Puyallup Tribe Vice Chairman Bill Sterud, Dr. Alan Shelton, Chairman David Z. Bean are seen here inside the Puyallup Tribal Health Authority building. (Courtesy Puyallup Tribe of Indians)
This article originally appeared as the cover story of the summer 2019 edition of Native Business Magazine.
According to David Bean, Chairman of the Puyallup Tribe of Indians, when he was born in 1969, the Tribe “really didn’t have anything.”
That all started to change when Ramona Bennett, one of the Tribe’s elders and a longtime social services activist came home from Seattle in the late 1960s and began to lead the charge to improve the Tribe’s standing. In addition to Bennett, Bean also gave a lot of credit to Puyallups who, in the late 1960s and early 1970s, realized that, as a result of the Tribe’s sovereignty, it could pass and implement its own laws and license businesses like fireworks stands, tobacco stores and casinos.
“The federal government wasn’t living up to its treaty responsibilities,” Bean said. “So folks went out and made things happen. It was a survival mechanism.”
The new businesses created jobs for Tribal members and a tax base for the Tribe. They also taught critical business skills, like hiring staff, selling and developing communications skills. More than just that, though, it opened up avenues for the Tribe’s entrepreneurial spirit to flourish and launch new endeavors.
Bean said that the same entrepreneurial spirit that drove the Puyallups to selling fireworks and tobacco is still alive today, albeit on a much greater scale. In 1989, the Puyallup Tribe incorporated Marine View Ventures (MVV) as its economic development arm, and today MVV focuses on four key areas: gas stations, real estate, a marina and car washes. This includes seven fueling stations in the South Puget Sound region, more than 300 acres of real estate holdings, one of the premier marinas in the Puget Sound region with 200-plus slips, and two express exterior car washes.
And MVV is just the tip of the iceberg of the Puyallup’s economic initiatives. Earlier this year, the Tribe’s Puyallup Tribal Cannabis Enterprises also opened its second cannabis retail location in Tacoma with a major launch event attended by Richard “Cheech” Marin and Tommy Chong.
Like many Tribes in the state and across the nation, the Puyallups are also heavily involved in gaming. The Indian Gaming Regulatory Act of 1988 and the Puyallup Land Claims Settlement Act of 1990 provided a new avenue to economic development and an unprecedented revenue source. The latter supplied millions of dollars that the Tribe could invest in economic development and services.
“Fast forward to today — we’ve grown explosively,” Bean said.
For 15 years, the Puyallup Tribe has operated the Emerald Queen Hotel and Casino in Fife, which has been one key driver of the Tribe’s economic development. This December, the Tribe will open the doors to a new 310,000-square-foot facility, which they expect to rival not only their regional counterparts, but the best casinos in Las Vegas.
One of the activities that these economic development revenues supports is the Tribe’s health care system, which is almost as old as Bean himself. He says that health care is important because taking care of one another is deeply ingrained in the Tribe’s very fabric.
“You know, we’re always taught to be thankful for the Creator and thankful for Mother Earth,” Bean told Native Business Magazine. “If we take care of Mother Earth, Mother Earth will take care of us, because she provides everything needed to sustain life.
“And we’ve always taken care of one another,” Bean continued. “Our fishermen, our hunters, our gatherers, they did not go out and hunt and gather and fish for themselves, they went out and took care of the community with those efforts. So, fast forward to today, we do our best to provide for every need that our community would ever have and provide them with opportunities to be successful.”
In 1968, Ramona Bennett was elected to the Puyallup Tribal Council, and she served as Tribal Chairwoman from 1971 until 1978. While in office, the Tribe set up the Puyallup Tribal Health Authority (PTHA) and sought federal funding to run its own health services. In 1976, Bennett’s lobbying efforts paid off when the Tribe received formal funding and PTHA became the first ambulatory health clinic to enter into a 638 “self-determination” contract with the Indian Health Service.
“It started with a dental trailer,” Bean said. “Going back in the 1950s and 1960s, when they talk about Indian Health Service efforts, they would set up these different clinics and it was known as the ‘drill and fill’ place. We didn’t have dental care or health care, so we started with this dental trailer, which I remember going to as a child.”
Today, more than four decades later, the PTHA has blossomed into an organization that provides health care to 15,000 clients in the Tacoma and Pierce County area. It offers a full spectrum of services, including addiction treatment, community health, dental care, medical care, mental health, pediatrics, pharmacy, X-ray facilities and lab work.
“It’s evolved into a health care industry leading entity,” Bean said. “They are the best-ran and most efficient entity within the Puyallup Tribe of Indians.”
“They have a pediatric wing that allows the doctors to focus solely on our children,” he continued. “They have a wing for our elders. They have an emergency section of the clinic. And I’m just so proud of the work they have done.”
The PTHA also has the distinction of creating the nation’s first Tribal family medicine residency program accredited by the American Osteopathic Association in July 2011 — and today, they are one of only two Tribes to offer such a program.
Bean said that this program came about after some of his staff read the 2009 Affordable Care Act (ACA) and recognized an opportunity.
“In the Affordable Care Act, there was funding for teaching health centers and that portion of the ACA was intended to train doctors in communities that were underserved,” Bean said. “When they created it, they weren’t thinking of Tribes. But our staff read it, they put a plan together, they applied, and they were awarded the contract for teaching health centers.”
“Seven years later, we’ve graduated five classes,” Bean added. “This latest class that we just graduated two weeks ago, all of them will be going into Native communities.”
According to Dr. Alan Shelton, who has been with the Puyallup Tribe for more than 35 years and today serves as the PTHA’s Clinical Director, the highly competitive program provides four students every year with an opportunity to get hands-on experience via a three-year residency. For the incoming class, they received more than 100 applications.
“They do a fair amount of their work in one of our local hospitals that we’re affiliated with, but their outpatient work is performed here,” Shelton told Native Business Magazine. “When they come to us, they’ve finished medical school, but after they complete the residency program, they are a board-certified family practitioner.”
According to Chairman Bean, an ancillary benefit of the residency program — and another reason he considers it to be wildly successful — is that on top of training future doctors, it allows their current doctors to spend more time with patients in the clinic or at hospitals. This allows them to dedicate more time to taking care of the Tribe’s elders who, alongside its children, are the highest priority members of their community.
Shelton sees the residency program as not just fulfilling a basic need for doctors who can fill positions in Native health centers around the country, but also as an opportunity to build a health care system around Native values. In so doing, they can create better patient outcomes.
“Conventional medical training produces technicians,” Shelton said. “They’re people that are highly, technically competent, but they’re not real good at training what we consider to be healers. That’s what we try to do here. We want folks to be technically competent, of course, but we want them to know how to connect deeply with patients — that empathy, compassion, being interested in their lives, being involved in their families — those kinds of things.”
“In Native clinics across the country, it’s very hard to recruit young doctors,” Shelton continued. “They’re remote, and they don’t have the resources that other places have. They don’t offer the kind of benefits or salary that other places do. But we’re hoping that by training young people here, we can show them the value of working in the Native community.”
Four years ago, the Tribe took another major step in providing this kind of care when it opened the Salish Integrative Oncology Care Center (SIOCC) in Fife, Washington. The 8,200-square-foot cancer care facility was the first Tribally-owned Cancer Care Center in Indian Country and the United States.
Chairman Bean gives the credit for this innovative center to his predecessor Chairman Bill Sterud, who now serves as Vice Chairman of the Tribe. In 2014, Sterud and Shelton learned of an opportunity through Cancer Centers of America, which was attempting to set up a hospital in Washington. But, Bean said, “for one reason or another, it did not work out.”
“They were just going to pick up their operation and completely leave the state of Washington with their clinic, and Dr. Shelton saw this as a wonderful opportunity for the Puyallup Tribe to acquire the assets and the staff for a successful clinic here in the state of Washington,” Bean said. “Given the high rates of cancer within the Native communities, we saw an opportunity to provide care for our clients — not just Puyallup members, not just our community members, but Tribes all around the Northwest.”
Roberta Basch, Native Outreach Coordinator for the SIOCC, said in an interview that the center works hand in hand with the Tribal Council’s goals for how the Tribe wants to approach health and healing.
“Within the Puyallup Tribe of Indians, the community continues to work really hard at restoring, preserving, and integrating our sense of well-being through our traditional ways of knowing and through traditional medicines,” Basch told Native Business Magazine. “Our well-being is central to our relationship with the natural environment and how we keep ourselves healthy.”
“So, we take an interpretation of our wellness which says that wellness is our natural state of being, and anything that bothers that is a cause for illness or sickness,” she continued. “Within the cancer center, we have taken that model of our traditional health and made that part of the model of cancer care.”
This means that in addition to the doctors prescribing and administering chemotherapy or other medical treatments, the SIOCC also employs other traditional healers from Native and other practices who work with patients.
“We have Native traditional healers that will work with individuals, diagnose where they need help, and will provide whatever is needed for that particular patient, whether it be spiritual prayers, a spiritual healing, energetic healing, supplements, teas or anything else,” Basch said. “All of our staff are prepared, for example, to support people on a spiritual level.”
“We also have, within that integrated model, naturopathic healing,” she said. “So if somebody comes in, a trained oncologist will see the patient first. The next appointment right after that will be with a naturopath. And then the nurse practitioner will let that patient know all of the services that are available to that patient, which includes oncology, naturopathic medicine, Native traditional healing that includes spiritual healing, acupuncture, Chinese medicine, and upcoming wellness education opportunities — and that patient will choose what they want to do.
According to the SIOCC’s website, since opening its doors on April 13, 2015, the facility has treated cancer patients of both Tribal and non-Tribal origin. And their approach to cancer care has been a draw for the facility, with approximately 80 percent of their patients being non-Tribal.
Another draw, Basch says, is feedback from their patients that “they love the way they’re treated here.”
“They’re treated like human beings,” she said. We take time out to talk to them and we establish a relationship with them. Patients are first above everything else. And we do the best that we can to help them, to listen to them, to be with them, to offer them anything that we possibly can.”
“Many of our patients came from other clinics,” she said. “And they said they didn’t like being treated like they’re going through a manufacturing facility where you come in, you sit down, you get your chemotherapy, and then you’re out the door. It’s very impersonal.”
“Here,” she said, “patients are first above everything else.”
When we spoke, Bean was only three weeks into his Chairmanship, so while he’s been passed the torch, he was adamant that all of the Tribe’s innovations and advances are merely the continuation of team efforts that started long before he was elected to lead the Puyallup Tribe.
“The credit [for the cancer center] really goes to our former Chairman, Bill Sterud, for going out with Dr. Shelton and visiting the Cancer Centers of America and coming back and talking to the Council about what he saw and how we have an opportunity to fill a need,” Bean said. “I’ve been on the Council since 2006, so I’ve been there alongside Chairman Sterud and other council members to help grow this operation. But we’ve done it as a team.”
“He brought the idea to the table, and then we brought it to life, and we’re sustaining it,” Bean added.
For Bean, all of these efforts are a way to honor the Puyallup Tribe’s ancestors and the sacrifices that they made to take care of future generations.
“As a child, we’re taught traditional ways,” Bean said. “And the one that stands out the most to me is ‘a person will be remembered for what they have done for their people, not what they have done for themselves.’ That’s a lesson that we’ve recited over and over in our circle.”
“So this is a collective effort from our ancestors and our elders who are with us today,” he said. “Many community members came together, recognized that we need to take care of one another and lift each other up, and that’s what we do. Not one of us can do this alone — it takes the support of the full Council, the support of the community, and the guidance from our ancestors and elders. And for that, we’re thankful for all of their battles and their sacrifices to take care of future generations.”
“And my mindset is: how do we honor them and thank them?” he asked. “We do so by continuing their legacy of taking care of their community and future generations.”