National Indian Health Board Consumer Conference

By:  Eric Shinseki
Date: Sept. 25, 2012
Location: Denver, CO

Good morning, everyone. Lester (Secataro), thank you for that kind introduction and for your service on the National Indian Health Board. Let me acknowledge the tribal elders and tribal leaders who are present. Let me further recognize:

Cathy Abramson, your Chair of the National Indian Health Board;

All the other members of the board, among them President John Yellowbird Steele, Andy Joseph Jr., and Buford Rolin, who like Lester Secatero are all Veterans;

Stacy Bohlen, National Indian Health Board Executive Director, and Paul Allis, program manager;

Jefferson Keel, Chickasaw Nation Lieutenant Governor and President of the National Congress of American Indians;

Dr. Yvette Roubideaux, Director, Indian Health Service;

Fellow Veterans, VA colleagues, other distinguished guests, ladies and gentlemen:
My name is Ric Shinseki, and I'm a Soldier. I'm honored to be here today as the National Indian Health Board celebrates 40 years of advocacy on behalf of tribal governments--the NIHB's commitment to provide quality healthcare for all American Indians and Alaska Natives.

I greet the tribal elders and tribal leaders with respect and thank them for allowing me to participate in this meeting. I would also like to recognize all the Veterans in the audience. If you are able to, please stand, and if not able, please raise your hand, so we can acknowledge you. Thank you all for your service.

I was born on the island of Kaua'i, Hawai'i about a year after the attack on Pearl Harbor and grew up under martial law in the 1940s. Korea quickly followed on the heels of World War II, and then Vietnam became my turn to go to war in 1966. I never planned on an Army career but ended up serving 38 years in uniform. When my friends back home ask me, "Why?" I don't really have good answers, except that my fellow Soldiers never let me have a bad day, and because of that, key jobs kept coming my way.

I did my best to do two things in every one of those assignments: accomplish the mission and take care of soldiers the best way I knew how. And this also explains why I accepted this appointment as Secretary of Veterans Affairs. Here, I have the privilege of giving back--taking care of those with whom I went to war in Vietnam 45 years ago, those I sent to war as a service chief, and those true heroes who saved the world in the 1940's and who saved a country in the 1950's. Some of those heroes came from island communities like mine and from tribal lands like yours.

American Indians and Alaska Natives have long served this country with great courage and distinction: 14,000 in World War I; 44,000 in World War II, like the American Indian "code talkers," who sent sensitive communications in code developed from their tribal language. Over 80,000 served in Vietnam. Today, an estimated 30,000 American Indians and Alaska Natives serve in the United States military.

More American Indians and Alaska Natives have served in our Nation's armed forces than any other ethnic group, including mine. One of your heroes was Charles George, a member of the Eastern Band of Cherokee Indians.

Born in 1932, he grew up in Birdtown, North Carolina, enlisted in the Army at age 18, and following basic training, deployed to Korea. On 30 November 1952, Private First Class George was part of an infantry raiding party operating behind enemy lines to capture a prisoner for intelligence purposes. The patrol suffered several casualties from intense mortar and machine gun fire. PFC George fought valiantly, engaging the enemy in hand to hand combat.
As the raiding party completed its mission and began its withdrawal, PFC George and two other soldiers remained behind to provide covering fires. As they did so, an enemy grenade landed in their midst. PFC George shouted a warning to one soldier, pushed the other out of danger, and without hesitation, threw himself onto the grenade, absorbing its full explosion. Seriously wounded and in excruciating pain, he remained silent, not revealing their location. For conspicuous gallantry and courage above and beyond the call of duty, PFC Charles George was posthumously presented the Medal of Honor. Our VA medical center in Asheville, North Carolina, is named in his honor.

The honor roll of Native American heroes is long and distinguished. We are privileged to have these brave and courageous men and women walking the halls of our VA facilities nationwide every day.

For these reasons, VA is privileged to partner with the National Indian Health Board to host the first-ever Veterans' track at this conference. We at VA are committed to working with and for tribal leaders on a nation-to-nation basis, to address the many issues, some of them quite complex, being experienced by Veterans and their families across Indian Country.

From access to care in rural and remote locations, to engaging every generation of tribal Veterans, including those with unfavorable opinions about VA and those who have never been able to access VA healthcare before.

Three-and-a-half years ago, I committed to working with the Indian Health Service (IHS) to take the best care possible of our eligible American Indian and Alaska Native Veterans. Three-and-a-half years later, I am still trying to do this well, frustrated that time eludes my best efforts.

I know there is a record of mistreatment and injustice in your history, as there was in my community. I cannot change that history, nor the lack of trust that some may have about my government and my department. But in our time, yours and mine, I intend to make things different. We are not where I want to be for eligible Veterans in your tribes, but VA has not and will not stop reaching out to improve the care we provide for our American Indian and Alaska Native veterans.

You see, VA is a large healthcare provider, the largest integrated healthcare system in this country--152 medical centers, 80 percent of which are affiliated with one of the Nation's top medical schools. Clustered around these medical centers, we have 817 community-based outpatient clinics, 300 Vet Centers, and outreach and mobile clinics that deliver healthcare to the most remote areas where Veterans choose to live.

Through an extensive and growing telehealth network, linking these 1,300+ points of care, Veterans are able to access VA's benefits and services, including critical medical specialists at distant locations. We are overcoming the tyranny of long distances in this country through the technology of our telehealth networks. We are asking Veterans to drive less with each passing year.

Here's what's also true about VA:

VA is second only to the Department of Education in providing educational benefits of $10 billion annually.

VA guarantees nearly 1.6 million home loans, the only zero-down lender in the nation. Our foreclosure rate is the lowest in all categories of mortgage loans (2.25 percent).

VA is the Nation's eighth largest life insurance enterprise with 7.1 million clients, and a 95 percent customer satisfaction rating.

VA operates the country's largest national cemetery system--131 cemeteries. For the past 10 years, our cemetery administration has been this country's top-rated public or private sector organization in customer service, according to the American Customer Satisfaction Index conducted by the University of Michigan.
Three-and-a-half years ago, the VA budget was $99.8 billion. President Obama's 2013 budget request, currently before the Congress, is for $140.3 billion, a 40 percent increase since 2009. The President understands our obligation to Veterans, and has provided the funding needed to better care for them. We must better distribute these funds to benefit and care for eligible Native American Veterans and family members in the most direct and immediate way possible. VA has only one mission--to care for the men and women who have secured our nations.

To improve our outreach, we've embarked on a robust consultation effort that will focus on listening, aiding, and advocating on behalf of tribal Veterans. In January 2011, we stood up our Office of Tribal Government Relations to better communicate with tribes and better understand your needs. Deputy Assistant Secretary John Garcia and Director Stephanie Birdwell are my personal trusted agents in these initiatives.

In February 2012, I signed VA's first Tribal Consultation Policy. This collaboration with tribal governments will help us develop, improve, and maintain partnerships with Indian Country. It is vital that we hear your voices--listen to your concerns--on issues that affect Veterans and their families.

We've held a series of four tribal consultations this past year alone, and we intend to continue both formal and informal dialogue with tribal leaders to better understand and meet the needs of Veterans in tribal communities. An aggressive outreach schedule to expand our relationships with the American Indian and Alaska Native governments is a top priority.

We are also committed to nurturing an environment that fosters trust and provides culturally competent care for Native American Veterans--including creating culturally sensitive outreach materials, incorporating traditional healing practices and rituals into treatment, and ensuring the best possible experience when Native American Veterans receive healthcare from us. We advocate for Veterans. There will be no difference in the quality or the safety of the care we provide to all Veterans, wherever they choose to live. We intend to earn the trust of Native American Veterans in the process.

We are proud of the quality and safety associated with VA's healthcare system. We are not proud that Veterans in Indian Country haven't always received the treatment they deserve. VA is vitally interested in providing better access to care and to coordinating our activities with tribal health programs, the Indian Health Service, and urban Indian health programs to improve access and delivery of healthcare services and benefits.

Because so many native Veterans live in remote or rural locations, our Office of Rural Health, directed by Dr. Mary Beth Skupien, has dedicated $50 million to fund 54 projects in Indian country over the last four years--including telehealth, mental health and PTSD treatment, mobile clinics, home-based primary care, and transportation and homeless projects.

In partnership with the Indian Health Service and tribal governments, VA is expanding its home-based primary care program onto tribal lands, an initiative that will collocate home-based primary care satellites at IHS hospitals and clinics, tribal clinics, or VA community-based outpatient clinics adjacent to tribal lands. For the chronically ill, this will eliminate the long commutes, while increasing access to primary care through continuous telehealth monitoring.

A model of collaboration between the Charles George VA Medical Center and the Eastern Band of Cherokee Indians, and its Cherokee Indian Hospital Authority, has been established to expand home-based primary care from a 45-patient model to a 120-patient model in western North Carolina. The program will:

Enable Cherokees to receive services through both VA and the Cherokee Indian hospital systems;

Expand home-based primary care services to the most remote parts of western North Carolina; and

Develop a model that will better serve not only Cherokees, but all other Native American Veterans, as well.
In other initiatives, we have --

Activated telehealth and tele-psychiatry sites that now serve 14 tribes at nine Indian Health Service and tribal healthcare sites in Montana, Wyoming, North and South Dakota;

Provided funding for healthcare programs in five new community-based outpatient clinics in Indian country, increased our mobile clinic fleet, and increased cultural competency training for VA healthcare providers.
In 2010, our Veterans Health Administration and the Indian Health service signed an updated MOU--Memorandum of Understanding. One of the goals for VA and the IHS is to promote patient-centered collaborations with tribes. The MOU is national in scope, but provides the necessary flexibility to tailor programs through local implementation. It spans areas from improving the delivery of care by sharing programs and increasing cultural awareness, to improving information technology and increasing efficiency through purchasing and reimbursement agreements.

Let me be clear: VA is responsible for the healthcare of any eligible American Indian or Alaska Native Veteran, and we will serve those Veterans with great care and pride. We have not always done the best job of providing care in the past. But I offer you that during my tenure we will do better. We are working to develop reimbursement agreements with tribes and the IHS. But we must move beyond negotiations and provide eligible tribal Veterans the healthcare they have earned. Let us codify the best processes possible for eligible Native American Veterans that will outlast our tenures.

The Alaska VA healthcare system has already negotiated and signed 25 reimbursement agreements with tribal health programs this year, and I am pleased to announce that we are now reimbursing tribal health programs, beginning last week. These agreements enable VA to pay for direct healthcare provided in tribal health programs for eligible Veterans, and we are looking to increase the number of these agreements with tribes across the lower 48 states.

As a direct result of the VA-IHS MOU, our suicide prevention office has collaborated with IHS through the Suicide Prevention Work Group to conduct 67 tribal outreach activities, engaging nearly 15,000 participants. A cultural competency work group has also been established and is developing, in collaboration with the tribes and IHS, culturally appropriate training materials for providers, patients' families, and caregivers in Indian Country.

One of our most successful outreach efforts is our Veterans' Crisis Line. Since 2007, over 640,000 people have called in, including over 8,000 active-duty service members. 99,000 were referred for care, and over 23,000 rescued from potential suicide--suicides in progress. In 2009 we added on-line chat, and in 2011, a texting service. We continue to find ways of reaching out to Veterans in need, including Native American Veterans.

VA is working with Veterans' Treatment Courts across the country to identify treatment options for many of our Veterans with substance abuse disorders or mental health conditions. We just published a how-to guide to help identify and link Native American Veterans involved with the criminal justice system with VA resources and other providers as an alternative to incarceration.

Veterans and their families need sustainable economic opportunities. Our Office of Tribal Government Relations is working closely with our Veterans Benefits Administration to increase tribal Veterans' access to established benefits such as compensation and pension, vocational rehabilitation, and employment services. The Post 9/11 GI Bill offers college education benefits to eligible Veterans and their families and was expanded last year to provide vocational and other non-degree training.

Let me close with a story that exemplifies the kind of care VA is determined to provide to tribal Veterans.

"Victor" is a 52 year-old Lakota Sioux who served with the Marines from 1967 to 1970, deploying twice to Vietnam. He started to abuse alcohol during his military service, which continued when he came home from Vietnam. Two marriages and divorces followed over 17 years. After returning from Vietnam, he remembered a clinician suggesting that he might have PTSD, but he did not seek treatment. Warriors are strong enough to withstand combat. He wanted to participate in more traditional ceremonies, like a sweat lodge, yet he avoided them due to crowds and claustrophobic conditions, becoming more withdrawn at work and from his family.

Victor was reluctant to seek care from the local mental health services. Two broken marriages, alcoholism, and struggles at work finally led him to seek treatment at the local VA, where he participated in a telehealth clinic to treat PTSD.

Skeptical at first, Victor is now making progress. He participates in treatment sessions via video conferencing that provide the space and distance he needs to feel safe in exploring his combat memories.

We look forward to a future where Veterans like Victor will no longer have to suffer the effects of war alone--a future where tribal governments, tribal health programs, urban Indian health programs, and Native Veterans view VA as an advocate and a partner.

I appreciate this opportunity to speak with you today. I invite you to change our history. VA will be there for our Native warriors who have safeguarded this Nation for all of us.

Thank you.

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