The basic equipment at the medical clinic at Montezuma Creek in remote San Juan County is antiquated and sometimes doesn't even work. The clinic needs a new X-ray machine and basic emergency medical capabilities.
The clinic itself is dilapidated and has been condemned.But what to do about providing health services to Utah Navajos, three-fourths of whom live without running water or electricity? The Board of Trustees of the Utah Navajo Trust Fund - all of them urban whites - think the answer is computers, and they are considering a request by San Juan County health officials to spend up to $350,000 of Navajo trust fund monies on computers and fiber optic capabilities for the tiny clinic in southeastern Utah.
That proposal has outraged Navajos who want medical care, not technology.
"The Utah Navajo feel there are much greater needs at hand than providing money from their trust fund to install a complex computer system," said San Juan County Commissioner Mark Maryboy, a Navajo and an elected delegate to the Navajo tribal legislature.
"The Utah Navajo feel that if the Trust Fund Board proceeds to authorize expenditures of money such as this, a clear misappropriation of funds for a very misleading project is under way and that a call for another legislative audit is warranted."
Maryboy is not alone in his opposition to the proposal. The Utah Department of Health spoke against the idea, so did Utah tribal officials.
But the opposition that irritated board members the most was a fax sent from Navajo tribal president-elect Albert Hales to Gov. Mike Leavitt that stated: "Until we can discuss this further, I would appreciate your support in discouraging outside interests from accessing trust fund monies. It appears that currently anyone can appear before the Utah Navajo Trust Fund board and access funds for a variety of projects even over the expressed opposition of the beneficiaries."
Congress set up the trust fund as a means by which a portion of royalty payments from oil-rich Navajo lands in Utah would be set aside for the health, education and general welfare of Utah Navajos specifically. But a 1991 audit detailed a long history of mismanagement and corruption in which almost $100 million was diverted to projects that had questionable benefit to the Navajos.
Vowing to correct the abuse, the Utah Legislature set up the Dineh Committee, comprised of Utah Navajos, to make recommendations on how the money should be spent. And they created a board of trustees, consisting of Ed Alter, Gordon Crabtree and Dale Hatch, to authorize the actual expenditure of funds.
Given the fragmented nature of Navajo politics, rarely have all factions agreed on the expenditure of funds, either before or after the reform. But the proposal to equip the Montezuma Creek clinic with expensive computer technology has united most Navajos against the board of trustees.
Alter insisted the "only purpose is to provide medical care to San Juan County Navajos" and that computer technology "is the most efficient way to provide services."
When tribal members questioned the motivations behind the decision, a clearly irritated Alter snapped, "You won't have a very good clinic if you don't let us spend any money on it."
The proposal to equip the clinic with fiber-optics would appear to be in line with Gov. Leavitt's concept of using technology to provide education and medical services to rural areas. Instead of massive expenditures for medical equipment and school programs, the technology could allow interaction with hospitals and schools in other areas that would deliver the same service.
Alter insisted that patient records at the Montezuma Creek clinic "are a mess," and the lack of an appropriate computer billing system means those who provide services often don't get paid by the Indian Health Services.
"We don't see it (a computer) any different than an X-ray machine," Alter said.
The Utah Department of Health sees it differently. They want the Indian Health Services to construct a modern clinic in the Montezuma Creek area. In fact, they insist that IHS is bound by treaty obligations to provide those services, and they have been negotiating with IHS to build a new facility.
The use of trust fund monies to install computer capability could upset those negotiations, said Pat Johnson, director of governmental relations for the Health Department.
Johnson also told the board that the cost of the computers and fiber optics appears excessive, and he said the department would review the proposal for cost accuracy. Alter declined that offer, saying the Department of Health was not unbiased on the issue.
The proposal to install computers came from the San Juan Health Care Services, a special service district in southeastern Utah. That entity was awarded a contract by the Indian Health Services to operate the Montezuma Creek clinic beginning Jan. 1.
The service district, which is supposed to provide health care services to all residents of San Juan County, requested from the Navajo Trust Fund $85,000 for computers and transmission systems, $7,000 for installation of hardware and software, $6,000 for consulting, $50,000 for start-up organizational costs, $3,000 for off-site training and $199,000 to operate the clinic until a "break-even" point is reached.
Navajos have long questioned the motives behind the San Juan Health Care Services. "Utah Navajos want to know why San Juan County cannot provide health care services for all its residents - Anglo and Navajo alike - using dedicated county funds for such purposes," Maryboy said.