Partnership Between Tribe, Hospital Held Up As National Model
The new health facility on North State Street holds the promise of growing cooperat ion between the Sault Ste. Marie Tribe of Chip pewa Indians and the community, says Tribal Chairman Joe McCoy. The partnership between the hospital and tribe already are a national model, as the building is likely the first such joint health facility in the nation. It also provides opportunities for future possibilities in local health care, as the hospital and tribal health center continue to explore shared services.
Chairman McCoy is quick to point out he cannot take credit for establishing the cooperation between the tribe and the hospital or for the new facility arrangement. They began under the tribal leadership of others, he said. Health care, however, remains the number one priority for the tribe, and Chairman McCoy said he is determined to do whatever he can to improve its future for local tribal members.
Many people believe the tribe's five casinos support its health care program, he said, but they don't. The federal government is supposed to provide all Native American health care costs, according to the treaties, but, locally, only 40% of the tribe's needs, he estimates, are paid by the government.
“We've got patients to see and doctor spaces to fill, but we don't have the money to do it. A misconception that people have -- just because we have casinos doesn't mean we have a bunch of money. They are not providing enough revenue to meet all of our needs. We still need help, and it's not [coming from] the federal government. It's their duty because of our treaties.”
The other tribes in the country don't get all their health care provided, either, said Tribal Health Director Bonnie Culfa, and are all underfunded. The Bemidji Area Indian Health Service in Bemidji, Minnesota, which serves 34 federally recognized tribes in Michigan, Wisconsin, and Minnesota, is the lowest funded of all the area offices in the nation, she noted, and has the highest health care disparities. “The Bemidji area tribes need to work together to make sure we receive equitable funding from the federal government,” Ms. Culfa said. “It is important that we educate our federal legislators in regard to their treaty obligations. It is our ultimate desire that they will implement policy that supports and recognizes these.”
Mr. McCoy and other tribal leaders, including tribal board representative Cathy Abramson, have been promoting that idea in Washington, D.C.
The task is daunting, he said, and the politics are unlike the easygoing Upper Peninsula way of life, yet he remains determined, and Sault Tribe leaders are taking the first steps by taking their message to policy makers. They listen and take notes, he said, leaving him and others wondering if and when any change will take place.
The region was cut short on federal funding for reasons Mr. McCoy can only speculate, and now no longer matter, he said. His focus is directed to today's tribal needs and his desire to ensure health care is available for the people seeking the services provided at the Lambert Center at Wa Seh Drive in St. Ignace, as well as for the future needs as the population ages and health care demands grow. Currently, 8,500 people receive health services at the Lambert Center.
The two highest concentrations of Sault Tribe members are in Chippewa and Mackinac counties, respectively, with a populations of 6,700 in Chippewa County and 2,782 in Mackinac County.
The tribe also has ambulatory health facilities in Manistique, Sault Ste. Marie, and Munising and two smaller nursing sites at Hessel and Newberry.
Mr. McCoy hopes the unique arrangement at Mackinac Straits Hospital will help secure more federal health care funding. Tribal Health Director Bonnie Culfa and Rural Health Program Manager Marlene Glaesmann, both registered nurses, agree with his observation .
“As far as I know, this collaboration, where a tribal center is in a hospital, is the first ever in the entire nation,” said Mrs. Glaesmann.
Keith Massaway, who represents St. Ignace on the tribal board of directors, said the new facility has been needed, and the tribe has been eager to support it.
“It will be an incredible asset for our community, tribal and non-tribal members alike,” he said.
The Sault Ste. Marie Tribe of Chippewa Indians donated the 16.5-acre site for the new hospital in December 2004, with the agreement that the tribe will have use of the building for 40 years, with an annual lease payment of $1. Early in the project, the tribe also advanced $1 million for an escrow account to assist in securing the loans, and this money has now been used for the construction.
Collaboration actually began more than 15 years ago when the Lambert Center contracted with the hospital for radiology and laboratory services for urgent care patients. In 2002, the Moses Dialysis Unit was established at the hospital as a partnership to bring dialysis services to the community, with joint fundraising and continued annual tribal contributions.
The early success of these relationships helped lay the foundation for a common health care complex, although not all services will be shared, although tribal members can still purchase them.
“What we hope to have here is a one-stop shopping kind of place where, if our patients in ambulatory care need X-rays, need laboratory services, that it would be in one facility and tribal members won't have to make an extra stop to get those services done,” said Mrs. Glaesmann. “Another advantage is that if our tribal members are hospitalized here, our physicians can see our tribal members right within the same facility.”
The tribe is considering expanding cooperative services with the hospital. Physical therapy is one such service that could be included in shared services, although details have not been finalized, said Ms. Culfa.
With the opening of the new hospital, most Lambert Center services will move to the new facility, doubling the amount of space available for tribal health care from about 8,000 square feet to 15,000 square feet. Moving to the new building are traditional medicine, pharmacy, medical-nursing, optical, dental, community health, behavioral health, and social services.
About 36 employees will make the move.
The Lambert Center is about 20 years old and not designed for an ambulatory care center, said Mrs. Glaesmann. The new facility improves the environment for care of the patients and provides a more efficient working space for the staff. Like the current Burdette Street hospital, rooms at the Lambert Center are small, leaving little room for necessary equipment and patient space.
The larger space housing tribal services at the new facility will allow for growth and expansion of current Lambert Center services in the future.
The dental department will have six dental rooms rather than four, as it has now. The tribe also hopes to hire another dentist in the next year, along with support help. Already on staff are one full-time and one part-time dentist.
In anticipation of the move, the tribe is expanding its clinical services and already has hired a physician's assistant to work with the tribe's two physicians.
Behavioral health, said Ms. Culfa, is expanding to include a children's play therapy room with a two-way mirror. The capability is not available at the Lambert Center, but already is offered at the tribe's Sault Ste. Marie facility and in Manistique.
“This will allow us to treat some of our youngest tribal members who have issues that they need to deal with and getting to them early for therapy and treatment,” said Ms. Culfa.
The new building includes room for traditional medicine. Traditional healers will have a designated room to store medicines. They will be able to treat patients in a room that meets traditional medicine requirements, such as facing east. With the increased space, administrators hope more members will be able to visit the traditional healers.
The building also offers more clinic rooms, including two procedure rooms and space for a visiting specialist.
“We have a lot of unmet needs with our tribal membership,” Ms. Culfa said. “Having the space available to provide for additional services for those members that haven't been able to get in in a timely fashion and looking ahead to what the need is we're trying to meet or add to, or expand that service, at least now, we have the space to be able to do so.”
The optical department will more than double in size in the new facility and the tribe is exploring offering additional optical services in the future.
“We're always looking ahead to see what possibilities we might have for adding something that we currently are not doing, or something that is going to be a greater need,” said Ms. Culfa.
Chairman McCoy said the tribe is working on recruiting and retaining its professional staff to enhance the patient's experience, while keeping familiar faces in place.
Connecting health services to the tribe's strategic plan, Ms. Culfa said, will allow the tribe to retain and increase services if the turnover of professional staff is minimal. Improving the physical space of the workplace is one way to retain employees, and the new facility is expected to help with that goal. The tribe recently started a program that offers salaries based on the market salary for that job around the state. The program is evaluated and tied to the strategic plan.
“It is kind of a more enhanced way of looking at delivery of care and services, and that's what we've been working on for a year and a half,” she said. “We've just got that implemented, and as we move into this facility, we'll start seeing the benefits of that.”
The tribe is looking at the needs of its aging population and its strategic health plan, said Ms. Culfa, and at how best to approach the more prevalent diseases tribal members face.
“We target a number of things in our strategic health plan that relate to our higher incidence of certain diseases in our population, diabetes being one of them, cardiovascular disease being another,” she said. “Cancer is another high-number disease that our population has.”
The tribe has a comprehensive health care package, she said, including a community health staff that visits patients who are unable to travel for medical care. She pointed out that the tribal health care program is accredited by regulators in the health field, meaning it meets high standards set for care.
The tribe's health care program has been accredited since the 1980s based on national standards, including the Accreditation Association for Ambulatory Health Care and the Commission on Accreditation of Rehab - ilitation Facilities.
The new Tribal Health and Human Services facility will cater to tribal members, their spouses, employees of the tribe, and Upper Peninsula Health Plan (UPHP) members. Patients will still travel to the tribe's largest facility at Sault Ste. Marie for routine radiology (X-rays), ultrasound tests, and mammography, however, any time these and other services are required on an urgent or emergency basis, the hospital will perform them for tribal patients. The tribe is interested in having some of these services performed routinely in the future.
Services will continue to be shared at the Moses Dialysis Unit.
The tribe has taken on a new focus on preventing illness among young people.
Driven by increasing child obesity and the need to teach youth about a healthier lifestyle, the tribe has begun work on creating educational programs, said Ms. Culfa. The focus on improving the community's health will continue to be the focus of the tribe for the next 10 to 15 years.
“For us in our population, obesity and our diabetes numbers is something that we are needing to really continue to focus on, and we have this Strategic Alliance for Health grant,” she said. “We're looking at changing actual behaviors in four key communities, St. Ignace being one of the communities selected by us, to work with the whole community, not just the tribal community, but the entire community to look at getting kids more active.”
“We are at the tipping point of our children not living as long as we have because of obesity and poor diet, poor nutrition, and poor health habits that are all preventable,” she said. “That's concerning to me as a person who has been in nursing for 28 years. That's a real big concern.”
Having the new hospital in St. Ignace should help improve the health of tribal members, said Chairman McCoy.
“The newness and the layout of the facility is going to add to the care patients are receiving,” he said. “That's always been the tribe's number one priority, health care.”