When award-winning hospital administrator Casey Cooper first assumed his role as chief executive officer of Cherokee Indian Hospital, it was an impoverished Indian Health Service (IHS) facility, unable at times to treat patients due to a shortage of funds.
“There were times we would have to reach out to other local entities,” Cooper recalls. “We’d say, ‘according to the feds, we’re broke, but our patients still need care.’ There were extreme examples of administrators saying, ‘Refer your patients to us anyway; we’ll take care of them.’ We would negotiate these bottom-dollar agreements between the Eastern Band [of Cherokee] and these partners.”
Aside from those pinch-hitting deals, it was difficult for the hospital to enter into formal agreements with neighboring health care facilities, because of prohibitive red tape associated with federal control.
Cooper had known about the frustrations of IHS administration from his previous years as a public health nurse. “I became passionate about self-governance and self-determination when I saw how passionate and committed [health care workers] were but how inhibited and limited they were as a result of the Congressional appropriations process,” he said. “I knew that the Eastern Band had the competence, the capacity and the capabilities to provide a better health system for its members.”
It didn’t take long for Cooper, his colleagues and the Eastern Band to hatch an ambitions plan: they would break free of IHS and manage their own hospital. The idea began to form in the late 1990s. By the fall of 2002, the Eastern Band pulled out of the IHS system and formalized a self-governance agreement for its health care.
Located in Cherokee, North Carolina, the hospital provides for 11,000 Native Americans across five counties near Great Smoky Mountains National Park. Since its independence, its services have multiplied.
“We developed a robust and comprehensive pediatric dental program,” Cooper said. “We’ve improved access to immediate care clinics. We’ve streamlined and improved pharmacy services. We’ve been able to increase access to specialty care. In partnership with the tribe, we’ve been able to offer complementary medicine, anything from massage to acupuncture. With the tribe’s help, we’ve provided things like braces for our children, and dentures for our elders.”
He added that the hospital has also begun offering state-of-the art radiology services like computerized tomography (CT) scans and digital archiving, and will soon add magnetic resonance imaging (MRI) technology.
Because of the successes on his watch, the National Indian Health Board honored Cooper with the Area/Regional Impact Award at its 28th Annual Consumer Conference, this past September in Anchorage, Alaska.
Still, Cooper is reticent to accept credit for the hospital’s revolution.
“These changes are the result of an entire community pulling together,” he said. “We grew up with, we went to school with and we go to church with the administrators and the people who work in the public health system around us. We were all equally vested in improving the health of the population.”
Asked about his role, Cooper was humble: “Maybe I facilitated the process,” he said. “Maybe I’m a servant. Maybe I’m just a passionate advocate for public health.”
Cooper is well aware that many health problems remain unresolved in the population he serves.
“I’m still very concerned about the prevalence of diabetes, hypertension, depression, alcoholism and substance abuse,” he said. The hospital has added a psychiatrist to its staff and implemented a telepsychiatry program to address depression. In addition, he said, “we’re pretty optimistic about our capabilities in chronic disease care.”
But a significant portion of the hospital’s funding still comes from the IHS, and the future of IHS funding isn’t looking bright. “We know demand is going to continue to go up, but we’re very concerned about the loss of purchasing power from flat or decreasing federal appropriations,” he said.
The good news is Cooper’s passion and ambition for public health shows no sign of letting up. “It may be a trust responsibility, but the health of the local community is our responsibility,” he said, “and we have to do this.”