But help unlikely for reservations, Sanford says

PINE RIDGE INDIAN RESERVATION - The people here who care for the sick amid rural isolation and a deep-rooted poverty that's created Third World health conditions see opportunity in a medical project backed by the wealth of a Sioux Falls health system.

The people here on South Dakota's largest reservation, far removed from the daily life of most Americans, also face a continent of competition and strong odds of exclusion.

Sanford Health, already a massive collection of hospitals and clinics spread across four states, plans to use part of the $400 million donated by its namesake philanthropist, T. Denny Sanford, to build a network of pediatric clinics across North America. The project, to be carried out during the next decade, promises to bring first-rate care to far-flung areas and, at the same time, collect data from diverse patient populations to feed back to a children's hospital and burgeoning research empire in Sioux Falls.

Some Native Americans point out that, when it comes to the Upper Midwest, they epitomize diversity - not only in terms of race but also in economics, geography and the range of health issues that afflict the reservations much more severely than anywhere else in the region. They would welcome a private enterprise on a reservation that knows only a comparatively anemic government-run health system.

Leaders of Pine Ridge's Oglala Sioux Tribe say they will formally apply to be the home of one of the five clinics Sanford plans to build. The health system is accepting applications from all over North America.

But Sanford executives, when they announced the clinic project earlier this year, said they planned to look outside South Dakota, and they emphasized the clinics, while not meant to be cash cows, would be financially self-sustaining. That criteria has not formally changed and, barring a shift in direction, leaves the Sioux Indians of Pine Ridge and South Dakota's other reservations out of the loop.

"We don't have any plans to do anything of that nature at this point in time," said Dave Link, Sanford's executive vice president of development and research, said of opening a reservation clinic in the state.

That, many Native Americans say, continues a long history of neglect - intended or not.

Federal care on reservations falls short, many Indians say

As part of treaties signed by Sioux Nation in the late 1800s, the federal government agreed to provide medical care on Indian reservations - care that generally matched the nation's accepted standards. Indian Health Service, a government-run health system, grew out of that and today runs hospitals and clinics on Pine Ridge and most other reservations.

But critics and many within the bureaucracy have long complained that IHS is woefully underfunded, the simple result of Native Americans falling low on lawmakers' priority lists. IHS spends about $2,100 per patient annually, while Medicare, the federal health plan for American's senior citizens, pays almost $8,000 per patient, according to the government's own statistics. Medicaid, the state-federal coverage for the poor, spends nearly $4,500 per patient.

The result: Constant turnover among IHS doctors and nurses, understaffed hospitals, sparse specialty care and long waits to see a doctor.

A need to add clinics, reduce waits for medical help

Josef Catches, 25, and Samantha Garnette, 20, waited about two hours for a routine checkup for their 2-month-old son, Mason Catches, one recent morning at the Pine Ridge IHS medical center. After finally being called into a patient room, they were sent back out to wait again when another infant needed to be weighed on the hospital's scale, Garnette said.

"It would be nice to have more scales," she said, as Catches cuddled little Mason on his shoulder. "And more clinics."

Demand for services - and the ability of IHS to meet demand - makes such waits routine, they and others say. Resources taken for granted in Sioux Falls - such as scales - often are difficult to come by.

Such is the case on most of South Dakota's reservations. Pine Ridge, because it is the largest both in terms of land and population, serves as the principal example. Unemployment tops 70 percent. Poverty breeds depression, alcoholism, illegal drug abuse and malnourishment.

That all converges to create higher-than-average rates of cancer, heart disease, diabetes and infectious disease. In 2005, for example, more than two- thirds of reported gonorrhea cases in South Dakota were among Native Americans.

Catherine Looking Elk of Oglala is among the few here who has private health insurance. The 69-year-old school teacher says that affords her prompt care. Without it, she says, she might not get care "unless you're almost dead."

Areas of greatest need might not be good investment

The conditions affect adults and children, and this is an area where youth is in abundance. Children ages 4 to 16 make up 26 percent of South Dakota's Native American population, compared with 14 percent statewide.

Bolstering care among youth - including preventing drug abuse, smoking and other problems that lead to poor health later - is key.

"The area of prevention is our area of greatest need," said Francine Red Willow, chief executive officer of IHS' Wanblee Health Clinic on the Pine Ridge reservation.

All of which makes a public-private partnership in Indian Country appealing, health care leaders who work here say.

"I know no one is totally funded at the resource level they should be," IHS deputy director Mary Lou Stanton said while in Sioux Falls recently. "And so we have to work together, we have to partner; those are the only ways that we can make some inroads."

Others in health care outside Indian country agree.

Larry McAndrews, president of the National Association of Children's Hospitals and Related Institutions, said Sanford could do the most good working in underserved areas - in particular, impoverished reservations.

"Bringing pediatric services to some of those areas ... would be really wonderful," he said.

But, he added, "The key is how to scale what you're investing the money in, so you're not trying to do something that goes beyond" what can be sustained financially.

And there's the rub for Pine Ridge: the seemingly impenetrable circle of poverty.

Based on financial instability of both the reservations and IHS, Sanford's financial analysts are unlikely to find a way to run a clinic here in the black. The health system has said it can't afford to lose money on the clinics, especially at a time when it is trying to build and pay for a new children's hospital and research campus in Sioux Falls. But the people here want to at least try.

Prime population for study, in-school health advice

They've enlisted Bill Pourier, chief executive of the Pine Ridge Indian Health Service service unit, to help.

"We're going to pool some resources together and apply for that," Pourier said.

Planning is in the early stages, but health and tribal leaders on the reservation are crafting a proposal, outlining what they see as an area of obvious need and a population that would provide a mountain of worthy research material for Sanford.

In addition to opening a pediatric clinic here, Pourier envisions Sanford working with IHS and the tribe on in-school clinics - education programs that teach children to avoid the hazards of drugs and how to live healthily even when those around you are not.

The proposals are due July 31, and Sanford officials have received about 80 inquiries so far.

"They range from very small communities to the very largest of the metro areas of the country," Link said.

'A major contribution to Native American health'

Should all five clinics end up outside South Dakota, as expected, some in Native American health care say pressure should nevertheless stay on Sanford to work more on the reservations.

Sanford has vowed to direct research efforts at the disadvantaged and in fact some plans already would include Native Americans living in Sioux Falls and other cities.

Individual doctors and nurses from the health system do outreach work and some research in Indian Country, but they are not sweeping efforts on the scale of Sanford's national plan. Because IHS has built clinics and hospitals on the reservations, and because that's the one service most residents here can afford, Sanford or other major health systems do not currently have medical centers here.

"For a long time, this state and many other states that have sizeable American Indian populations were all too glad to consider this a federal problem," said Dr. Jeff Henderson, president and chief executive of the Black Hills Center for American Indian Health.

Henderson said Sanford should focus some component of its upcoming research efforts on health disparities, and that Native American health would be an obvious area of investigation.

Ben Perryman, vice president of research for Sanford Health and assistant director of the Sanford School of Medicine at the University of South Dakota's Cardiovascular Research Institute, said that is indeed on the table.

"We have discussions ongoing with several tribes and the IHS to explore other research" and health services, Perryman said. Pourier attests to that, and the patients he serves hope that's a foundation for something significant to come.

At least one prominent figure at Sanford wants to make that happen.

Dr. Eugene Hoyme, a Dell Rapids native who will take his position as Sanford Health's chief pediatric medical officer in August, has focused much of his career on health issues that disproportionately affect Native Americans, including fetal alcohol syndrome and diabetes.

"We can make a major contribution to Native American health in South Dakota," Hoyme said.

Reach Megan Myers at 331-2257.