By KEN LEISER
Native Americans are far more likely to suffer from obesity and clinical depression than the rest of the U.S. population. Nationally, their life expectancy is five years shorter than non-Native Americans. And their death rate from drug overdose is higher than the national average, according to the Centers for Disease Control and Prevention.
Youngsters and adults gather for horse races at the Veterans Powwow in Pine Ridge Indian Reservation in South Dakota, home of the Oglala Lakota Sioux Nation.
Aaron Huey/Alamy stock photo 2012
In June 2015, Sioux Falls, S.D.-based Avera Health named Leroy "J.R." LaPlante as its director of tribal relations — the health system's primary liaison with regional tribal governments. Prior to that, LaPlante — who graduated from University of South Dakota School of Law — was South Dakota's first Secretary of Tribal Relations and later an assistant U.S. attorney.
LaPlante, 50, was born and raised on the Cheyenne River Sioux Indian Reservation in north-central South Dakota. The reservation encompasses Ziebach County, the poorest county in the nation, according to U.S. Census Bureau figures showing more than 56 percent of residents lived below the poverty level in 2017.
LaPlante spoke with Catholic Health World about meeting the health care needs of Native Americans.
How did your childhood on the reservation and your education and career experiences prepare you to work as director of tribal relations at Avera?
I've always walked with one foot in one world and one foot in the other world. I understand the Indian world and I understand the non-Indian world. I don't feel at a disadvantage in either one.
Roughly 30 percent of Native Americans are uninsured, or twice the national average. Between that fact and the underfunding of the Indian Health Service, what role can Avera play to address these kinds of systemic inequities?
What I try to do with Avera Health, the tribes and Indian Health Service is to try to identify common interests that we have. One of those common interests would be to expand Medicaid in South Dakota. (North Dakota expanded Medicaid in 2013.) The expansion of Medicaid would vastly improve access to quality care for American Indians. It would create another funding source for Avera because IHS is traditionally a payer of last resort, especially for purchased care it cannot provide within its facilities. And to the extent the IHS could bill Medicaid and bring in that revenue to bolster their local services, that would be a tremendous advantage.
The other thing we can do is help advocate for funding increases for the IHS at the federal level. One thing that a lot of people don't realize is that IHS cannot lobby for funding increases at the federal level.
You have said in the past that you believe Native Americans living on reservations suffer from Third World health care. Can you elaborate?
Yes. I will tell you a story. A colleague and I were co-presenting at our physician academy a couple of years ago. She was giving her presentation about our Haiti mission trip, and she had a slide describing all the demographics of Haiti — population, median income, median age of death and so on and so forth. Then I was following her. As we were transitioning to my presentation, I said "Why don't you just leave that slide up there?" Because those demographics are very similar to what you would find here in Indian country in South Dakota. The unemployment rate. The median age of death. The health disparities. So, it's kind of an anecdotal example of how we don't have to go outside the borders of the United States to find Third World health conditions because we really have those here in our own backyard. Our median age of death in South Dakota for American Indians in 2014 was 58. The median age of death for their non-Indian counterpart in South Dakota is 81. That median age of death was very similar to what you would find in Haiti. I think as you go across the country on other Indian reservations, you will find very similar statistics.
What are some initiatives you've pursued with Avera Health to address pressing health care needs of Native Americans?
The very first project I worked on was a behavioral health collaboration we did with the Oglala Sioux Tribe. Between 2014 and 2015, the Pine Ridge Indian Reservation had suffered probably one of the worst suicide crises it had seen in its history. I think they had over 20 completed suicides in a 12-month period. All the people who died were under the age of 25. The tribal president called me and asked whether Avera would help assess what was going on. So, we took our behavioral health team, and went down and met with the IHS, the tribal leadership, and community program providers. Probably the biggest takeaway was that while there were a lot of different types of behavioral health services, they weren't really collaborating very well, and a lot of the services were temporary.
One of the things we were able to do was help the tribe write a grant to the U.S. Health Resources and Services Administration's office of telehealth and we helped them implement a program that evolved into a school-based, behavioral telehealth program serving students in six area schools. Telehealth and behavioral telehealth services were really among the first programs that we worked on in our American Indian health initiative. Avera is providing that care and building it out.
After that, the Yankton Sioux Tribe came to us and said, "We've been trying to develop a dialysis program down here for years. It is not a historical program function service or activity of IHS, so we have to do it on our own." The tribe had a building it wanted to convert into a dialysis unit and asked Avera for technical assistance. One thing led to another and eventually they wanted us to come in and be their provider. The tribe owns the facility and the equipment, but they have contracted with Avera McKennan (Hospital and University Health Center) to provide the nephrology and dialysis services under a management agreement.
How do you address the logistical challenges of providing essential services across the vast and remote reservations?
I think the remoteness is the least of our challenges. If there is one thing that Avera has proven it can do, it can provide services in remote areas because of telehealth. Recruiting health care providers out to an Indian reservation can be a big challenge.