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HEALTH CARE WITHOUT AN IHS HOSPITAL:

OVERTAXING THE CONTRACT HEALTH

SERVICES PROGRAM

FIELD HEARING

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE

ONE HUNDRED ELEVENTH CONGRESS

SECOND SESSION

OCTOBER 2, 2010

Printed for the use of the Committee on Indian Affairs

(

(II)

COMMITTEE ON INDIAN AFFAIRS 

BYRON L. DORGAN, North Dakota, Chairman 

JOHN BARRASSO, Wyoming, Vice Chairman 

DANIEL K. INOUYE, Hawaii 

KENT CONRAD, North Dakota 

DANIEL K. AKAKA, Hawaii 

TIM JOHNSON, South Dakota 

MARIA CANTWELL, Washington 

JON TESTER, Montana 

TOM UDALL, New Mexico 

AL FRANKEN, Minnesota 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

TOM COBURN, M.D., Oklahoma 

MIKE CRAPO, Idaho 

MIKE JOHANNS, Nebraska 

ALLISON C. BINNEY, Majority Staff Director and Chief Counsel 

DAVID A. MULLON JR., Minority Staff Director and Chief Counsel 

(III)

C O N T E N T S 

Page 

Hearing held on October 2, 2010 ............................................................................ 1

Statement of Senator Dorgan ................................................................................. 1 

WITNESSES

Bell, Hon. Billy A., Chairman, Fort McDermitt Paiute and Shoshone Tribes ... 10

Prepared statement .......................................................................................... 12

Curley, Cindy, Health Director, Pyramid Lake Paiute Tribe .............................. 14

Prepared statement .......................................................................................... 17

Harris, Catherine S., CFO, Reno Heart Physicians .............................................. 18

Prepared statement .......................................................................................... 20

Moyle, Alvin, Chairman, Fallon Paiute Shoshone Tribe; President, Indian 

Health Board of Nevada ...................................................................................... 5

Prepared statement .......................................................................................... 9

Sammaripa, Hon. Loren, Chairman, Walker River Paiute Tribe; accompanied 

by Kenneth Richardson, Health Director ........................................................... 22

Prepared statement .......................................................................................... 24

APPENDIX

Campa, Hon. Lucille, Tribal Chairperson, Las Vegas Paiute Tribe, prepared 

statement .............................................................................................................. 39

Charts, submitted for the record ............................................................................ 56

Joe-Kinale, Rose Mary, Human Services Director, Yerington Paiute Tribe, 

prepared statement .............................................................................................. 41

Letters, submitted for the record, by: 

Hon. Elwood L. Emm, Jr. ................................................................................ 48

Alex Conway, Bea McMinn, and James McMinn .......................................... 51

Tina M. Nino ..................................................................................................... 54

Katherine Marie Quartz .................................................................................. 52

Melendez, Hon. Arlan D., Tribal Chairman, Reno-Sparks Indian Colony 

(RSIC), prepared statement ................................................................................ 39

Walker, Hon. Waldo W., Chairman, Washoe Tribe of Nevada and California, 

prepared statement .............................................................................................. 45

Wright, Jr., Hon. Mervin, Chairman, Pyramid Lake Paiute Tribe, prepared 

statement .............................................................................................................. 43

(1)

HEALTH CARE WITHOUT AN IHS HOSPITAL: 

OVERTAXING THE CONTRACT HEALTH 

SERVICES PROGRAM 

SATURDAY, OCTOBER 2, 2010

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Reno, NV. 

The Committee met, pursuant to notice, at 1:30 p.m. in the Hyatt 

Place Reno-Tahoe Airport Building, Hon. Byron L. Dorgan,

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. BYRON L. DORGAN,

U.S. SENATOR FROM NORTH DAKOTA 

Senator DORGAN. We’re going to begin the hearing today. I’m 

Senator Byron Dorgan. And this is a hearing of the U.S. Senate Indian Affairs Committee. I want to thank all of you for being here. 

This is a formal hearing of the Committee. We have held many, 

many hearings this year on the subject of Indian health care. And 

we will be holding at least one more hearing by the end of the year, 

but this is beginning to rap up a series of hearings that we’ve held 

on health care. 

I wanted to say at the outset that we’ve made, I think, very significant progress this year on a range of issues dealing with Indian 

health care. For the first time in 18 years the United States Congress has taken action and the President has signed a piece of legislation that reauthorizes permanently in federal law the Indian 

Health Care Improvement Act. I’m enormously proud that we were 

able to do that. We got it passed through the Senate in the last 

Congress, and it died in the U.S. House. But this year we got it 

through the Senate and the House and it is now law. In addition 

to that, we passed the Tribal Law and Order Act, and, as you may 

know, the President had a signing ceremony in the East Room of 

the White House. We’re enormously proud of that legislation, as 

well. 

There are other things that we have done in the Indian Affairs 

Committee this year that are very, very important, but I wanted 

to mention those two especially, because I think both will have a 

very significant impact going forward with assistance to Native 

Americans in this country and to tribal governments, as well. 

Senator Reid had asked if I would hold a hearing in Nevada on 

the subject of Indian health care. And I said I would. I wasn’t able 

to get here until now, but I’m really pleased to be here now, and 

2

on behalf of Senator Reid, say welcome to all of you. Since he’s not 

able to be here on this day. This was the day I was able to come 

and he is somewhere else in the state. But I know that he asked 

me to hold a hearing here on Indian health for a couple of reasons. 

I know that there is substantial use of contract health funds here 

in this area of Nevada. I know that the State of Nevada does not 

have a hospital within the Indian health care system and that 

often it’s 700 or 800 miles to drive to the hospital in Phoenix. I 

know that in the Indian Health Care Improvement Act, there is a 

provision that requires the development of a plan to create an IHS 

area office here in Nevada, which I assume would be the precursor 

to all of the things that would accompany the designation as a region. This is the only state, I think, of its size that does not have 

a hospital within the Indian health care system. The State of Nevada previously, as I understand it, had two hospitals. Both, I believe, have lost certification and are no longer hospitals. 

But it’s pretty clear that if you are a Native American, one of the 

First Americans who welcomed everyone who showed up later—if 

you are a Native American living here in this state, you rely more 

heavily on Contract Health Services. It’s also the case that Contract Health Services is inadequately funded by virtue of not having sufficient money in the budget; it never has. And it’s also the 

case that the formula by which the basic amount of contract health 

money is distributed around to the various tribal governments is 

a formula that no one in the country understands, including those 

who distribute the funds. And that says something. If you ever 

want to try to get the bottom of it to say: Let us understand the 

base formula that goes back some many years? Be prepared to sit 

and listen until your eyes glaze over and still never understand the 

description from someone who’s offering the description, because 

those who are offering it don’t understand it either. 

Having said all of that, this year we have embarked on something, in addition to passing legislation to improve Indian health 

care. We have also begun a very specific investigation of one region 

of the Indian Health Service. I know that many of you, perhaps, 

have read about this and understand it, but the specific investigation is of the Aberdeen region. We have undertaken the investigation for very important reasons. There are very significant allegations, and have been for a long, long while, of things that we 

should not allow to happen. I have always said as we begin this 

process—and I said it again the other day when we had a hearing—I think there are a lot of very wonderful people working for 

the Indian Health Service. I think every day there are men and 

women, doctors, nurses, health care professionals who go to work 

and are proud to serve, do everything they can possibly do to provide the kind of service that all of us are proud of. 

I also know that at the Indian Health Service there’s a bureaucracy that in some cases is not thinking very clearly, they do things 

they shouldn’t do. They transfer people instead of fire people when 

people, in some cases, misappropriate money or in other cases, take 

narcotics, pilfer narcotics, or when they harass people. I can’t describe to the whole series of things, but I’m just saying to you I 

know plenty of instances where problem employees in the Indian 

Health Service have not been to just one or two, but they have 

3

been transferred to one and two and three and four different places 

in the Indian Health Service when they have failed at each place. 

That, in my judgment is shameful. 

One example is a woman who has had four separate EEOC complaints against her, adjudicated against her, and in each case she 

was transferred to another facility, only to fail there. We cannot 

allow that to continue. Even as I’m proud of a lot of good work by 

a lot of people, I’m determined that the bureaucracy in the Indian 

Health Service has to begin making the right decisions on behalf 

of Native Americans in order to provide the best kind of health 

care for American Indians. 

Now, even if we had the best people available in every circumstance and I didn’t have horror stories to tell you or horror stories that required me to investigate one area of the Indian Health 

Service—and, by the way, there will undoubtedly be investigations 

of others—even if that were not the case, there are other problems 

that I think lead all of us to understand this system doesn’t work 

very well. 

I have told the story on the Floor of the Senate and used a chart 

that shows a very large photograph of a woman named Ardel Hale 

Baker. She happens to come from a tribe in my state, but that’s 

just happenstance. I’ve also used photographs of others from other 

states. Ardel Hale Baker was having very serious chest pains. She 

went to a clinic on her reservation. She was told she was having 

a heart attack, diagnosed as having a heart attack, and she was 

sent to the nearest hospital, which is about 80 to 90 miles away 

off of the reservation. When they took her out of the ambulance—

which she didn’t want to go in because she was worried she would 

be stuck with paying a bill that she couldn’t pay and ruin her credit—but, nonetheless, she was taken by ambulance, and when they 

took her out of the ambulance and transferred her from the gurney 

that she was on to the hospital gurney, they found a piece of paper 

taped to her thigh. It was an eight-by-ten piece of paper with 

masking tape attached to the thigh of this woman, it was a letter, 

from the Indian Health Service to the hospital, which said something like, Understand this: If you admit this woman to your hospital, you’re doing that at your own risk because we are out of contract health care money. 

Now, just think of the consequences of that. You’re having a 

heart attack, being transferred to the hospital, and someone tapes 

a piece of paper to your leg to tell the hospital provider: ‘‘If you 

admit this person, understand we’re out of contract health care 

money. Do it at your risk.’’

On that reservation, and on many others that have testified before our Committee, the mantra very clearly was: Don’t get sick 

after June, because by June we’re out of contract health care 

money. You get sick after June, tough luck. 

The reason I tell you that story is I know that the majority of 

the reliance on health care in this region, because you don’t have 

a hospital, is on contract health care. And the funding in contract 

health care is woefully inadequate. There should be front page 

headlines in newspapers about the rationing of health care to 

American Indians. It is rationing. About 60 percent of the need is 

met; 40 percent is not met. That means rationing. That ought to 

4

be a scandal. That ought to be front page headlines in newspapers, 

but it’s not. And this Committee has tried in every way that it 

knows how to hold a mirror to say to the Congress, to the Indian 

Health Service to say to Department of Health and Human Services: We can’t allow this to continue; this must be fixed. 

So as I indicated to you, Senator Reid asked me if I would hold 

a hearing in Nevada. I had hoped to get here a couple months ago, 

but was not able to do that. But this hearing is focusing especially 

on the difficult circumstance of contract health care funding. 

Before I begin with witnesses, and I very much appreciate the 

witnesses for being here—I do want to introduce a couple of people 

who are joining me today. One is the Chief of Staff of the Indian 

Affairs Committee, Allison Binney. Allison is from a tribe in California. 

There is also Erin Bailey, right behind me, who did a lot of work 

as a principal staffer on the Indian Affairs Committee on the 

health care bill that is now signed into law. Allison and Erin had 

everything to do with that. Wendy Helgemo is Senator Reid’s staff 

person that works on the Indian Affairs Committee issues. And 

Wendy is with us back here. 

As a matter of courtesy, I’m going to introduce all of the folks 

who are going to be witnesses today, but I want to especially introduce the tribal chairs. Before I do that, let me introduce Dorothy 

Dupree, who is the acting Director of the Phoenix Area Indian 

Health Service office. Dorothy is right back in the back of the room. 

We appreciate very much your being here today. 

Ms. DUPREE. Thank you very much. 

Senator DORGAN. We have a number of tribal chairs. I want to 

pay recognition to the tribal chairs, some of whom I’ll introduce as 

witnesses. Let me indicate who is here. Chairman Waldo Walker 

from the Washoe Tribe. Right back over there. Mr. Chairman, 

thank you. 

Chairman Mervin Wright, Pyramid Lake Tribe, right here. Mr. 

Chairman, thank you. 

Daryl Crawford from the Inter-Tribal Council of Nevada. 

Mr. CRAWFORD. Right here. 

Senator DORGAN. Daryl is right over here. 

And the Honorable Alvin Moyle, Chairman of the Fallon Paiute 

Shoshone Tribe. Right here. I’ll introduce Alvin in a moment. 

The Honorable Billy Bell, Chairman of the Fort McDermitt Paiute-Shoshone Tribe. Where are you? Right here. 

The Honorable Loren Sammaripa, Chairman of the Walker River 

Paiute Tribe, right over here. 

And Larry Curly is with the Indian Health Board of Nevada. 

He’s right back here. Larry, it’s good to see you again. 

Let me thank all of you who worked on these issues, and especially thank the Chairmen of Tribes who are here. They represent 

the government leadership of the various tribes. As I understand 

it, there are 27 tribes in Nevada. It’s a big old state. Somebody was 

telling me if you go from the north part to the south part, you’re 

driving about 700 or 800 miles. It’s a big place. And these tribes, 

based on the map that I looked at earlier, are spread out. I know 

that it is a challenge, even under optimum circumstances, to try to 

5

make certain you’ve got the provisions for the delivery of health 

care in an area that size. 

But let me say that those who have agreed to be witnesses today 

and talk to us about what they are facing and the challenges that 

confront them, I very much appreciate you being here. 

Alvin Moyle is Chairman of the Fallon Paiute Shoshone Tribe of 

Fallon, Nevada. Mr. Moyle, thank you very much for being here. 

And what we will do is, we will take all of the formal statements 

that you have brought as part of the permanent record of the Committee, and we will ask each of you to summarize your testimony 

as best you can. We will have a two-week period following this 

hearing, and we will invite anyone who wishes to submit any testimony to the Committee to be a part of the permanent record, as 

well. We offer that invitation to any interested observer or tribe 

based on what they’ve heard at this hearing. 

So, Mr. Moyle, welcome. Thank you very much for being here. 

And you may proceed. 

STATEMENT OF HON. ALVIN MOYLE, CHAIRMAN, FALLON

PAIUTE SHOSHONE TRIBE; PRESIDENT, INDIAN HEALTH

BOARD OF NEVADA 

Mr. MOYLE. Good morning. Thank you very much, Senator Dorgan, for taking the time out of your schedule to come out here to 

the State of Nevada. And I’d like you to also pass this on to Senator Reid: That we appreciate him asking you to do this. We are 

grateful to him and we are grateful to you. And we are grateful to 

a number of people that are advocates that helped pass the Indian 

Health Care Improvement Act. What I would like to do, Senator, 

on your permission—that we allow a blessing before we begin. 

Senator DORGAN. I’d be honored. And who would——

Mr. MOYLE. Billy Bell. 

Senator DORGAN. Chairman Bell, we would be honored if you 

would offer a blessing today. 

Mr. BELL. Thank you for giving me this opportunity to offer this 

short prayer. On behalf of everyone here as well, Senator, thank 

you. If I may use my own language. 

[Prayer/Blessing.] 

Senator DORGAN. Chairman Bell, thank you very much for that 

blessing. I was thinking, as you completed the blessing, that among 

the things I’m very proud about this Committee is the passage 

some while ago of the Esther Martinez Language Preservation Act. 

It was a long time coming, and the passage of that was, I think, 

a very significant event. 

Mr. Moyle, Chairman Moyle, you may proceed. 

Mr. MOYLE. Thank you, Senator. Is this also recorded, other than 

the fact that we can turn in our testimony? 

Senator DORGAN. What we have is a court reporter. That’s the 

method of recording. We also have amplification as a result of the 

microphones. 

Mr. MOYLE. Okay. Senator, I do ask that because of the fact that 

I have testimony prepared, but I would also like to speak on and 

with the subject as I am getting to that area. 

Senator DORGAN. That’s fine. Your formal testimony will be part 

of the record, but anything else that you say or add is also a part 

6

of the record today as a result of the recorder that we have with 

us. 

Mr. MOYLE. Thank you for that. I think that you have done well 

with taking a look at the Indian Health Care Improvement Act in 

that it’s a needed item in the lives of the Indian people. And the 

order of summarization of that—there’s no use of me restating 

something that you’ve already said, and it was part my oral statement. I want to thank you for being a big part of that. I’ll go that 

far because I know that you were one of the major players in what 

went through Congress, as you stated it already; I’ll still go ahead 

and state it because it is going to come from the leadership from 

the State of Nevada. 

I happen to be, also, the President of the Indian Health Board 

in Nevada, and at the present time, President of the Inter-Tribal 

Counsel of Nevada. I also serve on two committees that have been 

set up by the Indian Health Service Director. One has to do with 

the consultation policy, which we pretty much, I think, completed 

at this point. There are two items that we’re working on—the Contract Health Service and the formula. We had began talks at two 

meetings already on the Contract Health Service, and we have yet 

to begin on the formula. And this is one which, as you spoke on 

earlier, is a major issue. I appreciate the fact that you mention that 

there’s going to be some investigations at some of these Indian reservations, because that is what we’re trying to bring to you or Senator Reid, our Senators, is the story that’s at our reservations. If 

Congress fails to observe what is actually happening and continues 

to disregard what is actually happening, our people will suffer, and 

continue to suffer. And it should not happen. Not in this century 

that we’re living in, and it shouldn’t have happened in the past. 

Not for what the Indian people gave. I wouldn’t say ‘‘gave.’’ What 

was taken. I’m talking about the land. They have contributed a lot 

to the United States of America. And to be treated like a thirdworld country is unreal. And I could say it in many different ways, 

but, myself, as a tribal leader, I have a responsibility, for one, a 

huge responsibility. And I am proud to be in a position that I’m at 

to be able to relate to you what some of those responsibilities are. 

And this morning what we’re talking about today is health. And I 

don’t want to go on and on about it, but I just want you to be 

aware. 

In this case, I’m from Fallon, but there are tribal leaders here 

from some of the other reservations, which I’m grateful of, and I 

appreciate your asking for as many of them to show up here. But 

as being president of the Indian Health Board in Nevada, it is also, 

not only a responsibility for me to look at as far as my people in 

Fallon, but there’s also the State of Nevada. But I do have other 

colleagues with me now that are going through the same, I guess 

you would call it an issue that is critical to our people, critical to 

the point of—there will be expressions made, and I appreciate the 

people that are here that I see sitting at the table that will explain 

what we’re going through. And that is the other question I have 

that: If we provide you with testimony here and it will be going forward to another point in time, you did talk about another hearing, 

is that what we have looked at time after time—and I’ll go back 

to being a member of NCAI, is that we asked for a follow up, and 

7

you know, we were a big part of helping them move the Health 

Care Improvement Act with the efforts of all of the tribal leaders 

and NCAI, but the issue is still there, such as the one that, even 

more or less expounded on talking about the Aberdeen area. The 

State of Nevada is similar to that. Very similar. In the meetings 

that we’ve had the with the director, the tribal leaders that have 

been able to be appointed to that Committee, we talked about: 

Okay, we’re doing this, we’re working on this issue, but how far 

will it go? How far will this go? And we keep asking that. 

Discussing it just a little bit further: At our last session that we 

had in Denver, we talked about that again. And we talked about 

it to the point of bringing it before the next assembly in NCAI, the 

one coming up. I know that you have been a person that has been 

at almost all the NCAI conferences. If you’re not there in live person, you’re there on screen. And there’s a lot of people that realize 

that your heart is with us. I’d like to mention one of the items before I get into this testimony. You brought it out. The system that 

has been developed—and I’ll say it’s been developed by—in this 

case, the Indian Health Care system, let’s call it—it has a beginning point of how to get to developing a program. It gets to a certain point of being developed and then it starts becoming where it 

gets into this political arena. And what I mean by that is that regardless of each year that the tribal leaders are asked to develop 

a budget for your reservation, and then we go further and develop 

the one for the State of Nevada, and then we turn that in and it 

goes to the Phoenix area office. And then from Phoenix, they take 

it further, and the budget continue on coming from around the 

country, and before it gets too far up the ladder, before it gets to 

the Congress that would make a decision on appropriation, O.M.B. 

takes their visit with it. And this is where I have, being a tribal 

leader for a number of years, have taken a look at that and listened to a lot of people that take a look at where is the—let’s call 

it the real concern that those people sitting on the Office of Management and Budget, as far as making decisions about let’s just cut 

this because we don’t feel it’s necessary. We feel that there is a gap 

in this, let’s call it, the process that has been developed by Congress in this case of a need that has been asked for and requested 

for by tribes working day and night to develop a budget. And it 

goes to one point and it goes to another point and O.M.B. gets it 

on their desk and it gets cut. 

And then in the meantime, behind the scenes at home, we have 

a lady dying, we have a young child that needs an operation that 

is being denied that because we don’t have enough money or, like 

you said, that lady had a message taped to her leg that said that 

if she gets admitted, it’s your bill, not ours. Now, that is totally 

wrong, and you brought that out; I appreciate that. 

Anyway, my people are going through this of being denied services, and I do believe that there’s a few more other people here 

that’s going to say the same thing. And I don’t want to take a lot 

of time and keep elaborating on that, but I do want to make that 

expression; I want you to know that. The testimony that I have is 

a few pages long and I’ve already said who I am and how many 

tribes are in the state of Nevada. I think that’s very important. 

8

There are a number of people that we have that we have a responsibility to help and I’m glad that you acknowledge that. 

The Fallon Paiute Shoshone people live 65 miles from Reno, I’m 

pretty sure you’re aware, in an area that has been known as the 

Oasis of Nevada, also it’s what is called the Great Basin Area. 

So getting back to the 27 tribes. And really three tribes in the 

state: the Washoe people, the Paiute people, and Shoshone people. 

But because over the years that bands were formed and they’re 

from north to south, east to west in the state of Nevada, actually 

beyond the state, into Idaho, into California, California on into Arizona, the Paiute people, Shoshone people, and the Washoe people. 

We’re not only in the state, but we do have a number of miles to 

go if we are to receive medical care, because of no hospital. And 

that is a detriment to our people. I think what I’ve done as far as 

expounding on some of the issues, I think I’ve provided you with 

that. I think you have a chance or opportunity to read my testimony and I appreciate Allison being here because, to me, she has 

been a real advocate for Indian people in working with those issues 

that you assign her to. 

One of the areas that I think that is very important for—other 

than the fact that I have some of this in my testimony that I’m 

going to refer to, I guess I can start off: I do believe that you talked 

about another hearing happening—and I’m not just exactly sure, it 

might be happening in another area which will give that other 

group of tribes an opportunity to be able to testify—the one thing 

that I do believe is very important that happens in the state of Nevada, talking about that area office, we’re talking about one way 

to take a look at this issue of adequate health—or the access to 

health care. Access to health care, to me, is very important. How 

does the State of Nevada justify to the people, at the area level, 

at the regional levels, and then at the headquarters level, and then 

further on into Congress? And I have to bypass O.M.B., because it’s 

immaterial to them. 

Getting back to my point is that access to health care: How is 

that really determined other than the fact that O.M.B.—we don’t 

really—you know, that’s no concern of ours. Congress says this is 

the amount of money we’re going to have and this is what it will 

be. There has to be a, call it, a collection of data that can prove 

for a fact that this is what’s happening in the state of Nevada; such 

as the one in I think that you’re going to take a good look at in 

the Aberdeen area. There has to be a collection of data. And that’s 

why when I look at, okay, what is the real benefit of an area office? 

To me, if you’re looking at a problem, okay, let’s get some people 

there and we’ll take a serious look at this, and that’s what I would 

like to see. That we take a serious look at this, not just a look at 

some spreadsheet that someone types up and it will tell the area 

of this and then we’ll go further and tell headquarters of that. 

When you take a look at it, in some cases what we would have, we 

would have a number of denials that are not going to be on that 

spreadsheet. It flat isn’t going to be on that spreadsheet. They’ll be 

back at our clinic. And that is wrong. 

In the meantime we have—other than the fact that we have that 

problem, we have a problem of people that would be treated, let’s 

call it, with preventative medicine or preventative treatment that 

9

could prolong the life of that person—be it in a youngster or in the 

oldest person we have—it could prevent that person from getting 

worse, and yet we’re prohibited right now because of the funding 

from having that preventative care. I think it’s just to me, I 

wouldn’t want to offend you at all. You’re probably way past that 

point. But to me, it’s almost a replication of genocide. By denying 

a person treatment for cancer—and I’m talking about not a person, 

I’m talking about people, a number of people. And that’s happening 

right today in the state of Nevada. To me, I’ll put a label on it, this 

is a replication of genocide. It shouldn’t happen. It should not happen. 

Senator DORGAN. Well, Chairman Moyle, we certainly understand and can feel and hear your passion in the testimony. And we 

will hear from the others, as well, and then I’m going to ask a series of questions about some of the items that you’ve mentioned as 

well. 

But I really very much appreciate your testimony and the fact 

that I know it is heartfelt. We appreciate your being here. 

Mr. MOYLE. Thank you. 

[The prepared statement of Mr. Moyle follows:]

PREPARED STATEMENT OF HON. ALVIN MOYLE, CHAIRMAN, FALLON PAIUTE

SHOSHONE TRIBE; PRESIDENT, INDIAN HEALTH BOARD OF NEVADA

Senator Dorgan, Members of the U.S. Senate Indian Affairs Committee, and Staff. 

It is a pleasure and honor for me to welcome you to Nevada and the opportunity 

to address the Committee regarding the healthcare crisis that we, in Nevada, have 

endured for the past 24 years. There will be others who will present their views and 

comments on this crisis. 

My name is Alvin Moyle. I am the Chairman of the Fallon Paiute Shoshone Tribe 

and currently the President of the Indian Health Board of Nevada and the InterTribal Council of Nevada. There are twenty-seven Tribes in the State of Nevada 

with a total Indian population of over 36,000; approximately half of this number reside on the reservations and colonies previously mentioned. Twenty-five of the tribes 

are located in the northern half of the State—a State that measures over 777 miles 

from the Duck Valley Shoshone Paiute Reservation on the Nevada/Idaho border to 

Laughlin, Nevada at the southernmost tip of Nevada. It is mostly rural with at one 

County having 4/10’s of a person per square mile! It is within this geographical environment that Nevada tribes exist—a place where they have lived for centuries. 

Approximately 65 miles east of Reno lies Lahonton Valley and referred to as the 

‘‘Oasis of Nevada:’’ an area known for its agriculture and ranching environment. It 

is also an area where my ancestors lived, hunted, and gathered. This land was given 

to the United States government in exchange for a guarantee that the Federal Government will provide certain services to our tribe and one of them was the provision 

of health care. Unfortunately, it is a guarantee that has not been honored for the 

past few decades. It is within this historical background that 13 tribal health clinics 

were either contracted or compacted by tribes. There are no Indian Health Service 

Hospitals anywhere in the State and if specialized medical care is required by patients, they are either sent to Phoenix Indian Medical Center (PIMC) or to local providers using the Contract Health Service (CHS). Either of these options are 

daunting options: (1.) Traveling to PIMC requires enduring ground transportation 

of over 600 miles from the Fallon Paiute Shoshone Tribe to Phoenix or air travel 

that requires an hour and half of flight time—too long when one is sick and in pain; 

or (2.) being CHS-referred to local providers, who for lack of timely payment by the 

Indian Health Service will report the patient to collection agencies or worse, being 

requested to ‘‘pay up front’’ for their healthcare. 

As the elected leader of my tribe, it is my responsibility to ensure the health, safety, and well-being of my tribal constituents. I have begun to conclude that access 

to quality healthcare in Indian country has become a struggle between the ‘‘haves 

and have nots.’’ Nowhere on the Indian Health Service list of healthcare facilities 

to be built in the foreseeable future is there any mention of a Nevada tribe on the 

list—yet it appears that larger tribes with greater resources continue to inhabit the 

top rungs of that priority list. Maybe they continue to be on the list due to their 

10

population growth and maybe they are growing in population because they are getting better healthcare and living longer! In some areas of the country, there are 3–

4 Indian Health Service hospitals within a 50 mile radius of an IHS Medical Center. 

Yet, we in Nevada have no access to an IHS hospital Within a 600 mile radius and 

thus, our reliance on Contract Health Service funding for the provision of specialized medical care grows exponentially. When my medical director of our tribal 

health clinic makes a CHS referral, it is due to his knowledge of medicine. Yet his 

practice of medicine is dictated by the availability of CHS dollars. When President 

Obama signed an Executive Order requiring all federal departments to develop and 

implement their respective Tribal consultation policies, nowhere in that document 

was there an exemption for any federal department. Yet, the Office of Management 

and Budget (OMB) cuts Contract Health Service funds WITHOUT consulting with 

tribes—funds necessary for my medical doctor to practice medicine and provide the 

best medical care which was promised when we gave away the Lahonton Valley. 

The Federal Trust Responsibility is a federal responsibility of which the OMB is a 

part. Furthermore, it should be noted that the guarantee of healthcare to my people 

and the tribes of Nevada was not contingent on the availability of funds or whether 

it fit into the ‘‘Priority One’’ category of the CHS Program. 

Senator Dorgan, the combination of these issues have impacted our communities, 

our families, and the future of Nevada tribes. The lack of CHS funds, the inequitable funding formulas, the non-existence of an IHS Hospital in Nevada, and the 

arbitrary treatment of tribes by OMB contrary to the promises made and the federal 

trust responsibility that are inherent to every federal agency. In the past decade, 

there have been many unnecessary deaths due to patients delaying their medical 

needs ‘‘until there are more funds at the beginning of the fiscal year.’’ I have gone 

to far too many funerals in the past year and I am tired. Even with these dire circumstances, there have been rays of hope which is contained in the passage of the 

Indian Health Care Improvement Act. To you Senator Dorgan and members of the 

Indian Affairs Committee, we are grateful and thank you for your continued support. Specifically, contained in the new law is the establishment of the Nevada Area 

Office. We believe this to be a major accomplishment in beginning to address the 

healthcare disparities in Nevada. In order to make this a viable office, it will require 

funding. It is estimated that this amount is $8.7 million. Senator Dorgan, keep the 

promise that was made and ensure that it is funded adequately and ensure that 

CHS funds are available so I will not have to write condolences to families who have 

lost their loved ones unnecessarily. 

Senator, thank you for the opportunity to provide our testimony and we continue 

to look to you for your leadership—whether you are in the Senate or whether you 

are at your favorite fishing pond.

Senator DORGAN. Next we will hear from Chairman Billy Bell, 

who is Chairman of the Fort McDermitt Paiute and Shoshone 

Tribes in Fort McDermitt, Nevada. Mr. Chairman Bell, thank you 

for being here. You may proceed. 

STATEMENT OF HON. BILLY A. BELL, CHAIRMAN, FORT 

MCDERMITT PAIUTE AND SHOSHONE TRIBES 

Mr. BELL. Thank you, Senator, and good morning and also welcome to Nevada. It’s a great pleasure to be here this morning and 

represent Fort McDermitt Tribe. I, too, like the rest of the leadership here, and I’m sure the rest of the leadership throughout the 

country that you’ve heard so far, would like to discuss some of the 

impacts that the Contract Health Services inadequately provided 

for a lot of our tribal members. And it’s created a lot of impacts 

for a lot of us. 

And as far back as I can remember, it’s been over a decade or 

so, where I recall as a tribal employee over at Fort McDermitt 

Tribe and its leaders are working pretty close with their neighboring tribes, some of who are represented here today, in fact. And 

I’m trying to make this awareness to the IHS leadership out of 

their service unit, as well as the area office, as well. I think at 

some point we realize that all of our people’s health care is really 

11

beginning to dwindle. In fact, you’ve heard Chairman Moyle’s testimony of how some of it is really impacted a lot of us. And some 

people are not here today to testify if they were given that opportunity. And, I guess, there at Fort McDermitt, if you will, Senator, 

we’re No. 9 on the map, which is way up on the top left-hand corner, Fort McDermitt side of the Nevada/Oregon border. I guess, 

what we looked at there at Fort McDermitt is the geographical location, the retention there, that we try to maintain, I suppose, at 

out clinic. We are a direct service tribe from the IHS. That’s what 

separates us from the rest of Nevada. The tribe’s under the Schurz 

Service Unit, which we’re serviced under. And a lot of it has to do 

the inadequacy of our contract health funding and lack of oversight, the administrative part from the Schurz Service unit. 

So more recently what we became more concerned with is the denial for referrals to outpatient treatment and diagnosis. And, of 

course, that has to do with the Contract Health Service budget, 

and also the IHS, which is a tier–1 system, that approval rating 

system that they have created. And, historically, Fort McDermitt 

is a former military reservation. It was established in 1865. It was 

abandoned in the late 1800s, and it became an Indian agency. We 

call ourselves the ‘‘Pah-na’kwit’’; that means people that come from 

water. It has to do with the Great Basin itself. It was Lake 

Lahontan at the time. And, like many other tribes, we’re located 

approximately 75 miles from any type of goods and services, which 

is in Winnemucca, Nevada, and that’s our nearest hospital. And it 

doesn’t provide all of the specialized services that we require. And 

for those specialized services, we highly depend on the Contract 

Health Service budget. 

The majority of people, in order to receive that type of care, come 

here to Reno. Round-trip, that’s an eight-hour drive. The majority 

of those people are diabetics, elderly, and very sick people that are 

transported in 15-passenger type vans. Right now we have an IHS 

health facility, the very first one. It was built somewhere in the 

early 1970s. And, then, more recently we had it replaced. Currently, we have about ten full-time IHS employees. We also have 

emergency medical service, which at some times is not staffed. And 

it also has to do with the budgetary issues. It also has to do with 

administrative oversight. And, I guess, the government’s gone to 

contracting a lot, and not be able to maintain or hire any IHS employees. IHS has been contracting a lot of its services to people. 

And I believe that through contracting, in order to fulfill some of 

those quotas, we don’t have the quality or qualified personnel to fill 

some of those vacancies. 

And we also do have a diabetes program on my reservation, 

through a wellness center. And the tribe there has given or has an 

agreement with IHS to utilize our tribal health—or our tribal gym 

and our youth center. We’ve turned it into a wellness center for the 

people. And ever since Fort McDermitt realized these problems 

began, the tribal leaders, their efforts was to ensure that we at 

least somehow receive quality health care. And we banded with the 

other tribes. And, in fact, that’s how the Indian Health Board became an entity itself because of the concerns from our people and 

the tribal leadership. 

12

But, I guess, more specifically, Senator, we affirm that our basic 

health demands is the trust responsibility to the IHS for overseeing 

our health care delivery system and for ensuring that the delivery 

of that care of services and programs provided by IHS. And we continue to insist that our health services were mirrored by a lack of 

administrative oversight. An example is the Phoenix area office at 

one point owed health providers over $6.7 million in unpaid health 

costs, just like the Aberdeen office. As of a few days ago, when I 

spoke to the administrator of the Humboldt General Hospital 

which serves our reservation, IHS currently owes them $609,000 

for the past two years. These are an unpaid debt that’s owed to 

them still. And really there, Senator, has created an almost a defensive mode and somewhat similar to the story you talked about 

this lady that was brought into the ER. It’s almost the same situation. It’s created an animosity amongst the health care providers 

in our area, especially with our ambulance service when they bring 

in patients; they’re ridiculed by some of the staff there because of 

this issue. 

As you are aware, it’s not just in Aberdeen, but here, we believe 

the service unit caused the catalyst amongst our Northern Nevada 

health care providers. Some of them has discontinued their relationship with us. Not only in the tribal clinics, but also through the 

IHS. Because of the IHS issue, our tribal members are denied 

those services. As you mentioned earlier, it does affect personal 

credit. 

One thing that I would like to point out directly is that in Fort 

McDermitt, we assert that the Federal trust responsibility through 

President Barrack Obama Tribal Nation’s address for governmentto-government stability and transparency, and his overall all strategy on health care. We believe that it can be delivered to us 

through a Nevada IHS Indian hospital. 

In closing, Senator, and to fulfill America’s health care needs—

which is a big concern and talk around many tables, I’m sure, 

around the country, and also to meet our tribal nations unmet 

health care needs, I urge the Senate Committee to take all of our 

testimonies here today and earnestly go to our request and utilize 

the contents. It shows how we care about our people. At the same 

time we strive to reside among ourselves within our own communities and with the other tribes and neighbors in our homelands 

here. 

And I also want to thank you, Senator Dorgan, for this time here 

today, and also the diligence in serving the American people and 

the interests and allowing me to speak on behalf of all of my NaNuwuhs, relatives, Paiute and Shoshone and the Washoe peoples 

of Nevada. Thank you. 

[The prepared statement of Mr. Bell follows:]

PREPARED STATEMENT OF HON. BILLY A. BELL, CHAIRMAN, FORT MCDERMITT PAIUTE

AND SHOSHONE TRIBES

Good morning. Senator Dorgan, it is my great pleasure to appear before the Senate Committee on Indian Affairs this morning to discuss the IHS Contract Health 

Service and the impacts it created along the way for my Na-Nuwuh (relatives) of 

the Fort McDermitt Indian Reservation of Nevada and Oregon. 

For over a decade the Fort McDermitt Paiute and Shoshone Tribe and its leaders 

has worked extensively with neighboring tribes to ensure that the Health needs of 

13

our Tribes were met and made aware to the Schurz Service Unit, the Phoenix Area 

Office and their respective directors, especially when health care services on our reservations became ever so despairing as our people’s health began to rapidly decline. 

Fort McDermitt’s efforts were based on our geographical location, retention of key 

medical and support staff, the inadequacy of contract health funding, lack of oversight from the Schurz Service Unit, and more recently, the Indian Health Service’s 

denial of referrals to special providers for out-patient diagnosis and treatment due 

to the lack of funding in the Contract Health Service budget and the IHS tier–1 approval rating system. 

The Fort McDermitt Indian Reservation straddles Nevada and Oregon, is a former 

military reserve built in 1865 and abandoned to become an Indian agency. We are 

known as the Pah-na’kwit (People from water). Today, we are located 74 miles from 

goods and services and our nearest hospital in Winnemucca, Nevada. For our specialized health care needs we highly depend upon the contract health services and 

receive this type of care our nearest facility is here in Reno, a tiresome eight hours 

round-trip drive. 

Approximately 9 years ago our long-time resident provider retired due to his own 

ailing health, the medical records person is nearing retirement, and our substance 

abuse provider has retired. Currently, we have a temporary medical provider, a 

community health representative, a billing clerk, a facilities manager, facility maintenance, and two motor-vehicle operators, an Emergency Medical Service (two ambulances and several paid volunteers) and on a monthly basis we have a contract 

optometrist, dentist, podiatrist and psychologist. Our pharmaceutical and prescription requests are filled from the pharmacy at the Schurz Service Unit. We also have 

a diabetes program, which contracts two positions and operates our wellness facility. 

Our first health clinic was built in the early 1970s and was recently replaced in 

2009. 

Fort McDermitt is a direct service tribe, our administrative and support services 

to maintain and operate our clinic is managed and overseen by the Schurz Service 

Unit Director in Schurz, Nevada. 

Over the past decade, our efforts to ensure we at least received quality health 

benefits, has fallen on deaf ears, from the unit director to the area director. Our 

remoteness, lack of providers, retention and recruitment, and distance from acute 

and long-term health facilities has attributed to the health needs of my People. Moreover, we affirm that our basic health demands is the trust-responsibility of 

the IHS for overseeing our health care delivery system and for ensuring the delivery 

of that care consists of services and programs provided directly by the Indian Health 

Service. We continue to insist our health services were mired by the lack of administrative oversight. The Phoenix Area Office owed health providers $6.7 million in unpaid health costs and currently IHS owes Humboldt General Hospital $609,184.00 

for the last two years. HGH serves the Fort McDermitt IHS area. 

This oversight has caused a catalyst among some of Northern Nevada’s health 

care providers to discontinue their relationship and refusal to provide specialized 

services to our tribal members and the unpaid bills turned over to collections affecting personal credit. 

We assert that the Federal trust-responsibility through President Barrack 

Obama’s Tribal Nation’s address for government-to-government stability and transparency, and his overall strategy on health care can be delivered to us through a 

Nevada IHS Indian hospital. 

In closing, to fulfill America’s health care needs and to meet the Tribal Nation’s 

unmet health care needs, I urge the Senate Committee to take our testimonies and 

earnestly look to our requests and utilize their contents to show how we care about 

our People while we strive to reside among ourselves and our neighbors in our 

homelands. Thank you Senator Dorgan, for your time here today and the diligence 

serving the American people’s interests and allowing me to speak on behalf of all 

my Na-Nuwuh; the Paiute, the Shoshone and the Washoe Peoples of Nevada.

Senator DORGAN. Chairman Bell, thank you very much. My un- derstanding is that $6.7 million that is owed to providers here in 

this region has grown to nearly $10 million, which I assume puts 

more and more pressure on some of these providers. To say, You 

know, we don’t want to continue to offer these services is a serious 

problem. We’ll talk about that in a bit. 

Ms. Cindy Curley runs a tribal health clinic. So we’re talking 

about the things in the abstract; now we’re going to hear from a 

witness who is the Director of the Pyramid Lake Tribal Health 

14

Clinic. My assumption is your experience is you go to work every 

morning trying to see what this clinic is doing and managing the 

affairs of the clinic, and you understand what day-to-day all of this 

is about. So we’re very pleased that you’re willing to be here with 

us today to testify. 

Ms. Curley, you may proceed. 

STATEMENT OF CINDY CURLEY, HEALTH DIRECTOR, PYRAMID 

LAKE PAIUTE TRIBE 

Mr. CURLY. Thank you. I’d like to start off by saying thank you 

for the opportunity and honor to come up here and share my 

thoughts and views. I also want to thank the Chairman of the Pyramid Lake Paiute Tribe and the other counsel members for being 

here today. The Pyramid Lake Paiute Tribe is located in Nixon, Nevada, and we’re 45 minutes northeast of Reno. You should go out 

there sometime; it’s absolutely beautiful. 

More to the point: Due to the depletion of the contract health 

funds, last year we ran into a huge problem. We had over 100 

health care providers that refused or limited the services that they 

would provide to our patients, unless either the patient or the clinic paid up front. The situation got so bad that when we finally 

could get an approved referral, we had no provider to send our patients out to. We had cases that we would even try to send them 

to PIMC, Phoenix Indian Medical Center, to try to get care, and we 

couldn’t even get them into Phoenix Indian Medical Center. They 

were turned away, saying that there was no time available to see 

our patients. This puts our patients in a really bad situation. We 

have had dialysis patients, patients we need to refer out for various 

kinds of heart disease, pacemaker implementations, no providers to 

send them to. Nevada is one of the highest health care states in 

the Nation. 

And to further exacerbate this problem is the fact that we pay 

full billed charges for any health care to these contracted providers. 

So what little money we do get for contract health care, we pay the 

highest rate possible. We have asked for years that we have somebody that could negotiate with these specialty providers for a reduced rate agreement. And to date, this has not happened. So the 

CHS funds deplete rapidly. And in a lot of cases, we’re out of CHS 

funds by April or May, and we have nowhere to send our patients. 

This not only puts our patients in a really bad situation, but it puts 

our providers that we have at our health care facilities in a very 

precarious situation. It forces our providers to work more and more 

outside of their scope of work. So there’s a lot of liability issues. 

We have cases, and we still deal with cases today, where we cannot get approved referrals to send our patients out that need care 

that we just cannot give in our facilities. If you were able to come 

out and take a look at a lot of our clinics, you would see that we 

don’t have the same equipment that other clinics, like in Arizona 

and other places, have. We don’t have all the equipment that they 

do. We have limited labs. We don’t have the resources to provided 

good prenatal care. Yet we have denials, CHS denials for prenatal 

and delivery services. So those aren’t getting paid for. We have patients who need their pacemakers put in, and that’s not paid for. 

Seizure patients that we have to refer out that they don’t get paid 

15

for. Patients who we can send out and they can find out that they 

have cancer, but they won’t be approved—the chemotherapy treatment that they need to save their lives. We have a patient who has 

a pacemaker and the battery was going dead. We couldn’t get an 

approved referral for a new battery for that pacemaker. So if his 

heart stops, there’s nothing to get it going again. These are just a 

few cases. 

My contract health clerk put together a spreadsheet. And after 

I get approval, I would like to send it to you guys. There is a rather 

detailed spreadsheet that lists all of the referrals we’ve done in the 

last year. We did four hundred—and I updated the list—we had 

486 referrals from November to current. Out of those 486 referrals, 

only 94 of them were approved. Ninety-four. That’s it. Most times 

when we try to send our patients to Phoenix Indian Medical Center 

because we can’t afford to pay the specialty providers out of our 

own clinic funds, we can’t get them into Phoenix Indian Medical 

Center. The Schurz Service Unit Hospital wasn’t shut down because it lost its certification; it was because it was condemned. And 

there was a promise of replacement—or repair by replacement, and 

today that hasn’t happened. 

We have a huge need. Almost every day I talk with the patients. 

For one reason or another a patient will come in to my office. We 

have patients that have severe 1 injuries that have never had the 

opportunity to be able to go in and have the surgical procedures to 

correct those injuries. So instead they’re put on high-powered pain 

medications that were never intended to be taken for long periods 

of time. The prolonged use of these pain medications create other 

problems with these patients. It does liver damage, kidney damage. 

They become addicted. And then they’re labled as addicts. Well, the 

patients didn’t do this to themselves. They can’t get referred out for 

the—and they can’t afford the surgeries themselves. So by no 

choice of their own they’re put on pain medications; they get addicted. And more and more the formularies in our pharmacies are 

being reduced. And we don’t have pain management specialists. 

And we don’t have access to them. 

I called last week. For example, we had a few cases that we need 

to—some patients that we need to send for pain management. And 

this costs $391 for the first initial visit; between $45 and $91 for 

each follow-up visit thereafter. We can’t afford that at our clinic. 

And it’s not something that’s paid for by contract health dollars. So 

we have a big problem on our hands. And we have had accidental 

overdoses. We have been faced with a huge gauntlet of problems. 

The patient, when we have to send them out—and we tell them up 

front that there’s no guarantee that their health care bills are 

going to be taken care of. A lot of them, even if we get them a referral and it’s been approved, they’re still afraid to go to the doctor 

because they know they can’t afford to pay that bill. They get 

hounded by the bill collectors, even though we send letters out telling the bill collectors you cannot send that to our patients if they 

have an approved referral. Therefore, they just won’t go and seek 

the medical care they need. And this leads to a lot of other health 

conditions for them, a lot of health problems that they have that 

are totally preventable and avoidable. 

16

And it’s frustrating for the patient. It affects them mentally, it 

affects them physically, and emotionally. When they can’t have 

their health care needs taken care of and they cannot go out and 

get a full-time job, it affects their quality of life. It not only impacts 

the patient, but it impacts the patient’s family and relatives, as 

well. We have a very high unemployment rate out there. And we 

have a lot of patients that are in a lot of pain. Some of their medications that they take are not part of our formulary, and they are 

no longer approving for our patients to go to outside pharmacies to 

receive what they need. We have a very high diabetic population 

out there. They suffer from a lot of other health conditions and 

comorbidities that are actually preventable. 

We have, as part of our CHS denials, one of our contract health 

patients, one of their denials was that they were a dialysis patient. 

We have a dialysis patient that did not get an approved referral. 

We have patients, not only at the Pyramid Lake Tribal Health 

Clinic, but at other tribes that will make the comment: They’re just 

waiting to die. We had 18 mortalities this last year. And I can’t sit 

here and say that their lack of health care is the only reason for 

them passing away, but it does contribute to a shortened life span 

for these guys. I mean, it is really sad. And the family members 

that they leave behind—and it’s extremely frustrating. 

All of us health directors—and there’s a couple of us here 

today—work on the frontlines. And we spend a lot of time trying 

to find alternative resources for our patients. The problem is staggering. And it’s not getting any better. And when we have less than 

one percent of the American Indian population here in Nevada that 

can access Phoenix Indian Medical Center, but we can’t get a hospital here, this is a serious problem. And the providers are upset, 

the specialty providers we send our patients to, they’re angry because they went for a long time without having their bills paid. 

They don’t want to have to deal with this. In a lot of cases our patients come back and say they’ve been treated badly, so they don’t 

want to go back again. So, the clinics—we do spend our own funds 

to try to help for medications. We had a dialysis patient—she was 

a kidney transplant patient—she got approved for a kidney transplant, but we cannot get an approved referral for the medications 

that she needs to keep her body from rejecting the kidney. The 

medications are not part of our formulary. So here’s this huge cost 

for a kidney transplant, but if it was left up to the IHS contract 

health—this patient doesn’t have the funds to pay for help, so she 

would die without any intervention. So we help pay for her medications to keep her going. 

I’m trying to keep it toned down. This is a very frustrating issue. 

We’ve spent years talked about these situations. There was another 

hospital that was put in Nevada, but the tribes weren’t consulted 

as to where that hospital should go and where it would be most effective. 

Bottom line is we have patients that are suffering because they 

cannot get the health care they need. We’re not equipped in our facilities to deal with a lot of the needs of these patients. 

Senator DORGAN. Ms. Curley, I have a hunch that you could talk 

about this all day. 

Ms. CURLEY. Yes, I could. 

17

Senator DORGAN. And what you’re telling me is pretty unbelievable in many ways. I expect we’ll hear from Catherine Harris, as 

well. I think a lot of policy-makers would be very surprised to hear 

much of the testimony about the day-to-day difficulty of people who 

have very significant health issues. The provider knows it; that is, 

the Indian Health Service. That comes to the diagnosis at the clinic 

and then the question is, yes, that’s a very serious health problem, 

but a patient can’t get from ‘‘A’’ to ‘‘B’’ to ‘‘C,’’ because the system 

doesn’t allow that. And so it is—I’m going to ask some questions 

about the testimony that you’ve given me. But it appears to me 

when you talk about 59 percent that were turned down and I believe you indicated 6 percent of those died. That’s 14 people that 

died, despite having shown up, tried to get help, and didn’t get the 

help they needed. I mean, whoever those 14 people might be, no 

one will ever know because they just dropped through the systems. 

Ms. CURLEY. Yes. 

[The prepared statement of Ms. Curley follows:]

PREPARED STATEMENT OF CINDY CURLEY, HEALTH DIRECTOR, PYRAMID LAKE PAIUTE

TRIBE

Mr. Chairman, members of the Committee and staff, thank you for the opportunity and the honor of sharing with you our views and thoughts about the 

healthcare crisis that we in Nevada face with a shortage of contract health service 

dollars. 

My name is Cindy Curley; I am the Health Director for the Pyramid Lake Paiute 

Tribe located in Nixon Nevada which is 45 minutes northeast of Reno Nevada. I do 

not pretend to speak on behalf of the 26 other tribes in the State of Nevada. I will 

however; share with you our experiences with the CHS program, lack of access to 

healthcare and the impact of these two issues on our population at Pyramid Lake 

Paiute Tribe. 

And what are these issues?

1. Due to the depletion of CHS funds, 106 local healthcare providers are either 

restricting or declining to accept any additional CHS patients who are referred 

to local health care provider UNLESS they are ‘‘paid up front.’’

2. Further exacerbating this problem is that local healthcare providers are still 

billing Tribal Health Clinics at ‘‘full charge billing.’’ Although regulations were 

disseminated to clarify that the Tribal clinics are exempt from this practice, 

healthcare providers have interpreted the revised regulation as pertaining to 

only ‘‘inpatient care’’ and not ‘‘outpatient care.’’

3. As a result, patients who have been referred are being hounded by Collection 

agencies to collect the cost of the healthcare provided—bills that rightfully IHS 

should be paying. Patients are impacted by this situation—mentally, physically, 

and emotionally. Moreover, their credit ratings are being negatively affected.

4. More significant are the numbers of CHS-referred patients either declining 

or deferring their healthcare until additional CHS funds are available. As a result, their health status worsens and will eventually cost even more. The number one health issue affecting Nevada Tribal members is Diabetes—chronic disease with costly co-morbidities such as heart disease, chronic kidney disease, 

amputation.

5. CHS approves renal transplant yet patient unable to obtain required medications to support the transplanted kidney. Medications include: Cell Cept, and 

rapid acting insulin regimens per the Stanford protocol at high risk for rejection 

of donor kidney due to formulary restrictions.

6. Pain management issues are huge in this environment. Individuals with 

chronic pain are denied orthopedic and neurological consults with escalating 

narcotic requirements now at risk for sudden death due to extraordinary requirements without pain management availability. Sometimes the cost of the 

narcotics may be more than the procedure needed to correct the problem or the 

appropriate pain management which is not available.

18

7. In the past year, we have had 413 referrals of which 59 percent have been 

denied due to ‘‘not within priority’’ What constitutes priority? The response is: 

if you can make an appoint to have it done, it does not constitute priority level 

one. And Mr. Chairman, members of the Committee, of the 59 percent that have 

been denied; 6 percent have died. Yet we are told this problem is the same 

across the board. This explanation holds no comfort to the families affected by 

these untimely/preventable deaths.

Proposed solutions 

The CHS Funding Formula Needs to be Revised to Reflect: 

Distance Traveled 

Members of the Pyramid Lake Paiute Tribe have to travel between 45 and 90 

minutes to see a specialty provider or get to the hospital. Other tribes have to travel 

2 hours or more each way to receive any sort of healthcare. This is extremely difficult and tiresome for Dialysis patients who have to make this trek 2 to 3 days per 

week. 

Access to Healthcare 

There is no Indian hospital in the state of Nevada since the Schurz hospital was 

shut down in the 1980s and further exacerbating the problem; less than 1 percent 

of the Nevada Tribal populations have had access to Phoenix Indian Medical Center. 

Cost of Healthcare 

Since no contracting has been done with specialty providers or hospitals, we are 

forced to pay full bill charges which rapidly deplete the CHS dollars. 

Need for Preventive Healthcare 

This would in the long run reduce CHS spending and improved the health status 

of Native Americans in Nevada. 

Funding for the creation of the Nevada Area Office; this would give Pyramid Lake 

and other tribes in Nevada a louder voice and provide the Nevada tribes and clinics 

much needed assistance.

Senator DORGAN. Well, thank you for your testimony, Ms. Curley. And we’re going to hear from a couple others and I have a series of questions I’d like to ask. Ms. Catherine Harris is Chief Financial Officer at the Reno Heart Physicians in Reno, Nevada. Ms. 

Harris, thank you for being here and giving us your perspective. 

STATEMENT OF CATHERINE S. HARRIS, CFO, RENO HEART 

PHYSICIANS 

Ms. HARRIS. Thank you for having me. 

Good afternoon to all the tribal leaders and community members 

and Senator Dorgan. I do want to let you know that in my over 

30 years of health care experience, it is a privilege to be here to 

be able to potentially have an impact on what is, not a minute by 

any chance, portion of the health care crisis that this country is 

facing right now. 

I am here on behalf of the providers of care who, in their way 

shape or form are advocates for their patients and strive every day 

to make sure that we can accommodate the patients and their 

needs and provide the continuum of care that is so lacking. 

My focus is more navigational within the system, and the reimbursement and being able to cover costs. I represent a 21 cardiology practice that provides services here in Reno, Sparks, Carson 

City, as well several rural areas, including Minden, Elko, 

Winnemucca, Fallon. Our providers generally have a passion for 

providing care to their patients, but they also have a a business to 

run. It is very frustrating when they insert a pacemaker and can’t 

get the approval to have a pacemaker checked and follow ups. AlVerDate 0ct 09 2002 14:13 Mar 15, 2011 Jkt 064673 PO 00000 Frm 00022 Fmt 6633 Sfmt 6601 S:\DOCS\64673.TXT JACK
19

though, I would have to say that we’ve had a few meetings in the 

past and that situation specifically has gotten much, much better. 

Being community-based health care professionals, we provide a 

very valuable service to this community. As far as the Indian 

Health Board goes and the beneficiaries, residents of the reservations, we are one community, as far as we are concerned, and our 

responsibilities to providing care for the members of this community, including those who are not always able to afford it. 

Again, our focus is cardiology. It’s been very sad for us, as a provider of care, to see how many local area providers, health care 

providers, have turned away and discontinued providing services to 

tribe beneficiaries. Most of those decisions have been made because 

they’re not able to cover their costs of providing care. Again, very 

serious issue as our population continues to age and as we have 

longer life spans, the strain on health care resources and resource 

dollars continues to be an issue nationwide. 

I do believe, though, it is our position that there are some deficiencies within the Indian Health Care system that are contributing significantly to these costs of providing care. And that what 

we would like to see is some review and refinement of the internal 

processes of processing claims, getting claims paid, getting visits 

approved. I think a lot of the panel here have already touched the 

topic of the continuity of care in a case-by-case basis. I don’t believe 

that this is an issue that bubbles up to the budgetary and fiduciary 

owners of this process, in that they don’t understand that where, 

as we may see ten patients for a pacemaker insert, there is a series 

of follow-up visits that have to occur after that in order to keep this 

patient well and to keep them healthy. No single one of our providers in our practice want to treat a patient and lose them because they don’t have coverage. 

About six months ago, as I was alluding to, the authorizations 

department of our practice made significant milestones and 

progress in getting these pacemaker checks approved so we’re not 

getting as many denials as we were. However, we continue to experience frustrations in dealing with various individuals, particularly 

with the communications within the IHS clerical staff. We have 

certain individuals that we leave messages for and never hear back 

from them, so we can’t get the authorizations or P.O.s we need to 

continue treating patients. We have individuals that we contact 

that are great at the claims processing piece and getting us paid 

and terrible at the initial authorization and approval of the visit. 

So it appears that there is just a lot of the inconsistencies in the 

practices and how the system is administering the authorization 

and approval of visits as well as the reimbursement. We have noticed, and I know that it is not the technical practice, but we have 

also noticed that every year, they run out of funds, the system runs 

out of funds. And every year, a portion of those current year funds 

are used for old claims. May not be the intention of the fiduciary 

responsibility party; however, it is what happens. 

We currently have over $18,000 in unpaid claims from 2007 and 

2009; that does not include any of the 2010 claims. And I do want 

to say that things have gotten better, but they still have a long way 

to go. 

20

Again, the inconsistency between case workers is just very, very 

frustrating. Also, the inconsistency between IHS and their fiscal 

intermediary, particularly in New Mexico. Whereas I respect the 

comment that was made earlier about collecting data—what appears to be a major problem for us is that there’s no consistency 

in the data. For example, we have a patient that has Hometown 

Health coverage as well as Indian Health Services coverage. We’ll 

get a response from New Mexico that they received the explanation 

of benefits for this patient that has Hometown Health coverage, 

but they’re waiting on information from Blue Cross. When we go 

ahead and investigate that particular case, the patient has no Blue 

Cross coverage; that coverage was termed three years ago. So then 

we have to go through the process of calling the Board, having 

them communicate with the fiscal intermediary in New Mexico, 

having to turn around and reprocess. 

There is such a disparity in the system as far as the content of 

the data and consistency as far as it being updated on a regular 

basis. I don’t need to tell anybody in this room how much that costs 

us on the back end. We’ve all heard comments about the detriment 

to the patient and not being able to have the access to the care. 

It’s really heartbreaking on the back end when we have to spend 

many hours to get one case resolved, that really, if there were a 

refinement of the process and some consistency between the systems, it wouldn’t be the case. 

I want to assure everyone here that we have no intention of denying access to care. We care about our patients. We want to see 

them treated. We want to see them treated well. We want to be 

able to continue to provide excellence in quality in cardiology care 

to all of our patients, including our tribal patients. We are very 

much open to any improvements, conversations, communications 

that we can enter into jointly in making sure that we can go forward. 

I feel very strongly that the concept of having negotiated rates 

with providers who have agreed to provide care, much like any 

other health system—the Cignas, the Blue Crosses—is an excellent 

idea, and would provide some budgetary stability. However, I think 

that there’s a lack of understanding at the budgetary level that 

needs to be part of the budget process. 

[The prepared statement of Ms. Harris follows:]

PREPARED STATEMENT OF CATHERINE S. HARRIS, CFO, RENO HEART PHYSICIANS

Thank you for the opportunity to speak to you today. I am here on behalf of Reno 

Heart Physicians, a 21 physician Cardiology practice that provides services in Reno, 

Sparks, Carson City and rural areas from Minden to Elko. 

Community based healthcare professionals like Reno Heart Physicians provide a 

very valuable service to those in our community who are in need of cardiology services. Not only are our physicians board certified in their specialty, but being community based allows them to respond in a more timely, efficient manner to the needs 

of patients within our community. This ensures continuity of care and is also convenient for patients. 

Indian Health Services beneficiaries are among community members who benefit 

from our quality cardiology care. They are also the beneficiaries of discounted rates 

that are reflective of our practices commitment to provide excellence as well as affordability to our community. 

Sadly, more and more local providers are not, however, able to continue providing 

care to Indian Health Service patient because they are unable to cover their costs 

of providing care. As our population continues to age and live longer, the strain to 

21

provide coverage and service to our community becomes like an elastic band that 

is stretched so tight that it is about to break. 

The responsibility to continue to provide quality medical care to those who need 

it at an affordable rate is the responsibility of every citizen in our community. As 

providers, we are constantly evaluating our expenses and quality outcomes and 

making adjustments wherever necessary. We continuously strive to refine our processes in order to more expeditiously serve our population. 

It is our position that there are a number of deficiencies within the Indian Health 

System that significantly contribute to the increase cost of care that our community 

providers are experiencing that have not received the same level of review and refinement. It is imperative that this take place in order for the safety net to remain 

in tact as the population ages and we are called upon to continue to provide care. 

The systems fiduciary responsibilities to their beneficiaries and providers as well as 

its internal claims processing practices need to be refined and improved upon. 

Since the last meeting with IHS about six months ago the Authorization Department at Reno Heart Physicians requests for pacemaker checks are being approved 

without any denials with few exceptions. However, we are experiencing communication issues with IHS clerical staff. We can leave multiple messages and we don’t 

get any correspondence back. We would like to see the communication between our 

business office and IHS be more consistent and timely, to make sure the care of the 

patient is not disrupted. Reno Heart Physicians believes that there should be a specified timeframe within which all patient related requests are responded to and that 

this should be no more than 24 hours. 

Distribution of funds has been irresponsible at best. Not only are the rates nominal, but the delay in getting paid is unacceptable. Reno heart Physicians continues 

to carry over $18,000 in unpaid claims for IHS patients that date as far back as 

September 12, 2007 through 2009. This does not include any unpaid claims in 2010. 

Of specific interest to us is the lack of consistency between case workers. It is apparent that once the claim is received by the contract health unit, no one can predict 

what will happen to it next, much less when it will be processed and paid. One specific individual case worker is responsible for the ‘‘old’’ accounts. Another specific 

case worker (who processes claims efficiently) is notorious for not returning messages, particularly from our authorizations department. Reno Heart Physicians believe that there should be a consistent, measurable, monitored process that these 

case workers are not only held to, but evaluated based upon. Giving them a stake 

in the outcomes, would make them more of a partner with providers of care and 

therefore improve the communication and response times. 

There are also inconsistencies between the FI and IHS. Of particular interest to 

Reno Heart Physicians is the FI in New Mexico, Blue Cross. As providers, we are 

supposed to be able to get updates from IHS with regards to eligibility and other 

coverage, however we are not able to get that information and when we do it is not 

current. For example, we will get information on a patient who has Hometown 

Health Plan coverage as well as IHS; we will get a response from New Mexico that 

they have received the patients’ explanation of benefits from Hometown Health Plan 

and are waiting for an explanation of benefits from Blue Cross; we will initiate researching the specific patient with Blue Cross we find that their coverage terminated 3 years ago. IHS and the FI in New Mexico are either not communicating 

and/or are working on disparate data systems. 

Having to go through this lengthy process of calling the FI, then calling Blue 

Cross then contacting IHS to tell them that they are reflecting the same information 

as the FI cost us hundreds of dollars every case. Indian Health Services then has 

to call the FI in New Mexico and request that they update their system so that our 

claim can be processed. These two entities need to communicate consistently and 

have the same information in their systems for every single IHS beneficiary. 

The distribution of funds has been unpredictable at best. It appears that every 

year when funding is received, a significant portion of those funds are used to ‘‘clean 

up’’ old accounts receivable. This creates a situation where the system is constantly 

in arrears—robbing Peter to pay Paul if you would. Perhaps if the data was accurate and consistent, then not only would the provider’s cash flow be more stable and 

predictable, but IHS would have a better grasp on what their funding needed to be 

from one year to the next. 

Reno Heart Physicians is dedicated to providing quality affordable care in our 

community. We are prepared to do whatever we can to improve the communication 

and or processes of IHS in order to make this possible. To do otherwise would be 

irresponsible. However, we are not in this alone. We need your help and commitment to making this process more efficient and productive so that our patients can 

continue to receive excellent cardiology care where they live. 

22

Thanks again for your time today. Reno Heart Physicians is looking forward to 

partnering with you in improving the provision of cardiology care to our community 

at large, and more specifically to IHS beneficiaries. 

Thanks again!

Senator DORGAN. Ms. Harris, thank you very much. 

With respect to the point you made about not being able to get 

returned telephone calls and so on, I hope you will take advantage 

today of the fact Dorothy Dupree is here. I know that she’s here 

because she wants to understand what’s going on in the region. 

And so that would be very helpful to her, I think. I know she’s 

shaking her head back there saying ‘‘Yes.’’ You’ve indicated that 

there’s been some improvement, but make sure you don’t leave 

without accessing that opportunity. And I appreciate Ms. Dupree 

being here. 

Ms. HARRIS. Thank you. 

Senator DORGAN. Finally, the Honorable Loren Sammaripa, 

Chairman of the Walker River Paiute Tribe in Schurz, Nevada. 

Chairman Sammaripa, thank you for being here. 

STATEMENT OF HON. LOREN SAMMARIPA, CHAIRMAN,

WALKER RIVER PAIUTE TRIBE; ACCOMPANIED BY KENNETH 

RICHARDSON, HEALTH DIRECTOR 

Mr. SAMMARIPA. Thank you, Senator. As you noticed on the map, 

we’re No. 22. And I want to thank Mr. Moyle, Mr. Bell, Cindy Curley, and Catherine Harris for presenting their side of the issue that 

we all have our concerns with. 

I know what we’ve talked about in various meetings with our 

health committees, and each and every time, you know, we address 

health issues, lack of service, denials. All this has surfaced, and 

we’re still at this point. And as we continue through with our meetings and our attendance, no matter where it’s at, we’re going to 

still talk about it. And I appreciate you being here this afternoon 

to hear our concerns, and also your Committee. 

And, again, I just want to say, my name is Loren Sammaripa, 

Chairman of the Walker River Paiute Tribe. I was born and raised 

in a hospital that we all talk about: Schurz Hospital. This was in 

the early 1940s, at which time the hospital was a full-staff hospital. 

We served the whole State of Nevada at one point. And the services 

that were provided there were services that we talk about today, 

and being that they denied, and here in the big cities. 

But, again, the opportunity that I have here today and to speak 

regarding our Contract Health Service and our health care crisis 

that we are encountering on our reservations is a main concern. 

Our tribal members, they were currently placed on Level 1. These 

levels that we talk about, they’ve been established throughout our 

meetings that we meet with our health representatives. And Priority 1 is defined as: Emergent or acutely urgent care services that 

are necessary to prevent the immediate death or serious impairment of the health of the individual, because of the threat to the 

life or health of the individual necessitate the use of the most accessible health care available and capable of furnishing such services. 

So, again, we talk about all these diagnosis and treatments that 

we are being denied on the outside service. Schurz being centrally 

23

located in Nevada, we have to sometimes rely on air flights for our 

most severe cases of patients that needed direct attention. Our care 

flights are costing around $15,500 per flight. And we have no other 

alternative but to provide and pay for these services because IHS 

has not made any type of cost comparison with any other direct 

services. So we are located primarily 102 miles south of Reno. And 

which Fallon is about 30 miles north of Schurz; they provide the 

necessary care for some of our minor and emergency care, also. But 

our lab and X-rays and our pharmacy costs are well above, and 

quite severely drains our funding. 

We have providers, also, that we have to make contracts with. 

A lot of times our providers are denying seeing our patients, because of the payment again. As our panel here has talked about, 

the needs that have been not addressed by CHS, we are imposed 

with all these issues. So, again, the referrals that we had for FY 

2010 for Walker River was 740. And the number of denials for 2010 

for Walker River was 586. We have a list of referrals that would 

be available to you in our pamphlet, and it will give you each and 

everyone of them that have been mentioned here. 

I have some scenarios that I want to read a few to you on that 

tells of the devastating that we have encountered. We had a 63-

year-old grandmother in November 2009; she was having chest 

pains. Our doctor requested a referral to have a scan done to rule 

out cardiac or a malignancy. She suffered through numerous clinic 

visits, pain, and weight loss. In December she was sent to the ER 

with left chest pains at Banner Hospital; that’s in Fallon. And then 

later tranferred to Renown here in Reno with lung mass. This ER 

visit was approved. Subsequently, she was referred for CT scan and 

bronchoscopy of her lungs for her mass with possible malignancy, 

and the sad course continues. And by February 2010 she was severely debilitated, wheelchair bound, and wasting away. She had 

one more visit to the ER with prolonged hospitalization toward the 

end of her life. She passed on in March of 2010. 

So as you can see, the concerns that we have and our elders that 

are chosen not to be seen by providers and for creating more bills, 

we are faced with this situation each and every day. But the struggle, we continue. And with the services, limited service that we 

have with our facility now, we have no other alternatives but to 

refer out our patients. And to be seen and the referrals denied, we 

have to deal with. 

Numerous cases that we have are listed in the testimonies that 

I have here today. All our representatives here that we have sitting 

before you testified of the health concerns, just as I have done. We 

talk about area offices, our Schurz Service Unit has been condemned, but we are still providing services on a limited basis. 

And we would also like to seek funds to build a facility that 

would benefit our people, not only for Schurz, but for surrounding 

communities. This would be something that I would like to see 

funded in my lifetime. I’m one of the few elders that are left on the 

reservation, and still have the ability to represent our tribe. We 

have a handful left that are dependent on dialysis, health care 

services, but they, too, have chosen not to go out and see a provider. A lot of the testimonies that we have presented, the distance 

that is involved to go to the PMS in Phoenix, the health services 

24

there, that’s the alternative. But when you get to the area in Phoenix, a few of our patients have also been denied. And they are left 

down there, stranded. Some of them are told that maybe you can 

return back or stay here for a week or so to come back in to be 

seen. But within that time frame, and the expense that occurs for 

them to be on a waiting list to be seen at the Phoenix unit is, you 

know, a burden on the families. 

So, again, I can’t stress the importance that we have presented 

to you today with our health issues. And until that is addressed, 

it would be a benefit to all of our tribes here in Nevada to hear 

that we would be refunded to address our health concerns. 

And the funding in 2010 on the backlog of unpaid bills for five 

to six years total in the amount of 4.6 to 4.8 million. But to the 

money that was there, a lot our bills weren’t paid. The money 

amount didn’t reach it. 

So, again, I thank you for being here today to hear the concerns 

of our Nevada people and our health services. We can go on with 

many scenarios of patients that have been denied, patients that 

chose not to be seen. So, again, the bill paying is something that 

we need to address so our people can survive. And I want to thank 

you for the concerns today for listening to us, and I’m sure that our 

Natives that are in attendance at this meeting today have more to 

add. So with that in mind and our testimony that we have presented as true facts. So, again, for Walker River I want to thank 

you for listening to our concerns and we’ll continue on. 

[The prepared statement of Mr. Sammaripa follows:]

PREPARED STATEMENT OF HON. LORREN SAMMARIPA, CHAIRMAN, WALKER RIVER

PAIUTE TRIBE

Good afternoon Senator Dorgan and distinguished members of the Indian Affairs 

Committee. My name is Lorren Sammaripa, Chairman for the Walker River Paiute 

Tribe of Nevada. I would like to thank you for this opportunity to speak to the Committee regarding Contract Health Services (CHS) and the Health Care Crisis we are 

encountering on the Walker River Paiute Reservation and in the Schurz Service 

Unit. 

Our Tribal Members are currently placed on Priority Level 1 services which is defined as Emergent or acutely urgent care services (diagnostic or therapeutic) that 

are necessary to prevent the immediate death or serious impairment of the health 

of the individual. Because of the threat to the life or health of the individual necessitate the use of the most accessible health care available and capable of furnishing 

such services. Diagnosis and treatment of injuries of medical conditions that if left 

untreated, would result in uncertain but potentially grave outcomes.

Due to years of funding shortfalls in the Schurz Service Unit, the Phoenix Area 

Office has begun the implementation of life or death only diagnosis for the patients 

of the Schurz Service Unit and payment by Indian Health Service Contract Health 

Service funding. As a result, services for treatment and follow-up care are no longer 

allowed. We were told by the Medical Director at Phoenix, ‘‘if you can make an appointment, then it does not meet the definition of Priority Level 1 services and any 

referrals will be denied. 

The Schurz Service Unit is solely dependent on Contract Health Services for hospital stays, specialty visits, lab and X-rays and all Pharmacy costs paid for with 

CHS funds. For the past five (5) years, Walker River has had to call Care Flight 

out of Reno for severe cases at a cost of $15,500 per flight as IHS has failed to contract with a provider to lower these costs. This is the case for many of the providers. 

Here are some of the case examples of the Health Care being provided or should 

I say not being provided to our Tribal Members and community. Services for all 

these cases had been DENIED for not being Priority Level 1 eligible.

• A 63-year-old grandmother in November 2009 was having chest pain. Our doctor requested a referral to have a scan done to rule out Cardiac or Malignancy. 

She suffered through numerous clinic visits, pain and weight loss. In December 

25

she was sent to the ER with left chest pain at Banner Hospital and then transferred to Renown Medical with a lung mass. This ER visit was approved. Subsequently, she was referred for CT Scan and bronchoscopy of her lungs for her 

masses with possible malignancy. The sad course continued and by February 

she was severely debilitated, wheelchair bound and wasting away. She had one 

more visit to the ER with prolonged hospitalization toward the end of her life. 

She died on March 19, 2010.

• A 39-year-old mother of five came to the clinic with shortness of breath. She 

begged the provider to just give her antibiotics or a breathing treatment. She 

did not want to go to the ER and incur more bills she could not pay. She explained that IHS had not paid for her gall bladder removal or her heart catheterization. The provider informed her that she may have a pulmonary emboli. 

She still refused to go the ER. She died the next day from a pulmonary emboli.

• A 34-year-old mother of two with central abdominal pain near a hernia repair 

site was denied to go back to the surgeon. She went on her own and had a CT 

scan ordered by the surgeon for diagnosis to rule out a second hernia. Payment 

was denied. The CT scan showed a right ovarian cyst and the provider recommended a Gynecologist. This was denied. The patient’s mother is currently 

being treated with chemo for ovarian cancer with metastasis.

• Two male patients have been diagnosed with brain and liver cancer. All services 

have been denied by IHS.

• A 63-year-old male with Diabetes since 1995. This disease has affected multiple 

body systems. He has had a partial foot amputation, his kidneys are beginning 

to shut down, endocrine referral was denied. Patient has had a heart attack 

with angioplasty with a 23 percent ejection fraction (normal is 60 to 80 percent). 

In early 2009 his pulmonary consult s were approved but later denied. He has 

hypoxia, fibrosing alveolitis, and chronic respiratory failure. Pulmonologist is requesting follow-up tests. This complex patient has over 30 significant active 

problems being managed by a family care physician. The Podiatrist, 

Nephrologist, Endocrinologist, Cardiologist and Pulmonologist have all been denied. Patient was sent to collections by the Endocrinologist for non-payment and 

he will not see the patient.

• A 11-year-old female patient with full blown Rheumatoid Arthritis was referred 

to Rheumatoid Arthritis specialist so he could prescribe Embril shots that the 

Drug Company would pay for at no cost to IHS. This was also denied.

• A 15-year-old female diagnosed with a type of Rheumatoid Arthritis called 

Raynauds. Parents paid for the diagnosis as all her referrals were denied. She 

must wear gloves to prevent severe pain, she also has syncopal episodes and 

altered mental status and palpitations with shortness of breath. Specialty referrals for a Neurologist, Cardiologist and Rheumatoid Arthritis were all denied.

• A 50-year-old male with a family history of Heart Disease came into the clinic 

with significant chest pain and had an EKG that showed a heart attack at age 

indeterminate. Cardiology referral was denied even though the standard of care 

dictates Cardiologist involvement.

• A 70-year-old female who has severe Obstructive Sleep Apnea documented by 

a sleep study previously approved by IHS in October 2009. Subsequently was 

denied treatment of this condition by IHS. Untreated Obstructive Sleep Apnea 

can cause or worsen many medical conditions including Hypertension, Coronary 

Artery Disease and Diabetes. She is at significant risk for a major medical 

event at any time. She has also been denied for a re-evaluation by her Cardiologist for chest pain and her nighttime oxygen supplementation in May 2010.

• A 24-year-old female had a gall bladder removal that had the risk of complication causing pancreatitis. She was admitted to the ER with pancreatitis at a 

small rural hospital then transferred to Carson Tahoe Regional Medical Center.

We have been told that we should utilize Phoenix Indian Medical Center as it was 

created as a tertiary care facility for the Phoenix Area Tribes of Nevada, Utah and 

Arizona.

• A 25-year-old male that tore his Achilles heel in February, 2010 was denied 

service to an Orthopedic Specialist in Reno and was told he had to go to PIMC 

for service. It took until the middle of May (3 months) before he got to see a 

specialist at PIMC.

There are currently no approvals for Orthopedic Care in the SSU, no physical 

therapy for patients after surgeries, no durable medical equipment for anyone including elders and no prenatal care. I am sure with what you have heard so far 

26

that you now have a better understanding of the Health Care Crisis that my people 

have had to endure. These are only a few out of the total 511 cases denied by IHS. 

It is appalling that bonuses are still being paid to all levels of personnel at the 

Phoenix Area Office while our people are dying on a daily basis for lack of funding 

for Healthcare. 

IHS received the largest increase in CHS funding in 2010 which didn’t even begin 

to address the healthcare needs of our Nevada Tribes and our Indian people especially when there was a backlog of unpaid bills for the previous 5–6 years at the 

Phoenix Area Office in the amount of $4.6 to $4.8 million. 

There’s also a huge difference in Priority Level 1 care between Tribal Health Clinics in Nevada compared to Hospitals in Arizona.

Senator DORGAN. Chairman Sammaripa, thank you for testifying. 

Chairman Bell, you’re a friend of Chairman Wright. I know that 

he had to leave very quickly. I have a note as to the reason for 

that. Is it appropriate or not for me to describe why? Would you 

wish to? He had to leave for a family emergency, I guess. 

Mr. BELL. I think I’d leave that up to him. 

Senator DORGAN. All right. Let me just say that my thoughts are 

with him. As we appreciate him being here, but understand the 

reason that he had to leave. 

Let me thank all of you for being here today. I also wanted to 

mention that Susan Lisagor is with us. Susan is with Senator 

Harry Reid here in the State. I indicated when I started this, I’m 

here because Senator Reid, some while ago, had asked if I could 

hold a hearing on the subject of contract health because there’s no 

state that has more reliance on contract health than the State of 

Nevada. And we know the problems with contract health. And 

when you are subject to having that kind of reliance on it, there 

are destined to be circumstances that are really dysfunctional and 

in some cases fatal. 

Mr. Sammaripa, I read your testimony. And let me read one 

other example. You provided some really interesting and tragic examples. Let me read one, because it is at the heart of the reason 

that I’m here and the reason that Harry Reid and I are desparately 

trying to find a way to fix this. 

This from Chairman Sammaripa’s tribe, and I’m quoting now: A 

39-year-old mother of five came to the clinic with shortness of 

breath. She begged the provider to just give her antibiotics or a 

breathing treatment. She did not want to go to the emergency room 

and incur more bills that she could not pay. She explained that the 

IHS had not paid for her gallbladder removal surgery or her heart 

catheterization. The provider informed her that she may have a 

pulmonary embolism. She still refused to go the ER. She died the 

next day from a pulmonary embolism. 

Now, why did this 39-year-old mother of five die? Because she 

had had opportunities to get some amount of health care previously 

for which Indian Health Service and contract health did not provide reimbursement. My guess is she was living with a circumstance of her credit being destroyed, bills she couldn’t pay, so 

she comes to the clinic with a very serious problem, and what’s on 

her mind? ‘‘I can’t pay for this; I can’t possibly get health care 

that’s going to cost me money.’’ Now five children are without a 

mother. That is such a powerful description of the dysfunction that 

exists. Dysfunction that in this case proves fatal. And, you know, 

if all of us in this room knew this young mother, you know, our 

27

heart would break. It breaks just talking about the story. So we’ve 

got to fix this. We can’t ignore it. We have to find ways to fix it. 

All of you have provided really interesting and troubling testimony in many ways. I want to ask a series of questions, if I might. 

Let me ask: Miss Curley, tell me about the prevalence of diabetes. Would diabetes be one of the significance problems—and I 

would ask others, as well—the rate of diabetes multiple times the 

national average? Is diabetes a serious driver of health care problems on the reservations in Nevada? 

Ms. CURLEY. For the Native American population, it is. The diabetes rate is higher than the non-Native. It is a big driver of a lot 

of health problems. A lot of diabetics have a lot of comorbidities 

that go along with them. They’re hypertensive, they’re obese, they 

have issues that lead to unpreventable amputations. There’s a 

whole gauntlet of problems. Part of the problem is, you know, the 

kind of medications that we have in the formularies, you know as 

part of our formularies. Health conditions that are beyond what we 

can do for the patient, but we can’t get the patient referred out to 

deal with. 

Senator DORGAN. How about dialysis? Do you have people from 

your tribe on dialysis? 

Ms. CURLEY. Yes. 

Senator DORGAN. Where do they get the dialysis? 

Ms. CURLEY. Carson City or Reno. 

Senator DORGAN. And how far is that? 

Ms. CURLEY. So to go to Reno for the dialysis patients, it’s between 45 minutes and an hour to go to Carson City. 

Senator DORGAN. One way? 

Ms. CURLEY. One way. And Carson City is——

Senator DORGAN. How many times a week? 

Ms. CURLEY. Two to three times a week, depending on the——

Senator DORGAN. So two to three times a week, a two-hour 

round-trip, plus the time they’re on dialysis. 

Ms. CURLEY. Yes, it’s very taxing for them. 

Senator DORGAN. How many people in your area are on dialysis? 

Ms. CURLEY. I think we only have two left on dialysis. The others 

have passed away. 

Senator DORGAN. Mr. Chairman, how about in your area: Is diabetes a significant problem? Do you have people on dialysis, and, 

if so, where do they get the dialysis? 

Mr. MOYLE. Yes, thank you, Senator. The exact number right at 

this present time, I do know that we have six. We had eight, but 

as Ms. Curley said, some of them get to the point of they’re gone. 

Senator DORGAN. And where do they get the dialysis? 

Mr. MOYLE. They just recently built a dialysis treatment facility 

in the town of Fallon. Prior to that, up until about a year and a 

half ago, they were getting their treatments at Reno. And I thank 

you for asking that, but the funding that comes from the Federal 

Government for diabetes, I will tell you that is very helpful. But 

once again, it gets back to the follow-up to that, other than the fact 

that we can educate our people and try to begin a program that 

would probably help relieve that from happening—that could be 

done. But then, again, let’s say they get to the point of the dialysis 

issue and the fact that once again, I’ll go back to that, decrease in 

28

funding—we were thankful the hundred million got approved and 

the Schurz Service Unit was able to get some of that, but still, basically, what that did was almost like help out with inflation. It’s 

helpful, but in a sense, when you get down to that many patients 

that—and I’ll refer to our statement—is inadequate funding. Okay. 

So I hope I answered your question. Are you going talk with Mr. 

Bell? 

Senator DORGAN. Yes, I’ll ask Mr. Bell to answer the question. 

Mr. MOYLE. Because his people——

Senator DORGAN. Yes. Go ahead. 

Mr. MOYLE. Did I answer your question? 

Senator DORGAN. Yes. Chairman Bell: Diabetes, dialysis? 

Mr. BELL. Yes. Mr. Senator, I’m not sure of the percentages but 

we have a number of Diabetes Type 2. Most recently, within a 

year, we’ve learned that some of them are in our youth now. And 

like the rest of the tribes, our specialized services are here in Reno. 

And I’ve had to—I don’t know if I want to call them a privelege 

or pleasure—about 11 years ago I used to ride on this transportation van. I used to transport dialysis patients. I guess the only 

reason why I liked riding with them is amongst themselves they 

had a pretty good charisma and they liked to joke a lot. But when 

we’d come back after their treatment, they’d be so worn out and 

tired. By the time we’d get going down the road, they’d be nagging 

on each other, so on and so forth. So, yes, we had a high number. 

A lot of those people are now deceased. 

Senator DORGAN. I should mention that in the Economic Recovery Act that was passed, there was not Indian funding originally 

proposed. I was able to get $2.5 billion in the Economic Recovery 

Act, with Senator Reid’s help, specifically for Indian Country. We 

were able to add $2.5 billion. Of that $2.5 billion, $300 million of 

it went to Indian country for health service facilities, especially, 

and the information technology system for the services. Now, that’s 

not a lot of money, but it’s more than is generally made available. 

And I have not yet seen how the IHS has moved that around the 

country. But there has been several hundred million dollars available building facilities in the last year and a half. 

Ms. Harris, as I indicated to you previously, you know, we want 

to have the Indian Health Service have people working who return 

telephone calls and you know, the system doesn’t work if you can’t 

get answers, can’t get responses, can’t get approvals, and so on. So 

I hope we’ll get that addressed. I just think it’s very important that 

we try to find ways to make sure that when someone testifies they 

say, ‘‘You know what? This service is great because there are people there we know and we work with, and they respond quickly.’’

The thing that was troubling today is the issue of approval for 

a pacemaker, but not for a battery. Or approval for a kidney transplant but not for the drugs that will prevent rejection of the kidney 

transplant. I don’t understand the decision-making process, where 

the decision-making process would break down. Because it’s just 

common sense: Why would you approve a kidney transplant if you 

don’t intend to approve the lesser cost of the drugs that would prevent rejection? Why would you possibly approve a pacemaker if you 

don’t intend to provide batteries for the pacemaker? So where does 

this breakdown? 

29

Ms. CURLEY. Well, what we’re told is, and when our providers do 

a referral and refer a patient out and it gets denied, and we specifically ask, what do we have to do to get our patients approved for 

a referral? And the come back is: If you have to make an appointment to have it done, it’s going to be denied. And that’s the rational. 

Senator DORGAN. Explain that to us again. 

Ms. CURLEY. If our patient needs to go, say, into a specialty provider to have a new battery put in their pacemaker, you make an 

appointment to go and have that battery put in——

Senator DORGAN. Yes. 

Ms. CURLEY.—therefore, it will be denied. 

Senator DORGAN. So that means it’s not Priority 1, Life or Limb? 

Ms. CURLEY. Right. 

Senator DORGAN. If you have to make an appointment, it means 

that there’s not an urgent emergency at the moment if you have 

time to make an appointment, the thought process is to say I’m 

going to need this, therefore they say ‘‘It’s not covered’’? 

Ms. CURLEY. Right. 

Senator DORGAN. Okay. 

Ms. CURLEY. But even as far as ER visits—my contract health 

clerk just came back after a CHS meeting the other day—and she 

came back to the clinic and told me that some of the information 

she found out through the course of that meeting is that they’re 

looking at no longer approving a lot of ER visits. So even if you 

have to have an appointment to have it done, it doesn’t get approved, but what if you have to race to the ER, those aren’t going 

to get approved either? 

Senator DORGAN. Right. Ms. Harris wanted to say something, 

then I’ll call on Chairman Sammaripa. 

Ms. HARRIS. I think the basic problem is a lack of understanding. 

A diagnosis and treatment does not cure a disease, it does not cure 

a spell of illness. There’s a lack of case management and a case 

management approach to the provision of care, as well as the reimbursement. Again, it doesn’t make sense to you or me that we 

would get a diabetic, diagnosed as a diabetic—diabetes is horribly 

debilitating disease if not treated; it is fatal—why would you go 

ahead and say, yes, this patient’s a diabetic and not provide somewhere budgetarily as wells as physically for this patient and their 

life span? And I think that is an essential component that is missing. 

Ms. Dupree and Mr. Curley were very reluctant when we sat 

down and said, ‘‘Listen, when we put a pacemaker in, here’s the 

situation, here’s the follow up.’’ We have had very little trouble 

with those cases since then. But I think what we’re getting to is 

a lack of understanding and a lack of a case management approach 

to the funding. 

Senator DORGAN. Well, let me understand that point, though. 

Ms. Curley, you’re the one who talked about a pacemaker without 

a battery, right? 

Ms. CURLEY. Yes. 

Senator DORGAN. Ms. Harris, you don’t work in Ms. Curley’s clinic. So you say that you’ve got an understanding and you feel pretty 

good about that. 

30

Do you, Ms. Curley? Do you have that understanding? Or is it 

something that happened in the past that you think won’t happen 

again? 

Ms. CURLEY. No. This is a more recent one, and it’s on our list 

of denied referrals that we have. And so this is a case that was 

brought to my attention about three months ago. I don’t think this 

patient goes here. But, no, this is a more recent case that we had. 

Senator DORGAN. Where would that approval or denial happen? 

Ms. CURLEY. We do the referral at our facility. 

Senator DORGAN. Right. 

Ms. CURLEY. Then we send it—it used to be the Service Unit. 

But the referrals are getting approved or denied in Phoenix. 

Senator DORGAN. All right. Ms. Harris, the understanding you 

have is working better with Phoenix; is that correct? 

Ms. HARRIS. Well, locally, too. 

Senator DORGAN. Okay. 

Ms. HARRIS. And it is working well. I guarantee that’s not one 

of our patients. And if it is, you call my office. 

Senator DORGAN. Chairman Sammaripa? 

Mr. SAMMARIPA. Yes, thank you. If I may, Mr. Richardson here 

that actually works with the referrals and runs our health care at 

Schurz, if I may turn this over to him to—he has some more to add 

to it, so with your permission. 

Senator DORGAN. That would be fine. 

Mr. SAMMARIPA. Thank you 

Senator DORGAN. Mr. Richardson, welcome. Would you give us 

your full name. 

Mr. RICHARDSON. Kenneth Richardson. I’ve worked for the Walker River Tribe for 23 years as health director. And I worked, before 

that, with the hospital when it was running. 

And the thing that we’re seeing right now, Senator, is that the 

heart patient that goes into Renown and is ready to die, they’ll put 

a heart monitor in them so they will keep them alive. But right 

after that, then we’re getting denied for everything. And it became 

very hard this year for our providers; we’ve lost providers because 

they couldn’t live with this either, at our clinics. We have kids that 

have broken wrists, they were swollen up, the doctors couldn’t do 

anything until a couple days when the swelling goes down. Well, 

that’s been denied now. Because if you can make an appointment, 

it’s not within priority. 

Senator DORGAN. Let me understand. I don’t understand the notion ‘‘If you can make an appointment.’’ If a kid has a broken wrist 

that’s ‘‘limb,’’ right? 

Mr. RICHARDSON. Right. 

Senator DORGAN. I mean, you’ve got to set a broken wrist so it 

heals properly. And if you can’t set it properly when it’s swollen 

badly, you have to wait until the swelling goes down. And so the 

kid comes back three days later and two days later and gets it set, 

are you saying because an appointment is made for that return 

visit, it is denied? 

Mr. RICHARDSON. It’s denied. 

Senator DORGAN. Now, who denies that? I mean, what’s the 

basis—this almost seems to me like it would be impossible for 

someone to make that judgment. I mean, I know what you’re tellVerDate 0ct 09 2002 14:13 Mar 15, 2011 Jkt 064673 PO 00000 Frm 00034 Fmt 6633 Sfmt 6601 S:\DOCS\64673.TXT JACK
31

ing me is what you believe and what you see. I’m just telling you 

what I hear is that has no basis in common sense. So someplace 

this is broken. It’s a broken understanding somewhere between you 

and whoever is going to make this judgment that the kid with the 

broken wrist shouldn’t get coverage because they showed up two 

days later. 

Mr. RICHARDSON. Well, It goes way back. But like everybody 

said: Just last November, they started paying five years of bills for 

us, because we had all our providers quitting us, we had to bring 

a lawyer in, Senator Reid had to help us, you know, to get IHS to 

pay for five years of bills that were still out there on the table just 

to get services. And at that point, with the new fiscal year, FY10, 

it became a dollar amount, a figure that we were being told they 

had to control. And, basically, for the Schurz Service Unit, we get 

$6.4 million dollars for Contract Health Services to take care of 

9,000 people. Out of that, $2 million is spent on pharmacy and labs 

and X-rays, anything like that. So it brings you down to about $4.4 

million for services. And this is what we’ve had trouble explaining 

to Congress——

Senator DORGAN. Well, I understand it’s short. I understand 

that. What I don’t understand is the criteria by which someone 

says: We’re going to allocate this based on a criteria that seems artificially ignorant; that is—not artificially—really ignorant, by saying that life or limb shall be described as whether you make an appointment or not. I can understand the rationale of suggesting that 

is true in many cases, perhaps, but never could I understand that 

that would be true in all cases. You’ve described one that is probably a perfectly good description of it: a broken wrist, unable to set 

it for two days, and, therefore, gets denied. Somehow, that suggests 

to me somebody’s not thinking in this process. 

Mr. RICHARDSON. And that’s exactly how we feel. And that’s why 

in our Chairman’s testimony, that’s the first thing we talk about, 

because it does say: Also for diagnostic and therapeutic purposes, 

a patient can be seen as long as you know, so we don’t harm the 

patient. 

And that’s how we’ve felt like third world, we felt like, we’re not 

part of the Phoenix area. And when you see, you know, our people 

sitting here dying because they can’t get treatment, and we’re expected to accept that. 

Senator DORGAN. But let me ask you: If I might go to the 39-

year-old mother of five—are you familiar with this case? 

Mr. RICHARDSON. Yes, it came from our clinic. 

Senator DORGAN. It came from your clinic? 

Mr. RICHARDSON. Yes. 

Senator DORGAN. A 39-year-old mother of five came to the clinic 

with a shortness of breath, begged the provider to just give her 

antibiotics or breathing treatment, did not want to go to the ER—

where would she have gone, if she should not have gone to an 

emergency room? 

Mr. RICHARDSON. We were trying to take her to Fallon. She was, 

actually, a Pyramid Lake patient that just happened to be visiting 

relatives that day. 

Senator DORGAN. I see. Okay. 

32

Mr. RICHARDSON. And so I also run with the ambulance service. 

I also had to deal with that on the ambulance side. You know, and 

also from the EMS side, it makes it very—you know, because do 

we care-flight that patient, because——

Senator DORGAN. Right, I understand the ambulance issue, as 

well, because I’ve been involved in some of that. 

So this woman said that she doesn’t want to go to the ER because IHS previously had not paid for gallbladder removal and her 

heart catheterization. So was that a case where she came in after 

you were out of funds and had procedures that didn’t get paid, and 

I suppose ruined her credit—is that what we’re talking about here? 

Mr. RICHARDSON. That, and she’d also been denied, I believe, at 

Pyramid Lake——

Ms. CURLEY. Yes. 

Mr. RICHARDSON.—for services to go be checked out. 

Senator DORGAN. And why was that—tell me about that denial 

at Pyramid Lake. 

Ms. CURLEY. It was denied due to ‘‘Not within priority.’’

Senator DORGAN. Not within priority one—you mean——

Ms. CURLEY. We did a referral, we had to refer her out to a specialty provider, and the referral comes back—because we can’t 

make the appointment until we find out if it’s going to get approved. And it came back, ‘‘Denied, not within priority.’’

Senator DORGAN. And that means, like, on Priority 1: 63 gunshot 

wounds, severe burns, coma, apendectomy, obstetrical emergencies, 

and if it’s not within that, they’re told ‘‘Sorry? ’’

Ms. CURLEY. Yes. 

Senator DORGAN. I mean, that’s what I——

Ms. CURLEY. But you don’t get deliveries paid for anymore either. 

And we have prenatal deliveries that don’t get paid for either. 

Senator DORGAN. Well, that’s what I talked about at the start of 

this, about health care rationing. 

Ms. CURLEY. Yes. 

Senator DORGAN. Everybody’s always worried about rationing: 

It’s going on in this country, every single day to American Indians. 

Ms. CURLEY. Yes. 

Senator DORGAN. It’s unbelievable. It ought to be headline news. 

And then, perhaps, the country would say, We’ve got to stop this. 

Ms. HARRIS. Yes. 

Ms. CURLEY. Yes. 

Senator DORGAN. Senator Reid and I and others have been grappling with this Contract Health Care issue for so long, and we have 

to get it fixed somehow. We just have to get it fixed. 

Mr. RICHARDSON. One other thing. 

Senator DORGAN. Yes. 

Mr. RICHARDSON. Our prenatal care is all being denied. Yet we’re 

expecting our mothers to go into ER, have emergency surgery 

that’s costing more. I mean, this is what is hard for us as tribes 

to try to visualize is it’s costing us more in the long run not doing 

the preventative care. 

Ms. CURLEY. Yes. And I would like to add to that. We had a case 

study. We had an epidemiologist come and do a case study with 

some of our patients to track their health conditions over a prolonged period of time. And so when she was looking at them, it 

33

took from the time that patient got that injury or whatever the 

health condition was, and then looking for all the referrals in their 

history and watch their health conditions decline over time to the 

point where it gets really severe, now your going to pay a much 

larger amount of money on the back end, and a lot of times it’s still 

too late; the damage has already been done. Whereas, if you were 

spending a little more money in dealing with the immediate problem when it starts, the early intervention and prevention component, you would save a lot more money in the long run. But to wait 

until their health conditions deteriorate to the point where it’s 

going to cost an astronomical amount doesn’t make any sense to 

any any of us. You’re spending a lot more money. 

Senator DORGAN. What’s it feel like to have to run a system like 

that—because you’re at the ground level where all the patients 

show up? 

Ms. CURLEY. It’s extremely frustrating when we’re trying to figure out how we’re going to get the patients out of the facility with 

what they need, or dealing with a system that assumes that our 

facilities can do things that other facilities can’t. Some of this rationale comes from an assumption that our clinics can do a lot 

more than what they really can. Our providers are extremely—we 

came ‘‘this close’’ to losing our provider, our doctor. You know, 

they’re very frustrated. And they’re terminology is ‘‘It should be illegal to make people suffer like this.’’ They get angry because they 

know what the patient needs. It’s a liability for everybody. The patient knows that their condition is just going to get worse. The doctor is working outside of his or her scope to try to help, and we’re 

just equipped to deal with the cases that—we’re a clinic; we’re 

not—and it’s extremely frustrating. 

Our doctors and our nurse practitioners and our nurses, our benefits coordinator, contract health clerks, they do extraordinary 

things. Our staff took up a collection at the clinic to buy medications for our kidney donor patient, because she couldn’t afford to 

buy it on her own. I mean, these are—Walker River—or, you know, 

Walker Lake: They do a lot of—but there’s a lot of extraordinary 

things that we do within our clinic to try to help our patients. Our 

providers spend a lot of time working with the drug companies to 

try to get free medications for our patients. And we do a lot of 

things. We have money that we pull out of our own clinic funds, 

our third party revenue funds, that we spend to help our patients. 

But it’s not enough. It’s not enough. 

Senator DORGAN. And, you know, the Chairmen of Tribes, I visited a lot of reservations, of course, as Chairman of the Indian Affairs Committee, and I know how the political system and the government system works in tribal government. And my guess is that 

all of the issues that confront the clinic, that they just can’t deal 

with, end up, very often, with the tribal chairman, saying, ‘‘What 

are you going to do about this? And then what can the tribe—how 

do I get help? I’m assuming that, unless you represent tribes—I 

don’t think you do—that have independent wealth and extra revenues, I’m assuming that when Contract Health Service runs out, 

you’re all in the same dilemma, in the same situation. 

Ms. CURLEY. Exactly. 

34

Senator DORGAN. When does your Contract Health Care funding 

run out, on average, Mr. Chairman? 

Mr. MOYLE. I’ve been the Chairman for going on 23 years now—

it has been for years—you could look at May, we’re out. And we 

began to get the, let’s call it the, ripples of that going to be happening in April. By May, we are out. And going back to what they 

were all saying——

Senator DORGAN. So that’s seven months out of the year, and 

then the next five months there’s no money. 

Mr. MOYLE. As you stated earlier that you’ve visited a lot of the 

Chairmen and realize a lot of what you might call frustrations—

it really amounts to that, because I’m responsible for entire tribe. 

A lot of them are relations, a lot of them. They’re dying. Not only 

my own relations, but other members of our same tribe, other 

members—we’re related because of our closeness to Pyramid Lake, 

Walker Lake, and also Reno and Sparks that there’s relations 

amongst all five of those tribes, even Fort McDermitt area. But all 

of our people are going through the same thing. Because of that 

lack of funding that handcuffs our people from being able to walk 

in the door and have a provider see him and then have a person—

well, in this case, because of the insufficient dollar Phoenix follows, 

I’ll just make a reference to this—the Bible, about Level 1 Priorities and which ones will be approved. You have some good examples of how drastic it’s got to be before that person can be either 

seen or turned out the door. We’re not going to authorize it. And 

that’s daily. 

Senator DORGAN. Chairman Bell? 

Mr. BELL. Mr. Senator, Fort McDermitt is a direct service tribe. 

We did compact our 648R Fund, so the Schurz Service Unit is responsible for oversight on all of our administrative oversight. But 

as a tribal counsel, we’ve asked numerous occasions for the unit director to come to our reservation. All of these exact same concerns 

were brought to his attention. Basically, he’s the health director for 

our clinic. And I could tell you that about maybe four or five years 

ago, basically what it boiled down to is this formula that we keep 

speaking of. And from my reservation, out of the youths, for me, 

and for everybody else, it’s only for our contract health dollars for 

me to come to a contract health provider, it’s only $500 for me. So 

I rarely use that source. 

Senator DORGAN. Chairman Sammaripa, I assume you and Mr. 

Richardson confront these things every single day. When do you 

run out of Contract Health funds on your reservation? 

Mr. SAMMARIPA. Well, Mr. Richardson can probably address that, 

and he has the facts and figures, so. 

Senator DORGAN. All right. 

Mr. RICHARDSON. Thank you. It’s real hard to say, Senator Dorgan, because, like we’re on a continuing resolution now, and, you 

know, health care is not static; it’s continuing. Bills are coming in 

now that are probably piling up as we speak. So, basically, we are 

out of money for this quarter already, because those emergencies 

or whatever, they’re coming in, and by the time we get the money, 

there still has to be pharmacy taken out of it, all the X-rays, laboratories, we’re really out of money all the time. And one of the big 

things, like, for us, I can track historical spending of almost $1.8 

35

million just for Walker River on a yearly basis. Now we’re down to 

about 400,000 because we’re basically being put on our user population. And the user population, in some cases, always benefits the 

bigger tribes. And we have to fight the Phoenix Indian Medical 

Center that has an urban population of 55,000, but you know we 

really fought this year with the big increases in CHS, you know, 

unheard of. And we get $1.1 million. And the bigger get bigger, 

richer, basically. And there’s nothing in there about needs or any 

of those type of things, but we’re always out of money. That’s the 

way we feel. And this year was the worst. And it’s one of the things 

that we put in our report—is that it’s really hard for us to understand how I just can give out bonuses, which are monetary rewards, to their staff when our people can’t even get care. You 

know, it really affects all the tribes. 

Senator DORGAN. Ms. Harris, you may proceed. You wish to say 

something? 

Ms. HARRIS. I’m sorry. Getting back to the disconnect, as far as 

the Priority 1 and the approval process, I can’t speak for IHS, but 

as I alluded to before, I’ve been around the health care block for 

a while: What you have is you have a situation, you call for an approval, the person on the other end of the phone is not a clinician, 

what they hear is there’s a child who has broken their wrist, and 

they say, ‘‘Okay. Go ahead.’’ The child appears, there’s too much 

swelling, the wrist can’t be set, so they have to come back in two 

days. When you call for that, what the person on the end of the 

line, a nonclinician, is hearing ‘‘follow-up visit.’’ A follow-up visit 

doesn’t meet the criteria; broken wrist did. And that’s part of the 

lack of understanding between the people who are granting the 

permission, if you would, for these visits and access to care. 

Senator DORGAN. All right. I believe we’ve been at this about two 

hours. We’ve been at this so long that the roof starting leaking. 

[Laughter.] 

Senator DORGAN. I want to make a couple of comments to you. 

Number one, I indicated at the start that we passed the Indian 

Health Care Improvement Act. I’m really proud of that. It will not 

by itself, just like that, fix everything in health care; we understand that. But in the previous congress, the 110th Congress, I 

asked Senator Reid for time to get to the Floor to deal with this 

Indian Health Care Improvement Act. I told him we could be on 

and off the Floor of the Senate in just a couple days. Well, it turned 

out that wasn’t the case. It took longer. It was controversial. Nonetheless, we got through it, and we passed it, and then it got hung 

up in the House of Representatives, and it didn’t become law. This 

year, again, with the Indian Health Care Improvement Act, I went 

to Senator Reid and said, ‘‘We need to move this, get this done. I 

think we can get it through the House this time.’’ So we got it 

added to the larger health care bill, and it is now law. 

And we included a couple of things that are important. One of 

them written by Senator Reid, and I supported that, and that is 

there is now a requirement for the Secretary of Health and Human 

Services to develop a plan by which Nevada would become its own 

IHS area. This is a big state. I believe it’s the only similar geography that doesn’t have a hospital. I think it would be the first step 

towards finally getting a hospital. But, in any event, having to 

36

drive 700 or 800 miles, 600 miles to access the hospital in Phoenix 

is just not an adequate way for our country to meet its promise, 

treaties and other responsibilities, trust responsibilities. 

So, number one, there’s a requirement, Secretary of HHS develop 

and report to Congress a plan for a regional IHS office here. Number two, the Act also requires the Secretary of—number one, we 

asked for a Government Accountability Office to conduct an investigation into the Contract Health Service program and also the formula for the program, and then after the study and tribal consultation, which is included in the language, required tribal consultation, which I think is critical. After the study and the tribal consultation is complete, if the Secretary determines that the formula 

will need to be changed, then she will recommend that to the Congress and recommend the type of change. 

I think because no one can explain what the formula is or how 

it was developed, this formula must be changed. There are three 

things, it seems to me, that are critical here. One, you are the most 

reliant, of all the states, on Contract Health Service programs. 

Therefore, what happens to Contract Health Care Services is much 

more important—it’s important to everybody, every tribe in the 

country, but even more important to you. So this process by which 

we finally at long, long last are going to say, ‘‘You’ve got to investigate this, work through it, and come up with a better approach,’’ 

I think is going to be very important. 

But most important, at the end of the day, is once we’ve discovered what kind of payments and how they are apportioned and so 

on. Once there is a plan for implementation of an Area Office here, 

then the question is how are we going to make certain that the 

Congress appropriates funds that are sufficient to avoid what is rationing for about 60 percent of American Indians health care 

needs? Again, I can’t say it often enough: This ought to be a national scandal. 

And, I mean, the story you have told today of a 39-year-old mother, I’ve heard that story over and over again in so many different 

ways. And the way that I was able to get the Indian Health Care 

Bill through the Senate was to put a face on the these issues. Some 

of you may have seen me on the Floor of the Senate. I guess I did 

it probably ten times, talking about Ardel Hale Baker. I brought 

a big picture of Ardel Hale Baker to the Floor of the Senate to say 

here’s the woman on whose leg they masked-taped an eight-by-ten 

piece of paper as they hauled her in the hospital having a heart 

attack, saying, ‘‘If you let her in the hospital, you may not get 

paid.’’ Here’s the woman. Take a look at her. 

And then I brought the photograph of Ta’Shon Rain Littlelight, 

whose grandmother gave me the photgraph at the Crow Reservation when I was there one day. I told the story of this six-year-old 

little girl over and over and over again. And I’ll tell you the story 

just briefly because I think it bears repeating. Ta’Shon’s picture 

that her grandmother gave me showed a little beautiful six-yearold girl with bright eyes in a fancy dress, because she loved to 

dance, and she was beautiful. Ta’Shon became ill. She was taken 

to the Indian Health Service clinic and taken again and taken 

again and taken again, and was always sent home with the diagnosis of depression, and medicine for depression. This for a sixVerDate 0ct 09 2002 14:13 Mar 15, 2011 Jkt 064673 PO 00000 Frm 00040 Fmt 6633 Sfmt 6601 S:\DOCS\64673.TXT JACK
37

year-old girl. Well, finally, her condition became an emergency, and 

she was air-lifted to Denver, and they discovered she had terminal 

cancer. So Ta’Shon was not long to live. 

Make-a-Wish Foundation asked her what Ta’shon wanted to do. 

She wanted to go to Disneyworld in Florida to see Mickey Mouse 

and Donald Duck. So Make-a-Wish Foundation made it possible for 

her and her mother to go to Disneyworld. In the hotel, the night 

before they were to go into the park, she said to her mother, 

‘‘Mommy, I’m sorry that I’m sick.’’ And then she died. Never got to 

Disneyworld World. She died in a hotel in her mother’s arms. This 

is a six-year-old girl, believe it or not, who shouldn’t have died. 

But I asked her grandparents and her mother if I could use her 

photograph on the Floor of the Senate, not to exploit it, but, perhaps, to tell people: This is about real people; this is kids dying; 

it’s elders dying; it’s about real people. And I think enough members of the Congress finally said, ‘‘Boy, it’s hard for me to turn my 

head to that; it’s hard for me to resist doing what needs to be done. 

So we’ve made some progress. 

It’s not all the progress we need, but, you know, when I come 

here to the state that’s most reliant on Contract Health Services 

and hear your stories, it reminds me how urgent it is that we continue to get the funding, continue to move with the two provisions 

that are in the Indian Health Care Bill dealing with these issues. 

Do what this country promised: Provide for Indian health care for 

the first people who were here who met everybody else, provide for 

the health care needs we promised them. And if you don’t believe 

me, go look at the Treaties, see how they’re written, we signed 

them. So we’ve got to do this and we’ve got to continue this fight. 

Your willingness to come to a hearing and provide testimony and 

provide a base of information, especially about Nevada is very, very 

helpful. I know that Senator Reid wished he could have been here 

today, but he’s asked me for some months if I could come and do 

this hearing in Nevada because this contract health care issue is 

so important. It turns out the day I was able to come, he’s not able 

to be here in Reno. But I’m here because he cares about the issue 

and is with me to pass the Indian Health Care Improvement Act 

and the other things that we have done. 

So let me say one more time that we will keep open the record 

of this hearing for two weeks from today. If you want to submit testimony from someone else in your tribe or others who have witnessed this hearing, you’re welcome to submit formal testimony 

and it will become a part of our permanent record. 

And let me, with that, close this hearing and ask if we might call 

on Chairman Bell, once again, to provide a blessing as we close this 

hearing. 

Mr. MOYLE. May I ask one more question? 

Senator DORGAN. Yes, you may, Chairman Moyle. 

Mr. MOYLE. I want thank you because I know you have high 

standards and your staff. 

The one thing that I feel is important to ask is that, as we read 

it and as we hear about it, the GOP is working daily on issues that 

they feel are wrong that should be passed by the present administration. Now, listening to the issue of the repeal of the health care 

reform that had been approved at this point: Will the Indian 

38

Health Care Improvement Act, because it is a part of that, be affected by that decision if there is going to be one? 

Senator DORGAN. If there were a repeal of the health care bill 

that was passed by the Congress, the Indian Health Care Improvement Act would similarly be repealed, because that’s where we attached it. But let me just say this: That is not going to happen; it 

will not happen. Let me tell you why: Even if those who believe 

this should be repealed—and I don’t; that would be a profound mistake to repeal that law—even if they had enough votes to repeal 

it, they would not have enough votes to override a presidential 

veto. There would need to be 67 senators that would say, yes, we 

want to repeal this law, and we would overturn a president veto. 

Clearly President Obama would veto a bill that would repeal the 

Health Care Bill, and clearly the Senate would be willing to sustain a veto. 

Mr. MOYLE. Thank you very much. Thank you very much. 

Senator DORGAN. All right. Chairman Bell, again, you opened 

this hearing with a blessing. Let me ask you, similarly, to close it 

with a blessing. 

Mr. BELL. Thank you. First off, Senator, I want to thank you 

again. Thank you for listening to all of our testimonies here, each 

and every one of us. And I believe you are personable in the area 

that you’re working with throughout this country in the testimonies that’s already been provided to you on behalf of Contract 

Health. So I appreciate that. Appreciate the honor to meet your acquaintance. I’ve met you once before in Bizmarck, North Dakota, 

Tex Hall with the NCAI president, he held one of the conferences 

there when I was attending the college. So I appreciate that. I’ve 

had an opportunity to go back to your state. I enjoyed and look forward to going back; I’ve been invited as a guest speaker at the college. Thank you for being here. 

[Prayer/Blessing.] 

Senator DORGAN. This hearing is adjourned. 

[Whereupon, at 3:37 p.m., the hearing was adjourned.] 

(39)

APPENDIX

PREPARED STATEMENT OF HON. LUCILLE CAMPA, TRIBAL CHAIRPERSON, LAS VEGAS

PAIUTE TRIBE

As Chairperson of the Las Vegas Paiute Tribe (the Tribe) I would like to outline 

some key concerns regarding coverage for medical and dental care through Contract 

Health Services, utilization patterns, billing issues, and how these key issues have 

impacted the Tribe and our service population. We are aware that our fellow Tribes 

may face different issues where reimbursements and CHS budgets are concerned, 

and where certain common concerns exist—there are variations depending on the 

Tribe in question. Our hope is that we will be able to identify areas for improvement 

to avoid budget shortfalls and billing errors that have compromised access to muchneeded healthcare. 

Our service populations has experienced significant delays in obtaining medically 

services necessary specialty care for our covered members due to barriers to access 

at the nearest Indian Health Service facility, Phoenix Indian Medical Center. When 

possible, we rely on our local referral network; however, there are gaps in this system due to our inability to negotiate contracts with providers who are unwilling to 

accept Medicare’s fee schedule. Due to funding limitations on CHS dollars, we have 

had to deny treatments and supplies that were deemed to be beneficial and necessary by our contracted providers. In addition, we are unable to meet the dental 

care needs of our orthodonture candidates, as well as our elders in need of dentures 

and bridge work. Some of our infirm elders, as well as some younger members, with 

major medical problems need enhanced medical and social service support that unfortunately we are unable to provide. 

Las Vegas Paiute Tribe strongly supports the development of a Nevada Area Office of the Indian Health Service that would allow us to better channel Federal resources to Nevada Natives. In southern Nevada alone, there are an estimated 

25,000 Indians who have no IHS services readily available. Further, the exclusions 

by PIMC have caused hardships to our patients, which is ironic given that the Tribe 

is part of the Phoenix Area. Extending the Medicare-Like-Rates rule to apply to outpatient services would dramatically alleviate the strain on CHS dollars and severely 

impact the services to our primary services population. 

Please feel free to contact me or our Acting Clinic Director, Andrea Harper, if you 

have any questions or need further assistance. 

PREPARED STATEMENT OF HON. ARLAN D. MELENDEZ, TRIBAL CHAIRMAN, RENO- SPARKS INDIAN COLONY (RSIC) 

Background 

The Reno-Sparks Indian Colony (RSIC) is uniquely situated in Washoe County, 

right at the borderline of the Cities of Reno and Sparks, Nevada. RSIC has also established the Hungry Valley community 19 miles away. The urban population is included in the tribe’s catchment area. 

Between our own patient count, the urban Indians and the patients crossing-over 

from nearby tribes, one would begin to understand the strain placed on the Contract 

Health Services (CHS) and Hospitals and Clinics (H&C) funds realizing that we 

exist in a Contract Health Services Delivery Area (CHSDA) state and adhere to the 

Indian Health Service (IHS’) open door policy.

RSIC views the distribution of CHS funds as inequitable among the Service Units 

within the Phoenix Area. Our Tribe is located within a multi-tribal service unit. The 

Schurz Service Unit (SSU) is one of the few Service Units in the Phoenix Area that 

does not contain a hospital directly operated by the IHS, nor are the tribal clinics 

fully staffed, equipped or constructed per IHS standards. The seven (7) clinics within SSU rely solely on CHS funds to pay for hospital and certain outpatient specialty 

services. RSIC regards the difference in service availability as inequitable. This is 

especially true when Service Units are placed on Level 1 priority for CHS services, 

40

where the Service Units without direct hospital or in-house ancillary services appear 

to suffer unfairly. 

CHS Funding Inequity 

It has come to our attention that the CHS-dependent Area Offices in Portland and 

California fared better in the last CHS funding distribution due to their CHS-dependency. Unfortunately, the Nevada Tribes fell under the Phoenix Area which is 

dominated by the Phoenix Indian Medical Center (PIMC) and Arizona hospitals operated by the IHS. Our CHS-dependent needs were ‘‘masked’’ in the formula. 

Several options to address the CHS shortfall in Nevada, and more specifically, for 

the Reno-Sparks Indian Colony include the following:

• RSIC does recognize that a major problem in the Schurz Service Unit is the 

lack of medical contracts with specialty and Hospital providers which contributes to the high CHS costs. A concerted effort by the IHS needs to be made 

as soon as possible, to contract with providers using Medicare or better rates;

• The lack of direct inpatient care in Nevada creates an unfair service delivery 

for IHS beneficiaries in the Schurz Service Unit. The CHS distribution formula 

for new monies should contain the following factors, by Operating Unit:

• CHS-dependency weight (75%)

• Active CHS User Population (15%)

• Cost Adjustment for Cross-over of patients (5%)

• Cost Adjustment for Inflation and Population Growth (5%)

• These rate adjustments to the formula are proposed; the final rate should 

be agreed upon after Tribal consultation with the affected tribes;

• Another option that IHS needs to consider is the reallocation of CHS base budgets to address the inequities among the IHS Areas nationwide.

• The limited CHS funds could be more efficiently used by using a portion of the 

CHS funding to establish a ‘‘Center of Excellence’’ within the Reno-Sparks Tribal Health Center to provide services that are currently paid for by CHS funds, 

namely:

• Regional lab or radiology services;

• Same day surgeries;

• Or other specialty services.

By moving towards a Center of Excellence concept, the IHS will save the CHS program thousands of dollars. The Reno-Sparks Indian Colony is willing to plan for 

these services on a regional basis. Our tribe has already constructed a 65,000 square 

foot health center using private, public and tribal funds and we stand ready to expand services for the benefit of our beneficiaries. Funding for a Center of Excellence

will go a long ways addressing health needs in Nevada as well as the CHS shortfalls.

• The limited CHS funds in the Schurz Service Unit are used to pay for pharmaceutical supplies for the tribes under this service unit. Should decisions be made 

to eliminate the financing of these costs, RSIC wants assurance that the IHS 

will allocate other additional funds to cover the costs, and not transfer the burden to the tribes.

Health Crisis in Nevada 

Indian health care is on the verge of crisis in Nevada. The health care funding 

has been woefully inadequate. Denials of CHS care have increased 400-fold in the 

last 9 months, ranging from life-saving treatment of dialysis to emergency room visits involving congestive heart failure, motor vehicle accidents, birthing, and other 

emergencies.

• To be more consistent with services provided elsewhere in the IHS, the IHS 

needs to drop the priority levels used by the Schurz Service Unit in favor of 

a ‘‘Medically Necessary’’ approach to medical care. The medical provider determines that care is needed and the care is arranged;

• The IHS has not addressed the ‘‘crossover’’ issue impacting the Reno-Sparks 

Tribal Health Center. As the regional hub of specialty and hospital services in 

northern Nevada, patients from surrounding Tribes have migrated to our facility out of convenience. The current funding formulas do not give credit to the 

crossover workload that is occurring. The term crossover is used to identify 

those patients whose community of residence lies with Tribal clinics throughout 

41

northern Nevada and California. Our tribe is not given credit for the active 

users from the surrounding areas, since the IHS is defining active users as a 

patient’s community of residence. This policy has added a financial burden to 

Reno-Sparks and there needs to be a process to compensate for the time and 

expenses incurred as a result, including but not limited to the providers, medical supplies, support personnel, ancillary services, transportation and any referrals to outside providers that must be prepared for the continuation of the 

care. 

In Closing 

In summary, we are fully aware that more funding is needed for Contract Health 

Service nationwide, but that does not mean that substantial increases will reach the 

most needy and CHS-dependent Tribes. The CHS funding formula needs to be 

changed to address the needs of the Tribes who are primarily dependent on CHS 

due to the lack of access to an Indian Hospital within close proximity to where they 

live. If there is a strong correlation between having Indian Health Service Hospitals 

and the need for CHS funding, then more funding should go to the primarily dependent Tribes without access to Indian Hospitals. 

PREPARED STATEMENT OF ROSE MARY JOE-KINALE, HUMAN SERVICES DIRECTOR, YERINGTON PAIUTE TRIBE

This is my personal viewpoint, and the expressions are from my experience with 

IHS matters. I have worked in all the tribes under WNA–BIA and see virtually the 

same issues. 

The Schurz Service Unit has been primarily the focal of misunderstanding, failed 

agendas, and always behind on paying the bills of the service population of the Native Americans of Nevada. To begin with there are several items that are in dire 

needed of changing in order to facilitate better services. These include:

• Budget to the Unit: The questions of who administers the funding, what clinics 

are involved, is there policy and procedures that govern the budget, do tribes 

have a say in their funding and though not directly involved in the clinics, as 

a tribal social worker I have always had to work with the local tribal clinic that 

I am assigned or work at. These are matters that I don’t know about. I do know 

that we are always at Level 1 and referrals are not honored. As a matter of 

fact, one of the providers told me ‘‘I feel guilty, and don’t know if my personal 

ethics will allow me to stay.’’ I asked him what he meant and he said ‘‘your 

people come to me for their illness, I assess, evaluate, and diagnosis then make 

a referral which IHS-Schurz Service Unit many times denies.’’ He said that he 

feels guilt because he than has to prescribe a stronger pain medication and 

there is addiction to pain relief medication and it is a vicious cycle to many native clients.

• Policy and Procedures: There is no policy laid out for the referral system. I was 

ill in June, and woke up at my Mother’s home in Schurz, Nevada and had 

symptoms of a heart attack. I was taken by ambulance to Yerington, Nevada 

and the Care Flight—REMSA flew me to St. Mary’s Hospital in Reno, NV. I 

didn’t have an attack; however was referred back to my own physician. Than 

I had major issues about paying the bill although I had private insurance with 

my employer (Yerington Paiute Tribe) and Medicare—Part A.

• Referrals: After my discharge from St. Mary’s several weeks later, I went to see 

my doctor to set up surgery for the diagnosed health issue. I was very aggressive as I was told at the Pyramid Lake Paiute Tribal Clinic that I need to go 

to Phoenix but would need to pay my own transportation and IHS would reimburse me. I asked why as I had two insurance plans, and also was concerned 

as if the procedure didn’t go the way it was supposed to, than where I would 

go for follow-up. I told the referring staff person to schedule me anyway, and 

I would deal with IHS later. I did have complications.

• Computers and Software for Billing: The computers at the unit are very, very 

old, and with new computers and software the filling could be taken care of in 

a short time and we wouldn’t always be behind in payments to our providers. 

In all of the tribal areas that I have worked at this is a major issue. There could 

be a centralized system with all Western Nevada tribal clinics working the billing system the same.

• Training: This brings up the responsibility of Phoenix Area Office to train and 

have a training packet so when new tribal clinic personnel began work they 

have some notice and ways to work. I believe that most tribal clinics are small 

42

with the exception of the Reno-Sparks Indian Health clinic and maybe the 

Washoe clinic.

• Meeting: At a meeting that I went to there was a representative from IHS and 

St. Mary’s Hospital in Reno and the representative offered to have a meeting 

with clinic directors, IHS personnel and others to set up what clinics should 

look like and this included a billing process. He stated that hospitals and all 

that is needed to provide comprehensive services was his business. He offered 

his CEO to be at the meeting and nothing came of this. This was information 

that he felt that he needed as now we no longer use the Renown Medical Center 

and have to go to St. Mary’s.

• Substance Program: As a social worker, I see a dire need for this issue as any 

provider who gets this recommendation will tell you that this issue must be 

dealt before we see any results in a change of the person and than the family. 

Substance use and drugs are a major issue and there is a definite need for the 

program. Our clinic doesn’t have funds to send anyone to in-patient treatment. 

Why are we left out?

I would like to see these major matters dealt with. For so long our Schurz Service 

Unit has been running like it is now and we are like 30 years behind in comprehensive services to our people. Something must be done with planning, adequate budgets, and programs. 

Thank you for the opportunity to offer testimony. 

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PREPARED STATEMENT OF HON. MERVIN WRIGHT, JR., CHAIRMAN, PYRAMID LAKE

PAIUTE TRIBE


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PREPARED STATEMENT OF HON. WALDO W. WALKER, CHAIRMAN, WASHOE TRIBE OF

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