WASHINGTON — Some medical clinics serving Native Americans are running out of funds thanks to the federal government’s partial shutdown, and closures could begin by week’s end.
“Friday is going to be our last day until the government reopens or another source of funding becomes available,” said Kerry Hawk Lessard, executive director of Native American Lifelines, which operates clinics in Boston and Baltimore under contract with the federal Indian Health Service (IHS).
“Lives are definitely at risk because of the shutdown,” Mary Smith, JD, former IHS acting director and a member of the Cherokee Nation, told MedPage Today
The IHS provides direct services, run by the federal government, and also funds tribally run services. Under the shutdown, the direct services continue, although employees are not being paid. Funding to the tribes and to urban contractors such as Native American Lifelines, however, has stopped.
Some tribes have more funding than others, Smith explained.
At this point, IHS has stopped paying the tribes, but “they can still pay their people if they have the funds available,” Smith said.
The same holds for urban clinics funded through grants allotted by IHS. Of the more than $5 billion in funding for IHS, about 60% is directed toward tribally run programs and urban clinics, Smith said. Most Native Americans eligible for services live in cities, not the tribal reservations.
The Indian Health Service was contacted for this story and no response was given as of press time.
Native American Lifelines’ clinics are critical to helping connect Native Americans with medical services and often times helping pay for their care, Lessard said.
“If somebody comes to me and says, ‘I’ve got a prescription at the pharmacy,’ we write a check for it… We pay for glasses, we pay for durable medical equipment, we pay for emergency room bills… When somebody overdoses, outside of family, we’re one of the first people that gets a call.”
In Baltimore, where the opioid epidemic is particularly acute, Lessard’s clinic helped with three overdoses the week of Christmas. Two of those people died, she said.
While the clinic does not provide direct medical care, it offers psychosocial counseling services and refers people to substance abuse treatment or inpatient detoxification.
And if victims of overdose die, the clinic provides grief support for their family members and help with funeral arrangements and costs.
In an email to MedPage Today, Lessard explained that because the program is preparing to close in 48 hours, its staff had to explain to a current client who is in the hospital for an overdose that staff can no longer help.
“We’ve had to let the client and the client’s family know that we will not be available to coordinate care, make purchases, or refer to additional treatment,” Lessard said in the email.
“Substance use will continue to occur and, no doubt, so will the overdoses. That we won’t be in place to assist is deeply troubling,” she wrote.
In Boston, where that clinic’s focus is mainly on needy care and elderly clients, a Lifelines employee was in the emergency room at the bedside of an elderly woman with pneumonia until 4 a.m. Wednesday. The employee has coordinated all of the client’s care in recent months, and helped to manage her type 2 diabetes, Lessard said.
“This is an 82- 0r 83-year-old woman who doesn’t have anyone else. That is going to be a significant loss for her,” Lessard said.
Lessard said the clinics serve an active patient load of about 75 patients per month.
Plea for Action
Francys Crevier, executive director for the National Council of Urban Indian Health, sent a letter to Congress on Monday calling for “urgent action” to end the shutdown.
According to the group’s survey of 13 Urban Indian Health Programs (UIHPs), five face closure within 30 days if the shutdown continues, the letter said, including Lifelines.
“Despite the fact that approximately 78% of [American Indian/Alaska Native] people live in urban areas, the urban Indian line item constitutes less than 1% of the IHS budget, making every dollar of funding absolutely critical to the fulfillment of the national obligation for the provision of health care to AI/ANs,” Crevier wrote.
In addition to the imminent closures, ripple effects from the shutdown may also hinder patients’ access to care, Smith noted. There’s already a shortage of clinicians working for IHS and during the sequestration of 2012, doctors and nurses left, Smith recalled.
“It may be hard to get them back ever again,” she said.
Drug Supply in Limbo
Aaron Payment, tribal chairperson for the Sault Ste. Marie Tribe of Chippewa Indians, told MedPage Today that his tribe is especially concerned about supplies of prescription medications. Tribes have a formulary for the medications they carry, which are typically purchased through supplier contracts at “a fraction of the open market value,” he said in an email.
Payment said he’s concerned that this supply could be interrupted, or that tribes may have to pay extra for medications, some of which are life-saving.
“We’ve got our fingers crossed that some deal is struck by the 15th of January,” he said, when the next allotment of funding is slated to be wired.
“We predict we have about 2 to 3 weeks of unobligated reserve funds to be able to operate,” he said.
But by late January or early February, they may not be able to fill prescriptions, he said.
And “we’ll be looking at doing furloughs and layoffs” if funding does not come through.
Payment said he was particularly disappointed in the way the Trump administration handled the shutdown.
During previous shutdowns, the Obama administration held “tribal leader calls” up to a week before the shutdown. “This time we got one memo and no opportunity to ask questions,” he said. “Nobody should be experiencing this, because there doesn’t seem to be any real crisis.”
“The United States has a legal and trust responsibility to provide healthcare to Native Americans, and they should honor that responsibility,” Smith told MedPage Today. She noted that, under the the treaties negotiated decades ago, the government promised to provide healthcare, education, and social services in return for the millions of acres of land ceded by Native Americans.
“We prepaid for everything that we get,” said Payment.