Fort Defiance wants hospital '638 stopped

Members of Fort Defiance Chapter voted Sunday to freeze privatization of the local Indian Health Service facility because of numerous concerns over its effects, but it may be a case of too little, too late.

About 125 people appeared at the Fort Defiance Chapter House to rally against the local hospital board, which is utilizing federal law P.L. 93-638 to transfer operation of the hospital from IHS to private nonprofit status. The same board, the Fort Defiance Indian Health Board, will head the nonprofit, which will contract with IHS to run the hospital using federal dollars.

The move has sparked alarm among employees concerned about exactly how their jobs will be affected. Their questions, they say, have been buried in bureaucracy.

The chapter passed two resolutions: The first rescinded its earlier approval of the takeover, and the second asks the hospital board to stop the process until the numerous concerns of staff and community members are answered.

"We want to put a stop to all of the processes until everybody's concerns and issues are addressed," said Elouise Watchmen to the cheers of a packed chapter house.

However, the change to '638 status is but two weeks from completion. The process has been underway since January, when the hospital board signed a master contract with the IHS Navajo Area office. The board has until March 28 to finalize its paperwork, including new employee contracts.

Although the board could elect to relinquish the '638 contract, that move seems unlikely, said one board member. The board is expected to take control of the hospital March 28.

"The contract was signed back on Jan. 28," said Steve Boos, a Durango, Colo., attorney who has been representing the hospital board through the transition to a '638 corporation. "It's pretty much a done deal."

However, chapter members, particularly IHS employees, say neither the board nor IHS has done much to address their concerns or even fully explain what is going on.

Chapter members were concerned that the hospital board rushed through the process at the price of clearly explaining the details to the community and hospital staff.

Boos said the board wants to complete the privatization process by April 1 in an effort to make the hospital eligible for up to $10 million in extra federal funds.

Congress appropriated an additional $107 million for contract support for '638 facilities this year. If the contract is complete by April 1, then Fort Defiance can share in that pot.

"Fort Defiance is getting that money because we got the process done in time," Boos said. "I think most people would agree this is a good thing."

It's a debatable point.

Contracts confuse many

Employees, facing a deadline this week to sign a contract with the new corporation, say they feel backed into a corner with little guidance. The changeover will cost employees their union, normally the workers' main source of information on the often-complex terms of an employment contract.

"(The contract) is for the next two years but it has not been explained in detail to us," said Ronald Benally, whose wife works at IHS and has signed her contract. "We hear people are leaving and there are a lot of other people working there who may or may not have their job after this."

Both IHS and the board have held regular informational meetings to answer questions and concerns of employees. Most recently, administrators and human resources representatives offered three days of informational meetings to employees last week. Still, a handful of IHS employees say those meetings have been of little help.

"They never have answers," said one employee, who did not want to be identified for fear of reprimand by the board. "Every time we ask a question, they tell us to go somewhere else. When they do answer a question, it's confusing and opens up so many more questions."

Specifically, employees are concerned over the Intergovernmental Personnel Acquisition contracts they have been asked to sign with the corporation. The agreements are meant to ease the transition through the '638 process. They are two-year agreements in which the employee continues to work under the umbrella of the federal IHS program. The corporation, using federal funding, then reimburses IHS for the cost of that employee's contract.

However, the contracts still omit crucial information for some employees, particularly benefits. The contracts also state that the employee can be terminated at any time.

"The IPA is not a guarantee of a job," said another employee, who did not want to be named.

All employees interviewed provided their IHS credentials to a Navajo Times reporter.

Under the '638 law, IHS is required to offer IPA agreements to employees that have received satisfactory or better performance ratings.

Of the hospital's 750 employees, IHS has offered IPA agreements to all but about 15 people, said Leland Leonard, ex-officio member of the Fort Defiance Indian Health Board. The new corporation also has offered to outright hire a number of hospital employees, and about 120 accepted as of Wednesday evening, he said.

Leonard did not know how many of the eligible employees had signed IPA contracts by the deadline Wednesday.

"The agreements are too vague," said Melanie Thatcher, an IHS employee unhappy with her contract. "It says nothing about salary and benefits."

The contract does state an annual salary for the employee, but is immediately followed by a clause that it could be adjusted without requiring a new contract to be signed.

Does the clause refer to cost of living increases, some employees wondered. And some were confused about the meaning of X's that were marked at various points in the contract, and wondered if these mean a provision is in effect, or do they mean the opposite.

The contract also lists the accrual of leave time, which varies from four, six or eight hours of paid leave per pay period, and an additional four hours of sick leave.

Bye-bye job security

Another issue employees have with the contract is on the final page.

"I have been informed that my assignment may be terminated at any time at the option of the IHS or the tribe/tribal organization," the contract states. There is another 'X' typed into a space next to the sentence.

"They can get rid of us any time they want," said one employee. "They can hire us today and fire us when they become a corporation."

While under IHS, administrators are required to follow a set policy before terminating an employee. That protection disappears once the hospital goes '638, the employee said, citing this as a reason for a reported mass exodus of employees.

Both Leonard and Boos say they are not aware of employees leaving the hospital because of the privatization. In response, Thatcher rattled off four names of people who she said have left in the past month, three of them ER doctors. In total, she estimated at least 50 people have left since September, when the hospital board went public about its plans.

"When all is said and done, we'll probably see 100 or more leave," she said. "I'll be on that list. I'm not going to sign that contract unless it was more clear and concise."

Once Fort Defiance is a '638 facility, management will be local and the idea is that this will result in more efficient use of resources, better patient care, and a health system more attuned to the needs of the community.

Personnel matters, equipment purchases, facility maintenance, will no longer be controlled by the Navajo Area IHS or IHS headquarters in Maryland. Such decisions can be made on the spot, Leonard said.

The hospital will also open itself up for millions of dollars in extra revenue via third-party collections and grants that the hospital is not allowed to pursue as part of IHS, Boos said.

Both the Tuba City Regional Health Care Corp. and the Winslow Indian Health Care Center Inc. reported increasing their annual revenue by more than one-third after going private. Because '638 corporations are nonprofit, they can plow all the savings and extra revenue into patient care.

Both Tuba City and Winslow say they have increased both employees and patient visits since going '638, but both experienced birth pains similar to what Fort Defiance is now going through.

And in Chinle, the move to '638 status has been thwarted by opposition among some chapters, a problem the Fort Defiance privatizers didn't have until after they'd quietly gotten endorsement resolutions from all the chapters in their service area.

"This is the greatest thing to ever happen to Native America," Leonard said. "It's about local control, opposed to people making decisions for us in Washington, D.C., or Rockville, Md."

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