Indian Health Facilities

Facilities and Environmental Health Support

#### Facilities Support

+-------------+-------------+-------------+-------------+-------------+
|             | 2002        | 2003        | 2004        | Increase    |
|             |             |             |             |             |
|             | Actual      | President's | Estimate    | or Decrease |
|             |             |             |             |             |
|             |             | Budget      |             |             |
+-------------+-------------+-------------+-------------+-------------+
| BA          | \           | \           | \           | +           |
|             | $63,032,000 | $66,920,000 | $71,391,000 | \$4,471,000 |
+-------------+-------------+-------------+-------------+-------------+
| FTE         | 566         | 581         | 601         | +20         |
+-------------+-------------+-------------+-------------+-------------+

**[PURPOSE AND METHOD OF OPERATION]{.underline}**

Funds appropriated for the Facilities Support sub-activity are used to
pay certain personnel and operating costs at the Area and Service Unit
levels[^1]. The personnel paid from this account operate and maintain
health care facilities and staff quarters. Staff functions supported by
this sub-activity include management, operation, and maintenance of real
property, building systems, medical equipment technical support, and
planning and construction management for new and replacement facilities
projects. In addition, related Area and Service Unit operating costs,
such as utilities, building operation supplies, facilities related
personal property, and biomedical equipment repair and maintenance, are
paid from this account.

The IHS is committed to ensuring that health care is provided in
functional and safe structures. Because many IHS facilities are located
in isolated and remote environments far from urban centers, the IHS
builds and maintains residential quarters at those locations to house
non-local health care personnel.

The IHS owns approximately 850,000 square meters of Federally-owned
space and 770 hectares of land. The nature of space varies from
sophisticated medical centers to residential units and utility plants
(see following table). Facilities range in age from less than 1 year to
more than 100 years. The average age of our health care facilities is 32
years. Many IHS facilities were built when medicine was practiced much
differently than it is today and service populations were much smaller.

In addition to Federally-owned space, the IHS manages direct leased and
GSA assigned space. The table on the following page shows the space
occupied by IHS and Tribal Health Care Programs.

+---------------+-------------+-------------+------------+------------+
| Space         |             |             |            |            |
| Occupied by   |             |             |            |            |
| IHS and       |             |             |            |            |
| Tribal Health |             |             |            |            |
| Care Programs |             |             |            |            |
+---------------+-------------+-------------+------------+------------+
| Type of       | Federally   | Direct      | GSA        | [Tribal]{. |
|               |             |             |            | underline} |
| [Facility     | [Owned]{    | [Federal    | [A         |            |
| ]{.underline} | .underline} | Lease]{     | ssigned]{. |            |
|               |             | .underline} | underline} |            |
+---------------+-------------+-------------+------------+------------+
| Hospitals and | 465 263     | 75 845 M^2^ | -0-        | 288 965    |
| Health        | M^2^        |             |            | M^2^\*     |
| Centers       |             |             |            |            |
+---------------+-------------+-------------+------------+------------+
| Staff         | 257 312     | 2 070 M^2^  | -0-        | 144 M^2^   |
| Quarters      | M^2^        |             |            |            |
+---------------+-------------+-------------+------------+------------+
| Other         | 127 746     | 10 834 M^2^ | 58 681     | 125 098    |
|               | M^2^        |             | M^2^       | M^2^       |
+---------------+-------------+-------------+------------+------------+
| Total         | 850 321     | 88 749 M^2^ | 58 681     | 414 207    |
|               | M^2^        |             | M^2^       | M^2^       |
+---------------+-------------+-------------+------------+------------+

\*Tribal Space listed for Hospitals and Health Centers includes all
space at locations where direct medical services are provided under P.L.
93-638 contracts in non-IHS owned buildings. Staffing and operations
costs (including lease costs) are funded from the Services
appropriation.

# [STAFF FUNCTIONS]{.underline}

Four principal staff functions are funded at the Area and Service Unit
levels through the Facilities Support sub-activity.

-   **Facilities Engineers**

Area and Service Unit facilities engineers are responsible for ensuring
that IHS building systems are operated properly, facilities and grounds
are maintained adequately, utilities are managed appropriately,
environmental compliance requirements are met, and buildings are safe.
The need for maintenance and improvement projects is determined at the
Area level and identified in Area Facilities Engineering Plans.

-   **Clinical Engineers**

The IHS has highly sophisticated medical equipment in its inventory.
Skilled, specialized personnel are employed to maintain and service that
equipment because the lives of patients and level of patient care depend
on accurate calibration and safe operation. Clinical engineers and
technicians perform this critically important function. Larger IHS
facilities have clinical engineering personnel on-site, but most IHS and
tribal facilities depend on Area, district, or service unit-based
clinical engineers and technicians who travel to several facility
locations to repair and maintain biomedical equipment.

-   **Real Property Management**

Area Realty Officers provide technical and management assistance for
realty activities associated with direct-leased, GSA-assigned, and
IHS-owned (and to some degree tribally-owned) space. The program
includes facility and land acquisitions and disposals,
licensing/easement processing, use-permit issuance, quarters management
and rent setting activities, lease administration, and budget functions.
The program also helps tribes and tribal organizations acquire,
administer, and/or manage excess federally owned and tribally leased
real property.

-   **Facilities Planning and Construction**

Some IHS Areas have facilities planning and construction-monitoring
components that assist in the planning and construction management of
new and replacement health care facility and staff quarters projects.
The need for new facilities is determined by applying the IHS Health
Facilities Construction and Quarters Construction Priority System
methodologies. Area staffs develop initial proposals for new and
replacement facilities, prepare Program Justification Documents, Program
of Requirements Documents, and Project Summary Documents for projects.
While construction is underway, Area facilities management staff may be
supplemented with construction management personnel to oversee Federal
interests in the construction of new and replacement facilities.

### OPERATION COSTS

-   Utility Costs \-- Utility costs include heating and air conditioning
    expenses, fuel oil, natural gas, propane, water, sewer,
    and electricity for lighting and equipment operation.

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-   Building Operation Supplies and Equipment \-- Funds for building
    operation supplies and equipment, including special tools to perform
    maintenance, heating and air conditioning supplies, etc.

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-   Biomedical Equipment and Repair \-- The clinical engineering program
    provides technical service and support for biomedical equipment at
    IHS and tribal health care facilities. The program also administers
    service contracts for biomedical maintenance and repair where
    clinical engineering personnel are not available to perform this
    service.

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-   Leased Space \-- The IHS continues to apply its Lease Priority
    System (LPS) methodology in order to plan/budget for
    Federally-funded IHS and tribal program space. The LPS improves
    lease management by establishing specific criteria for evaluating
    Federal and tribal health program space requests.

**All lease costs are paid from the Services appropriations**.

Funding levels for the last 5 fiscal years follows:

+----------+-------------------+--------+-----------------------------+
| [Y       | [Fun              | [FTE]  | President\'s Budget         |
| ear]{.un | ding]{.underline} | {.unde |                             |
| derline} |                   | rline} |                             |
|          | \$53,857,000      |        |                             |
| 1999     |                   | 580    |                             |
|          | \$56,990,000      |        |                             |
| 2000     |                   | 535    |                             |
|          | \$59,907,000      |        |                             |
| 2001     |                   | 550    |                             |
|          | \$63,032,000      |        |                             |
| 2002     |                   | 566    |                             |
|          | \$66,920,000      |        |                             |
| 2003     |                   | 581    |                             |
+----------+-------------------+--------+-----------------------------+

**[ACCOMPLISHMENTS]{.underline}**

In FY 2002, Facilities Support provided Area offices and Service Units
with staff to operate and maintain the health care buildings and
grounds, and to service medical equipment. This responsibility includes
an inventory of approximately \$310,000,000 of medical equipment,
hospitals, health centers, staff quarters, smaller health stations and
satellite clinics, school health centers, and youth regional treatment
centers. IHS will continue these functions in FY 2004.

**[RATIONALE FOR BUDGET REQUEST]{.underline}**

**[TOTAL REQUEST]{.underline}** -- The request of \$71,391,000 and 601
FTE is a net increase of \$4,471,000 and 20 FTE over the FY 2003
President's Budget of \$66,920,000 and 581 FTE. The increases include
the following:

[Pay Costs: +\$1,446,000]{.underline}

The request of \$1,446,000 would fund pay cost increases for
Federal/Tribal/Urban.

The IHS continues to strive to increase access for the IHS patient
population. Maintaining the current I/T/U health system is necessary in
eliminating disparities in health status between AI/AN and the rest of
the U.S. population.

[Phasing-In of Staff for New Facilities: +\$3,025,000 and +20
FTE]{.underline}

The request of \$3,025,000 and 20 FTE provides for the phasing-in of
staff and related costs for new facilities allowing IHS to expand
services in areas where existing capacity is most overextended. The
staffing of new facilities also contributes to the recruitment and
retention of medical staff and promotes self-determination activities.
The following table displays the requested FSA increase:

+----------------------------------+---------------------+-------------+
| **[Facilities]{.underline}**     | **[Dol              | **[FTE]{.u  |
|                                  | lars]{.underline}** | nderline}** |
+----------------------------------+---------------------+-------------+
| Ft Defiance, AZ Hospital         | \$1,335,000         | +10         |
|                                  |                     |             |
| Winnebago, NE Hospital           | 1,109,000           | +7          |
|                                  |                     |             |
| Pawnee, OK Health Center         | [5                  | [+3]{       |
|                                  | 81,000]{.underline} | .underline} |
| Total                            |                     |             |
|                                  | \$3,025,000         | +20         |
+----------------------------------+---------------------+-------------+

[^1]: ^1^/ Costs for these functions performed by P.L. 93-638
    contractors at non-Federally-owned or previously Federally-owned
    facilities are funded from the Services appropriation.