A long-running dispute between the Indian Health Service and a county in Montana has escalated with a lawsuit and a prominent citizen of the Blackfeet Nation accusing the federal agency of putting the lives of his fellow people at risk.

According to Glacier County , the IHS has failed to pay for care provided to Blackfeet citizens despite promising to do so as far back as 2014. A complaint filed in federal court on Tuesday demands "no less than" $1.8 million from the federal agency, which has gone without a permanent leader for more than four years

“We had hoped it wouldn’t come to having to sue a federal agency, but it has become clear that Indian Health Service has intention to do the right thing and reimburse Glacier County,” said Michael DesRosier, a Blackfeet citizen who serves as chair of the county's board of commissioners. “This travesty shows Indian Health Service has no regard for the people that agency was created to serve.”

“Indian Heath Services is putting Blackfeet lives at risk,” added DesRosier, who is the highest-ranking official in the county.

The lawsuit includes a copy of the most recent letter in which the IHS agreed to pay the county for emergency medical service . But the federal agency says it hasn't been provided with adequate documentation about the money allegedly owed on behalf of Blackfeet patients.

"Despite repeated request for documentation, IHS has not been able to substantiate the amount claimed by Glacier County," the agency said in a statement provided to Indianz.Com "At this time, IHS does not believe the $1.8 million amount is accurate."

"For the past 9 months, IHS has been working closely with the county to identify any outstanding claims that are eligible for payment," the statement continued.

Though the payment dispute has largely played out on the local level, it was brought up during the recent confirmation hearing for Micheal Weahkee to serve as the first permanent director of the IHS since 2015. Sen. Jon Tester (D-Montana), a former chair and former vice chair of the Senate Committee on Indian Affairs , wondered whether the lack of leadership has prevented the agency from fulfilling all of its obligations to the first Americans.

"It's why I asked if your leadership team was fully staffed," Tester told Weahkee, a citizen of the Pueblo of Zuni who has worked at the IHS and in tribal health settings for more than two decades.

"I'm not saying IHS is wrong and I'm not saying Glacier County was wrong," Tester said at the hearing on December 11. "But it would be great to put somebody on this to get this resolved."

The lack of resolution has forced the county to halt ambulance service to the Blackfeet Community Hospital, the IHS facility on the Blackfeet Nation. DesRosier said his government can no longer afford to transport patients from the reservation to other facilities, even if those patients need life-saving care and other services that always can't be provided by the federal agency.

The Purchased/Referred Care program at the IHS was designed to cover such situations. But the agency, in its statement, said claims for payment must be reviewed and must meet certain requirements before they can be paid out.

"IHS is committed to paying all eligible Purchased/Referred Care claims submitted in accordance with applicable requirements," the statement read. "Medical referrals are not a guarantee for payment. The PRC program must review the claim to make the determination for IHS approval of payment. All PRC eligibility requirements must also be met."

In hopes of improving services to more than 2 million American Indians and Alaska Natives, Congress just approved an appropriations package that includes a record amount for the IHS. The bipartisan bill provides $6.047 billion for the agency, a 4 percent increase from current levels.

“Our Interior bill provides key investments for Indian Country, funding education, housing, infrastructure, and other priorities to help ensure healthy and prosperous Native communities,' Sen. Tom Udall (D-New Mexico), the vice chairman of the Senate Committee on Indian Affairs, said in reference to the portion of the H.R.1865 that funds the IHS and most other Indian programs.

A recent visit by Indian Health Service National Director, Michael Weahkee (l) and Blackfeet Community Hospital CEO, Garland Stiffarm (r). Posted by Blackfeet Indian Health Service on Tuesday, May 7, 2019

Purchased/Referred Care, however, will not be seeing any major increases once President Donald Trump signs the bill, as he is expected to do. Funding for this program is remaining level, at exactly $964.8 million, according to a report accompanying the spending package . [See Page 116

"We cannot solve everything at once, but we can make a positive, real and lasting difference in the lives and health of our patients," Weahkee said in his opening statement at his confirmation hearing. "And we can make what some say is impossible, possible."

Weahkee, who has been serving as the highest-ranking official at the IHS since June 2017, received bipartisan support at the hearing last week, including from Tester, who predicted full by the U.S. Senate . But the lawmaker said the nominee needs to do more to address the needs of tribal citizens, like the ones back in his home state of Montana.

"This isn't on you -- it's on the agency in general over decades and decades and decades," Tester said. "They don't believe there's anybody in IHS that's fighting for them."

Michael Weahkee testifies before the Senate Committee on Indian Affairs in Washington, D.C., during his confirmation hearing to serve as director of the Indian Health Service on December 11, 2019. Photo by Indianz.Com (CC BY-NC-SA 4.0)

Earlier this year, Weahkee visited the Blackfeet Nation to apologize for the agency's role in a scandal that was also brought up repeatedly during the confirmation hearing. Stanley Patrick Weber , a non-Indian, was convicted of abusing young male patients on the reservation following a trial in federal court in Montana. Weber worked at the Blackfeet hospital as a pediatrician between 1992 and 1995, according to a sentencing memorandum

In September, Weber was convicted in federal court a second time, for abusing young male patients on the Pine Ridge Reservation in neighboring South Dakota, home to the Oglala Sioux Tribe . During the hearing last week, Weahkee said the IHS has implemented a number of changes in response to the scandal.

“Those types of activities are absolutely unacceptable and will not be tolerated," said Weahkee, who vowed to set a "tone at the top" in which transparency and openness are key values at the IHS. "We cannot risk any harm to our patients."

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