Ask Elouise

Dear Indian Country
This is the fourth letter in a series of open letters I’m sending to Indian Country to answer questions that you have asked me about settlement of the Cobell class action lawsuit. Prior Ask Elouise letters can be found on the settlement website: http://cobellsettlement.com/class/ask_elouise.php. We also have a “frequently asked questions” section to answer the most common questions we’ve received: http://cobellsettlement.com/press/faq.php. I can’t answer every question, but I will try to answer as many as I can every week.
When will you be meeting with Indian Country? I am beginning to schedule meetings in Indian Country with our attorney team now. I won’t be able to attend each meeting, but I will do my best to attend as many as my schedule permits. You can visit http://cobellsettlement.com/class/local_outreach.php for additional details and future dates and locations. I’ll also update our travel schedule in future Ask Elouise letters. More dates will be added soon, including Nebraska reservations, and Arizona and New Mexico reservations beginning March 15.
Why have you not traveled to Indian Country before now? During the course of negotiations, the government resisted allocating any funds for outreach to Indian Country prior to the passage of legislation, despite our strong feelings that it was important to meet with Indian Country to explain the settlement. The government instead assured us that legislation would be passed a few weeks after we signed the settlement agreement on December 7, 2009, and that outreach to Indian Country would take place under the normal notice process in class action lawsuits, which would include extensive travel to Indian Country. Unfortunately, legislation was not passed (and has still not been passed) and the need to meet with Indian Country is stronger than ever. As you know, traveling to many areas of Indian Country is expensive and time consuming, but it is critical, and I can no longer wait for legislation. I heard that my settlement check will not be taxable, is this true? That is correct. We negotiated with the government to include a provision in the legislation and settlement agreement that provides that all settlement proceeds are not considered taxable income by the Internal Revenue Service. If you have a tax preparer or other tax professional you should make sure to inform them of this important settlement benefit. You may want to refer them specifically to the legislation when it is passed and page 42 of the settlement agreement, if they have any questions. A copy of the settlement agreement can be downloaded here: http://cobellsettlement.com/docs/2009.12.07_Settlement_Agreement.pdf.
I receive federal assistance and I am concerned that receiving a settlement check will affect my eligibility or benefits, what should I do? You don’t have to do anything. The legislation negotiated by the parties provides that the settlement proceeds received will not be treated as income in the month received or as a resource for a period of one year after you receive your check. Congress is currently considering this legislation.
How much will I receive as part of this settlement? While it is not possible to precisely calculate how much any particular individual will receive as part of this settlement, I have asked the government to provide a rough approximation of what each individual may receive as a member of the trust administration class.In my next Ask Elouise letter I intend to provide an estimate of the amount you may receive if you are in the trust administration class.
In your last Ask Elouise letter you indicated that I could remain in the trust administration class and still sue the government for claims related to leases that were active on September 30, 2009, is there any limitation? Yes, there is a limitation. To the extent the government is acting in any capacity other than as a trustee, you may bring a lawsuit against the government for leases active on September 30, 2009. That means, for example, if the Department of Energy or Department of Agriculture or Department of Defense are leasing or trespassing on your land as of September 30, 2009, you may bring a lawsuit against the government and still participate as a class member in the trust administration class. Moreover, your fiduciary related claims are also preserved where the lease in question predates September 30, 2009, but the injury occurs after September 30, 2009. For a complete list of claims you may bring against the government and continue to remain in the trust administration class, please see pages 44 and 45 of the settlement agreement. http://cobellsettlement.com/docs/2009.12.07_Settlement_Agreement.pdf.
If you are not currently receiving an IIM statement from the government, please remember to register for correspondence over the Internet or by calling the number below.
Internet: https://cert.tgcginc.com/iim/register.php

Telephone: 1-800-961-6109.
If you have a question, send an e-mail to: askelouise@cobellsettlement.com. Otherwise you can send me a letter to the address below. To expedite the processing of your letters our contractor has set up a post office box in Ohio, but I assure you this letter is coming from me and I will see your letters.
Ask Elouise 
Cobell Settlement, 
PO Box 9577, 
Dublin, Ohio, 43017-4877.
Thank you and keep your questions coming!


Best wishes
Elouise Cobell
 Browning, Montana

Why Facebook complaints about IHS are important

By Mark Trahant
How does a health care agency listen to patient complaints in the era of social media? Well, the easiest thing to do is to ignore complaints or to explain them away. The best practice: Treat complaints as critical nuggets of information.
Let’s start with a bit of context. The U.S. Department of Health and Human Services and the Indian Health Service have an extensive process for tribal consultation. There is a formula for listening to tribal leaders about its operation, priorities and budgets. There’s also an open line for internal IHS reform. The IHS collects data about best practices, ranging from treatments for cardiovascular disease to partnerships with traditional healers. This is a simple, but important, way to share ideas about programs or treatments that work.
So the context is that the Indian Health Service has an extensive practice collecting information, complaints, from tribal and community leaders. In general the Indian Health Service does a better job of listening to its constituents than most health care agencies. But that system was designed for another time.
So back to the question: How does a health agency listen to patient complaints in the era of social media? Each unit, clinic or hospital has a formal process, but most complaints aren’t filed, they are spoken between family members or said in the waiting room? How does a modern health care agency learn from those?
This is where the new world of social media kicks in. Patients are contributing thousands of bits of information on Facebook in a group called, “I just spent 6 hours at IHS just for them to give me Tylenol.”
Angel White Eyes writes from Pine Ridge that she got the idea after getting sick a couple of months ago. “I was throwing up and coughing up blood. Plus had flu symptoms. I contemplated on going to IHS all weekend because I knew they'd only give me Tylenol.”
Her Facebook friends convinced her to go into the clinic anyway. “After sitting at IHS for 4 hours, I told them all my symptoms, and they said I had a virus and gave me some Tylenol and cough syrup and told me to stay home,” White Eyes said.
Then she posted a rant to her Facebook page. “At first I had joked about creating the group but one of my friends convinced me that it should actually be done. And I knew there were a lot of people who had their IHS stories too. I did expect to see their complaints and what had happened to them at IHS. I didn't know what to categorize the group so I put it as just for fun because IHS is a joke in a way.”
More than 1,600 people have joined the group and are telling their own stories. Long waits and Tylenol are common themes. And not all of the information is critical. Some report good experiences with IHS.
This may sound odd but the Indian Health Service is lucky to have such a page already created on Facebook. The agency ought to embrace it, monitor it, react when it can and learn. It’s golden intelligence because it’s a real time reaction from patients. (This is why federal agencies ought to have a social media policy that allows open access to Twitter, Facebook and other public communication tools).
To me the most damning complaints on Facebook and other comment boards is from the people who’ve completely given up on the Indian health system. Some say it’s better to make a co-payment at an off-reservation clinic because service is better. Or they suggest using insurance at IHS until their insurance deductible is met and then fly free from the system. That is a narrative thread that limits what can be done to improve Indian health for every patient. If you’ve already given up, why bother?
But those who complain openly want a health care system that works. Every time they write about what happened to them, it’s an open invitation for improvement. The IHS is lucky to have so many volunteers posting helpful information. In fact, I would put a terminal in every waiting room, perhaps with someone who could help patients who don’t use computers to get even more direct response. Embrace Facebook.
As a friend wrote on Facebook: “Angel White Eyes … Bless your Heart!! haha! This is too TRUE!!”
Mark Trahant is a Kaiser Media Fellow examining the Indian Health Service and its relevance to the national health care reform debate. He is a member of Idaho’s Shoshone-Bannock Tribes. Comment at www.marktrahant.com