Federal Agency Works to Clear 30-Year Medical Facility Construction Backlog

The Indian Health Service is finally moving forward with medical facility construction projects promised decades ago, including a new center in New Mexico first pledged over 30 years ago. Despite a recent $1 billion federal investment, officials say it could take another 40 years to complete all delayed projects without additional funding.

SANTA ANA PUEBLO, N.M. (AP) — A vacant piece of land situated between a fire department and soccer field near Albuquerque will soon house a federal healthcare facility that Native American communities were promised more than three decades ago.

This month, Santa Ana Pueblo Governor Myron Armijo guided representatives from the U.S. Indian Health Service and Department of Health and Human Services through the site where patients will access services ranging from kidney dialysis and diabetes treatment to eye care.

“This will definitely change the game for healthcare in our area,” Armijo said.

Construction on the 235,000-square-foot facility is scheduled to begin in 2027, with the IHS operating the center that provides medical care to Native Americans. Community leaders expect the new center will ease the burden on the overwhelmed Albuquerque Indian Health Center, a federal facility constructed nine decades ago where patients report appointment waits stretching for months.

The Albuquerque location was part of more than 60 medical facilities the agency marked for replacement in 1993 because of their deteriorating condition and inadequate capacity for growing patient populations. Seven projects from that original list remain incomplete, scattered throughout Arizona and New Mexico. IHS leadership plans to replace the Albuquerque facility with two new centers in the metro area, including the Santa Ana Pueblo location.

HHS Secretary Robert F. Kennedy Jr. announced $1 billion in February for these long-overdue construction projects, with $22 million designated for the Santa Ana Pueblo facility. Agency estimates indicate $8 billion is required to finish all outstanding projects from the 1993 priority list, which federal law mandates must be completed before the IHS can pursue other major building initiatives.

A.C. Locklear, who leads the nonprofit National Indian Health Board, characterized the $1 billion as the largest single financial commitment any administration has made toward updating these deteriorating facilities. However, he emphasized this also demonstrates the federal government’s failure to meet its legal obligation to provide proper healthcare to tribal communities.

“It’s a drop in the bucket in terms of what’s needed to modernize these facilities,” Locklear said.

The IHS provides medical services to 2.8 million Native American and Alaska Native patients through 21 hospitals and 78 smaller healthcare centers across the country. These facilities average approximately 40 years old, with one-third rated in “poor” physical condition according to a 2023 Government Accountability Office assessment.

Theresa Nelson, a 62-year-old member of the Navajo Nation, understands these challenges firsthand after beginning to use the Albuquerque Indian Health Center following retirement when she lost private insurance coverage.

“It felt like going back in time,” she said, describing outdated equipment from X-ray machines to examination rooms and lobby seating.

Nelson explained the facility depends on a complicated referral network for treatments and diagnostic tests that were readily available through private healthcare providers. She has waited eight weeks for IHS approval of a 3D mammogram referral, technology the Mayo Clinic reports is standard at most American medical facilities.

The Indian Health Service maintains that appointment delays at the Albuquerque location are under 14 days for patients with established primary care relationships. However, Nelson and fellow patients describe going years without assigned physicians and waiting months for preventive healthcare visits.

Further west, the Gallup Indian Medical Center functions through a combination of temporary modular structures and partial renovations. The hospital, which began operations more than 60 years ago and appears on the 1993 replacement list, serves communities including the Navajo Nation. Tribal representative Vince James noted that ongoing construction and fragmented building design create navigation difficulties for elderly and disabled patients while hampering medical staff efficiency.

“These are Band-Aid fixes,” James said. “Eventually the GIMC campus will become unsafe.”

Senior HHS adviser Mark Cruz called on Congress to authorize special funding to complete the remaining construction projects currently in various planning and design phases.

Without additional appropriations, he warned it could require another four decades to work through the priority construction list.

“It’s really unacceptable that we’re still working off of that 33-year-old construction list,” Cruz said during his Santa Ana Pueblo visit.

Federal regulations require the Indian Health Service to finish the 1993 list before replacing medical facilities that have deteriorated since that time. This includes two hospitals approaching 90 years old in Montana and Minnesota. The agency also cannot construct new facilities to address patient demand that has expanded and shifted locations over recent decades.

“I can’t get to additional projects that have merit across Indian Country or Alaska because I have a statutory obligation to get through the 1993 list first,” Cruz said.

The IHS completed one project from its priority list in 2023 when Rapid City, South Dakota received its replacement facility. The substitution of the deteriorating Sioux San Hospital has proven “transformational,” according to Jerilyn Church, who heads the Great Plains Tribal Leader’s Health Board.

The renamed Oyate Health Center provides three times the space of the previous hospital and features significantly more advanced medical technology. Despite these improvements, patient demand at the new facility is already exceeding available capacity.

“That’s what happens when you work from a backlog,” Church said. “In the time between identifying the need and the money finally becoming available, the population grows.”