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SPCC Elders Committee given update on THHS clinic plans

By B.L. Azure
Public Information Officer

John Wells and Colin Lane, architects with MMW Architects of Missoula, gave the SPCC Elders Committee a presentation on the reconstruction project at the St. Ignatius THHS Clinic last week. (B.L. Azure photo) John Wells and Colin Lane, architects with MMW Architects of Missoula, gave the SPCC Elders Committee a presentation on the reconstruction project at the St. Ignatius THHS Clinic last week. (B.L. Azure photo)

ST. IGNATIUS — The present health care system on the Flathead Indian Reservation is not your Uncle Sam’s. The Confederated Salish and Kootenai Tribes Tribal Health and Human Services Department is not the Indian Health Service model of health care delivery that is common throughout Indian Country, especially in Montana. It is — by initiative and forward thinking — a unique Indian health care delivery system that has no equal in the state when it comes to delivery of services to its eligible clientele.

Kevin Howlett, THHS director, told the Salish Pend d’Oreille Committee Elders Committee at their February monthly meeting, that the tribal health care delivery system on the Flathead Reservation they grew up with has undergone monumental changes in the last decade.

Howlett has been involved with the tribal health care system is some way or another for 30 years and that 20 years of hard slugging has led to the new direction THHS took a decade ago.

“The first twenty years were hard. We were always playing catch-up, just trying to get money to pay outside providers. There were a lot of years we as a tribe just pushed health care money out the door,” Howlett said about the previous practice of being bill-payers to third party health care providers for services to tribal folks eligible for treaty obligated health care. “Ten years ago we began the operation of our clinics — we now have five.”

In the last 10 years THHS has expanded its clinical services and has turned from a bill payer to a service provider that gets paid for services they provide. The funding for the clinics as well as increased health care staff is derived from funds paid by third party funding sources such as Medicare, Medicaid and Healthy Montana Kids for services the THHS clinics provide to tribal people under those programs. Funds received from the THHS provided services are kept in a stand-alone THHS account, not in a CSKT general fund line item and can only be used for health care.

“We will use the revenue we’ve collected to build clinics and improve health care on the reservation,” Howlett said. “We have come a long ways in ten years.”

The five clinics are located in Elmo, Polson, Ronan, St. Ignatius and Arlee. The Elmo and Polson clinics are modern with ample floor space. Tribal Health has a memorandum of understanding with the non-THHS clinic in Hot Springs to ensure access to it for folks eligible for THHS services. Besides the expanded access to clinical facilities the additional clinics have created at least 40 new fulltime health care related jobs.

Howlett said the prime example of the course change is the new Polson THHS Clinic.

“What is there now is really amazing considering what used to be there,” Howlett said of the three-story clinic kitty-corner from the Lake County Courthouse. “Our old clinic would fit inside the waiting room of the new clinic.”

The present THHS St. Ignatius Clinic was constructed a half century ago as a hospital. The sturdy concrete, brick and mortar structure fit that purpose well but not so much so as a clinic. The facility is scheduled to be remodeled and floor space expanded by approximately 40-percent with new construction.

THHS Director Kevin Howlett shows SPCC Director Tony Incashola the floor plans for the new St. Ignatius THHS Clinic. (B.L. Azure photo) THHS Director Kevin Howlett shows SPCC Director Tony Incashola the floor plans for the new St. Ignatius THHS Clinic. (B.L. Azure photo)

Phase-1 of construction will begin late-spring or early summer on the south section that includes demolition of the former “nunnery” section and the building of the additional floor space. The timeline is fluid and dependent upon the relocation of staff out of the affected area as well as the estimated four to six weeks it’ll take to complete asbestos abatement. Work on that section is estimated to take one and a half years. Once phase-1 is completed phase-2 remodeling will begin on the north section and that will take another year.

In all the St. Ignatius THHS Clinic will have 37,000 square feet that includes 14,800 square feet of new construction; 14,800 square feet of remodeled floor space; and 7,400 square feet of unaffected floor space.

Howlett told the folks at the SPCC EC meeting that the 50-year-old hospital — now clinic — is part of a couple of special memories of his.

Howlett, as a youth, was part of a large extended family that lived with his grandparents, John and Lydia McDonald in a house a half block south the present clinic just across the street from the historic St. Ignatius Mission Catholic Church.

He said he wheeled his grandfather John from the former hospital that was located across the street in Taelman Park to the new one when it first opened. John McDonald was the first patient in the new hospital. Then nearly 40 years later, his grandmother Lydia was the last patient in the “new” hospital when it closed down in the 1990s.

The present Arlee Clinic is slated to be replaced with a new one on Powwow Road between the Community Center and the Arlee Volunteer Fire Department building — the process is in the early planning stages.

“We are putting together a plan to replace the small clinic in Arlee and have asked the Tribal Council to reserve that property for the new clinic,” Howlett said. The Tribal Council has also given Howlett the green light to proceed with discussions with Providence St. Patrick of Missoula about a potential joint venture with them. The joint venture would provide for access to the clinic by non-Indians seeing St. Patrick health care professionals. “We are trying to figure out how to make that work but we are going to build the new clinic with or without an agreement with St. Pats.”

Also on the to-do list is a new clinic in Ronan. “We intend to construct a new clinic in Ronan,” Howlett said. The present clinic is in the footprint of the southbound lane of the proposed Highway 93 reconstruction project through Ronan. The Montana Department of Transportation is fiscally responsible to provide property for the new clinic as well as pay for its design and construction. The Tribal Council is presently in negotiations with the MDOT related to the funding.

Howlett also told the SPCC EC that THHS is going to get aggressive on getting a handle on the illegal use and sale of legally prescribed drugs — narcotics — on the reservation. He said he has witnessed many fatalities related to prescription drug use including his mother and a brother.

“How many deaths do we have to see before we address this problem,” Howlett wondered. “There are children being raised in this type of environment. Children living with addicts become addicts.”

Howlett said there is a thriving black market in the resale of prescription narcotic drugs.

“People sell their drugs for $15, $20 a pill. It’s a big deal that is making its way to the very young,” Howlett said. “And it is not just younger people who are selling, there are elders doing this too. We have asked the DEA (Drug Enforcement Agency) to come to the reservation and do an audit.”

Howlett invited the SPCC Elders Committee members to be a part of the ground breaking for the new wing of the St. Ignatius THHS Clinic.

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