Ponca Tribe prepares for brighter future with plans for $26 million health center

Wednesday, December 6, 2017  

'We just continue to grow and grow and grow'

Fred LeRoy Health and Wellness Center set for big move in Nebraska
By Kevin Abourezk
@Kevin_Abourezk

OMAHA, Nebraska -- A folding table, a couple dozen folding chairs and a non-functioning phone.

Those items constituted all the office equipment inside the first Ponca Tribe service center in Omaha when it opened 24 years ago near 69th and Dodge streets. The one-room space, which had an entire wall covered in glass, opened just three years after the tribe had been restored.

The service center was one of the first efforts by the newly re-recognized tribe to serve its people and would later become a full-service clinic serving the tribe’s members and members of other tribes.

“We started at that point, and where we’re at today is amazing,” said Candy Schott, medical director of the Fred LeRoy Health and Wellness Center and one of the first employees of the clinic.

Today, the clinic calls a three-story, 18,000-square-foot building south of downtown Omaha home. The clinic not only provides medical services to its patients, who have come from 150 different tribes, but also provides pharmaceutical, behavioral health, dental, community health and midwife services.

The clinic also boasts a public health nursing program and purchase/referred care services to Ponca tribal members who need health services not offered at the clinic.

But the 63-year-old building is beginning to show its age and limitations for providing space to an ever expanding tribal health care operation.

A narrow hallway provides the only avenue for patients and staff to reach the clinic’s eight exam rooms. Visitors must stand to the side and wait their turn to walk from one end to the other.

The only suitable conference room where the clinic’s staff can meet doesn’t have enough chairs and some attendees have to sit on stationary bikes while listening to presentations.

Without enough offices for clinic staff, administrators have had to renovate closets, locker rooms and bathrooms to make room. The building’s only elevator is barely large enough to accommodate a single person in a wheelchair.

And with just 30 parking stalls outside, patients often have to park on residential streets.

But tribal leaders welcome the problems a thriving clinic, which sees nearly 20 new patients a month.

“We just continue to grow and grow and grow,” Schott said.

About 13 years ago, the clinic’s skyrocketing growth motivated tribal leaders to begin searching for new digs for the clinic. Their efforts led them to a shiny, much newer building some six miles to the west of the existing clinic.

The tribe is poised to finalize its purchase of the $6 million former headquarters and call center for InfoGroup by the end of January.

* * *

For the Ponca, several factors aligned in recent months that encouraged tribal leaders to move forward with plans to expand their Omaha clinic.

Tribal leaders are hopeful a new funding opportunity will allow the tribally-operated clinic to begin receiving money from the Indian Health Service to operate the new clinic once it’s renovated and ready for use. The tribe recently was selected by IHS as a Joint Venture Construction Program recipient, and will be eligible to receive federal funding to cover up to 85 percent of the operating costs for the clinic for 20 years once it’s running.

The tribe is still negotiating with the federal agency on the size of its expected patient population once the clinic reopens in the former InfoGroup building, said Larry Voegele, CEO of the Fred LeRoy Health and Wellness Center.

He said the tribe plans to use traditional financing instruments, including bonds, loans and a capital campaign, to pay for the cost of buying the InfoGroup building and renovating it. The tribe also plans to pursue grants, but it is unlikely to find many that will cover the cost of brick and mortar, Voegele said.

Revenue generated by the clinic from third-party sources, including private insurance, Medicare and Medicaid, also will help cover the costs of property acquisition and renovation, he said.

“We were planning on using our third-party income, just like any other provider, to cover the cost of financing this expansion,” he said. “That kind of carries some degree of risk, especially since we have about half uninsured population.”

Another potential revenue source convinced tribal leaders the $26 million investment into a new clinic facility was a sound venture.

Last month, the tribe won a major legal victory after the National Indian Gaming Commission approved the tribe’s plans to move forward with a casino in Carter Lake, Iowa, just a few miles from downtown Omaha, the largest city in Nebraska.

The decision capped a nearly decade-long battle for the descendants of Ponca Chief Standing Bear. A 2007 decision by the NIGC had approved the tribe’s casino plans. However, legal challenges from the states of Iowa and Nebraska and the city of Council Bluffs, Iowa, led to a federal judge’s ruling saying the commission lacked the authority to make the decision.

But a subsequent ruling by the 8th Circuit Court of Appeals reversed the lower court’s decision and gave the commission another chance to consider the matter.

The appellate court ruled the NIGC should have taken a purported agreement between the Ponca Tribe and the state of Iowa – in which the tribe promised not to build a casino on its Carter Lake property – into account. However, the court ruled, the agreement wasn’t valid and couldn’t be used to stop the tribe from gaming.

The attorney generals for Iowa and Nebraska haven’t decided whether to appeal the latest NIGC decision.

“No decision in the foreseeable future,” said Geoff Greenwood, spokesman for Iowa Attorney General Tom Miller, this week.

However, the city of Council Bluffs in Iowa is considering its legal options, said Mayor Matt Walsh.

Walsh said city leaders from Council Bluffs did not object to the Ponca Tribe’s purchase of its Carter Lake land after receiving what it believed were promises from the tribe about how it would use the land.

“After receiving written assurances from the tribe’s legal council that the location would be used as a health clinic and wouldn’t be used for gaming purposes, the city acquiesced and didn’t object with the land purchase,” he said.

He said he disagrees with the tribe’s contention that its legal council at the time of the land purchase lacked the proper authority to make commitments related to the tribe’s future land use.

Larry Wright Jr., chairman of the Ponca Tribe, said the tribe did initially plan to build a clinic on its 5-acre Carter Lake parcel of trust land. However, the tribe decided the site wasn’t suitable for a clinic and purchased the building that now houses the Fred LeRoy Health and Wellness Center instead.

Today, the tribe runs its smoke shop, Smoke Signals, on its Carter Lake property.

Wright said the tribe is hopeful the casino will be a major revenue source for the clinic and for other tribal programs.

“It means everything to us when we look at that revenue and how it affects the services that we provide for our people,” he said.

At the time the tribe proposed building a casino in Carter Lake, plans included 50 table games and 2,000 slot machines, as well as a 150-room hotel.

Wright said the tribe is still considering exactly what the gaming operation will look like in Carter Lake. He said the tribe actually owns about 11 acres in the town and plans to use the 5 acres of that land that is in trust for the casino. Much of the rest of the land would be used for parking and other ancillary needs.

“We will have as much gaming stuff in 5 acres as we possibly can,” he said.

* * *

The story of the Ponca Tribe of Nebraska is a familiar one to Indian Country.

Forced from their lands along the Niobrara in northeast Nebraska in 1877, the Poncas moved south to Indian Territory in present-day Oklahoma.

Beset by disease and facing starvation, a small group of Ponca under the leadership of Standing Bear began the long walk home.

The chief had promised his dying son to bury him along the chalk bluffs of his homeland. How could a father deny such a request?

Their journey home ended in March 1879, when they were captured by the U.S. military and Standing Bear was forced to defend his decision to leave his people’s reservation in Oklahoma before a federal judge. His subsequent trial, in which his impassioned speech before Judge Elmer Dundy convinced the judge to free him and allow him to return home, proved to be a resounding civil rights victory for Native Americans, who were then recognized as human beings under the law.

But the tribe’s troubles and efforts to maintain their lands and culture along the Niobrara weren’t over.

In 1966, with federal politicians deep in the fever of Indian termination, the federal government revoked the Ponca Tribe’s federal status, making it one of 109 tribes to lose its federal status. It would be another 24 years before the tribe would succeed in regaining its federal recognition.

But restoration didn’t result in the tribe regaining its former trust lands. Instead, the federal government decided to allow the tribe to establish service centers on trust land in five different areas where it had significant numbers of members. Those areas included Omaha, Lincoln, Norfolk and Niobrara in Nebraska, along with Sioux City in Iowa.

Restoration for the Ponca was just the first step in a 27-year climb to where it is today, a thriving tribal government that offers its members a host of services ranging from housing and education to health care and cultural support.

Wright said gaming in Carter Lake would inject much needed revenue into all of the tribe’s programs. Unlike a corporate casino owner based outside Nebraska, the Ponca Tribe will use its casino profits to serve its members, most of whom live in Nebraska and most of whom pay taxes and purchase goods in the state, he said.

“When you talk about revenue that is generated from the casino and where it goes to, it’s not going to stakeholders in other states,” he said. “It’s not going to dividends. It’s going back into programs and services for our people.

“Our funding goes to those places, and that goes right back into the communities that we’re in.”

* * *

When staff members for the Ponca clinic begin moving into their new space, they’ll be trading their 18,000-square-foot home for one more than 10 times bigger. The vast former InfoGroup headquarters also will offer nearly 642 parking stalls and a massive open interior room capable of accommodating a powwow.

Three buildings make up the property, and while the tribe will have to renovate most of the building to make it suitable for use as a clinic, staff and administrators likely will be able to move into existing executive office space without having to make significant improvements, Wright said.

He said he expects to have most of the clinic’s support staff moved into the new building by the end of February. However, the tribe will still have to gain approval from Omaha city officials to complete renovations to the building that will allow it to begin offering medical services there, he said.

That means the clinic likely won’t begin offering services in the InfoGroup building until sometime in 2019.

The building is so large, in fact, that tribe is looking for other possible uses for it that could generate income, Wright said.

“That’s a good problem to have,” he said.

He said he has considered renting space there for community events and outside programs, including a new potential Indian center that a group of Omaha Natives are considering establishing.

The Poncas also are considering providing space in the building for a satellite educational center for Little Priest Tribal College, a tribal college based on the Winnebago Reservation, home to the Winnebago Tribe.

And Wright said he would love to see area medical colleges – including those at Creighton University and the University of Nebraska Medical Center – begin partnering with the Poncas to train their students at the Fred LeRoy Health and Wellness Center.

“There’s a real opportunity for them to find opportunities for their graduates to come and get experiences, internships, whatever it might be, and even possibly placement for a job,” he said.

Voegele, the clinic’s CEO, said the new clinic site will allow the tribe to expand its health offerings and generate increased revenue through those new services.

Indeed, he said, Indian Health Service officials already have committed to increasing the rate the agency pays the clinic to cover the costs of providing health care to its Native clientele once the clinic opens in its new location.

Currently, IHS pays the clinic at a rate of $1,141 per patient per year -- far lower than the average expenditure of $3,688 per patient, according to the agency's figures. Even that's lower than the per capita national health expenditure of $9,990, according to the National Center for Health Statistics

“They expect us, with this money, to provide a very comprehensive set of services,” Voegele said. “With that amount of money that they give us, we have to stretch that as best as we can.”

The new clinic site will allow the Ponca Tribe to justify increased funding for its patients as the tribe will now be able to serve more people with increased health programs, Voegele said.

He said about 78,000 square feet of the new building will be dedicated to health services and he’s planning to introduce new health programs in the expanded space, including radiology, additional physical therapy services, optical, podiatry and urgent care. The new site also will have a drop-in childcare center.

The tribe also hopes to open up its clinic to non-Natives, though it still must prove to IHS that it can do so without impeding the services it provides to its Native patients, Voegele said.

As a tribally-run clinic – rather than one operated by IHS – the Ponca clinic has a much different atmosphere than other clinics on reservations, Wright said.

Much of the clinic’s staff have decades of experience and longevity within the tribe, he said. And many of them are Ponca tribal members themselves and truly believe in the clinic’s mission to improve the health of the tribe’s members and other Native people, he said.

Many of its staff volunteer to provide programs, including a Friday morning physical therapy clinic, in order to better serve the clinic’s clients, Wright said.

“Our people work here,” he said. “This is theirs. This is where their families get taken care of, their moms, their dads, their kids, grandkids. Their relatives are working here.”

The clinic also offers services specific to Native Americans, including sweat lodge ceremonies, that other health care providers in the Omaha metro area simply don’t, he said.

“There’s going to be nothing like this for the Native community in the metro area,” he said. “As we build this one-stop shop for our tribal citizens, it really becomes that opportunity for all Natives here.”

As he prepared to check out of the clinic recently, Alan Lehl – a 22-year-old Oglala Lakota man from Lincoln – said he enjoyed his first visit to the clinic and planned to come back for physical therapy.

“It was really quick,” he said. “Everyone that I encountered was really friendly.”