Tahlequah Daily Press

April 24, 2008

Hospital takeover concerns mount


TAHLEQUAH DAILY PRESS — Following an announcement last week that the Cherokee Nation will assume operations of Hastings Indian Medical Center Oct. 1, some tribal officials were surprised the decision was made without a vote of the full council.

The Daily Press obtained a copy of an e-mail Dr. Brad Cobb, District 8 councilor and chairman of the health committee, sent to fellow councilors to voice his concerns.

“As chair of the health committee, this press release has personally put me in a difficult position,” wrote Cobb. “And has, at the same time, de-edified the tribal council as a whole.”

Speaker of the Council Meredith Frailey indicated Cobb is not the only person concerned about the situation.

“There have been many inquiries about the Cherokee Nation assuming operations of W.W. Hastings Indian Hospital,” wrote Frailey in a e-mail to the Daily Press. “And, rightly so, because it is a major, challenging endeavor. Many constituents have inquired whether the level of care at WWHIH will be improved under CN management.”

Frailey said several Indian Health Service employees are concerned about their jobs and benefits retention, and some council members expressed concern that the recent news release announcing the takeover gives the appearance of indifference to council opinion.

Cobb explained in his e-mail that he believes tribal councilors are elected by constituents to represent the people, and in announcing the takeover to the media and all employees, the administration effectively disenfranchised the citizenry.

“It is my belief that the Cherokee Nation and W.W. Hastings Indian Medical Center are merely in a negotiation phase,” wrote Cobb. “To assume anything more would be conjecture.”

Cobb asserted the Hastings matter should be put to a vote of the tribe’s health committee, the executive and finance committee, and finally the full council, before any move is made to take over the hospital.

“Until that time, it [the takeover plan] is nothing more than a plan on a blackboard.”

In a Daily Press report published in January this year, Cobb, during a health committee meeting, “stressed the importance of properly addressing the tribe’s intentions [to take over HIMC], and that the council will be responsible for making any final decision.”

Frailey pointed out to proceed to the second phase of negotiations with IHS, an “expression of intent” is required.

“It is my understanding a letter of intent has been provided to IHS by the administration to continue the analysis and planning phase of negotiations,” wrote Frailey. “Therefore, it is premature to make a decision on whether to assume operations at the hospital. The planning process and analysis have not been completed. The concerns of citizens and employees certainly are being considered during the process.”

District 9 Councilor Chuck Hoskin Jr. responded to Cobb’s e-mail, offering support and indicating he, too, believes the matter should be approved by the council and its committees.

“Anyone who has read the press release or subsequent news articles comes away thinking it’s a done deal,” said Hoskin. “I support Dr. Cobb in his response and back him up 100 percent. This decision would appear to be a public display of indifference to us [tribal council].”

Hoskin indicated he had not yet been contacted by concerned constituents, but that the struggle seems to be internal.

“In hearing about the takeover, most constituents would probably assume we’ve been involved,” he said. “I think the biggest problem is our not being a part of that process.”

According to two resolutions passed by the tribal council, 11-93 and 15-06, the principal chief has the authority to “negotiate and execute each associated funding agreement to operate programs, services, functions and activities of the Indian Health Service as authorized by the compact.”

The first resolution, 11-93, was passed with full support of the council in February 1993, during Chief Wilma Mankiller’s tenure. The second, 15-06, reaffirmed the original resolution and was passed in March 2006, also with full support and endorsement of the council under Chief Chad Smith’s administration.

Hoskin agreed there may be legislation in place providing the chief with authority to enter into such agreements.

“I’m going back to my office to review the information,” he said. “It may be that we need to amend that legislation to require the chief, to at the very least, ask the council for ratification when he enters into such an agreement. It surprises me a previous council would have given up this power.”

While the chief may legally be permitted to enter into such agreements, Hoskin pointed out it is up to the council to make budget allocations.

“The one thing the council has is the power of the purse,” he said. “They can approve a takeover, and we can agree to not allocate one thin dime to its pursuit. It’s really the only leverage we have.”

Frailey stipulated that indeed, the tribal council “has authority from a financial oversight capacity in approving the budget covering the assumption of the [hospital] operations.”

“The decision to approve a budget for that purpose will involve careful consideration and deliberation by tribal council members,” wrote Frailey. “Specifically, the tribal council has authority as a legislative body and as a representative of the Cherokee people to be involved in the planning and analysis of assuming operations at WWHIH. During a recent CN Health Committee meeting, a request was made and approved to involve the tribal council in an advisory capacity to serve on the negotiation team when those conversations begin with IHS.”

In addition to Frailey, members include Jack Baker, Brad Cobb, and Bill John Baker.

“The purpose of the request was to keep the tribal council informed as planning proceeds and to provide requested input, if necessary, in the negotiations,” Frailey wrote.

She also indicated she plans to consider three options in her final analysis of whether the Cherokee Nation should assume operations of HIMC. Her questions include:

• Should the operations of HIMC continue under IHS?

• Should operations be privatized?

• Should Cherokee Nation assume the operations?

“As a sovereign nation, every decision our leaders make should be made to not only protect, but also to honor our inherent sovereign rights,” wrote Frailey. “It is indeed an honor for the Cherokee Nation to be recognized as a sovereign and to be able to negotiate on a government-to-government basis with the U.S. Indian Health Service.

“In a health care delivery system, to accomplish the above sovereign goals, we should be promoting healthy Indian people and assuring we are providing services that increase the status of their health. Therefore, in my analysis covering the three options listed above, I will need to determine who can best meet the needs of not only the Cherokee people, but all Indian people served through the [hospital.]”

She also wants to know who has the ability to elevate the health status of Indian people to the highest level possible.

“When the [tribe’s] administration presents the final plan as to whether we should assume operations of WWHIH to the council for approval, if they can resolve those concerns in my mind, then I will make a decision,” Frailey said. “The most important consideration is whether Indian people will be served at the highest level they desire.”