The Origin of the Carl Albert Hospital

Applying Pressure as Needed

by Richard Green

Introduction: A new comprehensive tribal medical facility, the Chickasaw Nation Medical Center, is being built in Ada and should be operating in the summer of 2010.  With the opening coming up, it seems appropriate (at least to an historian) to produce a version of the story of the development of the Carl Albert Hospital.
                                                        1968-1973
Improving health care for Indian people in the Chickasaw Nation was a top priority for Overton James when he was appointed tribal governor in late 1963. Although providing health care to Indian people was a treaty responsibility of the United States, James came to understand that political issues and considerations also would have to be addressed. Before health care could be improved, he and other Indian leaders would have to demonstrate to the U.S. the depth and scope of the problem and the need.

This was a tall order for Gov. James, who before 1977 was a part-time leader living in Oklahoma City where he worked full-time in another job to be able to afford to raise his family.

But he cultivated officials of the Indian Health Service (IHS) and asked the help of Representative Carl Albert, a Democratic leader in the U.S. House of Representatives. By 1968, IHS opened a clinic in Tishomingo. It was the first Indian health facility of any kind to be located in the entire Chickasaw Nation.

Owing to a meager budget, however, the clinic’s staff was portable, spending two days a week in Tishomingo, two days in Coalgate and a day in Ardmore. These clinics were flooded with patients, which underscored the magnitude of the health-care problem. Those needing a hospital, and had a way to get there (many had no transportation), had to drive to the nearest Indian hospital in Talihina or Lawton.

For Indians living in Tishomingo, for example, that meant a round-trip of some 260 miles. Indian people needing x-rays and some routine lab tests still had to travel to either Talihina or Lawton.

Keeping the pressure on in 1969, Gov. James produced a paper about the unmet health-care needs in the service unit and sent it to the state’s congressional delegation and the IHS. Getting no action, he sent virtually the same letter in 1970 and 1971.

James wrote that the health-care situation of Indians living in the Chickasaw Nation was drastic. The implications of having little or no prenatal care, immunizations, antibiotics or dental services ran deep and were profound. The infant mortality rate was high and life expectancy was low.

In addition to noting the deficiencies, he recommended additions in staffing and budget increases that would “be a major step in the delivery of comprehensive quality health care.” He knew expanding staff and clinics in Ardmore, Ada and Sulphur would take time, but he expected reasonable progress.

And he would help to grease the wheel, so to speak. By the time that Chickasaw people elected him governor of the Chickasaw Nation in 1971, he had become very skillful at bestowing kudos (to IHS officials and the Oklahoma congressional delegation while holding the recipients’ feet to the fire.

                                                 1973-1975
Finally, as a result of the lobbying by Gov. James and other Indian leaders in Oklahoma, IHS announced in 1973 that a new Indian hospital would be built in central Oklahoma. As a forerunner of self-determination, IHS decided to let a local group vote on the new facility’s exact location. That 35 member group was the Oklahoma City Area Indian Health Service Advisory Board, Inc.

Although Gov. James thought he had little chance to land the hospital for Ada, he decided to ask a few other members of the board’s nine-member executive committee to support his request because he knew that their tribes were outside the geographic area under consideration. He said they agreed to support his request because he asked them to, but it was also true that he was a handsome, well-spoken and personable governor. Figuring he had a majority at the next executive committee meeting, James called for a vote to recommend that the new hospital be located in Ada.

The committee voted 6-3 for Ada. The three opponents, according to James, “didn’t know what hit ‘em.” One told James “you caught me [she used a figure of speech meaning unprepared]. But a rival chief objected that the vote was improper because it had not been on the agenda. Accordingly, another vote was scheduled for the next month.

Despite James’s “politicking” in the interim, the majority voted to rescind their earlier vote. But James responded with as much conviction and authority as he could muster (even while semi-bluffing) that according to “Robert’s Rules of Order,” a two-thirds majority was needed to rescind. Knowing that the other side didn’t have two-thirds, James called for another vote and the move to rescind failed.

As a result, the full board accepted the recommendation to locate the hospital in Ada, and forwarded it to IHS on February 10, 1973. The next problem to address was reducing the waiting time before construction could begin from eight to ten years to two or three. “The only way to escape the IHS pipeline was to go the political route,” James said. That meant contacting Carl Albert, by then Speaker of the U.S. House of Representatives and the representative of many Chickasaws and Choctaws in the third congressional district.

James asked that he include the hospital funding as a line item in the appropriations bill. “This could be called ‘pork,’” the governor acknowledged, “but the way I saw it, it was just speeding up the process.”

In another politically astute move, James contacted several Ada civic leaders to whip up active support for the hospital. A brochure was produced and before he introduced the idea to the speaker, James added the finishing touch himself. To the drawing of the hospital on the cover, he printed “Carl Albert Indian Hospital.”

Next, he assembled the community delegation to travel to Washington to present their case to the speaker. “We got up there and first presented the brochure to Carl. He was quite surprised and pleased.”  The immediate need was for congressional funding for a feasibility study, and James felt good about his chances after he overheard the speaker talking on the phone to an appropriations’ committee member about “the need of the Carl Albert Indian Hospital.”

Meanwhile, back in Oklahoma, trouble was brewing. In the summer 1974, the United Indian Tribes of Western Oklahoma and Kansas, headquartered in Shawnee, Oklahoma, passed a resolution saying that Shawnee would be the most beneficial location for the hospital and asking that it be located there. It was signed by president Lee Motah and sent to IHS director Dr. Emery Johnson and the state’s congressional delegation.

Albert contacted IHS officials who said the decision wouldn’t be changed unless the Oklahoma City board changed its recommendation. Apparently, the boom for change fizzled at that point because the board did not change its recommendation.

                                               1975-1978
In early 1975, the governor sent to Speaker Albert a prospectus on the proposed hospital which he could distribute to key members of Congress.  He made three points in the statement of need. Most of the 16,000 Indians living in south-central Oklahoma were economically disadvantaged and lacked transportation to the nearest Indian hospital.

Second, from his experience growing up in Wapanucka, OK, he knew that subsidizing care at community hospitals wouldn’t do because “the reticent nature of most Oklahoma Indians would cause them, even in dire need, to refuse or postpone seeking treatment in a non-Indian facility. That contributes to the sad fact that the average Indian male had a life expectancy of only 46 years.” Finally, the proposed hospital, coupled with existing educational and employment opportunities, could serve as a catalyst to Indian health careers. Of approximately 340,000 medical doctors, only 56 were Indian and of 750,000 nurses, only 400 were Indian.

Such statistics were helpful, but members of Congress were mainly motivated by political considerations. Once, after describing the proposed hospital to a member of an appropriations’committee who had been an ardent supporter of the Vietnam war, Albert mentioned that “never, had even one fullblood ever asked me for a deferment from the military draft for his boy.” As Albert recalled, his House colleague was visibly moved. “He told me that I could count on him,” Albert said. The House passed the bill authorizing $800,000 for the planning study in late 1975. In his address at the tribe’s annual meeting, James told the audience that the hospital would be open by 1979.

Meanwhile, the hospital’s proposed namesake, Carl Albert, who had previously announced that he would not run for re-election to Congress, was going to retire in January 1977 after serving Oklahoma’s Third District for nearly 30 years.

To James, Speaker Albert was irreplaceable. Though other members of the delegation could be helpful and friendly to the Chickasaws, no one else had Albert’s prestige, clout and strong desire to be useful. And as James said, “Carl wasn’t helping us for the votes. Though there were a lot of Indians in his district, not many of them voted at all and those who did didn’t vote in a block. His interest in us was long-standing and sincere. We would never forget him.”

As a way of insuring that, James knew the hospital had to be named for Albert. The problem was a federal prohibition against naming federal buildings after people who were still alive. Perhaps Congress could make an exception. In due course, an exception to the rule was made, but James would recall in later years that Albert’s successor in Congress, Wes Watkins--despite several requests to act--had been “very tardy” in sponsoring legislation permitting the federal facility to be named for a living person.

Before Albert’s retirement, everything was in place for the 75-bed hospital. Ada’s Trust Authority had donated the land, 15 acres adjacent to the headquarters of the Chickasaw Housing Authority. The firm of Neal McCaleb, a Chickasaw and Oklahoma legislator, was awarded the architectural contract. The award was made on the basis of the firm’s capability and Indian preference.

Congress appropriated $4.5 million, the first of three years of financing for the hospital. Groundbreaking ceremonies were held on a frigid winter day in January 1978. The ground was broken by Gov. James and IHS director Johnson, both wearing hardhats and playing at operating huge bulldozers. A Chickasaw employee named Claud Johnson says he was next to the governor, telling him which of the dozer’s levers to pull. James announced that the new hospital would serve 15,000 Indians within a 50-mile radius, employ 230 persons and have an annual payroll of $3.5 million.

After delays caused by bad weather and a Congress that had to be cajoled into providing the money to fully staff the hospital, the $15 million Carl Albert Indian Health Facility was dedicated on June 14, 1980.

Among those on hand for the ceremony were Speaker Albert, his successor Congressman Wes Watkins and Dr. Emery Johnson, IHS director. It was announced that the new hospital would serve about 50 inpatients and 175 outpatients daily, or about 25,000 to 30,000 Indians annually living within a 50 mile radius of Ada. Aside from the dignitaries was another group that also was all smiles that day. These were tribal employees and citizens, and Indians of other tribes living in the Chickasaw Nation. Their prospects for living longer, more healthy lives had just instantaneously improved.

                                              Postscript
Soon after the new hospital opened, it was apparent that the in-patient and out-patient estimates were too low. In recent years, the Carl Albert facility (130,000 square feet) has accommodated more than 10 times the original estimates.

According to tribal media relations, the new Chickasaw Nation Medical Center will encompass about 370,000 square feet. It will see an increase in the number of doctors and nurses for many services including: family practice, obstetrical/gynecological, optometry, dental and behavioral health. Imaging services will be greatly expanded with an MRI, CT scan and a dedicated woman's imaging with digital mammography, ultrasound and bone scan.

Readers may contact Richard Green at Richard.Green@Chickasaw.net or 405-947-5020.