BIBLIOGRAPHY Attneave, C., 1977. "The Wasted Strengths of Indian Families" in Steven Unger (ed.), The Destruction of American Indian Families. New York, NY: Association on American Indian Affairs. Bureau of Indian Affairs, unpublished. "Therapeutic Residential Schools-Promise of the Future." Washington, DC, Office of Indian Education, distributed at August 1995 Indian Mental Health Advisory meeting, Washington, DC. Cross, T., Earle, K., Echo-Hawk Solie, H., & Manness, K., (2000). Cultural strengths and challenges in implementing a system of care model in American Indian communities. Systems of Care: Promising Practices in Children's Mental Health, 2000 Series, Volume I. Washington, DC: Center for Effective Collaboration and Practices, American Institutes for Research. Deserly, K.J., & Cross, T.L. (1996). American Indian children's mental health services: An assessment of tribal access to children's mental health funding. Portland, OR: National Indian Child Welfare Association. Geboe, Charles, 1995. Bureau of Indian Affairs, Report to the Indian Children's Mental Health Initiative Meeting, October. Gould, M., Wunsch-Hitzig, R., and Dohrenwend, B.P., 1980. Formation of hypotheses about the prevalence, treatment and prognostic significance of psychiatric disorders in children in the United States. In Dohrenwend, B.P., Dohrenwend, B.S., Gould, M.S., Link, B., Neugecauer, R., and Wunsch-Hitzig, R., Eds., Mental Illness in the United States. New York, NY: Praeger Press, 9-44. Hollow, Walt, 1982. "Health and Mental Health." In Indian and Alaska Native Mental Health Seminars, Seattle Indian Health Board, p. 263. Knitzer, J. 1982. Unclaimed Children: The Failure of Public Responsibility to Children and Adolescents in Need of Mental Health Services. Washington, DC: Children's Defense Fund, p. 6. Koren, P.E., DeChillo, N., & Friesen, B. 1992. Measuring empowerment in families whose children have emotional disabilities: A brief questionnaire. Rehabilitation Psychology, 37 (4), 305-321. National Institute of Mental Health. 1999: Science on our Minds: Depression Can Break Your Heart. 14 National Institute of Mental Health. 1999: Science on our Minds: Seeing our Feelings. National Institute of Mental Health. 1999: Science on our Minds: The Numbers Count. Perry, Bruce D. Memories of Fear: How the brain stores and retrieves physiologic states, feelings, behaviors and thoughts from traumatic events. (in press) Perry, Bruce. D. and Marcellus, J. 1977. The impact of abuse and neglect on the developing brain in Colleagues for Children, Missouri Chapter of the National Committee to Prevent Child Abuse. Swinomish Tribal Mental Health Project, 1991. A Gathering of Wisdoms, Tribal Mental Health: A Cultural Perspective. Mt. Vernon, Washington: Veda Vanguard. U.S. Congress, Office of Technology Assessment, 1990. Indian Adolescent Mental Health, OTA-H-446 Washington, DC: U.S. Government Printing Office, January. U.S. Congress, Senate Committee on Labor and Public Welfare, Special Committee on Indian Education, Indian Education, 1969. A National Tragedy-A National Challenge, Report 91-501. Washington, DC: U.S. Government Printing Office. Wagenfeld, Murray, Mohatt and DeBruyn, 1994. Mental Health in Rural America, Washington, DC: U.S. Government Printing Office. 15 TESTIMONY FOR THE RECORD OF CHAIRMAN WAYNE TAYLOR, JR. Thank you, Chairman Campbell, Vice Chairman Inouye, and other distinguished Members of the Senate Committee on Indian Affairs for allowing the Hopi Tribe to provide testimony on S. 2526, legislation to reauthorize the Indian Health Care Improvement Act. We are grateful for your continued attention to improving health care services for all Native Americans. The Hopi Tribe looks to Congress as the ultimate federal trust authority. Vested in your authority is the ability to ensure the provision of quality health services for all Native Americans. We value your counsel and depend in no small measure on your assistance in establishing an array of health services of critical importance to all Tribes. I wish to draw your attention to one health care service that has been largely ignored to date in Indian country -- the provision of emergency medical transportation services. Paramedics and Emergency Medical Technicians (EMTs) who provide emergency medical care and transportation to the general population were recognized as an important part of the health delivery system in 1966, with enactment of the Highway Safety Act. The Act provided funding to States to buy ambulances and train EMT-paramedics. States required those involved in the transport of sick or injured people to be certified as emergency medical technicians. Since the mid-1960s, this field has exploded and evolved with medical technology to provide essential front-line medical services as part of the continuum of care. Unfortunately, this critical component in today's health care system is underfunded in Indian country. Tribes are unable to keep pace with health care advances in this field. A growing disparity between comparable care off-reservation is evident and access to health services is impeded. On the Hopi reservation, providing necessary emergency medical transportation services is a difficult task. Insufficient funding for adequate staffing and outdated equipment leaves our present emergency medical service (EMS) team constantly struggling to provide services. Although the Hopi EMS team performs valiantly, its personnel are stressed for time and lack the equipment necessary to perform certain lifesaving functions. The program lacks the resources to staff the program according to industry standards for the time and distances involved in rural transport. Unfortunately, the Hopi Tribe witnessed the consequence of insufficient program funding this past April through a tragic incident. A young woman developed a serious condition during her pregnancy. After being brought to the Keams Canyon Hospital for care, physicians determined that she would have to be transported to the Tuba City Indian Hospital (some 84 miles west), a facility more equipped to handle this condition and able to perform surgery not possible at Keams Canyon. As the young woman was being stabilized and readied for transport, another urgent call was received and the ambulance was obligated to transport that patient from the Second Mesa Clinic to the Tuba City Indian Hospital. A second ambulance crew was already attending a local emergency and was committed to remain on the Hopi Reservation. EMS funding is not sufficient to provide for a third "off-duty" or back-up EMS crew -- as industry standards dictate. As a result, the woman was forced to wait for the first available transport - an air ambulance -- several hours later. During this delay, the woman suffered fetal demise (the death of her unborn child) and her own life was placed in extreme jeopardy. This scenario, as well as many others, could possibly have been avoided by providing adequate funding for full staffing of the EMS program, affording a third crew "on duty" or as an "on call" back-up crew. The current trend of closing hospitals in Indian country and replacing them with ambulatory care centers, or consolidating medical services, places an added burden on emergency medical services teams and elevates the importance of their role in providing necessary transport. With the rural nature of Indian Reservations, miles away from towns and urban centers, transportation is now needed over longer distances for inpatient care, requiring highly trained staff and more advanced equipment. Thus, the system itself is increasing the role of emergency transportation and advanced life support care without providing the necessary financial resources to meet the new need. The end result is a growing gap in the continuum of health care. We urge the Committee to examine the importance of improving and providing adequate resources for emergency medical transportation services. We recommend that additional funding be provided for the development and maintenance of effective emergency transportation systems through a mechanism included in the reauthorization legislation. The Hopi Tribe views the development and maintenance of emergency medical care systems as part of the trust responsibility in providing essential health and welfare services. Emergency Medical System Programs Are Important to Providing a Continuum of Health Care Services: Emergency medical care has become an important part of our health care system, providing a front-line interface with the health care system. Medical ethics dictate certain models of practice to facilitate and insure competent patient care. Previously permitted practices, such as medically unsupervised patient transport or transport supervised by minimally trained individuals for patients with severe conditions, are no longer acceptable practice and are, in fact, illegal. Individuals trained in advanced cardiac care or advanced life support must accompany patients with head injuries, internal hemorrhages, high-risk pregnancies/labor, severe cardiac conditions, 2 or other life-threatening conditions when the patient is being transported. Appropriate and expeditious emergency medical care not only means the difference between life and death, but can save substantial expense for the health care system. The health care community has learned in recent years that if appropriate care is administered to injured or sick individuals such as victims of heart attack within minutes of an event, loss of life can be prevented and the chance for full recovery is increased. The administration of expeditious care can save years of rehabilitative costs, lost labor, and other expenses. Injury is one of the leading causes of death among Native Americans. Emergency medical systems must be intact to respond to this public health need. As the trend toward constructing more ambulatory short-term care centers continues, more hospitals will close. This trend will dictate an increase in emergency and inter-facility transports. It is the job of Congress to ensure the appropriate provision of health services to Native Americans and address this gap in coverage. Emergency Medical Costs Have Increased Over the Past Two Decades: Emergency medical costs have increased over the past two decades for the following reasons: Industry Standards: Standards of care are developed by the industry to keep pace with advances in medicine. Courts often uphold standards of care as a measurement of liability. EMS standards define basic life support (BLS), advanced life support (ALS) and advanced cardiac life support (ACLS) modalities of care, ambulance configuration, dispatch and telecommunications protocol, resource distribution and interagency relations. As technology has improved our medical capacity to deliver state-of-the-art EMS care, standards of care have evolved to incorporate scientific advances in the practice of pre-hospital medical treatment. Regulatory Bodies: EMS programs must meet many standards to operate as a legitimate health provider. To name a few, EMS programs must follow state and federal Department of Transportation guidelines, federal and state labor standards, federal Medicare standards, state certification and licensing, state or regional medical control/supervision, local permit/licensing, and standards for performance through written agreements. Service Population Expectations: Americans expect access to high quality EMS services. The daily deluge of television programming demonstrates many of the stateof-the-art uses of emergency medical services. In rural areas where distances are great and the availability of transportation is a serious issue, a responsive and wellequipped EMS service becomes a lifeline upon which the community depends. Cost of Technology: Technological developments in the delivery of health-care--services have increased dramatically in recent years. Equipment is highly sophisticated and improved, giving every advantage to saving a patient's life. A three-lead 3 |