The Coeur dAlene Tribe plans to develop a $15 million health-care facility in Plummer, Idaho, about 45 miles southeast of Spokane to handle growing demand for services in that rural community.


Though the project is in its formative stages and at least three years away, the tribe has been acquiring land for it near the current Benewah Medical & Coeur dAlene Tribal Wellness Center there, says Debra Hanks, the centers executive director. The new facility would replace the Benewah Medical Center, which is part of a combined complex, she says.


Its going to happen, Hanks says. Were extremely busy, and weve run out of places to expand.


A needs-assessment study that will help determine what mix of services the new facility should offer will start next month, and comprehensive planning for the project will begin next summer, Hanks says.


State and federal funds likely will be used to build the facility, though the exact sources of funding for the project havent be determined yet, Hanks says.


The current clinic building likely would be converted for some other use, or possibly sold, she says.


The Benewah Medical & Coeur dAlene Tribal Wellness Center is owned and operated by the tribe. It consists of a medical clinic that provides primary care and a wellness center that includes athletic facilities and provides prevention programs.


The clinic and wellness center are located in separate large buildings within walking distance of each other on the north side of town. Together they employ about 150 people.


The 17,000-square-foot medical clinic, which has been expanded from an original 6,800-square-foot structure, opened in 1990 with a staff of 14 and initially served about 800 patients. It now has about 120 employees and serves more than 6,500 patients, who account for about 30,000 visits annually. The new medical clinic would be considerably larger and could have twice as many doctors, specialists, and support personnel, Hanks says.


The 48,000-square-foot wellness center was built in 1998, and about 30 employees work there.


Benewah medical clinic


Along with primary care, the medical clinic provides dentistry and counseling for mostly Benewah County residents and American Indians. Slightly more than half of the users are American Indians. About 12 percent of the American Indians using the medical clinic are from out of state, some from as far away as North Dakota and South Dakota.


There simply isnt the care available to them where they are, says Hanks. This is a place they know they can be seen.


More than half of the clinics users dont have any health insurance, and a third of its patients are 200 percent below the federal poverty guidelines, the clinics Web site says.


The clinic receives about 54 percent of its $11 million annual operating budget from the U.S. government through the Indian Health Services Act. The rest of the money comes from Medicaid, Medicare, private insurers, private donations, grants, and the Coeur dAlene Tribe, Hanks says.


The clinics non-Indian users, none of whom have insurance, pay for care on a sliding scale, determined by income level. Typically, non-Indians pay $10 per visit.


There are all sorts of challenges, Hanks says. We have to meet our obligations with limited resources.


Federal funding next year is expected to increase only minimally, which will put a greater strain on the clinic because of rising health care costs, she says.


The clinic contracts with Spokane and Coeur dAlene hospitals such as Sacred Heart Medical Center and Kootenai Medical Center to provide some services that it cant offer because of limited resources.


It has four full-time physicians on staff and one full-time nurse practitioner, plus nurses, physical therapists, and other specialists. It has about a dozen examination rooms and a room for emergency procedures, and can perform many laboratory tests and X-rays there.


The facility has its own heliport, and patients who need certain types of immediate care, such as surgery, can be flown by helicopter to a Spokane hospital.


Some patients routinely drive two hours to use the medical facilities in Plummer, which is about 35 miles south of Coeur dAlene, Hanks says.


Before this was available, the health care in this community was fragmented and really was non-existent. It was shameful, she says. We are very proud of what we have here.


High-use programs


The clinics dentistry program is extremely popular, and there are plans to hire a third dentist soon. The program performs most dental procedures, such as cleanings, cavity repairs, and root canals. It also offers orthodontic procedures to Coeur dAlene Tribe members.


Dental patients generally are treated on the same day that they make an appointment, Hanks says.


The clinic found that the conventional system of making appointments well in advance didnt work well with American Indians and low-income residents. For various reasons, including lack of transportation or fear of going to the dentist, patients would fail to show up for appointments made months in advance, Hanks says.


We went to a same-day appointment system because of a high cancellation rate, she says. Now, its much more successful this way.


The wellness center has several meeting rooms that can be used for community events and private parties. The athletic equipment and swimming pools are very popular, Hanks says.


It also has several large exercise areas and a five-lane lap pool, a large therapy pool, a hot tub, a small childrens pool, and a steam room, which is extremely popular with Indians. In addition, there is a full-length basketball court, a racquetball court, and a boxing ring.


The wellness center offers a myriad of prevention and health programs, such as for diabetes and heart disease.


The Indian population has significant issues with diabetes and heart disease, says Hanks. Were dedicated to prevention and education.


The Coeur dAlene Tribe covers the costs of any tribal member who uses the wellness center. Non-Indians pay to use the facilities on a sliding scale based on their income.


Even though the wellness center looks like a typical health club and spa, there are subtle design features that connect the modern athletic facility to American Indian culture, such as an Indian medicine wheel built in the ceiling of the building. It symbolizes physical, mental, spiritual, and social health.


A mural that depicts ancient Indian life on Lake Coeur dAlene is centrally located inside the structure. There is an Indian word painted in the center of the mural that means, A place to become well.