Fort Defiance hospital workers fear the worst in tribal takeover

Local elected officials were blasted Tuesday night for taking too little interest in the tribe's takeover of the Indian Health Service hospital here, which some workers say is causing the wholesale loss of doctors, nurses and other employees.

At a tense chapter planning meeting packed with hospital workers, one loudly accused the three Navajo Nation Council delegates from Fort Defiance, along with three chapter officials, of not monitoring the transition for possible violations of employee and patient rights.

Public Law 95-638, the Indian Self-Determination Act, allows tribes to control their own health care by setting up not-for-profit corporations to replace IHS on tribal land. The corporations then contract to run the facilities using mainly federal funds. Proponents say this leads to better cost-efficiency and patient care, while skeptics say it greatly weakens employee protections and offers no guarantee of better health care.

The angry IHS worker at Tuesday's meeting said Fort Defiance hospital supervisors are threatening workers with termination if they don't sign documents supporting the takeover.

"That's against the law," he said. Like all the hospital workers at the meeting, he asked not to be identified for fear of retaliation by hospital administrators and board members.

His words brought cheers and applause from about 50 people at the meeting, a routine get-together than determines what goes on the agenda for tonight's regular chapter meeting.

Rather than adding the hospital to the regular meeting agenda, participants agreed to hold a special meeting Sunday, March 7, to discuss issues surrounding the hospital's transition to a '638 corporation.

Chapter Vice President Aaron Sam led the motion for the special meeting, which was passed by a vote of 68-0-2. The two abstentions came from members of the hospital governing board, Lorraine Nelson and board president Elmer Milford.

Milford, who also represents Fort Defiance on the tribal council, asked Nelson to address the audience before the vote was taken, and she said hospital administrators had assured directors that employees were individually counseled about all the impacts of the change, and that they understood the process.

"We didn't understand what we were signing but we were assured each employee was individually counseled," Nelson said, eliciting loud groans from the crowd.

She added that the board specifically asked hospital administrators to make sure employees fully understood what is happening.

Quick and quiet

The change to a '638 corporation has been controversial in other IHS facilities on the Navajo Nation, but was accomplished with little public discussion in the Fort Defiance Agency, where hospital officials quietly visited each chapter and got their endorsements before announcing the planned change.

In Chinle, by contrast, opposition from a few chapters has stalled efforts to set up a '638 corporation to run health care facilities there.

"I feel for you guys," Nelson told the workers. "This is a very sudden change, almost traumatic. It was on a very fast track."

She said she would present the workers' concerns that the transition is causing "drastic changes to their lives" when the hospital board meets Friday.

Board member Leland Leonard said Thursday that board meetings would begin at 1 p.m. and would be in the executive conference room at the Fort Defiance Indian Hospital.

"The meetings are public," he added.

Milford noted that the board agreed to the changeover because it received numerous resolutions of support from chapters in the hospital's service area.

But several of the workers questioned how many people actually voted on the endorsement resolutions, as most chapter meetings are lightly attended and often have trouble maintaining the 25-member quorum needed to do business. The workers asked to see copies of the resolutions to determine the voting numbers on each.

One audience member said he wouldn't be surprised to learn that many who voted for the tribal takeover were "fed fry bread and stew, instead of the truth."

That statement drew the loudest applause and cheers of the night.

Milford agreed with Nelson that the tribal takeover of the hospital was rushed and admitted that he was "bothered" by the volume of revamped employment contracts the board was asked to quickly approve. Hospital administrators had the board sign 780 employee contracts last week and another 30 this week, he said.

A female worker, who identified herself as a single mother and caretaker of her 80-year-old father, said she heard that staff in the emergency room, security office, food services, maintenance department, and environmental health program would be replaced with contract workers.

Nelson confirmed that jobs are being outsourced, saying that bids to contract for work at the hospital were issued. Most IHS workers are members of the federal employees' union and because of that, enjoy job security and related protections that are unheard of in most contract workforces.

The transition to '638 status eliminates the union, and the process to reestablish union representation is complex and lengthy. Most employees are rehired under individual contracts, or they go to work for a private business that is contracted to perform a function formerly done in-house.

In addition, the former federal employees may be at risk of losing their accrued retirement benefits. Tribes are expected to make arrangements so the former IHS workers can transfer their years of service to a new pension system, but there's no requirement to do so, according to the federal employees' union.

A female employee said she had pleaded with the elected officials to "simmer down" the tribal takeover of the hospital, asking them to get hospital officials to extend the March 28 deadline to complete the transition.

In January the Fort Defiance Indian Health Services Board released a statement saying it will not assume actual control of the facilities until March 28.

In the same release, Milford praised the negotiating team for getting contract negotiations and revisions with IHS completed in six months.

"The team was under a lot of pressure to get this contract done quickly and efficiently and the team members really came through for us," Milford stated in the release. "By getting this done by March 30, the board will share in the distribution of $107 million in new contract support-cost dollars and our share will be about $10 million."

The negotiating team consisted of Milford and hospital board members Leland Leonard, Leland Anthony and Roy Dempsey, who also represents St. Michaels and Oak Springs on the tribal council.

The release quotes board members saying the '638 contract would provide local Navajo communities with $100 million in annual health care resources and would give community members control over the future direction of the Fort Defiance Indian Hospital and Nahata Dziil Health Center.

They also stated, "The FDIHS Board does not expect any significant changes at the hospital in the short-term."

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