By the time doctors told Leola Kennedy she had only a few months to live, her neck was so swollen from cancer she couldn’t turn her head.

In the eight agonizing months leading up to her diagnosis, the 46-year-old woman made repeated visits to the urgent care ward at Blackfeet Community Hospital in Browning, where she first complained of headaches and insomnia, then back pain and then a total loss of appetite.

In the last two months before her diagnosis, Kennedy says she spent every day in the emergency room. Her teenage daughter, Maranda, had to skip weeks of classes in order to drive her mom to and from the hospital.

Kennedy says she sometimes waited for seven hours in the emergency room before seeing a physician or practitioner, and then only to be misdiagnosed with a host of illnesses she didn’t have — pneumonia, bronchitis and emphysema.

Before getting the diagnosis and treatment she needed at special care facilities off northern Montana’s 1.5 million-acre Blackfeet Reservation, doctors mistakenly told Kennedy her salivary gland was blocked, causing her neck to bulge and ache, and prescribed pills that never seemed to help.

“They gave me painkillers and muscle relaxers,” Kennedy says. “They told me to take lemon drops but they never gave a biopsy.”

Doctors at Blackfeet Community Hospital couldn’t explain what made Kennedy’s visits to the hospital so frequent, and nothing they prescribed stopped her cancer from spreading.

First it attacked the parotid gland near her neck before spreading to her heart and eventually her brain, where the cancer metastasized.
All the while, Kennedy’s options for treatment were limited.

Like more than half the Indians enrolled on the Blackfeet Reservation in northern Montana, Kennedy cannot afford private health care and isn’t eligible for Medicaid or Medicare.

Instead, she relies on the federally funded Indian Health Service to pay for her medical needs.

But IHS provides health care services only to the extent that appropriated funding from Congress allows.

And even though the cost of health care has risen 25 percent in the last six years and inflation rates have increased, IHS has had no luck securing additional appropriations from the federal government.

IHS is so underfunded that to be transferred off the reservation for specialized treatment a patient must be in danger of losing life or limb.

So day after day Kennedy had to wait her turn in the crowded emergency room, which ranks number one in Montana for cases of trauma and quickly soaks up IHS resources. The hospital also lacks fundamental diagnostic tools like a CAT scan and MRI machine, so cancer often goes undetected.

IHS, the primary health care provider for more than 1.6 million members of federally recognized tribes nationwide, has gotten almost no additional money from Congress in six years. The Billings-area office alone oversees the health care provisions of nearly 60,000 Native Americans on seven Montana reservations and one in Wyoming.

In order to keep up with rising health care costs, inflation rates and the increasing number of emergency room visits, Blackfeet Community Hospital needs millions of dollars more, health officials say.

“It’s frustrating as heck because it doesn’t allow us to practice standard-of-care medicine,” says Dr. Mary DesRosier, one of two Indian doctors at the Browning hospital. “If somebody comes in with lower back pain and numbness down their leg, standard of care would get them a CAT scan to determine what the problem is. But without that diagnosis, it’s hard to tell if something is life- threatening or not.”

Until last year, DesRosier never missed an opportunity to show her support for more federal funding.

But now, rankled that federal funding is so low and galled that American Indians seem to be the first cut in the federal budget and the last funded, DesRosier has given up attending Contract Health Service committee meetings, where other hospital and IHS staff convene to discuss how they can reduce the number of patients who go untreated for too long — patients just like Kennedy.

The branch of IHS responsible for funding patients’ treatment off the reservation, CHS can’t even afford to pay for many patients whose conditions already mandate a referral to another hospital.

One patient complained to DesRosier that a clinic in Great Falls was billing him for treatment he received after doctors in Browning referred him there, treatment that CHS was obligated to finance.
But CHS is just as broke as many of its patients, and the man’s bill was turned over for collection.

“I just saw a list four pages long,” DesRosier says. “At least 100 people they referred off the reservation and now CHS can’t pay for because they’re broke. They are so underfunded.”

The poor state of health care on reservations nationwide is a testament to U.S. failure to live up to its treaty obligations to Indian people, says Carol Murray, a professor in Blackfeet studies at Blackfeet Community College in Browning.

“We’ve been without it for so long most people don’t even know what it’s like to have it,” Murray says.

A 2004 report by the U.S. Commission on Civil Rights titled “Broken Promises: Evaluating the Native American Health Care System,” states tribes exchanged about 400 million acres of ancestral lands in return for promises and payments, including for health care, an agreement that still exists.

The report concludes the United States’ “lengthy history of failing to keep its promises to Native Americans includes the failure of Congress to provide the resources necessary to create and maintain an effective health care system for Native Americans.”

Click Images to Enlarge

Busy Hall and her daughter, Ida Racine, say they have been misdiagnosed by Browning health services on numerous occasions. Hall believes her sister died prematurely because her cancer had spread before doctors diagnosed it.

A crowd lines up outside of the pharmacy in Browning's hospital waiting to get inexpensive or free medication for enrolled members of the Blackfeet tribe.

Dr. Mary DesRosier knows the system for properly diagnosing patients is poorly handled. She feels compelled to "fudge" on doctor referrals for patients, which allows them to visit a Great Falls Hospital for necessary care.

Doctors at Indian Health Services in Browning work 24-hour shifts in the emergency room - 12-hours on-duty, 12-hours on-call. Reservation law requires doctors to treat all medical emergencies. High demand make it difficult to find qualified doctors.

Ida Racine turned to traditional cures for her numerous ailments after she was misdiagnosed and over-medicated on several occasions by Indian Health Services in Browning.