Making Washington the Healthiest State in the Nation
Moms, Babies & Meth
Tuesday, April 17, 2007
Call to Order: Andy Joseph, Vice-Chairperson, called the meeting to order at 9:05 AM.
Invocation: Spencer McCarty performed the ci-qi and Reverend James Kallappa gave the invocation.
Posting of Flags: The Makah Veterans
Welcome: Ben Johnson, Jr., Makah Chairman welcomed the NPAIHB delegation.
Roll Call: Janice Clements, Treasurer called roll:
Burns Paiute Tribe – Present
Nisqually Tribe – Present
Chehalis Tribe – Present
Nooksack Tribe – Absent
Coeur d’Alene Tribe – Absent
NW Band of Shoshone – Absent
Colville Tribe – Present
Port Gamble Tribe – Present
Grand Ronde Tribe – Present
Puyallup Tribe – Absent
Siletz Tribe – Absent
Quileute Tribe – Present
Umatilla Tribe – Present
Quinault Nation – Absent
Warm Springs Tribe – Present
Samish Nation – Present
Coos, Lower Umpqua & Siuslaw Tribes – Absent
Sauk Suiattle Tribe – Absent
Coquille Tribe – Absent
Shoalwater Bay Tribe – Present
Cow Creek Tribe – Absent
Shoshone-Bannock Tribe – Absent
Cowlitz Tribe – Present
Skokomish Tribe – Present
Hoh Tribe – Present
Snoqualmie Tribe – Present
Jamestown S-Klallam Tribe – Absent
Spokane Tribe – Absent
Kalispel Tribe – Absent
Squaxin Island Tribe – Present
Klamath Tribe – Present
Stillaguamish Tribe – Absent
Kootenai Tribe – Absent
Suquamish Tribe – Present
Lower Elwha Tribe – Present
Swinomish Tribe – Present
Lummi Nation – Present
Tulalip Tribe – Absent
Makah Tribe – Present
Upper Skagit Tribe – Present (Wednesday)
Muckleshoot Tribe – Absent
Yakama Nation – Absent
Nez Perce Tribe – Present
There are 23 delegates present, a quorum is established.
Executive Director Report: Joe Finkbonner: A power point presentation was presented. (Attachment #1)
Indian Health Service Update Doni Wilder: A power point presentation was presented. (Attachment #2) I am going to talk a little bit about the 2007 budget. We are still not through with the whole thing, even though we do have appropriations and you can see the numbers for the final. That is the 4.4% increase over the ’06 enacted. Usually, or in pass years anyway, we could depend on Congress to give us a big increase over what the President proposed; but that didn’t happen. Finally the joint resolution added $135 million to the IHS budget; which included $9.8 million increase for pay act. There was some unusual language this time; all that money came in services and there was language prohibiting earmarks. It did create some issues for the Agency in terms of how they normally spread this across line items. What the Agency has done is we have distributed the lump sum dollars now. But we have not distributed the increases because we haven’t received the increases at the Area level. What is happening is there are some technical amendments in the supplemental bill. The supplemental bill we know is the one that Congress is working on that they are including the language on time lines for bringing troops out of Iraq. That is the bill the President is going to veto if that language doesn’t get compromised or worked out. Congress is just back from recess; so it is going to be a while before that all sorts itself out. What those technical amendments do is let the Agency spread some of that money over various line items to provide appropriate pay act and some mandatory increases. It also put some money in facility appropriations.
What they are asking for is $25.8 million of the increase will go to CHS; so there will be new program dollars. $7.8 million of that is for staffing new facilities. They are asking for a $5 million increase in contract support costs. $7.3 million will be moved into facilities appropriation; $4.3 million of that is staffing the facilities and then $3 million towards mandatories and some to joint ventures and maybe some in small facilities. So when the supplemental gets passed and technical amendments and I have been told that they are going to have to go all the way back up through the Department again and through OMB to get that approved. So we probably will not see that money out for quite a while. That is going to create some problems at Headquarters, because that is going to be money going out at the last minute which isn’t a good year for that to be happening because we are implementing a new financial system and they are going to pull the plug on most acquisition operations on September 1, 2007.
FY 2008; we have spent quite a bit of time on this at various meetings; but just for people that may not have attended those. The 2008 request is $3.2 billion; that is a $212 million increase. The HHS budget authority is $697 billion; but only 9.9% is discretionary. I think the Portland Area is going to come out better than they did last year. We are coming across some other costs that are new requirements. Some of the things that are adding to those costs are deployment of officers. I think you all know that they are having a tough time staffing Iraq positions and the Secretary has some world health initiatives that he is doing. So, the Commissioned Officers are being looked at as personnel to fill those positions. We are going to have an officer from our Area that is going to go tour Iraq. I am not sure how many officers are going to go on a trip providing health care to some communities in the Caribbean. You need to make sure your officers are getting permission from their supervisors before they volunteer.
We have some increased costs that we are going to absorb at the Area. One is regarding the homeland security initiative; that will require all federal employees have ID and security measures. We are going to have ID cards that have our personal information in them. We do not know the cost yet; we think it is going to be pretty expensive. HHS mail; we no longer support our mail service that is all done in IHS headquarters, we pay a mailbox fee; the new cost will be about $80,000.
The Federal Information & Security Management Act (FISMA) has some new requirements for protecting electronic information and some of that we have already spent. There is a committee that is actually looking at what parts of FISMA apply to tribe. It is a federal information security act so it primarily applies to federal information programs. It is a political climate where it certainly is important for information systems to be protected. It requires us to go through a certification and accreditation process to make sure we have appropriate fire walls and virus protection. That was a very expensive endeavor; there were consultants that were already geared up to do that. Some of our staff is now trained to do some of that ourselves; but you do have to have some security. The group is looking at what do we think the tribes are required to do as part of the act and it depends on their connectivity to our system or to a federal system.
The facilities construction priority system; most of you know that when we did our Area facilities master plan we included looking at and justifying three regional facilities plus a regional hospital. One of the problems that we had was that Headquarters didn’t quite know how to score one of these regional facilities because of the data issues. Users that are associated with individual tribal communities; if you have a regional facility that is intended to serve multiple tribes, you still want to score the local community’s facility needs. You want to give them a score so that they are on an eventual list. All Area sites in the Master Plan will be scored but this is our best hope for ranking high enough to see a facility built.
GPRA, you have handouts for the second quarter status report. You look really good so I would encourage you to look at your individual ones that Mary will be sending out shortly.
Just a reminder, I have told you this a couple of times, in negotiations we are going to be asking you to voluntarily include agreement to participate in GPRA and report GPRA data. This is the charge that OMB has given IHS. They would like to see more tribes reporting GPRA data so I would encourage you to do that.
BREAK FY2007 Portland Area Tribal Shares Doni Wilder: I was on the agenda to talk about tribal shares and I forgot to ask Joe to take that off because normally at the All Tribes meeting the mandatories are added on to the Area shares book and we give you a book and show you where mandatories are added. We didn’t have that for the All Tribes and so we said we would do it at this meeting; but as I said in my report we do not have mandatories yet and I do not know when we are going to have mandatories. So, hopefully for the July meeting and we will get time on the agenda and go through the Area shares.
Elders Conference Update Chandra Wilson: Before I begin my report I wanted to let you know that we have passed around a form that is asking for your tribal health director, delegate and chair to make sure our database is correct and we have also added on a section for the “elders program coordinator” name. If you would fill it out and return it we would appreciate it.
As far as a Northwest Elders conference being held by the Board, at this time we do not have funds to have one. We are currently and actively looking for grants that could fund an elder’s conference. I am not sure if this confirmed yet but some good news is that NICOA is suppose to be having their 2008 conference in Tacoma. I am serving on the conference planning committee for this and the first meeting will be April 24, 2007 at Muckleshoot.
Alaska Native Tribal Health Consortium Update Don Kashevaroff: I am Chair of the Tribal Self Governance Advisory Committee and also the President of the Seldovia Village tribe. A power point presentation was presented. (Attachment #3)
Lunch Methicillin Resistant Staphylococcus Aureus (MRSA)
Ellene Tuthsulee: Personal recount of MRSA and its effects on family members and friends.
Senator Patty Murray Office Mary McBride: I am with the office of US Senator Patty Murray and based in Tacoma, WA. I am her point person on a number of issues in Washington State, including community and economic development and a specific emphasis on affordable housing. Today I am here on her behalf to talk a little bit about some of the issues that are going on in Washington DC; the overlay of all the discussions, whether we are talking about health care or affordable housing or education.
Senator Murray has asked me to highlight a couple of issues that might be of interest to you specifically; some things that are being discussed in the Senate and then finally the real reason Senator Murray wanted me here is to listen to you and to take some information directly back to her. My commitment to you from her is that from this meeting your input will be given to her directly at the end of this week. In addition, I talked with my colleague who works with Senator Cantwell’s office and my commitment to them is to also share your input with them as well.
I want to start off by talking about the stage in Washington DC, what is going on there. From my office’s perspective this is perhaps one of the most challenging years. As you know the Democrats are in control of both the House and the Senate and part of the challenge that they face is of course coming in from both a legislative and funding perspective looking at things that have either gone under funded for a number of years or pieces of legislation that have not moved forward for a number of years.
Recently the Congress passed a piece of legislation known as PAGO; it is kind of the overlay of all of the discussions that will take place. As you know the federal budget right now is in the red; there is a huge deficit and a real deficit. Under PAGO what will take place is that whatever increases there are to any programs it has to be offset either with additional dollars coming in or other reductions elsewhere. The idea is to actually get to a balance budget position. You do that not just by simply increasing spending but you do it by balancing the other side of the ledger. The other important part of that discussion is the fact that, as many of you are probably aware, the funding for the war in Iraq has been done with what is known as ‘all ledgers’; so all of the costs associated with the Iraq war has not made a part of the funding discussions. What the Democrats have said is that the Iraq war will actually be brought into the whole picture.
Under health care Senator Murray has asked me to highlight just a few things that she would like for you to be aware of, that are issues that she is working on and she knows they will be priority in the near future.
One is the issue of mental health; when we talk about health care often times we talk about sort of the physical health care needs and there are many. From a standpoint of mental health one of the things that the Senator has talked about is the fact that in this Country she believes that there is a huge crisis looming on the horizon if we are not already in it. In fact, one of the things that is part of the national trend is that as programs have consistently been reduced across the nation dealing with health care, and one would argue that there has never really been enough money to deal with mental health issues at all, but as those programs have gotten more and more limited what is happening is that there is no safety net for people.
Another issue is the challenge of health care for veterans. When we take a look at the health care needs of veterans in this country, both needs and issues are growing as we have more and more people coming back from the conflict in Iraq. Those needs are, in many cases, quite substantial. One of the things that the Senator has said is that she believes that one of the lasting legacies to this conflict in Iraq is traumatic brain injury. There are a lot of individuals that even in past conflicts that they have been involved in, the same type of injury, those individuals likely would not have surveyed and today they are surviving. But unfortunately we have found in talking with people within the Veterans Administration that there is really no strategy and no planned type of assistance for people who are coming back from Iraq with traumatic brain injury. Added to that the fact that our veterans’ health care network is already really stretched pretty thin and we are finding that more and more people are waiting months for access to that health care. What complicates it is that we have veterans that live in some very remote areas. Senator Murray is a senior member of the Veterans Affairs Committee and really is committed to making sure that those services are available to our veterans.
The last thing that I will touch on that I know that the Senator is working on is the acknowledgement that in many of our rural remote communities the issue related to drug abuse and in particular meth, which has been growing to epidemic proportions. I know that we have met with a number of tribal leaders throughout Washington State and this issue continues to come up. I know one of the things that the Senator is looking at trying to do just from an appropriations perspective and that is to try and free up some dollars that could be made available to local communities to implement some best practices. Many of you are already working on a number of projects to address the issue locally.
American Indian Caregiver Health Study Rudolph Ryser: A power point presentation was presented American Indian Caregiver Stress and Health Study – Building Evidence for Cultural, Complementary and Alternate Medicine. (Attachment #4)
The National Indian Council on Aging DEOS Project Robert Comer: The National Indian Council on Aging Diabetes Education outreach Strategies (DEOS) is a 5-year CDC-REACH 2010 grant. The project is a partnership of tribal and urban Indian organizations committed to working together to plan, design, and assess the feasibility of implementing a culturally appropriate Diabetes Prevention model for American Indian elders. A power point presentation was presented. (Attachment #5)
Wemble YRTC Update for Design Angie Pool: Wemble Youth Residential Treatment Center has been in operation since 2002 and is located in Klamath Falls, OR. Currently we are serving youth ages12-18 years old. What we provide is dual diagnosis treatment. A power point presentation was presented. (Attachment #6)
Wednesday, April 18, 2007 Call to Order: Meeting called to order at 9:00 am by Andy Joseph, Vice Chair
Invocation: Andy Joseph gave the invocation
Legislative Update Joe Finkbonner: I am here in place of Jim Roberts, who is in DC today with Pearl testifying for all of us here in the Northwest. A power point presentation was presented. (Attachment #7)
Tribal Reports Nisqually Tribe –Rena Wells: There have been some changes at Nisqually. Last March we had elections and there is new tribal council. The substance abuse and mental health, the elders program and the certified billing program have been taken out of the health department and put into social services.
The dental program has 2 dentists and a part time ortho and part time hygienist and 2 dental assistants. In the medical clinic we had a medical doctor, who was there for 8 years, has left and that position is vacant. We still have a PA and 3 MA’s. The pharmacy position is vacant and the pharmacy tech position is vacant also. We still have 2 CHR’s
Some of the projects that we are working on are prevention – for elders and youth. We have four projects a year; they are all different cultural activities.
We have a health fair, it is usually in August. Our pow wow is the end of March.
Nooksack Tribe: Absent
Makah Tribe – Betsy Buckingham, Interim Health Director: On September 3, 2007 the Makah Tribe took over the clinic and going self governance on the clinic operations. The clinic was built in 1971. We have 25 staff; 3 providers that are on call 24 hours/7 days a week. There is a hospital close by; it is 2 hours by ambulance. Our pharmacy is on-site. We have a lab. We have a diabetes program with a diabetes nurse. We have 4 CHR’s and one of our CHR’s, Pat, has been with the CHR program for 20 years and I would like to acknowledge Pat and her service to this community. Our user pop of 2025; we have about 9500 visits per year. We have Allied Health now; that is one of the new changes that we can bill the integrated health care delivery system.
Julia Davis-Wheeler: With regards to the book for Rod Smith’s family that went around yesterday and as a board delegate and I know you all feel the same way, he was such a wonderful person and we are going to miss him so much. One of the things that I would like to see the board do is do a ‘Rod Smith Award’ in his name for community people we know at home who work really hard and do not ask for anything. He was such a work alcoholic. I would really like the delegates to think about it and maybe tomorrow we could take some action on this.
Perinatal Periods of Risk Assessment Leslie Randall: Using the Perinatal Periods of Risk Approach to Understand and Prevent Disparities in Birth Outcomes of AI/AN Infants in Washington State. A power point presentation was presented. (Attachment #8)
American Indian Recovery Program SAMHSA ATR Michael Weahkee: I am the Associate Director of CRIHB and the Director of the Family Community Health Services Department. What we are here today to do is to invite Northwest Portland Area Indian Health Board to partner with us on an expansion of our currently funded SAMHSA Access to Recovery program, whose purpose is to provide funding for alcohol and substance abuse services to American Indians in our service areas. I am co-presenting today with the Project Director for this program, Ms. Vicki Sanderford-O’Connor. A power point presentation was presented. (Attachment #9)
Sonciray Bonnell: I just want to let everyone know that Joe, Michael and I have been in contact about how to get our northwest tribes to access this great resource; so we are working on it in the background. We will keep you updated on everything.
A resolution will come once we establish a partnership between CRIHB and the board to access ATR.
Julia Davis-Wheeler: I would like to make a motion, as a representative of this board, that we support this effort with a resolution; seconded by Dan Gleason, Chehalis Tribe. Motion carried. Developing Elder Housing with Services on Tribal Lands in Washington State James Frymier: A power point presentation was presented. (Attachment #10)
Methamphetamine Presentation Craig Janis: Special Agent for the Drug Enforcement from District IV Headquarters in New Mexico. Items used to make meth were set up for board members to look at. A power point presentation was presented. (Attachment #11)
Making Washington the Healthiest State in the Nation Greg Vigdor: President and CEO of Washington Health Foundation. A power point presentation was presented. (Attachment #12)
BREAK Moms, Babies & Meth Joyce Oberly: Public Health Educator for the Warm Springs Community Health Education Team gave a power point presentation. (Attachment #13)
Ernie Kimball Recognition (30 years of service) & Tribal Roast Terry Smith Retirement Recognition Recess
Thursday, April 19, 2007
Call to Order: Andy Joseph, Vice-Chairman called the meeting to order at 9:05
Invocation: Dottie Chamberlain, Makah elder gave the invocation.
Committee Reports Elders Committee – Dan Gleason: Committee report included. (Attachment #14)
Veterans Committee – Cassandra Reck: Committee report included. (Attachment #15)
Public Health Committee – Curt Russell: Committee report included. (Attachment #16)
Behavioral Health – Debbie Wachendorf: Committee report included. (Attachment #17)
Personnel Committee – Whitney Jones: Committee report included. (Attachment #18)
Legislative/Resolution Committee – Joe Finkbonner: Committee report included. (Attachment #19)
Approval of Minutes Motion by Dan Gleason, Chehalis Tribe; seconded by Janice Clements, Confederated Tribes of Warm Springs to approve the minutes for the January 2007 quarterly board meeting. Motion carried. Resolutions 07-03-02 - Support Community Participatory Research to Address Fetal Alcohol Spectrum Disorders – Motion by Dan Gleason, Chehalis Tribe; seconded by Cassandra Sellards-Reck, Cowlitz Tribe to approve the resolution. Motion carried. 07-03-03 - Support for Health Promotion/Disease Prevention Initiative for Healthier American Indian/Alaska Native Communities – Motion by Dan Gleason, Chehalis Tribe; seconded by Marcy Parker, Makah Tribe to approve the resolution. Motion carried. 07-03-04 - Support for the Northwest Portland Area Indian Health Board Annual Budget Analysis – Motion by Dan Gleason, Chehalis Tribe; seconded by Cassandra Sellards-Reck, Cowlitz Tribe to approve the resolution. Motion carried. 07-03-05 - Support for the Northwest Portland Area Indian Health Board 2007 Legislative Plan – Motion by Dan Gleason, Chehalis Tribe; seconded by Cassandra Sellards-Reck, Cowlitz Tribe to approve the resolution. Motion carried. 07-03-06 - Support for Native Nutrition and Activity Evaluation – Motion by Dan Gleason, Chehalis Tribe; seconded by Cassandra Sellards-Reck, Cowlitz Tribe to approve the resolution. Motion carried. 07-03-07 - Support for the Submission of a New Competing Access to Recovery Grant Application to the Substance Abuse and Mental Health Services Administration by the California Rural Indian Health Board, Inc. (CRIHB) to Service Indians in the states of California, Idaho, Oregon and Washington – Motion by Dan Gleason, Chehalis Tribe; seconded by Rose Purser, Port Gamble S’Klallam Tribe to approve the resolution. Motion carried. 07-03-08 - Recommendation for Institutions of Higher Education and State Health Agencies to Conduct Cultural Competency Training to Healthcare Professionals – Motion by Dan Gleason, Chehalis Tribe; seconded by Barbara Finkbonner, Lummi Nation to approve the resolution with amended changes. Motion carried 07-03-09 – Racial and Ethnic Approaches to Community Health Across the US (REACH) Centers for Excellence in Elimination of Disparities and Action Communities – Motion by Dan Gleason, Chehalis Tribe; seconded by Cassandra Sellards-Reck, Cowlitz Tribe to approve the resolution. Motion carried. Future Board Meeting Sites January 2008 – Portland hosted by Siletz or Grand Ronde
April 2008 - Chehalis Tribe
ADJOURN at 11:05 am