Colville clinic long finished but still unused

NESPELEM, Wash. – A $4.7 million medical clinic sits unused on the Colville Indian Reservation nearly seven months after its construction was completed.

Meanwhile, 9,000 patients continue to be seen in the old Nespelem clinic, which was built for about 600 patients in 1934.

The move into the new building has been delayed by negotiations between the tribe, the Indian Health Service and the Bureau of Indian Affairs over the lease agreement. The lease is necessary for the agency to staff the new clinic, which is owned by the Confederated Tribes of the Colville Reservation.

“The government wouldn’t give us a staffing package,” said Andy Joseph, the Colville Tribal Business Council member who oversees tribal health and human services.

With the lease agreement apparently completed last month, a “move team” will now be “coordinating the project to ensure that the transfer of operations is not disruptive,” according to a statement by the Indian Health Service.

The tribe paid 70 percent of the cost of the project, which it designed and built itself. The Indian Health Service paid 30 percent.

The agency’s Portland office would respond only to a written request for information, and only after the request was cleared by headquarters in Washington, D.C. The Indian Health Service did not say when the move would occur, but Joseph said it was hoped the new clinic would be in use within a month.

The Colville Service Unit of the Indian Health Service is staffed at 53 percent of what’s needed to fully provide health care on the reservation, the agency acknowledges. Two physicians and two nurse practitioners currently staff the Nespelem clinic, which logged more than 24,000 patient visits in 2006.

The tribe’s other two clinics, in Keller and Inchelium, share the services of another physician.

Because there is no clinic in Omak on the western edge of the 1.4 million-acre reservation, tribal members must drive 43 miles over Disautel Pass to receive care in Nespelem.

They are forced to make the trip because Contract Health Services, which purchases primary and specialty care for Native Americans from private care providers, is currently at “priority one” status. This means such care is denied unless the patient is at risk of losing life or limb.

By treaty and by law, the federal government is responsible for the health and welfare of American Indians. It was a condition of their withdrawing to reservations.

But now, according to Joseph, native health care financing is a patchwork that includes tribal, state and federal funds, including Medicare and Medicaid.

“We never agreed to co-payments in any treaty we signed,” Joseph said.

Like many tribes, the people of the Colville Reservation suffer from high unemployment, drug and alcohol abuse, domestic violence and a high suicide rate. They also are at greater risk of diseases such as diabetes.

The federal government’s response to these social problems, Joseph and other tribal leaders said, has been inadequate. They note that federal prisoners receive more than twice the amount of funding for health care per capita than do Native Americans.

President Bush’s proposed fiscal 2008 budget would provide $3.27 billion for the Indian Health Service, a $212 million increase over 2007. However, because of the rising cost of health care, the Northwest Portland Area Indian Health Board estimates it will take at least a $471 million increase to maintain current services.

The president’s budget also eliminates the entire $32.7 million Urban Indian Health Program. Last year, Congress refused to eliminate this funding and is unlikely to do so this year either.

But when Congress completes its 2008 budget, the restored Urban Indian Health funding will likely come at the expense of any possible increase in the Indian Health Services budget.