Story Photos
 Photo by Greg Ebersole Dr. Sophie Hoptowit checks the heart of 9-month-old Kruz Lopez at the Cowlitz Indian Tribal Health Services clinic in Longview Thursday. |
Good medicine: Cowlitz Indian Tribal clinics earns accreditation
Friday, August 24, 2007 12:09 AM PDT
By Thacher Schmid
Printable version
E-mail this articleThomas Young and Helen Anderson swear the Cowlitz Indian Tribal Health Services' clinic on Fir Street saved their lives.
Young, 77, had a heart murmur for decades before the Longview clinic sent him to a cardiologist, who learned the Chickasaw Indian was on the verge of a major stroke or heart attack.
Young got a pacemaker; the clinic got his everlasting gratitude.
"I owe my life to that Cowlitz clinic."
Anderson, 73, went blind, and a rash of different medications didn't solve her health problems until the Cowlitz clinic sent her to Seattle for tests, which discovered a blood disorder
"It's just been a blessing to me that they did that, because nobody had even thought of this disorder before I went to the Cowlitz clinic," said Anderson, a Cowlitz-Yakama Indian.
She had an operation to regain sight in one eye and is free of the blood disease. "Three years ago (people) thought I was going to die."
The four-year old clinic recently received a clean bill of health itself -- though its finances are anemic.
Last week the clinic received accreditation from the Accreditation Association for Ambulatory Health Care, which means it's meeting national standards. It also recently added its first full-time doctor. In addition, it recently opened its services to non-Indians and plans to expand soon to a building next door in the old Fir Street medical complex.
The accreditation as the culmination of years' work that won't change the clinic's day-to-day routine but demonstrates its quality, said clinic manager Steve Kutz, a Cowlitz elder, said in a recent interview.
"It's not like you turn the switch -- it's a process," said Jim Sherrill, health services director.
"We've had employees in the past that didn't want to go through the process of demonstrating that they were providing quality work," Kutz said. "One of the ways you can demonstrate to (clients) that they're not coming here for second-class medicine is to go through this accreditation process."
Second class
Second-class medicine has long been a problem in American Indians, which suffer from a high incidence of chronic health problems such as diabetes. Sherrill and Kutz said the clinic treats diabetes, high blood pressure, cardiovascular problems, high cholesterol and weight problems on a regular basis.
Federal Indian health programs are notoriously underfunded, and attempts to reform the system have languished in Congress for 15 years.
"People in prison get better health care than natives on the street," Kutz said.
The Cowlitz clinic provides child wellness exams, immunizations, limited lab services, nutrition counseling, family planning, diabetes screening and women's health services. It also has a state-supported sexual assault treatment program that served 19 people last year.
The Cowlitz clinic gets $1 million from the federal Indian Health Service, one of the major tribal federal health care programs. IHS funding is significantly less, per person, than comparable federal health services like Veterans Administration or federal prisons, according to the Northwest Portland Area Indian Health Board.
Sherrill acknowledged that any windfall the tribe earns from its proposed La Center-area casino would help shore up the clinic, but now the facility's expenses exceed its funding, he said, declining to be specific.
"Unless things turn around, five years from now we're going to have to cut back," Kutz said.
One reason finances are falling behind is because tribal membership is expanding.
Indian Health Service funding is based on the tribe's membership when the Cowlitz were federally recognized in 2002. It had 944 members then but since has grown to 1,750, so available health care dollars have dropped from $929 per tribal member to $350.
Growing services
Although it is a Cowlitz Indian-owned facility, half of the clinic's caseload is from other tribes, such as Apache, Iroquois, Navajo, Yakama and Payute, whose members' health care is funded with federal dollars.
"Ours is like an alphabet soup of the tribes," Kutz said. "In Southwest Washington, there is no other clinic serving natives."
In part to increase its revenues and reach out to the community, the clinic last spring started accepting non-Indian patients, though they make up less than 5 percent of the caseload. Non-indians must have health insurance.
In July, the clinic signed a contract with Cowlitz County to provide chemical dependency treatment services to local youth of all ethnic backgrounds. Currently, Sherrill said, the program serves "eight or 10" local youths, which "will increase drastically once school starts." The contract plans for 80.
The clinic recently added a physician, Sophie Hoptowit, a Yakama tribal member who came aboard full-time in March.
Until June, the clinic employed Don Taylor, a psychiatric nurse practitioner from Oregon Health Sciences University who provided mental health services, but OHSU recalled Taylor. A representative of OHSU said the demands of Taylor's teaching responsibilities and clinical practice brought his work at the clinic to an end.
Currently, referring patients to "totally overloaded" public mental health providers has meant more people aren't getting the mental health services they need, Kutz said.
"We have been way more calling the crisis line than we did when we had our own provider," Kutz said. "We made some attempts to recruit a psychiatric nurse practitioner, with negative results."
Breaking ground
The Cowlitz will soon break ground on a clinic expansion that will increases the number of exam rooms to eight, up from three. Sherrill said the startup date is uncertain, but the project is scheduled to be completed in 18 months.
"It seems like forever to me," Sherrill said, but smiled.
Sherrill and Kutz hope to use the new space for dental and pharmaceutical services, a long-term goal.
While welcoming any new services, tribal members who used to struggle to find health care are elated with the services the clinic already provides.
"There was no health care, you had to get by on your own," recalled Ernie Donovan, 83, a Cowlitz elder, who goes for anxiety and general medicine. "We didn't have anything, so that's why we're so delighted."
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