent of the current operating costs and those costs
are expected to continue to increase sharply as energy costs continue
to skyrocket in rural Alaska.
---------------------------------------------------------------------------
\8\ Reprinted from The Village Built Clinic Programs: Village
Clinics in Crisis, Alaska Native Health Board, May 2007.
---------------------------------------------------------------------------
Without additional funding for the VBC Lease Program, Alaska
villages are forced to subsidize the day-to-day operating costs of
their clinics and defer long term maintenance and improvement projects.
Therefore, without an increase in funding to the VBC Lease Program,
village clinics will be increasingly forced to reduce clinic
operations, and these clinics will continue to fall into disrepair.
This situation reduces the health care available locally to village
residents and threatens the almost 200-million-dollar investment in
these facilities by the Federal Government, Alaska villages, and the
regional tribal health organizations in the Alaska Native health care
system.
Thus, we recommend an increase of $5.8 million in funding for the
VBC Lease Program to the current program base of the VBC Lease Program.
These funds are required immediately to sustain the program, covering
the expected operating costs in FY09 as well as establishing funding
for long-term maintenance and improvement. Without this funding, many
of Alaska's villages will not be able to continue supporting local
clinics, eventually leading to serious consequences for the health and
safety of Alaska Native people.
V. Impact of the Lack of Funding for Facilities & Facility Operational
Needs
The biggest impact of inadequate facilities is decreased access to
care, which in turn exacerbates health disparities. While we have
provided a snapshot of the unmet primary health care needs, we would be
remiss if we did not highlight for the Committee the lack of other
types of facilities like Long-Term Care, Skilled Nursing and assisted
living facilities, residential alcohol and substance abuse facilities,
and our huge unmet sanitation facilities needs.
Most AI/ANs do not have access to Long-Term Care services,
including skilled nursing and assisted living services. For example, in
the Alaska Tribal Health System which has a relatively comprehensive
range of services, there are currently no assisted living facilities
and only one long term care skilled nursing facility. Public health
measures, such as childhood vaccinations and improved sanitation in
rural Alaska, have increased the life expectancy of Alaska Natives and
we are now living longer than we ever have. From 1950 to 1997, Alaska
Native life expectancy rose from 46 years of age to 68 years of age.
\9\ As our population is aging, there are no facilities to provide
desperately needed community-based health care. For instance, if I were
an elder living in Bethel, Alaska, and my family could not provide the
medical care I needed at home, I would have to be sent to a nursing
home in Anchorage, hundreds of miles and hundreds of dollars away from
my family, community, and culture in order to get the care I need. Our
elders make the daily choice to forego this care because such a
separation is unconscionable in our communities. Unfortunately this
situation occurs throughout the Indian health system because there are
only a handful of long term care facilities to meet this need.
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\9\ Status of Alaska Natives Report, Institute of Social and
Economic Research, 2004.
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Many AI/ANs still do not have access to behavioral health services
despite the clear need. An integrated health system requires
availability of qualified and trained behavioral health providers in
every community. Prevention and treatment approaches to behavioral
health must be provided in a seamless integrated fashion, use best and
promising practices; and they must start at the community level. The
full implementation of this vision is only possible with resources that
ensure services are available in the right place and the right time to
prevent escalation of the need for more intensive and costly services.
Specifically, there is an overwhelming shortage of residential
alcohol and substance abuse facilities for AI/AN throughout the
country. Without sufficient facilities to meet this need people
continue to be turned away at the door of existing residential
treatment programs or wait listed for extended periods of time at the
crucial moment in their addiction where they acknowledge they have a
problem and are seeking help. Unfortunately, the current reality is
that AI/ANs who need residential alcohol and substance abuse services,
can expect to wait 6 months to a year for services. For many, treatment
is simply not available. The consequences are profound. Again, to use
Alaska as an example, 1 in 11 Alaska Native deaths is alcohol-induced;
\10\ Alcohol contributed to 85 percent of reported domestic violence
cases and 80 percent of reported sexual assault cases between 2000-
2003; \11\ and, Suicide among Alaska Natives remained steadily at 2
times the non-Native rate from 1992-2000. \12\ Many AI/ANs still do not
have access to behavioral health services facilities despite the
overwhelming need. An integrated and modern health system requires not
only the services but the facilities in which to provide those
services.
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\10\ Alaska Bureau of Vital Statistics.
\11\ Status of Alaska Natives Report, Institute of Social and
Economic Research, 2004.
\12\ Alaska Bureau of Vital Statistics.
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Inadequate sanitation continues to plague much of Indian Country
and is especially problematic in Alaska where 26 percent of Alaska
Native homes lack adequate water and wastewater facilities. It is 2008
and, despite the fact that we know that people live longer, healthier
lives in communities with water and sewage systems, there are over
6,000 homes in rural Alaska without safe drinking water and about
14,000 homes that require upgrades or improvements to their water,
sewer, or solid waste systems to meet minimum sanitation standards.
Increased sanitation facilities will improve these statistics and the
health of these communities, as well as contribute to increasing the
Alaska Native life expectancy, as discussed previously.
Funding for these services have been sorely lacking even though we
know that improvements in these areas can result in significant
improvements in health status. For example, infants in communities
without adequate sanitation facilities are 11 times more likely to be
hospitalized for respiratory infections and 5 times more likely to be
hospitalized for skin infections when compared to all U.S. infants.
\13\
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\13\ Impacts of Water and Sewer Service on the Health of Infants,
American Journal of Public Health, In Press, May, 2008.
---------------------------------------------------------------------------
In addition, the lack of facilities also increases costs to other
IHS budget line items. For example, tribes who are served in an IHS
area in which there is no hospital to refer patients to are become
dependent on Contract Health Services (CHS) resources and pay private
facilities premium rates for care that is too often culturally
insensitive. The CHS line item is already substantially under-funded
without adding facilities inadequacies into the equation. In order to
provide necessary patient care, IHS and Tribal providers are forced
into ``robbing Peter to pay Paul'' in life and death situations. We
also know that when facility needs are not adequately funded, these
funds necessarily come out of direct patient care dollars especially
when life-safety issues are involved, like the replacement of medical
equipment. Chronic under-funding of the IHS facilities line items
contributes to the lack of adequate facilities, the overburdening of
the other budget line items, and rationed health care on a systemic
level.
VI. Efforts to Update the Healthcare Facilities Construction Priority
System
In FY 2000, Congress recognized the significant and growing unmet
facility needs, and directed the IHS to consult with Tribes and the
Administration to revise the Healthcare Facilities Construction
Priority System (HFCPS). Congress highlighted the need ``to reexamine
the current system for construction of health facilities'' and to
develop ``a more flexible and responsive program.that will more readily
accommodate the wide variances in tribal needs and capabilities.'' \14\
---------------------------------------------------------------------------
\14\ Conference Report, H.R. 2466, FY00 Interior Appropriations,
Congressional Record--October 20, 1999.
---------------------------------------------------------------------------
Over the course of 8 years, the IHS, working with tribal leaders,
undertook a major overhaul of the facilities priority system. Although
the resulting proposal is a vast improvement over the current process,
it has not yet been implemented by the IHS. We describe the planning
process and resulting system below. We recommend that Congress direct
the IHS to implement this new system and that Congress provide
additional appropriations to ensure the new system is fully effective.
In early 2001, the Facility Appropriations Advisory Board (FAAB)
\15\ established an IHS Facility Needs Assessment and Priority Criteria
Workgroup (Workgroup) to develop specific recommendations to improve
the IHS construction priority system. The Workgroup, comprised of 19
tribal leaders, health directors, planners, urban health directors and
regional tribal associations, worked on specific recommendations
regarding:
---------------------------------------------------------------------------
\15\ The 14 member FAAB is comprised of a tribal representative of
each of the 12 IHS Areas plus 2 IHS members.
<bullet> Criteria to be used for establishing and annually reviewing
---------------------------------------------------------------------------
the need for facilities construction need in Indian Country;
<bullet> Criteria (and their relative weight) to prioritize competing
projects of the same type; and
<bullet> Strategies for prioritizing needs of different construction
programs (inpatient facilities; outpatient facilities; dental
units program; Joint Venture Program; Small Ambulatory Program;
the proposed Loan Guarantee Program; etc.).
The Workgroup's recommendations, IHS Facility Needs Assessment and
Priority Criteria Recommendations, were forwarded to the FAAB and to
the IHS in February, 2002 and became the foundation for the final
recommendation for the new priority system. \16\
---------------------------------------------------------------------------
\16\ IHS Facilities Needs Assessment and Prioritization Criteria
Workgroup Report on Findings and Recommendations, February, 2002.
---------------------------------------------------------------------------
The FAAB spent the next two and a half years refining the
Workgroup's recommendations. Extensive tribal consultation began in
June 2004 when the IHS sent out a ``Dear Tribal Leader'' letter in June
2004 with a draft copy of the FAAB priority system proposal. The IHS
received 80 responses from 11 IHS Areas containing over 1,200 total
comments. The FAAB spent the next two years incorporating comments and
working with IHS and tribal leaders on the final recommendation. The
final recommendation was forwarded to the U.S. Department of Health &
Human Services in November, 2007.
VII. The New Healthcare Facilities Construction Priority System
The new Healthcare Facilities Construction Priority System (HFCPS)
is more robust than the current system in that it is very orderly and
uses reliable data. It is also based on the master plan concept which
ensures that service needs of the local population are used for
facility planning. It also provides for a tremendous amount of tribal
involvement throughout all phases of the process. Among the highlights
are the development of a Master Planning process that recognizes the
needs of smaller communities, and an Area Distribution Program.
A. Area Health Services and Facilities Master Plan (Area Master Plan)
The Master Planning process is central to the new priority system.
Using the IHS ``Health System Planning'' (HSP) software/model, the
services and facilities required in individual service areas are
determined nation-wide. Based upon these community-specific or service
area specific HSP analyses, a community specific Master Plan would be
generated to quantify the costs associated with the potential
construction of expanded, replaced or new facilities.
From there, these data can then be integrated at the Area level to
produce a State-wide Health Services and Facilities Master Plan. A
Master Plan will help establish relative priority within an Area for
construction and development of new services and support decision-
making consistent with the Area-wide service delivery system, which in
turn, will provide the basis for an integrated Area-wide Master Plan.
The key to this approach to master planning is facility planning
and construction decisions will be based on accurate factual
information about the system-wide health service needs in each Service
Unit and Area. As the area wide service delivery plan is developed
decisions will be made about where and how each service will be
provided. Then, the discussion will move on to deciding what the
facility need is and how best to meet the need. Effectively, tribes
engage in an analysis of whether renovation and expansion of an
existing facility or whether construction of a new facility is
warranted and what will best serve their population's needs.
B. HFCPS Ranking Methodology
Once the facility requirements of each area have been identified in
the Area Master Plans, these projects will then be scored according to
the HFCPS. The HFCPS ranking is implemented in two phases. Phase I is
designed to assess all of the facility needs through the creation of
the Comprehensive National Listing of Facility Need (Unmet Needs List).
Phase II is designed to further refine the application and allow
innovative solutions to be applied to the scoring criteria. This two-
phased process allows the IHS and the Tribes to use limited resources
to both identify all of the facility needs (phase I), and to allocate
the necessary time and resources for concentrating analysis on those
facilities that have the opportunity to move forward to receive full
funding within 5 years.
1. Process Overview
In Phase I, all health care facilities in IHS Area Healthcare
Services and Facilities Master Plans are evaluated and scored by IHS
Headquarters using a HFCPS formula. Facilities on this list are
categorized according whether they are an inpatient hospital, health
center, small clinic, or other health facility, ranked and compiled
into the ``Comprehensive National Listing of Facility Need.''
In Phase II, facilities selected from the Comprehensive National
Listing of Facility Need are reviewed by the HFCPS Validation
Committee. \17\ The IHS will apply the HFCPS Phase II Formula to data
about these proposed facilities to develop the Priority List.
Facilities are selected from the Comprehensive National Listing of
Facility Need. The method for selecting facilities for Phase II review
differs based on the requirements of the specific facilities
construction funding program.
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\17\ The Healthcare Facilities Validation Committee is a standing
committee consisting of seven individuals appointed by the Director of
IHS. Membership may include but not be limited to IHS Headquarters and
Area Offices, Tribal, and other health oriented professionals.
---------------------------------------------------------------------------
Six evaluation factors are employed to evaluate and score facility
projects over two phases. The evaluation criteria are:
------------------------------------------------------------------------
Phase I Phase II
------------------------------------------------------------------------
<bullet> Facility Resources 400 points 400 points
Deficiency
<bullet> Health Status 200 points 200 points
<bullet> Isolation 100 points 100 points
<bullet> Barriers to Care 50 points
<bullet> Facility Size 150 points 150 points
<bullet> Innovation 100 points
------------------------------------------------------------------------
Total 850 points 1,000 points
------------------------------------------------------------------------
2. Implementation of Phase I
Implementation of Phase I should take approximately 6 months. Phase
I scores will be recalculated every five years to maintain a relatively
up-to-date Comprehensive National Listing of Facility Need. All Area
Health Services and Facilities Master Plans will be updated 24 months
before Phase I is recalculated.
The data required for completion of Phase I are:
<bullet> User population from the IHS National Patient Information
Reporting System;
<bullet> Existing facility size, age, and condition from the IHS
Facility Data System;
<bullet> The following indicators from the Federal Disparity Index
(FDI):
-- The Birth Disparities Indicator,
-- The FDI Percent of the population over 55 years old,
-- The Composite Poverty Indicator, and
-- The Disease Disparity Indicator
<bullet> The distance from the proposed facility to the nearest
emergency room.
<bullet> The size of the new/expanded facility from the Area Master
Plan
Validation of the data used is obtained from existing IHS databases
or will be verified by qualified professionals, e.g., certified
professional engineers, architects, etc.
3. Implementation of Phase II
The entire Phase II process should take approximately 1 year to
complete. Phase II of the HFCPS will be recalculated every year that
funding is available for one or more facilities construction program to
assure an up to date list of high priority projects.
The Phase II list will reflect the changes in funding status of
each project. The criteria for Phase II will be implemented and applied
slightly differently for each of the congressionally authorized
facilities construction programs. \18\ The basic formula will remain
the same, but other factors, identified in law and regulations, will be
used to select projects for Phase II review. Data for the scoring is
developed from the approved Program Justification Document (PJD).
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\18\ These programs include the line-item program authorized under
Section 301 of the Indian Health Care Improvement Act (IHCIA), Public
Law (P.L) 93-437; the Small Ambulatory Program, authorized under
Section 316; the Joint Venture Program authorized under Section 818,
etc.; and projects considered under the Area Distribution Program
within each Area.
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For Validation purposes, each PJD is approved by the Director,
Office of Environmental Health and Engineering. The HFCPS Validation
Committee will review the documentation supporting Innovation and
Barriers to Service proposals along with any Tribal facilities
information that is not included in the Facility Data System (FDS).
The IHS applies the HFCPS formula to the approved and validated
data. Finally, facilities under consideration, are prioritized
according to their scores and placed on the Priority List in rank
order.
Clearly the new process is based on more reliable data and improved
needs based planning. It also allows greater tribal involvement
throughout all phases of the process. We applaud the FAAB and the IHS
on the development of the new model and implore them to implement it
expeditiously. It is one more example of the opportunities in
innovation that arise when the IHS and tribes work collaboratively in
addressing our facilities needs. However, in order for the new system
to be successful more resources are necessary. To realize the full
potential of the new facilities priority system, and we urge Congress
to provide such funding.
Conclusion
For those of you who deal with the size and complexities of a
variety of appropriation needs a regular basis, the improvements we
seek here may seem inconsequential. That could not be farther from the
truth. As American Indians and Alaska Natives, we are a people with
painful legacies of forced removal--to boarding schools, to cities, to
faraway hospitals--and rampaging epidemics that disrupted families for
generations. Despite this, we still have very strong ties to our
communities.
We know from experience, that as resources get tighter, individual
AI/ANs and the IHS facilities that provide their care will feel the
impact more than any other. Why? The highest rates of unemployment are
in Indian Country. We have some of the lowest income levels; some of
the poorest health status; and we are primarily rural where access to
care is a problem. There is a high cost of providing care, and a high
cost of living where limited incomes get stretched even more. What this
means is that, when our people do finally get the care they need, they
have traveled farther with money they simply don't have, are sicker
than the average person, and are seen in clinics/hospitals that have
fewer resources than most other facilities in the country. Also,
because of their rural nature, our facilities have a higher cost of
providing care.
As one of the younger members of my Tribe, with the privilege and
opportunity to work in our health programs, it is my duty to try to
overcome this history and to assure that no AI/AN will have to make the
choice to forego medical care due to a lack of facilities or to receive
culturally insensitive care because we are buying care from others that
we can provide for ourselves. It is my duty to be sure that we protect
the health status improvements that have been made and that we
accomplish more. We must leave a better health system for our children
and grandchildren than we inherited. It is for that reason that I am
here today to testify before you.
The strategies we are discussing today will authorize many
important steps toward the goal of quality health care in our home
communities and in ways that respond to our needs and respect our way
of life. I know that we cannot knock down all of these barriers
overnight, but these recommendations will make a significant
improvement.
In closing, I want to thank the Committee again for all your work
and leadership in addressing these critical issues.
Attachment
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The Chairman. Ms. Davidson, thank you very much.
Senator Murkowski?
Senator Murkowski. Thank you, Mr. Chairman.
I want to thank all those of you on the panel for your
testimony, your perspective, Chairman Nosie speaking to the
detention issues and Mr. Roessel to appreciate a specific
situation within the school that you have addressed today, and
to also offer the Committee some specific recommendations. I
appreciate that.
Valerie, I always appreciate your testimony. As usual, you
have summed it up in a very well thought out and comprehensive
way. I wanted to just ask you very quickly, you mentioned the
reality that we face when we don't have the facilities, when we
don't have the providers, the Alaska Natives and the American
Indians have to go somewhere for care. And so what happens is
we see increased expenses to contract health services.
Has there been an effort to assess what is actually spent,
or the increase that we see in contract health care services
because we are not spending money adequately on the facilities?
Do we know what that number is?
Ms. Davidson. I can provide that number for you nationally
later, but I can provide you a more specific example that just
happened in the last couple of months in Alaska. For example,
we had a RSV epidemic in Alaska, in Barrow. We have had it
before in Bethel. My daughter had it when she was eight months
old. As facilities become overwhelmed with their inability to
be able to house patients, those patients get sent into the
Alaska Native Medical Center in Anchorage, and then when we are
full, they get sent over into Providence, in which contract
health dollars kick in.
As we indicated earlier, there are entire areas where there
are no inpatient beds available at all. California, Portland
area, there are entire States on the east coast, entire States
on the west coast that have no inpatient facilities, and those
are all contract health.
The other thing I wanted to point out is, as Chairman
Dorgan indicated earlier, that it is common knowledge in Indian
Country that contract health dollars run out in June. So if you
are fortunate enough to get sick, which is a terrible thing to
say, in those months, you are in a much better position.
Unfortunately, when contract health cannot pay anymore, there
is no way to be able to capture that data from what the patient
incurs when they are forced to go to a private facility. They
get sent bills. They get sent to collections. It is staggering
if you consider the cost.
Senator Murkowski. But the reality, then, is again, these
folks are going to have to go somewhere. So do they go to the
private clinic where they have to pay out of their own pocket?
Do they go to the emergency room? How are you going to pay
there? The reality is that this cost doesn't go away. It is
just allocated differently.
I also wanted to ask you just very briefly on the long-term
care facilities. We know that in the State of Alaska, we just
don't have the facilities for long-term care, and that is
something that we want to change. How did these types of
facilities, how will they be included in this newly revised
construction priority system?
Ms. Davidson. I am going to let my technical expert, Mr.
Boyce, answer how those are incorporated into the master plan.
Mr. Boyce. Actually, right now they are not included in the
master plan. The way the process is set up is they are
characterized under other facilities when they are identified
through the process, so they have been identified. Right now,
the IHS has not developed the staffing and service delivery
plans which would support that type of health care delivery. So
therefore, they don't have the planning models in place to
actually plan that type of facility.
So they are being identified. The costs are being captured,
but since that is not a service that they currently provide,
then they are not prepared to design and construct those
facilities.
Senator Murkowski. It is something that under the Indian
Health Care Improvement Act we said is an important aspect of
the health care we provide. So we want to make sure that this
doesn't get lost in the shuffle just because it hasn't been
part of that priority list in the past.
Valerie?
Ms. Davidson. Let me give you a snapshot of how that is
actually handled in our current system. Since we don't have
long-term care facilities throughout Indian Country, what
happens is when a patient needs long-term care, what happens is
they actually stay in the hospital for months and months and
months at a time. So when another patient presents who needs
inpatient care, they get put on divert, so they have to be sent
somewhere else. It is unacceptable.
Senator Murkowski. Think about the costs that are involved
with that.
Ms. Davidson. Exactly.
Senator Murkowski. Again, I want to thank the panel for
coming such a long distance to be with us today and for your
very important testimony.
Thank you, Mr. Chairman.
The Chairman. Senator Murkowski, thank you very much.
I regret that I have some up against the clock here. We had
a vote in the middle of this hearing, and I guess we have now
gone 2 hours and 15 minutes. I have to be somewhere that I
cannot change. So I am going to submit some questions to the
panel that I would like you to respond to. I appreciate very
much your filling in a gap of information this morning.
Chairman Nosie, I indicated it was two weeks from Monday. I
am told it is one week from Monday that I will be chairing a
hearing in Phoenix on law enforcement issues, and Senator Kyl
will also a part of that hearing. I would invite you to join us
there.
Mr. Roessel, thank you for your testimony. I have a couple
of specific questions I want to ask you.
And we appreciate your traveling, Ms. Davidson, all the way
from Alaska. I appreciate the two of you coming down and being
a part of the hearing this morning.
With that, this hearing is adjourned.
[Whereupon, at 12:15 p.m., the Committee was adjourned.]
A P P E N D I X
Prepared Statement of Linda Holt, Chairperson, Northwest Portland Area
Indian Health Board; Suquamish Tribal Council Member
Chairman Dorgan, Vice-Chair Murkowski, and members of the
Committee, thank you for this opportunity to include our statement into
the record concerning the state of Indian health facilities. Before I
begin, I want to take this opportunity to thank and congratulate the
Committee for its hard work in getting the Indian Health Care
Improvement Act (IHCIA) passed out of the Senate.
I am Linda Holt and service as the Chairperson of the Northwest
Portland Area Indian Health Board (NPAIHB) and am a Tribal Council
Member of the Suquamish Tribe located in Washington State. Established
in 1972, NPAIHB is a P.L. 93-638 tribal organization that represents 43
federally recognized Tribes in the states of Idaho, Oregon, and
Washington on health related matters. \1\ The Board facilitates
consultation between Northwest Tribes with federal and state agencies,
conducts policy and budget analysis, and operates a number of health
promotion and disease prevention programs. NPAIHB is dedicated to
improving the health status and quality of life of Indian people and is
recognized as a national leader on Indian health issues.
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\1\ As defined in the Indian Self-Determination and Education
Assistance Act, P.L. 93-638, 25 U.S.C., Section 450(b) a Tribal
organization is a legally established governing body of any Indian
tribe(s) that is controlled, sanctioned, or chartered by such Indian
Tribe(s) and designated to act on their behalf.
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This hearing has been a long time coming and is timely given the
movement of the IHCIA. The status of Indian health facilities is
deplorable when compared to mainstream facilities in which most
Americans receive health care. The Medicare and Medicaid programs
provide tens of billions of dollars for facilities construction
annually, but there is no discussion of facilities construction before
the Congress and no separate appropriation for facilities construction
in connection with the Medicare or Medicaid program. Yet most Americans
receive care in the most modern clinics and hospitals in the world.
Indeed it is remarkable, but true, that poor Americans who are eligible
for Medicaid in Washington, Oregon, and Idaho now receive their care in
the same facilities as other non-poor Americans, that's right, in the
very same clinics and hospitals that are the envy of the world. But
what about Indian people? Our clinics in the Northwest are notable
exceptions; most on average are more than 40-50 years old. A clinic on
the Colville Indian reservation is over 70 years old; and in other
Northwest Tribal communities, clinics are housed in mobile homes. The
clinics are not just old; they are also inadequate. They are often too
small, the equipment is often outdated, and the staff is forced to make
do as best they can. That is, the staff that is willing to stay under
these less than desirable conditions. Many tribes continually battle
recruitment and retention of medical doctors and nurses because of the
less than desirable working conditions. Who can blame someone for not
wanting to work up to his or her potential in a modern state of the art
facility?
I. Indian Health Service
The Federal Government has a duty--acknowledged in treaties,
statutes, court decisions, and Executive Orders--to provide for the
health and welfare of Indian Tribes and their members. In order to
fulfill this legal obligation to Tribes, it has long been the policy of
the United States to provide health care to American Indians and Alaska
Natives (AI/AN) through a network made up of the Indian Health Service
programs, tribal health programs and urban clinics. The Indian Health
Service (IHS), directly and through tribal health programs carrying out
IHS programs under the Indian Self-Determination and Education
Assistance Act, P.L. 93-638, as amended (ISDEAA), provides health
services to more than 1.9 million AI/AN people. These services are
provided to members of 562 federally-recognized tribes in the United
States, located in 35 different states.
Currently, IHS provides access to healthcare services for AI/ANs
through 31 Hospitals, 50 health centers, 31 health stations and 2
school health centers. Tribes also provide healthcare access through an
additional 15 hospitals, 254 health centers, 166 Alaska Village
Clinics, 112 health stations and 18 school health centers. There are
also 34 urban Indian health clinics that provide outreach and referral
services, or that provide direct medical care.
II. Why the Poor Condition of Indian Facilities?
Unfortunately, it is the budget process itself that annually under
funds the IHS budget that is the cause of the poor condition of our
facilities. There is no doubt that again this year little progress will
be made to address our backlog of facilities need. The average age of
IHS facilities is 33 years as compared to 9 years for healthcare
facilities in the United States; many are overcrowded and were not
designed in a manner that permits them to be utilized in the most
efficient manner in the context of modern healthcare delivery. It is
estimated by some Indian health experts that the unmet need for health
facilities for the IHS and tribal health system is at least $6.5
billion. This includes only the highest priority need for inpatient
hospitals, health centers, staff quarters, and youth regional treatment
centers. It does not include adult treatment centers, residential long-
term care facilities, or sanitation facilities, which are sorely
needed.
As a discretionary program, the Congress will ask tribes the annual
question: Do you want this year's proposed $100-150 million increase to
go to health services programs or facilities? This choice is unfair. No
one asks Medicare recipients if they want facilities or programs--they
get both. The health plans that deliver care to Medicaid and Medicare
patients take out a portion of each dollar paid by these programs to
provide adequate facilities. It is bad health care and bad business to
have poor facilities. The idea of slicing off a portion of our
inadequate health services dollars for facilities is not realistic.
There is nothing to slice. Because the Indian Health Service is a
discretionary program our funding is limited and proposals for
facilities construction are the low hanging fruit that is chopped off
every year. In fact, it is wrong that we don't ask for more than we do
each year. More facilities funding is needed within the Indian health
system.
Recommendation: While the need to provide more funding to address
facilities construction is great, there must also be a methodology to
access the resources that is fair and equitable to all Tribes
nationally.
III. Authorities for Indian Health Facilities
Tribes have seen the benefit of pursuing and leveraging additional
resources in the construction of health and sanitation facilities.
Between 1986 and 1990 project contributions from other sources to IHS
sanitation facilities construction projects averaged $55.7 million
annually. Between 1991 and 1995, the Sanitation Deficiency System (SDS)
program--established to fund water and waste facilities--averaged
approximately $106 million in funding. During this same period, the
program resulted in a $50 million annual increase in contributions from
other sources. Thus, funding almost doubled because of Tribal
contributions from other sources. This type of collaboration can
benefit the facilities construction program if established by the
Congress and implemented by the IHS. The IHCIA provides the authority
for construction and maintenance of Indian health facilities.
Section 301 authorizes the establishment of a Health Facility
Construction Priority System (HFCPS) that serves to evaluate
and rank the facility construction projects for the Indian
health system. The significance of Section 301 projects is that
they are provided a comprehensive funding package that provides
for facility construction, a staffing package, and for medical
equipment; and that they are continually provided funding.
Section 302 provides authority for the sanitation, waste, and
facilities programs which provide for development and operation
of safe water, wastewater, and solid waste systems, and related
support to facilities.
Section 306 provides authority for the Small Ambulatory Program
(SAP), which serves to assist Tribes with their unmet
facilities needs. This competitive program provides the
construction funds, facility maintenance costs, and medical
equipment costs, while the tribe provides the staffing package.
The SAP program has not been consistently funded by the
Congress nor has the IHS requested adequate funding.
Section 818 provides authority for the Joint Venture Program
(JV), which was developed to help assist tribes with their
unmet facilities needs. This competitive program provides the
medical equipment funds and the complete staffing package for a
selected facility that is constructed with tribal resources so
long as it meets IHS planning requirements. Again, the JV
program has been inconsistently funded by Congress and the IHS
has not requested adequate funding for the program.
Recommendation: The IHS could extend the benefits of appropriated
funds under the proposed HFCPS to a significantly larger number of
tribes and communities by consistently providing adequate funding for
the SAP and JV programs. Tribes have built approximately three times
more health care space than the IHS has under the HFCPS and have done
this with limited funds through the Joint Venture and the Small
Ambulatory Programs.
Recommendation: A recommendation developed by Tribes is the
creation of an Area Distribution Program (ADP). The ADP is intended to
provide funds to each IHS Area to fund projects on the national
priority list that are high priorities for the Area but don't rank high
enough to receive direct Congressional funding in the near future.
Thus, it provides a methodology for allocating funds to Area Offices to
address the highest priority projects within the Area. These funds can
be used to match other local, state, and federal funds to complete a
project that would take many more years to complete if they were
limited to using IHS funds. Congress should pilot this recommendation
as a demonstration in FY 2010.
IV. Health Facility Construction Priority System (HFCPS)
In FY 2000, Congress recognized the significant and growing unmet
facility needs, and directed the IHS to consult with Tribes and the
Administration to revise the Healthcare Facilities Construction
Priority System (HFCPS). The Interior Appropriations Conference Report
(106-406) directed the IHS ``to reexamine the current system for
construction of health facilities'' and to develop ``a more flexible
and responsive program. . .that will more readily accommodate the wide
variances in tribal needs and capabilities.'' Over the last eight years
the IHS Facilities Advisory Appropriation Board (FAAB) and Tribes have
been working collaboratively to make a major overhaul of the
construction priority system. Although the resulting proposal is a vast
improvement over the current process, it has not yet been implemented
by the IHS.
One recommendation from the FAAB is the creation of an Area
Distribution Program (ADP) that is described above. The ADP provides an
alternate funding method for facilities construction that is a hybrid
of the JV and SAP program. There is precedent for an area funding
distribution in the Sanitation Deficiency System (SDS). The program
strategically aligns project funds with healthcare mission by
eliminating or reducing deficiencies in water supply and waste disposal
facilities. It uses a methodology ``developed by the Secretary. . .and
applied uniformly to all Indian tribes and communities'' to address an
identified inventory of needed facilities. The system has worked to
minimize complaints and concerns from Tribes over access to funds and
has met the needs of most Tribal communities. An ADP could achieve the
same outcomes.
The ADP would be initiated when Congress appropriates funds for
this purpose, the fund would be another line item in the facilities
appropriation just as Joint Venture, Small Ambulatory Clinic, Dental,
and Priority List Construction are separate line items now.
The ADP proposal would require these funds to be distributed to the
highest priority Area Office facilities where the Area and Tribes agree
that only limited new staffing is required. Upon completion of ADP
projects, the facility will be allocated only about 40 percent of the
additional staffing and operational funds usually allocated to new
facilities. As proposed by the FAAB, the ADP funds would be allocated
as follows:
<bullet> In a given year, the Area Offices may not participate in the
ADP if the line-item amount in the Facilities Appropriation
exceeds 20% of the total appropriations for facilities
construction.
<bullet> Those Areas that receive 20% or less of the annual line-item
facilities appropriation are allocated a portion of the Area
Distribution Program funds using a formula based on Area user
population and location cost adjustments.
The benefit of this process is every IHS Area is able to
participate. Other matching funds can be used to build, renovate, and
expand a facility; and some staffing is provided. Each Area can
complete a high area priority project, and M&I funds can now be used
for code and infrastructure type projects like boilers, chillers,
pumps, air handlers and life-safety code issues. More projects
addressing the overall unmet needs are completed more quickly and at a
lower costs since non-IHS partners like private foundations and other
granting agencies contribute funding for some of the staffing and/or
construction costs.
Some Areas have expressed concern about projects identified back in
1991 that are now on the national priority list. They question whether
the Area Distribution Funds may dilute the facilities appropriation and
further delay funding for their projects. However, the Joint Venture
and SAP funding lines are already in place on the facilities
appropriation and Congress has continued to provide funding to these
programs along with funding individual projects on the priority list.
Recommendation: Tribes have recommended that $20 million be
provided for an ADF during the FY 2010 IHS budget formulation process.
Congress should pilot this recommendation as a demonstration in FY
2010. The recommendation provides equity for facilities construction
that is supported by most Tribes nationally.
V. Facilities Funding Inequities
Generally, tribes nationally support funding for facilities
construction as long as resources fund all authorities for facilities
construction on an equal basis. Those Areas such as Portland,
California, Nashville, and Bemidji have never had the opportunity to
compete for facilities construction funding on the same basis as other
Areas of the IHS system. The California and Portland Areas do not have
no inpatient facilities at all and rely on the Contract Health Service
(CHS) program to provide specialty and inpatient services. These Areas
are often referred to as CHS dependent Areas.
Because the CHS program is chronically under funded and the fact
that CHS dependent Areas have never had an equal opportunity to compete
for facilities construction funding that provides for staffing and
equipment packages, they are not supported facilities construction
funding. The significance of staffing new facilities is that it removes
funds necessary to maintain current services (pay costs, inflation, and
population growth) from the IHS budget increase, which then become
recurring appropriations. This results in a disproportionate share of
resources to only a few of the IHS Areas and results in developing gaps
in the level of health services throughout Indian Country. Tribes
nationwide ask, ``Why did our health program only receive less than a 1
percent increase in funding, when the overall IHS budget received a 5
percent increase? The answer to this is due to phasing in staffing at
new facilities.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
The graph above illustrates the significance of staffing new
facilities on the IHS budget increase. Staffing packages for new
facilities are like pay act costs in two respects: (1) They come ``off
the top,'' (i.e. they are distributed before other increases), and; (2)
They are recurring appropriations. In FY 2004, the new staffing was
over 60 percent of the IHS budget increase. In FY 2005 and FY 2006, new
staffing costs consumed over 50 percent of the increase. This year, the
proposed FY 2009 IHS budget was decreased by $21.3 million, yet a new
facility within the IHS system will receive $25 million for new
staffing. Clearly, the Agency proposes to cut the health budgets of 560
Tribes in order to fund staffing packages.
In addition to the staffing concerns, CHS dependent Areas are not
afforded the same opportunity to access facilities construction funding
that comes with staffing and equipment packages (Section 301 projects)
as other Areas. The graph below illustrates those Areas that have
received Section 301 funding between 1991 and 2008.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Recommendation: Tribes have demonstrated by building approximately
three times more health care space than the IHS, that alternative and
innovative forms of facilities construction financing should be
supported. If Tribes nationally are to support facilities construction
funding, a methodology that ensures equal access must be developed and
supported. If this does not happen, Tribes will continue to be divided
over facilities construction funding. Establishing the FAAB's
recommendation for and ADP would address this concern.
VI. Conclusion
The challenges in providing care to AI/AN people are unlike any
other. It serves the poorest, sickest, and most remote populations in
the United States. Despite the effective use of a public health
delivery model and the advances the Indian health system has made
toward addressing health disparities, the funding constraints often
result in rationing health services. It has been because of the access
to Medicare and Medicaid programs that have often kept many Tribal
health programs from going bankrupt. In order to provide quality health
care you must have access to services and facilities to provide them.
There is no doubt that the condition of Indian health facilities is
woeful and that funding is the root cause. There is also no doubt that
more new facilities are needed throughout Indian Country.
If the Congress is to provide more funding to address the state of
Indian health facilities, than it must also ensure that there is a
method that allows all federally recognized Tribes an equal opportunity
to access there sources. If an equitable system is not created it will
only result in inequities in the level of health services delivered
across Indian Country. Those Areas and Tribes that are fortunate to
receive new facilities will be able to expand their health services
base, while those that do not will continue to ration care.
Any new funding should also go beyond just addressing facility
construction and maintenance needs. It should also support medical
equipment replacement, facility and environmental support, and support
Alaska Native village programs. Adequate funding for these programs
will ensure that the facilities we build today will be available for
continued use into the future.
Thank you!
______
Prepared Statement of Ron His Horse Is Thunder, Chairman, Standing Rock
Sioux Tribe
My name is Ron His Horse Is Thunder and I am the Chairman of the
Standing Rock Sioux Tribe. Our Reservation is 2.3 million acres and is
located in North and South Dakota. We have 14,000 tribal members, 7,000
of whom live on the Reservation. I appreciate the Committee's attention
to the longstanding issue of facilities in Indian country and I thank
you for holding this hearing. I would like to tell you the story of our
efforts to build a juvenile detention facility at Standing Rock and the
obstacles we have encountered.
The question of how to deal with young offenders on our Reservation
is a significant problem. Nearly half of our population is below the
age of 25, and our young population is disproportionately affected by
risk factors known to increase the likelihood of delinquent behavior.
We have very high unemployment rates: 91 percent of our population in
South Dakota and 56 percent of our population in North Dakota is
unemployed. \1\ Educational attainment among our members is low: almost
one quarter of our members over the age of 25 did not finish high
school and only 9.5 percent of our members have completed four or more
years of college. \2\ Our members also deal with chronic health
problems \3\ and substandard housing. \4\ Drug and alcohol abuse and
dependency is the number one health problem among our members,
including youth. \5\ Standing Rock was the site of a much-discussed
suicide cluster in 2004-2005 and we continue to struggle with one of
the highest youth suicide rates in the Nation. Given the risk factors
faced by our youth, juvenile crime is an urgent problem here, and only
effective interventions can begin to stem this tide.
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\1\ U.S. Dep't of the Interior, Bureau of Indian Affairs, American
Indian Population and Labor Force Report (2003).
\2\ Census 2000 American Indian and Alaska Native Summary File,
Table DP-2, Profile of Selected Social Characteristics, Educational
Attainment for Standing Rock Sioux Tribe (2000).
\3\ Fifty-percent of our members aged 60 and older have been
diagnosed with diabetes; 43.6 percent have heart disease and 80 percent
suffer from hypertension. Fort Yates Indian Health Service Unit, GPRA/
DM Audits (2007). Only 3.6 percent of our members are over the age of
65, indicating a very low life expectancy. Census 2000 American Indian
and Alaska Native Summary File, Table DP-1, Profile of General
Demographic Characteristics, Sex and Age for Standing Rock Sioux Tribe
(2000).
\4\ Nearly 40 percent of houses on the Reservation we built before
1970 and 22 percent were built before 1960. Census 2000 American Indian
and Alaska Native Summary File, Table DP-4, Profile of Selected Housing
Characteristics, Year Structure Built for Standing Rock Sioux Tribe
(2000).
\5\ Standing Rock Sioux Tribe Comprehensive Chemical Prevention
Program, CY 2006 Annual Report (March 2007), at 2.
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Law enforcement services on our Reservation are provided by the
Bureau of Indian Affairs. For many years, the Tribe has considered
contracting with the BIA to provide these services for our own people,
but the financial resources available to the BIA which Indian tribes
may assume under a P.L. 93-638 contract are so severely inadequate that
we believe it would be impossible to provide an acceptable level of law
enforcement services to our members. We are unwilling to assume
responsibility for these services without the assurance of at least
minimally adequate base funding. So we continue to work with the Bureau
to ensure that services are provided.
The BIA operates an adult detention facility on the Reservation.
That facility is outdated by today's standards. For example, according
to a 2004 report by the Bureau of Justice Statistics, only routine
counseling and psychotropic medication are provided, but mental health
screenings, psychiatric evaluations, 24-hour mental health care, and
even on-site medical care are not available. \6\ Staff is not trained
in suicide prevention, and only basic intake screening and suicide
watch are provided when needed. \7\ Domestic violence and sex offender
counseling is not provided. \8\ An older adult facility such as ours is
also not physically equipped to house juveniles. BIA standards, which
mirror federal policies set forth in the Juvenile Justice and
Delinquency Prevention Act, require that juveniles be separated by
``sight and sound'' from adult offenders, and our building cannot
accommodate this. \9\ BIA standards also require that staff who work
with juvenile offenders be specially trained. Our facility has neither
the architecture nor the staffing and services necessary to handle
young offenders.
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\6\ U.S. Dep't of Justice, Bureau of Justice Statistics, Jails in
Indian Country, 2004 (Nov. 2006, revised Feb. 7, 2007), at 18, 24.
\7\ Id. at 25.
\8\ Id. at 26.
\9\ See 42 U.S.C. Sec. 5633(13) and 42 U.S.C. Sec. 5633(14) for
Juvenile Justice and Delinquency Prevention Act requirements.
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When a young person is arrested on Standing Rock, he or she can be
temporarily held in the adult facility for a maximum of six hours.
After adjudication, if a young person is given a disposition of
detention, the first challenge is to find bed space at an off-
Reservation detention facility. If we can find a bed, BIA law
enforcement officers must then transport the juvenile off-Reservation
to a facility at Cheyenne River Sioux or to a county facility. This
takes staff time from the limited number of BIA law enforcement
officers on the Reservation, making those officers unavailable to
respond to calls or to investigate crimes. Our youth must serve out
their detention miles from their home community. As you can imagine,
this situation makes it very difficult for family members to visit
youth while they are detained. Distance also makes it difficult for
family counseling to be effective. Even worse, many youth are not
arrested or treated at all because of the lack of facility space. BIA
law enforcement employ a ``catch and release'' strategy which leaves
young offenders unmonitored and untreated, leaving those youth to
create disruptions in our schools and our community. It sends a poor
message.
In 2004, to address the need for a safe and effective juvenile
facility, the Tribe began working with architects, planners and agency
officials to design a juvenile detention and rehabilitation facility.
The facility is planned as an 18-bed facility--just large enough to
meet our need to house young offenders. More importantly, it will
permit young offenders to be treated on the Reservation in a
culturally-appropriate setting. It will be staffed by professionals who
can address the behavioral, family, mental health and alcohol and drug
issues that our youth face.
In FY 2004, we received a $3 million grant from the Department of
Justice (DOJ) to build this facility and in FY 2006 we received a
supplemental grant from DOJ of $695,000. The Tribe contributed $900,000
towards the project. In December 2006, we secured a Finding of No
Significant Impact (FONSI) from the BIA, but our efforts have been
slowed due to lack of funding. We are grateful for the assistance
provided so far, but the amount we received is far short of the actual
cost of planning, designing and constructing a facility. Through our
planning and budgeting process, we have identified an estimated project
cost of $5.7 million. Our total budget so far is $4.5 million
(including $3.7 million in DOJ funding and nearly $1 million in Tribal
funds). This leaves the Tribe scrambling to cover a shortfall of $1.2
million.
Our Tribe battles extremely high poverty rates. Over 40 percent of
tribal households have incomes below the poverty line. \10\ Our rural
location means that economic development opportunities are limited. The
Tribe primarily raises revenue through various taxes, leasing of tribal
lands for grazing, and through operation of the Prairie Knights Casino
in North Dakota and the Grand River Casino in South Dakota. While the
casinos are an important source of jobs for Tribal members, they
contribute only modest revenues to tribal operations, due mostly to our
remote location. Simply put, we cannot afford to make up for these
federal shortfalls for construction of essential detention space.
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\10\ Census 2000 American Indian and Alaska Native Summary File,
Table DP-3, Profile of Selected Economic Characteristics, Employment
Status for Standing Rock Sioux Tribe (2000). The rates were similar in
2007.
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Because of funding shortages, we also had to cut a portion of the
original design. The facility was originally planned as a 36-bed unit
and included a Transitional Living Unit along with a secure detention
facility. This unit would contain eight beds and classroom space
designed to help youth transition from detention back into the
community. Transition and aftercare are extremely important pieces of
effective intervention and rehabilitation in order to ensure that young
people do not return to the destructive habits that brought them into
the system in the first place. Yet the Transitional Living Unit portion
alone would have cost an additional $1.5 million, so we were forced to
eliminate it from the project. We also reduced the planned number of
beds from 36 to 18. Yet even with this cutback, the facility has not
yet been completed.
Despite the Bureau's responsibility to provide law enforcement and
detention services at Standing Rock and the clear need for a facility
devoted to juveniles, the Tribe has had to work hard to make this
facility happen. The Tribe applied for the initial DOJ grant,
contributed a substantial amount of money, and has worked closely with
architects and planners to make sure construction continues to
progress. Quite simply, we have stepped in where the Bureau is failing
to provide adequate facilities to meet our population's needs. And yet
we still lack the resources to complete the facility. We have also not
been assured by the Bureau that program funds will be added to the BIA
budget for recurring staffing and operation and maintenance (O&M)
costs.
I know that you have heard from many tribes concerning the need for
juvenile detention facilities. While some funding has been made
available through DOJ to build facilities, the amount provided is not
enough to build a detention facility, nor does there seem to be any
coordination between DOJ, the Tribal grantees and BIA. BIA
participation is necessary because BIA is required to fund staffing and
operations and maintenance costs of such facilities. Many facilities
similar to ours have been fully constructed, but they stand empty
because of lack of staffing and O&M money. Idle facilities benefit no
one. We are not interested in building another substandard facility,
but a quality detention facility can easily cost $5-10 million to
construct. We were lucky-some tribes need detention facilities but did
not receive a DOJ grant at all. The outlook for more funding is not
good; DOJ has recently stated that only small grants (less than $1
million) are available for rehabilitation of existing facilities
because the entire DOJ facilities budget is only about $6 million
annually.
I understand the Bureau plans to release a report on the need for
detention facilities in Indian country, along with a plan to address
this need. I hope this plan prioritizes completion of the facilities
all over Indian country that are incomplete or lack adequate staffing.
I also hope that BIA and DOJ will coordinate in order to make enough
money available to construct, staff, operate and maintain new
facilities, rather than leaving Tribes stuck with the piecemeal
approach of requesting annual earmarks to complete construction, staff
and operate their projects. Detention facility construction and
operations seems to have fallen through the cracks between these two
agencies, with Indian youth and Native families as the main victims. I
hope that Congress will continue to encourage the agencies to work
together to correct this flawed system.
Thank you for giving me the opportunity to present this testimony.
______
Prepared Statement of Kyle Prior, Chairman, Shoshone-Paiute Tribes of
the Duck Valley Reservation
Chairman Dorgan, Vice Chair Murkowski, and members of the
Committee, thank you for accepting this testimony. My name is Kyle
Prior. I am the Chairman of the Shoshone-Paiute Tribes of the Duck
Valley Reservation. I am experienced in the area of juvenile justice
and I am a member of the Idaho Juvenile Justice State Advisory Group.
The story I want to tell you involves what I believe is an ongoing
problem for the BIA-the absolute failure to proved safe and effective
juvenile justice services to Indian children and the refusal to assist
tribes when they step in to create these services themselves. I know
all too well that facilities of all types in Indian country are in
dismal condition. At Duck Valley, we have seen our share of dilapidated
schools, outdated hospitals, makeshift office buildings, and
substandard housing. I want to focus on juvenile facilities because
this is our most pressing need at Duck Valley right now. I also believe
the problems we at Duck Valley have faced in trying to open a juvenile
detention facility are similar to the problems faced by many other
tribes in the same situation. Somewhere in the process of designing,
building, opening, staffing and maintaining a facility, the BIA always
seems to fall through. This is an area in which the BIA's inept
management of facilities is having serious consequence for Indian youth
and for tribal governments seeking to create effective community-based
interventions for those youth.
I. The Duck Valley Reservation
We live on a remote, rural reservation located in Idaho and Nevada.
The nearest population centers, Mountain Home, Idaho and Elko, Nevada,
are 100 miles away. A two-lane road runs through the Reservation
between these towns, and the road is sometimes closed during storms.
Approximately 2,300 tribal members live on the Reservation. Like many
isolated, rural tribes, our community is relatively poor. The
unemployment rate is 60 percent, and 95 percent percent of students are
poor enough to qualify for free or reduced lunch. \1\ In the area of
law enforcement, we are a direct service tribe. The Bureau of Indian
Affairs provides our police and detention services. Attracting and
retaining adequate law enforcement staff has always been an issue at
Duck Valley. We are now down to only 3 police officers, including the
Chief of Police.
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\1\ University of Nevada, Nevada Cooperative Extension, ``MAGIC''
(Making a Group and Individual Commitment): A Program for Entry-Level
Juvenile Offenders in Owyhee, Nevada (2000), available at http://
www.unce.unr.edu/publications/files/cd/2000/fs0031.pdf, at 2.
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II. The Need for a Juvenile Detention Facility
Several years ago, juvenile crime rates on the Duck Valley
Reservation were very high. At that time, we had no place to send youth
on the Reservation when they got into trouble. Although we have a BIA-
run adult jail in Owyhee, we do not have a facility in which to house
juvenile offenders. Our 27-bed adult facility is the only BIA facility
in Nevada, and it serves as a regional facility, housing offenders from
several other reservations. Our area has a similar lack of juvenile
facilities. Delinquent youth are sent by the BIA to a county facility
100 miles away in Elko, where the BIA rents detention beds. However, we
have encountered at least two problems with this system. First, the
local community is often overwhelmed by its own juvenile justice needs.
Often, no beds are available for youth from Duck Valley. Sometimes, we
send a young person there, only to receive a call several days later
saying the bed is needed and the juvenile has to be sent home. Second,
youth in Elko are usually detained for only a few days, whereas Duck
Valley youth are frequently given detention terms of weeks or months.
Because Elko is run as short-term facility, it is not well equipped to
handle offenders with longer terms.
The other option available to the BIA at that time was to send
youth several states away to Peach Springs, Arizona. At that time, the
Peach Springs facility was the only BIA-run juvenile facility in the
area. When your children are sent so far away, it is very difficult to
monitor their well-being or be sure they are safe. Parents were not
familiar with the Peach Springs facility. They didn't know what type of
programs and recreation were available, how closely the youth were
monitored, or whether adequate health care was provided. In one
instance, a young boy from Duck Valley was beaten up by other juveniles
while at Peach Springs. His tooth was knocked out, and his mother was
left to find him medical care. Incidents like these caused concern in
the community about what was happening to our children in this distant
facility. As it turned out, our concerns were well-founded. The Peach
Springs facility was closed by the BIA for several years after
questions were raised about the adequacy of supervision and whether
some youth were bringing contraband into the facility. Today, offenders
requiring longer detention terms are sent to a juvenile facility is in
Towaoc, Colorado, which is run by the Ute Mountain Tribe. In my
opinion, it is much better than Peach Springs; unlike BIA-run juvenile
facilities, it offers recreation facilities and an on-site nurse.
Nevertheless, our Tribes' overall experience with sending children away
from the community led us to begin searching for ways to bring a
juvenile facility to Duck Valley.
III. Planning and Building Our Facility
As you might expect, the BIA was unresponsive to our requests for a
juvenile facility. The Tribes then approached the state with a proposal
for a state-run juvenile detention facility in Owyhee. In our view,
having a state-run facility in our community was a better option than
letting our youth go to an Indian facility located hundreds of miles
away. This plan fell through, however, because the State saw the remote
Reservation as an ideal location to build a juvenile super-prison
containing several hundred beds. This was not the type of local
facility we had in mind.
In 1998, we were awarded a grant through the Department of
Justice's ``Correctional Facilities on Tribal Lands'' program. Planning
began in 2000, but we did not have enough money for the size of the
facility we sought to construct because of a significant increase in
fuel prices and construction costs. We received a supplemental grant
from DOJ, and construction began in 2002. The total cost of the project
was over $4 million, with the Tribes contributing the required 10
percent match (about $500,000). In addition to the basic building
costs, the Tribes also built the access road and the infrastructure
(e.g., water, power, sewer). Construction on the 28- bed facility was
finally completed in 2004, with building furnishings provided by the
BIA.
We worked closely with the BIA during the planning and building
process. As this was to be a BIA-run facility, we were careful to
follow all of the BIA requirements. We were in close contact with the
Owyhee office and the Regional office; the District Commander for
District 3 approved our plans. In 2004, the completed facility was
inspected by BIA's Office of Facilities Management and received all the
necessary certifications. After years of planning and building, the
Tribes expected that our new juvenile facility would open the following
year.
IV. Staffing and Operational Failures
It is now 2008 and our brand new juvenile facility has never
opened. Soon after we received our facility certification, officials
from the BIA Office of Law Enforcement Services visited the facility.
The staff of OLES at that time was almost all different people from
those involved in the planning process. These new staff had new ideas
about how a juvenile detention facility should look, and ours did not
fit that idea. For example, we were told our security glass was not
positioned correctly and that our doors were not made of the correct
type of reinforced steel. The type the BIA wants to see is the type
used in places where the most serious offenders are housed, places
where high-security reinforcements are needed to keep unruly offenders
from breaking down doors.
This is not the kind of issue we face at Duck Valley, and the
Tribes did not intend to build a high-security facility for the most
serious offenders. The Shoshone-Paiute Tribes are committed to a
community-based, treatment-focused approach to juvenile justice, rather
than an overly punitive model. While building the new facility, the
Tribes also worked to improve juvenile diversion and intervention
services through our MAGIC (Making A Group and Individual Commitment)
program, which teaches first time and non-violent offenders and their
parents the skills needed to avoid delinquent behavior. Working with
BIA and DOJ staff, we designed a built a facility suited to the type of
offender we most often encountered at Duck Valley, generally less
serious and nonviolent offenders. Yet at the very end of the process,
the BIA informed the Tribes that several changes that would need to be
made to bring the facility up to its new standards, standards that were
not communicated to us before. Of course, they never explained how
these changes were to made, who would pay for them, or whether the BIA
would assist with them or expected the Tribes to make these changes on
our own. In fact, during my tenure as Chairman, we have not even
received a comprehensive list of the changes that must be made.
Knowing that some changes would need to be made, the Tribes sought
to open half the facility to house juveniles. Our staffing plan calls
for about 30 staff to run the entire facility, meaning we need about 15
staff to open half of it. We have only 6 staff now. We have asked the
BIA many times about hiring staff, but the only answer we get is that
it's hard to find qualified staff people and hard to pass background
inspections. The Duck Valley Council passed a resolution long ago
waiving the BIA Indian preference, allowing them to hire non-Indian law
enforcement and detention officers. Yet even with this additional
leeway, they can find no one. In my view, the BIA's inattention to the
facility is to blame. We have hired juvenile detention officers. At one
point, we had 12 officers, nearly enough to open half the facility.
Currently, we have a highly qualified Juvenile Corrections Supervisor
from Chicago working on the Reservation. But the facility remains
closed, the space is used for BIA office space, and our juvenile
detention officers are detailed into other positions. One by one, they
grow frustrated and leave.
We are in a Catch-22. We are told the facility cannot open because
of a lack of adequate staff, but qualified staff do not stay long
because the BIA's failure to open to facility means they have no work
to do. The Bureau makes only minimal effort to recruit and hire staff.
And the question of whether the facility needs improvements, and what
kinds, looms. Meanwhile, the building itself is aging and will slowly
begin to deteriorate. Because it is not open, the BIA is not performing
any maintenance. Many tribes complain that they need new jails,
hospitals and schools. We have a new building, but it has been sitting
empty for over 4 years. We have traveled to Washington several times to
ask the BIA why our facility is not open. Each time, new Central Office
personnel say they will look into it. Each time, nothing happens at
all.
V. The Problem
Beyond the BIA's general failure to build and maintain facilities,
there are several factors at work here that should be remedied. First,
there is a lack of communication between the Central Office and the
field offices, which sometimes results in inconsistent policies. This
is how a multi-million dollar project that was approved by Regional
supervisors can be later disapproved and ignored by Central Office.
This is an expensive lack of communication.
Second, the policy shifts within the Office of Law Enforcement
Services (now Office of Justice Services) are frequent and abrupt. The
BIA's disapproval of our facility is based on the opinion of certain
Bureau personnel that it doesn't fit the current BIA mold, which is a
highly secure lockdown facility. My experience with juvenile justice
has taught me that such facilities are a poor choice, especially in a
community like ours, which does not have very many extremely violent
offenders. While I understand that BIA policies will change, these
shifts cannot be used as an excuse to completely abandon a tribally-
driven project just because it doesn't match the Bureau's preference
that young offenders be locked in high-security warehouses.
Finally, when issues arise, the Bureau utterly fails to communicate
with tribes. We know our facility is not open, but we have never been
given a clear explanation of why no staff have been hired, what aspects
of the building need to be changed, and whether the BIA intends to
assist us with making these changes and to begin maintaining the
building. This is especially inexcusable on a Reservation like ours
where the BIA is responsible for the delivery of law enforcement
services. Not only has the agency completely failed to meet the needs
of the Tribes in the area of juvenile justice, it continues to stand in
the way of solutions pursued by the Tribes.
Thank you for providing me the opportunity to present this
testimony, and thank you for your attention to the important issue of
facilities in Indian country. Chairman Dorgan, I hope you will consider
ways to address construction, operation and maintenance, and staffing
of detention facilities in your law enforcement bill. I would be
pleased to provide further information and recommendations as needed.
______
Prepared Statement of the National Indian Education Association (NIEA)
Founded in 1969, the National Indian Education Association is the
largest organization in the nation dedicated to Native education
advocacy issues and embraces a membership of nearly 4,000 American
Indian, Alaska Native and Native Hawaiian educators, tribal leaders,
school administrators, teachers, elders, parents, and students.
NIEA makes every effort to advocate for the unique educational and
culturally related academic needs of Native students. NIEA works to
ensure that the federal government upholds its responsibility for the
education of Native students through the provision of direct
educational services. This is incumbent upon the trust relationship of
the United States government and includes the responsibility of
ensuring educational quality and access. Recognizing and validating the
cultural, social and linguistic needs of these groups is critical to
guaranteeing the continuity of Native communities. The way in which
instruction and educational services are provided is critical to the
achievement of our students to attain the same academic standards as
students nation-wide.
A pattern has developed in recent years where Native education
programs get smaller increases in years where overall funding is up and
larger cuts in years when overall funding is down. This is
unconscionable and must be corrected! Over the years, the President's
budget requests have proposed many significant cuts in Native
education, which have deepened the negative effects of previous cuts.
If these budget cuts to Native education are not reversed, then Native
children and Native communities will be further harmed as well as
future generations, especially given the tragic reality that the
standard of living in Native communities continues to be far lower than
any other group in the United States. Native communities continue to
experience the highest rates of poverty, unemployment, morbidity, and
substandard housing, education, and health care.
There are only two educational systems for which the federal
government has direct responsibility: the Department of Defense Schools
and federally and tribally operated schools that serve American Indian
students. The federally supported Indian education system includes
48,000 students, 29 tribal colleges, universities and post-secondary
schools. Despite all of the funding needs for educational services for
American Indian, Alaska Native, and Native Hawaiians, many of the
programs critical to successful Native students academic achievement,
including stable and healthy learning environments and facilities, are
unmet year after year.
Indian School Construction and Facilities Improvement and Repair
The inadequacy of Indian education facilities is well documented
and well known. The continued deterioration of facilities on Indian
land is not only a federal responsibility; it has become a liability of
the federal government. Old and exceeding their life expectancy by
decades, Bureau of Indian Affairs/Bureau of Indian Education (BIA/BIE)
schools require consistent increases in facilities maintenance without
offsetting decreases in other programs, if 48,000 Indian students are
to be educated in structurally sound schools.
Of the 4,495 education buildings in the BIA/BIE inventory, half are
more than 30 years old and more than twenty percent are older than
fifty years. On average, BIA/BIE education buildings are 60 years old;
while, 40 years is the average age for public schools serving the
general population. Sixty-five percent of BIA/BIE school administrators
report the physical condition of one or more school buildings as
inadequate. Of the 184 BIA/BIE Indian schools, \1/3\ of Indian schools
are in poor condition and in need of either replacement or substantial
repair.
In May of 2007, the Department of Interior visited 13 schools as a
part of a Department wide audit and found ``severe deterioration at
elementary and secondary schools, including boarding schools, that
directly affects the health and safety of Indian children and their
ability to receive an education.'' In this report, the Department of
Interior found sever deficiencies such as classroom walls buckling and
separating from their foundation, outdated electrical systems,
inadequate fire detection and suppression systems, improperly
maintained furnaces, and condemned schools buildings.
At the Chinle Boarding School located in Many Farms, Arizona, the
children have to be transported by bus to an alternative meal site
because the cafeteria is condemned. As a result of the off site
``cafeteria'', injuries have been sustained to students and staff
related to transportation, and buses often return late resulting in
cold meals for the students. At the Shonto Preparatory School, located
in Shonto, Arizona, an employee and her husband were diagnosed with
carbon monoxide poisoning due to an aging wall furnace that had not
been properly maintained.
Funding for Indian School Construction and Maintenance for Fiscal Year
2009
For FY 2009, the President's budget will only allow for the
replacement of one school and the replacement of structures at another
school. There are currently BIA/BIE schools that are in need of major
repairs or replacements. At the funding level recommended in the
President's budget, the backlog for new BIA/BIE schools will not be
reduced at all. The need for additional school construction dollars is
so great that there should be no slow down in appropriations. Instead,
there should be an increased effort to get Tribes and the BIA/BIE to
work more efficiently on completing school construction projects while
recognizing that schools take time to plan and build.
NIEA requests a $120.47 million increase from the FY 2008 enacted
level of $142.935 million for a total of $263.4 million in FY 2009 to
the BIA for Indian school construction and repair.
After FY 2005, the funding levels have dramatically decreased for
this critical program. The funding level in FY 2005 was instrumental in
reducing the construction and repair backlog. BIA's budget has
historically been inadequate to meet the needs of Native Americans and,
consequently, Indian school needs have multiplied. The Administration
has sought to justify the decrease over the past few years by stating
that it wants to finish ongoing projects. The amounts over the past few
years have failed to fund tribes at the rate of inflation, once again
exacerbating the hardships faced by Native American students. Further,
the funding that has been allocated over the past few years will not
keep pace with the tremendous backlog of Indian schools and facilities
in need of replacement or repair.
In 1997, GAO issued a report ``Reported Condition and Costs to
Repair Schools Funded by the Bureau of Indian Affair'' that documented
an inventory of repair needs for education facilities totaling $754
million. In 2004 the backlog for construction and repair was reported
to have grown to $942 million. We believe that we must keep pace with
the FY 2005 level of funding in order to finally make some headway in
the construction backlog. The purpose of education construction is to
permit BIA funded schools to provide structurally sound buildings in
which Native American children can learn without leaking roofs and
peeling paint. It is unjust to expect our students to succeed
academically, if we fail to provide them with a proper environment to
achieve success.
The Mandaree Day School located in Mandaree, North Dakota has taken
out a loan in the amount of $3 million to cover the costs of building a
new education facility. The Mandaree Day School could not wait any
longer for the funding from the Department of Interior to build their
school. The loan only covers the facility structure and the 210
children attending this school have no playground and the teachers do
not have a paved parking lot.
Although education construction has improved dramatically over the
last few years, the deferred maintenance backlog is still estimated to
be over $500 million and increases annually by $56.5 million. As noted
by the House Interior Appropriations Subcommittee in its Committee
Report accompanying the FY 2006 Interior appropriations bill, ``much
remains to be done.'' Of the 184 BIA/BIE Indian schools, \1/3\ of
Indian schools are in poor condition and in need of either replacement
or substantial repair.
For the past three school years, only 30 percent of BIA schools
made AYP goals established by the state in which the school was
located. Department of Education statistics indicate that student
performance at BIA/BIE schools is lower than students at public
schools. NIEA strongly believes that there is a correlation between
academic achievement and the environment in which one is expected to
learn.
Conclusion
NIEA thanks the Committee for its tremendous efforts on behalf of
Native communities. With your support we are hopeful that we can begin
to provide the funding for education that Native communities deserve.
The National Indian Education Association thanks Chairman Dorgan and
Vice-Chairman Murkowski for championing on behalf of all Native
students and their successful educational achievements.
______
Response to Written Questions Submitted by Hon. Byron L. Dorgan to
Domingo S. Herraiz
Question 1. Your testimony indicates that 17 Tribes have received
funding for construction planning. How many of these 17 planning grants
will be for new construction? Is the Department's Indian Jails
Construction program moving away from new construction? If yes, please
explain why.
Answer. While these 17 grants are not for new construction, the
funding will directly support the Tribes' ability to effectively assess
their projected correctional needs to accurately determine whether new
construction, renovation, or incarceration alternatives will best serve
their communities' correctional needs.
With input from Tribal leaders, the Department has implemented a
comprehensive approach to supporting Tribes as they plan for short and
long term correctional facility needs. In this way, Tribal partners,
the Department, and the Bureau of Indian Affairs (BIA) can better
identify new construction and renovation priority projects that not
only comply with BIA standards, but are safe, secure, appropriate for
the intended population, and reflect cultural and traditional values.
Question 2. What is the Department's long term plan for meeting the
jails/detention center needs of Indian Country? And have you consulted
with Tribes on that plan?
Answer. The Department's long term plan for meeting jail and
detention center needs of Indian Country supports Tribal leaders as
they assess their own correctional needs and develop strategies to
address those needs through renovation, construction, and correctional
alternatives. Funding and technical assistance for planning,
construction, and renovation efforts is provided to Indian Country,
with activities based on input from Tribal leaders, BIA's Office of Law
Enforcement Services, and the Office of the Inspector General's
recommendations for Tribal jails. The Department will continue to find
ways to collaborate with Tribal and federal partners to maximize
current and future correctional resources to Indian Country.
The Department of Justice regularly consults with Tribes regarding
correctional needs. In 2005, the Department hosted ``Listening
Conferences'' with Tribal leaders and related partners regarding their
priorities for Tribal justice programs. Based on their feedback, the
Bureau of Justice Assistance (BJA) hosted a focus group with BIA for
Tribal leaders in September 2006. In addition, the Interdepartmental
Tribal Consultation, Training and Technical Assistance Sessions held in
FY 2007 and FY 2008 included several tribal consultation sessions and
training focusing on Tribal corrections.
______
Response to Written Questions Submitted by Hon. Maria Cantwell to
Domingo S. Herraiz
Question. In my home state of Washington, our tribes have seen a
drastic increase in gang activity and meth use on their reservations.
This criminal activity not only causes reservations to be less safe,
but many times the communities around them as well. Tribal police and
law enforcement have been chronically underfunded and the tribes are
struggling to gain control of the rising crime on their reservations.
How, in a time where crime is on the rise and the need for more law
enforcement funding crystal clear, do you justify the proposal to
eliminate funding for New Jails Construction in the DOJ budget?
Answer. The Department's Office of Justice Programs (OJP) has
developed a close working relationship with many American Indian and
Alaskan Native (AI/AN) tribes and remains committed to helping these
communities meet the unique challenges they face in the areas of law
enforcement and criminal justice.
The FY 2009 budget request proposes a reorganization of OJP's state
and local law enforcement and criminal justice assistance programs,
streamlining its many existing programs into three competitive,
multipurpose, discretionary grant programs: (1) Violent Crime Reduction
Partnership Initiative; (2) Byrne Public Safety and Protection Program;
and (3) Child Safety and Juvenile Justice Program. This reorganization
will enhance OJP's ability to direct assistance to those jurisdictions
demonstrating the greatest need, providing tribal grant recipients with
greater flexibility in using their grant funds.
In September 2007, OJP implemented a new Tribal Grants Policy,
which will help Tribal communities seeking OJP resources through our
competitive grant solicitation process. OJP will continue its support
for the Tribal Criminal Justice Statistics Program and victims
assistance initiatives serving AI/AN populations through discretionary
funding. OJP's tribal budget plan for FY 2008 estimates spending of
nearly $44 million in funding for programs to assist MAN tribes, an
increase of more than $6 million over FY 2007 funding levels.
In addition, OJP will continue hosting Tribal Consultations and
Training & Technical Assistance (T&TA) sessions. These sessions will
focus on tribal priority issues related to public safety for families
and communities. They will address drugs, tribal court systems, multi-
jurisdictional coordination and communication, sex offender registry,
and other law enforcement areas.
OJP will also continue to support efforts to expand federal
outreach to tribal governments, such as the Tribal Justice and Safety
website (http://www.tribaljusticeandsafety.gov) launched last year to
assist tribal governments. The website features information on a
variety of justice issues, as well as grant funding and training. These
efforts are designed to improve communication and to help build tribes
capacity to create and leverage resources.
______
Written Questions Submitted by Hon. Byron L. Dorgan to
Jack Rever and W. Patrick Ragsdale *
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* Response to written questions was not available at the time this
hearing went to press.
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Tribal Jails/Detention Centers
Question 1. How many jails and detentions centers in Indian Country
are newly built, but remain empty due to lack of staff? Please explain
why they are empty?
Question 2. Your testimony states that ``there are currently 84
detention facilities across Indian Country. Of these, 38 are owned and
operated by the Federal Government, five are owned by Tribes and
operated by the Federal Government, and 41 are owned and operated by
Tribes.'' However, the Bureau's Budget Justifications for Fiscal Year
2009 states that ``The OJS Division of Corrections funds 67 tribally-
operated detention programs and directly operates 24 detention programs
facilities.''
(1) Please explain the discrepancy, and
(2) provide the exact number of the following based on your latest
information:
(a) total number of tribal jails/detention centers;
(b) number of juvenile detention centers;
(c) number of jails/detention centers owned and operated by the
Federal Government;
(d) number of jails/detention centers owned by Tribes and
operated by the Federal Government;
(e) number of jails/detention centers owned and operated by
Tribes.
Question 3. The Budget also requests a nominal increase in
staffing. However, I note that of the 146 new staff that would come on
board if Congress granted your Budget request--only 20 staff would go
to fund staff at the 67 Tribally-owned and operated jails. The
remaining 126 new corrections staff would be placed at 24 directly
operated BIA jails. Please provide an explanation justifying this
request.
Question 4. The poor state of Indian Jails is a long standing
problem. Attorney General Reno testified in 1998 about this issue. The
Inspector General recommended in 2004 that Justice and Interior develop
a strategic plan for jails replacement and renovation. What the status,
if any, of the strategic plan between the two Departments to replace
and renovate Indian jails?
Question 5. Mr. Guillermo Rivera discussed the Shubnum Indian Jails
Report last March before the Prison Rape Elimination Commission. He
reported that Shubnum found an approximate $6 billion backlog in Indian
jails for construction and maintenance. Can you confirm that number?
Question 6. Have you shared any portion of the Shubnum Report with
the Department of Justice who is responsible for administering funds
for new Indian jails construction?
Question 7. We know that the backlog for Indian jails is in the
billions of dollars. However, the Department requested less than $8
million for Indian jails renovation--a $3 million dollar cut from last
year's appropriated figure. Can you explain the Department's
justification for this request?
Question 8. What is the condemnation process at the Bureau and what
do you do to help tribes once you've condemned their building?
Question 9. A number of Tribes have to transport their inmates to
far away jails. It is my understanding that your office does not
include a line item for prisoner transportation. Please explain why
transportation costs are not included in your budget, and answer
whether the Department will include a line item for corrections
transportation in the future?
Tribal Schools
Question 10. The Committee understands that in addition to the 14
schools on the priority construction list, over 70 schools need
replacement or repair.
Question 11. What it the cost to complete the 14 schools on the
2004 priority list?
Question 12. What is the estimated cost to replace or repair the
additional 70 schools?
Question 13. The Committee understands that a new priority list for
school construction will be developed this year with the goal of
releasing a new list in 2009. What is the current status of forming a
team to work on the list? Will it be open to all tribal leaders? What
process will you use to develop the list?
Question 14. We received testimony today describing a lengthy
process for school facilities construction. It appears that some
schools have been in the planning stage for 7 years and will likely
take 12-13 years for completion. Why does the process take so long?
What is the Bureau doing to address this backlog?
Question 15. How would you suggest the Bureau streamline the
process? Do you currently allow schools that are ready to move to the
next phase do so, or do you hold them up until schools ahead of them on
the list have progressed?
Question 16. The Inspector General released a Flash Report in May
2007 warning of the dangers that existed at Indian schools. It is our
understanding that a final report will be released within the next
month.
Question 17. What has the Bureau done to address these emergency
conditions?
Question 18. What is the Bureau doing to ensure these types of
situations don't occur in the future?
Question 19. We understand that in addition to those schools
identified in the Inspector General report, other schools face similar
emergency situations. For example, the Committee has been informed that
the Laguna Elementary School in New Mexico was temporarily shut down in
November due to ``unsafe'' conditions until a review of the structural
stability of the building could be completed.
Question 20. What has the BIA done in terms of follow-up since the
November engineer's report and re-opening of the school?
Question 21. Will the BIA provide any funding to temporarily cure
defects of the facility?
______
Written Questions Submitted by Hon. Tim Johnson to
Jack Rever and W. Patrick Ragsdale *
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* Response to written questions was not available at the time this
hearing went to press.
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Question 1. It seems that one of the major problems facing
detention facilities is actually the staffing issue. I find this ironic
because unemployment is one of the most severe problems facing Indian
tribes. What is the BIA doing to recruit detention officers in Indian
Country?
Question 2. Is there any coordination with tribal employment
programs or tribal colleges?
______
Written Questions Submitted by Hon. John Barrasso to
Jack Rever and W. Patrick Ragsdale *
In 2006, the Drug Enforcement Agency in cooperation with BIA and
local law enforcement officials took down the Hermosillo
Methamphetamine Trafficking Group operating on the Wind River
Reservation. This was one of the largest drug busts in Wyoming's
history. Yet, it is my understanding that Wind River Reservation law
enforcement officials are operating out of very limited facilities and
the detention center has even less space. There is clearly a trend of
drug gangs using Indian reservations to operate their criminal
enterprises, and the Wind River Reservation has already seen this
firsthand.
Question 1. As such, do you believe the Wind River Reservation's
law enforcement facilities are adequate to deal with this new trend?
We have fundamental problems meeting the needs of tribal facilities
in both funding and construction. Yet, we also need to focus on the
maintenance needs of these structures to get return on the investment
of federal dollars.
Question 2. How can the system be improved to ensure that money and
manpower is available and accountable for maintaining BIA properties?
On the Wind River Reservation, the one tribal school--St. Stephens'
school--was approved for a new high school facility. It is my
understanding that the much-needed construction project has been
reduced in scope several times since it was first approved by the BIA.
As a result, there will be no room for additional students.
Question 3. What BIA actions can be expected if the school
enrollment exceeds the new facility's capacity?
Question 4. Would the school be placed on a separate priority list
for expansion or would it be required to compete for funding with all
other replacement facilities?
Question 5. Considering the disparities in BIA facilities funding
allocated to certain tribes and regions in recent years, do you believe
the current priority system of facilities funding equitably distributes
federal dollars?
Question 6. How can it be revised to meet our obligation to all
tribal members?
______
Written Questions Submitted by Hon. Maria Cantwell to
Randy Grinnell *
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* Response to written questions was not available at the time this
hearing went to press.
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Question 1. Mr. Grinnell, I understand that the revised Health
Facilities Construction Priority System was submitted to the Indian
Health Service by the Facilities Advisory Appropriation Board in March
2007. It has now been a year, and we have seen no action by the Indian
Health Service on the Board's recommended changes.
When can we expect to see a decision on the revised system?
Given the backlog under the current priority list, how long do you
expect it will take to implement the new priority system?
Question 2. Mr. Grinnell, as you know, the current state of Indian
health facilities in Washington state is appalling. Our tribes do not
have access to their own Indian Health Service inpatient facility, and
some are making do with clinics operated out of mobile homes. Despite
the pressing need for health facilities, the Portland Area has not
faired very well under the current priority system, which includes no
project for Washington state under the locked priority list.
Your written testimony mentions that a revised Health Facilities
Construction Priority System would ``provide an assessment of health
services and facilities needs today and would rank those facilities'
needs based upon contemporary criteria.''
Can you elaborate on what you mean by ``contemporary criteria? ''
How would the revised system address the facility needs of the Portland
Area?
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