How The Shutdown Impacts Alaska Native Hospital Services

The Alaska Native Medical Center, the state's largest Native hospital, has been affected by the pandemic in several ways. In 2020, the hospital called for a pandemic fishery shutdown to prevent a potential influx of COVID-19 cases that it was not equipped to handle. The hospital's resources were already stretched thin, with a small number of beds and ventilators, and patients requiring intensive care having to be flown to Anchorage. In 2021, the hospital began operating under crisis standards for care, allowing doctors to prioritize resources and treatments for patients with the greatest potential to benefit. Additionally, the Alaska Native Tribal Health Consortium, which manages the hospital, has been working towards owning the hospital to address the space crunch and better serve the health needs of Alaska Native people. While the state of Alaska has experienced the potential impact of a federal government shutdown, there is no specific mention of how this would affect the Alaska Native Hospital. However, the state has instructed its executive branch departments to evaluate federal programs and prioritize essential services, particularly those related to life, health, and safety, to minimize disruptions for Alaskans.

Alaska Native Medical Center's ICU fights to keep COVID patients alive

The Alaska Native Medical Center in Anchorage is the state's largest Native hospital. It is owned by the Indian Health Service, though the Alaska Native Tribal Health Consortium, the nation's largest Native health organization, has been seeking to take ownership.

In 2021, the Alaska Native Medical Center ICU was fighting to keep COVID patients alive. Nurses reported working 18-hour days to provide the care their patients needed. They also had to deal with the emotional trauma of deaths, which were occurring almost every day. Staff found this particularly difficult because most of the suffering and deaths were preventable through vaccination.

The COVID-19 patients required more time and staff than the usual ICU patients. Normally, there would be one nurse for each patient, but due to the increase in patients and lack of staff, nurses now had to care for two patients. Each time nurses needed to enter a negative pressure room to treat a COVID patient, they had to suit up in a fit-tested mask and other layers of equipment, which took time and added to the burden.

The situation was so dire that dozens of hospital workers attended an Anchorage Assembly meeting to testify about the importance of vaccines and masking, and to warn that ICU beds were full. However, they were booed by audience members who supported Mayor Dave Bronson's hands-off strategy for dealing with the pandemic.

Bristol Bay Area Health Corporation calls for fishery shutdown

The Bristol Bay Area Health Corporation, which serves 28 villages in southwestern Alaska, called for a fishery shutdown in 2020. The hospital warned that Governor Mike Dunleavy's decision to permit commercial fishing during the pandemic could lead to a public health crisis in native villages in the Bristol Bay region.

The corporation's hospital in Dillingham, Alaska, had only 16 beds and two ventilators at the time. With a year-round population of 6,500, most of whom are Alaska Native, the region was at risk of being overwhelmed by an influx of more than 15,000 commercial fishery and cannery workers from other states and abroad. The corporation argued that the governor was creating a discriminatory two-tiered system, respecting the wishes of native tribes in the state's interior to exclude outsiders during the pandemic while overriding those requests in Bristol Bay.

Robert Clark, CEO of the health corporation, stated, "We don't have the infrastructure [...] Our hospital is too small. We can't take care of these folks coming in." The corporation sought assurances that state health guidance was being enforced and that adequate testing and quarantine measures were in place.

In response, Assistant Attorney General Maria Bahr defended the state's efforts, stating that the government was working closely with businesses to ensure public health protection. Fishing companies were ordered to develop and submit COVID-19 mitigation plans. However, the Bristol Bay health corporation warned that the guidance relied heavily on self-regulation by the fishing industry.

While the call for a fishery shutdown in 2020 did not result in a complete closure, there have been instances of temporary closures in Bristol Bay's Egegik fishery due to illegal fishing activities in 2024.

Alaska Native Tribal Health Consortium seeks hospital ownership

The Alaska Native Tribal Health Consortium (ANTHC) is working toward a long-held goal of owning the Anchorage hospital that it already manages. The Alaska Native Medical Center, the state's largest Native hospital, is the only facility in the tribal consortium's sprawling Midtown campus that is owned by the Indian Health Service. The newly appointed president and chief executive of the consortium, Natasha Singh, has pointed out that the split between ownership and management has turned out to be burdensome.

The desire to take ownership has become more urgent as hospital use has grown. Under Indian Health Service ownership, the building has not been expanded, and the consortium was reluctant to take on the responsibility of doing so without ownership of the facility. Singh said, "But we're at a breaking point. Our patients have increased by 70,000 since the doors first opened, yet the doors haven't expanded." The ANTHC board approved a $250 million expansion of the emergency department, with 18 new rooms and three new floors, considered Phase 1 of a hospital expansion. There are plans for a Phase 2, which would add another 60 rooms over three more floors.

If the consortium owned the hospital, it would have access to private-sector funding and other tools to pay for expansions and improvements. Making the ownership switch, however, requires some formal steps and possibly an act of Congress. Several tribal health organizations elsewhere in the state have already taken ownership of their regional clinics and hospitals, so it is a well-known process.

The consortium, established in 1997, is the nation's largest Native health organization. Through partnerships with more than two dozen tribal health organizations around the state, ANTHC is responsible for managing the services previously provided by the Indian Health Service. Funding agreements and other aspects of the government-to-government relationship are established through the Alaska Tribal Health Compact, which is updated periodically. The Alaska compact is unique in the nation as the only one covering multiple tribes. Through it, health care services are provided to members of all 229 federally recognized tribes in Alaska.

In addition to working toward gaining ownership, Singh and the consortium face new challenges posed by the Trump administration's deep funding cuts and cancellations of programs on which tribal members rely. The consortium has been a big player in programs and funding sources that are now under attack from the new administration, including water and wastewater improvements and projects funded by the Inflation Reduction Act of 2022 to help communities address climate change impacts.

Alaska prepares for a potential federal government shutdown

Alaska is preparing for a potential federal government shutdown by evaluating the impact on state-administered federally-funded programs. Governor Dunleavy has instructed state executive branch departments to assess federal programs administered by the state and identify potential repercussions for Alaskans. The state intends to maintain essential government services, particularly those related to life, health, and safety, during the shutdown.

Federal programs that are legally mandated, authorized outside the annual appropriations process, or classified as "excepted" due to their implications for life, health, and safety will continue to operate. These include programs such as Medicaid and federal air traffic control. Alaska has announced its readiness to sustain state-administered federally funded programs for up to 34 days, the duration of the longest previous federal shutdown. Should the shutdown persist beyond this period, the state will reassess the situation and prioritize programs vital to Alaskans' lives, health, and safety.

During the potential shutdown, employees in approximately 4,700 state executive branch positions, which are at least partially federally funded, will continue to receive their salaries and report to work without disruption. The federal government is not legally mandated to reimburse states for expenses during a shutdown, but it has consistently done so in the past.

While the state prepares for the potential federal government shutdown, some hospitals in Alaska, such as the Alaska Native Medical Center, are facing challenges. The Alaska Native Medical Center in Anchorage has recently transitioned to operating under crisis standards for care, becoming the third hospital in the state to do so. This shift allows doctors to prioritize resources and treatments for patients who will benefit the most. However, the hospital administrator, Bob Onders, assures that, at present, the crisis standards of care provide flexibility to maintain clinical care and do not affect who receives treatment or access to supplies.

Alaska Native Medical Center expands emergency department

The Alaska Native Medical Center in Anchorage has begun construction on a $257 million expansion of its emergency department. The project, approved by the Alaska Native Tribal Health Consortium (ANTHC), will add 18 new rooms and three new floors to the hospital, which has experienced significant capacity challenges.

The expansion is intended to address the growing pains of a hospital that has seen its patient population increase by 70,000 since it first opened. The hospital serves patients from across Alaska, many of whom need to travel to Anchorage to receive care.

The expansion will include 21 more rooms in the emergency department, an updated ambulance bay with multiple points of entry, and expanded behavioural health treatment and surgery recovery areas. The current ambulance bay has only one point of entry, which can lead to patients being offloaded in the parking lot during emergencies with multiple ambulances.

The Alaska Native Medical Center is the state's largest Native hospital, but it is owned by the Indian Health Service, not the consortium that manages it. This split between ownership and management has been cited as costly and burdensome, with the consortium missing out on potential funding and facing challenges in expanding the hospital.

The expansion of the emergency department is the first phase of a larger hospital expansion, with the second phase including 10 new surgical recovery bays and a Clinical Decision Unit. The final completion of all expansion phases is set for 2027.

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