Snoqualmie Casino Health Insurance
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Seattle Times Eastside bureau
It may not be the most auspicious time to foray into the world of health-care providers, but the Snoqualmie Tribe is doing it anyway.Against a national backdrop of skyrocketing health-insurance costs, a nursing shortage, dwindling government money and a growing number of doctors refusing to treat poor patients, the tribe is poised to take on the critical health-care needs of its members and non-Indian neighbors.
The Snoqualmie Tribe regained its rights as a sovereign nation three years ago. Today, it will open its second family health-care clinic, this one in Carnation. In three months, tribal officials hope to be able to open a mental-health clinic, also in Carnation, offering drug and alcohol treatment, counseling and other services not available in the community.
'They need to be strong on this particular path because health care is a tough journey, especially now. These are not the smoothest waters to start out on,' said Dr. Terry Maresca.
Maresca is a Mohawk Indian and faculty member at the University of Washington's School of Medicine. The Snoqualmies hired her to treat patients at the Carnation clinic one day a week.
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Two nurse practitioners, who now work at the tribe's North Bend clinic, will each work two days in Carnation, with their remaining workdays in North Bend. The tribe also has contracted with a chiropractor and a physical therapist. Each will work one day a week in Carnation.
Though Maresca knows the surgical cases she's likely to see in Carnation won't be 'too terribly exotic' — things such as skin lesions and toenail problems associated with diabetes — the goal is to keep patients 'in house' so they don't have to travel for basic care.
The tribe has a little more than 600 enrolled members dispersed across the Puget Sound area. Forty-two percent don't have jobs, tribal administrator Matt Mattson said, an unemployment rate that is almost seven times that of Washington state. Even Snoqualmie tribal members with jobs are struggling, with half living below the poverty line, he said.
During their decadeslong fight to regain federal recognition, Snoqualmie leaders were unable to intervene as their people were turned away from clinics run by private providers and other Indian tribes. Meanwhile, an epidemic of chronic diseases — diabetes, high blood pressure, arthritis, and heart and kidney disease — as well as poverty, alcoholism, drug abuse and suicide were taking their toll on the tribe.
As a recognized tribe, the Snoqualmies now receive money from the federal Indian Health Service. Those funds, combined with money from insurance companies for providing care to non-Indian patients, will be used to cover the operating costs of both clinics.
'This is the beginning of self-sufficiency,' Ray Mullen, a Tribal Council member and chairman of the tribe's economic-development committee, said. 'We can give our people something we've never been able to before.'
But it's not just about taking care of their own.
Seated around a table in the cramped garage attached to the tribe's former administrative office in Fall City, tribal health-board members spoke of their responsibility 'to all who are on the land' — that is, everyone who now lives in the Snoqualmie Valley, the tribe's traditional territory.
Responsible for setting health-care priorities and working to implement them, the health board is largely made up of the tribe's matriarchs. The women elders said their goal is to provide health care to all valley residents in the same way the tribe's food bank — which they began operating years before recognition — serves the entire community. Last year, about 8,000 residents used the food bank.
But opening the Carnation clinic has special meaning. The city — bordered by the Snoqualmie River to the west and the Tolt River to the south — is the heart of Snoqualmie territory.
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'Carnation — we call it Tolt — was the center of the Snoqualmie people,' health-board member Katherine Barker said. 'We're going back to our homeland.'
Winter villages with more than 150 longhouses once stood in the area between the Tolt and Snoqualmie rivers, said health-board Chairwoman Arlene Ventura. Chief Jerry Kanim, the tribe's last hereditary chief, died there in the mid-1950s, Ventura said.
About a block away from the health clinic on Tolt Avenue, Carnation's main street, the tribe is settling into its new administrative offices. Down the road is the tribe's economic-development office. It's the planning hub for the Snoqualmie Tribe's casino project.
The tribe never intended to make Carnation its center of operations. The Snoqualmies originally planned to open a combined health-care and mental-health clinic on the grounds of Snoqualmie Valley Hospital, next to where they want to build their casino. The hospital is about 12 miles south of Carnation.
Those plans changed in the spring when Kirkland's Evergreen Hospital closed its Carnation Family Clinic, leaving the city without any local health-care providers. The Carnation City Council approached the tribe, asking its members to take over.
'In these times of tightening social services and medical dollars, the fact the tribe was so willing and open to sharing this just shows the generosity in their hearts,' City Councilwoman Laurie Clinton said.
In return, the council offered use of the Schefer House, a city-owned rambler. The city and tribe are still negotiating the terms of occupancy.
About the same time the Carnation talks began, the tribe learned nurse practitioner Patricia Yetneberk was looking to sell her North Bend practice. The tribe bought the practice in April and hired Yetneberk as tribal health administrator.
Yetneberk said more than 70 tribal members have received treatment so far, and Yetneberk and another nurse practitioner are seeing several new tribal patients a week.
'These are good numbers, considering it's a small tribe scattered over five counties,' she said. 'We've had patients come as far as Everett and Olympia.'
Maresca, who will work her first shift in Carnation on Wednesday, anticipates a similar response. She has spent the bulk of her career working in Indian communities, including South Dakota's Rose Bud Indian Reservation, one of the poorest places in the nation.
While Washington may not be the toughest place to practice medicine, the state's health-care system is certainly struggling. The situation is especially dire in rural communities where access to health care has always been limited, Maresca said.
The eldest of seven children, Maresca, 44, decided at age 12 to become a doctor even though neither of her parents had graduated from high school. 'I just remember thinking as a kid ... all people deserve health care.'
In addition to her work at the UW, Maresca teaches herbal medicine and is an Indian health-care advocate. She was appointed by Congress to a national task force on fetal alcohol syndrome.
On her first visit to the Snoqualmie Tribe's Carnation clinic last month, Maresca walked from room to room, making a list of equipment and supplies she'll need to perform 'the lumps and bumps kind of surgery' typically needed in rural communities.
Then she spotted the big yard behind the clinic. If the tribe agrees, Maresca would love to plant things such as nettle, raspberries, mint and fever few — medicinal plants used to treat everything from prostate problems to migraines.
Compared with other places she's worked — such as the Alaskan fire station where she had to have water, towels and medical supplies flown in on a bush plane — the squat gray building in Carnation looks pretty good, she said.
'This isn't the Polyclinic, but I still think we can provide really good service here,' Maresca said. 'I'll be happy if patients walk away feeling they had their needs met.'
Sara Jean Green: 206-515-5654 or sgreen@seattletimes.com.
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