Health care helped by gaming money: Facilities improve but show tribes’ differences

LAC DU FLAMBEAU — Flat-screen TVs fastened to the ceiling of each exam room make the only sound as dentists and dental assistants filter through the dimly lit hallways of the latest addition to the Lac du Flambeau Band of Lake Superior Chippewa reservation.

The 36,000-square-foot Peter Christensen Dental Campus that had its grand opening last October was meticulously designed, from the newest dental tools to the vivid mural on the lobby ceiling representing the tribe’s long history.

This $10 million facility wouldn’t be here without the infusion of money coming into the tribe’s Lake of the Torches Casino.

Gaming is the largest source of revenue for the Lac du Flambeau and woven into every government operation, including the dental clinic. The tribe contributed $250,000 toward its construction and has provided $1.8 million in free care for members.

The dental-care clinic treats the tribe’s 3,400 members, but also residents of the surrounding community.

“This building will be here for decades,” said Paco Fralick, the clinic’s dental health director. “We’re already seeing about 15,000 people a year, and I expect that’s going to double in the next year or two. And, you know, it’s hard to put a value on that. I think that money is multiplying its value.”

Wisconsin’s 11 tribes have used gaming revenue, by far their largest source of income, to supplement ever-shrinking federal money to cover health care costs for their members. But there’s a broad range of gaming profit among the tribes, from the Forest County Potawatomi, which reported transferring about $244 million from gaming to tribal government in 2012, to the Bad River Band of Lake Superior Chippewa, which reported about $4.6 million.

The dramatic differences in size and age of health-care clinics on reservations scattered across the state shows what gaming dollars can do — and what tribes sacrifice when their main economic engine isn’t keeping up.

‘Band-Aid approach’

Even a pill-counting machine, which speeds the process of filling prescriptions, was a big addition for the Menominee Indian Tribe’s health clinic. But other facilities had them five years ago, according to tribal health administrator Jerry Waukau.

The clinic was built in 1977 on the tribe’s reservation, which sprawls across Menominee County.

It started out with six exam rooms. The tribe added 18 more over time.
Waukau said paying for simple updates is a challenge because they aren’t on “the same playing field” as tribes with more casino revenue. The Menominee reported transferring $8.4 million from gaming into government services in 2012.

Tribe members come to the clinic to see doctors and dentists and to get prescriptions filled, sometimes traveling from their homes elsewhere in Wisconsin or the Midwest.

“We can kind of do a Band-Aid approach,” Waukau said. “What we’re not able to do is give you those (specialist) appointments out of here.”

American Indians continue to struggle with higher rates of diabetes, alcohol abuse, obesity and suicide than the overall population. Providing for tribe members’ health care was a condition of treaties signed in the 1800s by the U.S. government and tribal leaders.

Tribal clinics use federal money to provide basic health care on the reservation and “contract health services” funding to hire specialists working at private hospitals and clinics.

Tribal clinics or hospitals also make money like any other health-care facility: charging patients, insurance companies and third-party providers. Any other money to cover health care expenses comes from the tribe.

When the tribe doesn’t have casinos or another steady form of income, federal money runs out quickly, said Jacqueline Pata, executive director of the National Congress of American Indians.

The group estimates that tribal health care is funded at 56 percent of total need. Annual funding for high-cost patients can run out by August, creating a gap until the new fiscal year starts Oct. 1.

Funding has increased since 2008, but more than half of health programs can’t pay for anything beyond basic health care except in “life or limb” emergencies. When that happens, tribe members turn to short-term solutions, especially medications for pain.

“Tribes have to make life-or-death decisions about who can get the supplemental care they may need,” Pata said.

Linda Helmick, health administrator of the Forest County Potawatomi Health and Wellness Center outside Crandon, said she empathizes with health care officials for tribes with less money to spread around.

The center has about 9,000 patients, 70 percent of whom are not American Indian. Patients travel from a six-county region to see doctors, dentists, physical therapists, optometrists and psychiatrists at one of the only major health care providers in northcentral Wisconsin.

The $10 million facility isn’t profitable, but the Potawatomi’s success with gaming and other industries allows the tribe to keep it open and give members and other residents access to health care.

“This tribe has more resources,” said Helmick, who began working for the tribe in 2000. “There’s no doubt.”

Gaming makes difference

On the Oneida Nation of Wisconsin reservation west of Green Bay, patients stream into a health center barely 10 years old.

They scatter to separate waiting rooms to be seen by dentists or doctors, including specialists in obstetrics and dialysis.

Staff are learning to use a new electronic record-keeping system.

The Oneida Community Health Center is one of the tribe’s key projects fueled by gaming dollars. The tribe contributes less every year toward operating the clinic as it inches toward financial independence.

“We’d be sitting in a field right now if it weren’t for gaming,” said Jeff Carlson, business operations director of the Oneida Comprehensive Health division. “This building wouldn’t be here, the (nursing home) across the street or a lot of the newer buildings.”

Health services started as a volunteer operation, run out of the Oneida administrative building until 1978 when a health center was built. Without gaming revenue, the tribe could not pay for the modern health clinic on Airport Drive.

In the old days, doctors from the area volunteered on weekends, and bingo games raised money for health care, said Judith Skenandore, assistant operations director for the Comprehensive Health division. She grew up on the reservation and has worked in tribal health care since 1974.

“Everything was pretty much all charity. We didn’t have money,” Skenandore said.

Fralick, the Lac du Flambeau dental health director, hopes his tribe’s clinic will follow the Oneida’s health center’s path and someday become more financially independent from tribal government. The dental clinic includes a laboratory where technicians make crowns and other equipment, which they plan to sell to other tribal clinics.

Fralick also wants the clinic to encourage young tribe members to consider a career in dentistry. He grew up in Rhinelander, making frequent visits to family on the Lac du Flambeau reservation and started his career working in the tribal center with only two chairs to see patients.

There are fewer than 200 American Indian dentists in the U.S. according to some estimates. Fralick said he had never met an American Indian dental hygienist until hiring a woman at the Lac du Flambeau clinic, one of 24 members of various tribes who worked there by December.

“It’s a good start, but a lot more to do,” Fralick said.