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In SANTA ANA PUEBLO, N.M. (AP), an unoccupied plot nestled between a fire station and a soccer field near Albuquerque is poised to become the site of a long-awaited federal medical center dedicated to Native American patients, a promise that dates back over three decades.
Recently, Santa Ana Pueblo Governor Myron Armijo guided representatives from the U.S. Indian Health Service (IHS) and the Department of Health and Human Services through the proposed site, which is set to offer a comprehensive range of services. Patients can expect treatments spanning from dialysis and diabetes management to optometry.
“This development is set to revolutionize healthcare access in our community,” stated Armijo.
Slated for groundbreaking in 2027, the expansive 235,000-square-foot (22,000-square-meter) center will be managed by the IHS, the federal body responsible for healthcare services to Native Americans. Tribal leaders anticipate that this new establishment will alleviate the strain on the antiquated and overburdened Albuquerque Indian Health Center. Originally constructed 90 years ago, this federal facility currently leaves some patients waiting for months to secure an appointment.
The Albuquerque center was among over 60 healthcare institutions identified for replacement by the agency in 1993 due to outdated infrastructure and insufficient capacity to meet the demands of a growing population. It remains on this list alongside six other projects across Arizona and New Mexico. IHS officials have announced plans to supersede the current facility with two new centers in the Albuquerque vicinity, including the forthcoming project at Santa Ana Pueblo.
In February, HHS Secretary Robert F. Kennedy Jr. pledged $1 billion toward those long-delayed projects, including $22 million for the Santa Ana Pueblo center. The agency estimates $8 billion is needed to tackle all remaining projects on the 1993 list that, under federal law, must be complete before the IHS can address other major construction needs.
A.C. Locklear, CEO of the nonprofit National Indian Health Board, said the $1 billion is the single largest financial investment by any administration in addressing the aging facilities. Yet, he said, it also shows the federal government has neglected its legal duty to provide adequate healthcare to tribal nations.
“It’s a drop in the bucket in terms of what’s needed to modernize these facilities,” Locklear said.
Aging infrastructure impacts access, quality of care
The IHS serves 2.8 million Native American and Alaska Native patients at 21 hospitals and 78 smaller health centers nationwide. The average age of those facilities is around 40 years old and one-third are in “poor” physical condition, according to a 2023 U.S. Government Accountability Office report.
That isn’t lost on Theresa Nelson, a 62-year-old Navajo Nation citizen who started relying on the Albuquerque Indian Health Center after retiring and losing her health insurance.
“It felt like going back in time,” she said, describing everything from the X-ray machines to exam rooms and waiting room furniture as outdated.
Nelson said the center relies on a complex system of outside referrals for treatments and tests that were easier to access in the private sector. She has been waiting for eight weeks for IHS to approve a referral for a 3D mammogram, a tool the Mayo Clinic says is offered at most U.S. healthcare facilities.
The Indian Health Service said appointment wait times at the Albuquerque center are less than 14 days for patients who are established with a primary care provider. But Nelson and other patients report going years without being assigned a doctor and waiting months to be seen for preventative care.
Farther west, the Gallup Indian Medical Center operates out of a mashup of modular buildings and piecemeal renovations. The hospital, which opened over six decades ago and is on the 1993 list, serves a population that includes the Navajo Nation. Tribal lawmaker Vince James said constant construction and a disjointed layout make it difficult for elderly and disabled patients to navigate the hospital and for providers to do their jobs.
“These are Band-Aid fixes,” James said. “Eventually the GIMC campus will become unsafe.”
An “unacceptable” backlog
Senior HHS adviser Mark Cruz urged Congress to make a special appropriation to complete the remaining projects that are in various stages of planning and design.
Without that funding, he said, it could take another 40 years to get through the priority list.
“It’s really unacceptable that we’re still working off of that 33-year-old construction list,” Cruz said during the Santa Ana Pueblo tour.
Federal law requires the Indian Health Service to complete that list before replacing clinics and hospitals that have fallen into disrepair since 1993. That includes two nearly 90-year-old hospitals in Montana and Minnesota. The agency also can’t build new facilities to meet patient demand, which has grown and shifted geographically in recent decades.
“I can’t get to additional projects that have merit across Indian Country or Alaska because I have a statutory obligation to get through the 1993 list first,” Cruz said.
In 2023 the IHS crossed a project in Rapid City, South Dakota off its priority list. The replacement of the aging and troubled Sioux San Hospital has been “transformational,” said Jerilyn Church, CEO of the Great Plains Tribal Leader’s Health Board.
The renamed Oyate Health Center is three times larger than the former hospital and equipped with far more modern medical equipment. But demand for care at the new center is already outstripping available space.
“That’s what happens when you work from a backlog,” Church said. “In the time between identifying the need and the money finally becoming available, the population grows.”