U.S. Government health services to Indians began in the early 19th century when army physicians took steps to curb the spread of contagious diseases not experienced by Native Americans prior to European contact. Official health services to Indian people took much longer to establish, and are the outgrowth of the trust responsibility assumed by the United States through the exchange of land for services.
The following dates are highlights in the progressive development of a health care system directly linked to the legal relationship between the United States and the Cherokee Nation.
1827 – Cherokees first established a constitutional government by convention to deal with the federal government on its own terms
1834 – U.S. Congress enacted legislation to organize the operation of superintendents and agents conducting Indian affairs
1838-1839 – Cherokees suffered physical, mental, emotional and spiritual hardship during forced, winter-time removal from aboriginal homelands known historically as "The Trail of Tears"
1839-1860 – Cherokees engaged in rebuilding of communities in the new land referred to as "Indian Territory"
1849 – Now considered a land issue (rather than a war issue) the federal government transferred the Bureau of Indian Affairs from the Department of War to the Department of the Interior and officially extended physician services to Indian people
1887 – General Allotment Act passed by U.S. Congress, requiring individual ownership of lands once held in common by Indian Tribes (specifically excluded Cherokees and other members of the "Five Civilized Tribes," resulting in dispatch of Dawes Commission of 1893 to negotiate allotment of "Indian Territory" lands
1891 – Field matrons were employed by the BIA to instruct people on sanitation and hygiene, to perform emergency nursing services, and to prescribe medicine for minor illnesses (eventual role of Public Health Nurses)
1893 – Cherokee Outlet opened for white settlement/Dawes Commission arrived in Indian Territory
1907 – Oklahoma statehood combined Indian and Oklahoma territories and abolished recognized authority of tribal governments
1908 – Establishment of a "Chief Medical Supervisor" of the BIA to oversee professional medical activities associated with Indian people
1911 – First federal appropriation for health services to Indian people (without provision for recurring appropriation)
1913 – Dental services first offered through the BIA
1920 – "Senior Public Health Officer" detailed to BIA from US Public Health Service to act as health service advisor
1921 – Snyder Act passed to authorize regular appropriation of funds for Indian Health Care; resulted in BIA "Health" division
1934 – Indian Reorganization Act reestablished tribal land bases in the form of jurisdictional service areas,
1936 –William Wirt Hastings (a Cherokee and a former U.S. Congressman) appointed "Chief for a Day" by the federal government to clear title to the land at Deer Park for construction of an "Indian" hospital in Tahlequah
1949 – President Harry Truman appointed W.W. Keeler "Chief" the Cherokee Nation
1954 – Transfer Act passed by Congress, authorizing movement of the Indian Health Service from the Bureau of Indian Affairs (where it had been placed from 1924 to 1955) to the Department of Health Education and Welfare (now the Department of Health and Human Services)
1964 – New wing added to W.W. Hastings Indian Hospital at Tahlequah
1968 – Indian Health Service initiated the Community Health Representative program (paraprofessional Native American health care workers trained by IHS but employed by their own tribal communities to provide early intervention) Note: Cherokee Nation's first tribally managed health program was the CHR program
1971 – Cherokee government formally reorganized and W.W. Keeler became the first elected Chief since Oklahoma statehood
1972 – Cherokee tribal health department formed, and first health director hired
1975 – Congress passed the Indian Self-Determination & Education Assistance Act, giving tribal governments the option to contract directly with the federal government (as states do) to staff and manage the programs serving Indian people
1977 – Cherokee Nation contracted with the U.S. Department of Agriculture for operation of the Women, Infants and Children (WIC) program
1979 – Cherokee Nation commissioned the draft of a 10-year, tribal specific health plan
1980 – Congress amended the Indian Health Care Improvement Act; Cherokee Nation contracted with IHS for outreach health care and began expansion of clinical services
1982 – Cherokee Nation contracted with IHS to operate the Public Health Nursing and Environmental Health Service programs
1983 – Construction began on new Hastings Hospital facility to offer expanded ambulatory service; tribe assumed responsibility for operating the Delaware County Indian Health Center (previously operated by IHS)
1984 – Cherokee Nation contracted the Behavioral Health and Donated Foods programs; new hospital facility officially opened
1985 – Cherokee Nation commissioned up-date to the tribal specific health plan developed in 1979
1986 – Congress passed the Indian Alcohol and Substance Abuse Prevention Act, authorizing the Indian Health Service to develop one youth treatment center within each of the twelve IHS geographic service areas"
1987 – Cherokee Nation developed a tribal action plan for operation of the Jack Brown Center in Tahlequah (one of the treatment centers mentioned above)
1988 – more Congressional amendments to the Indian Health Care Improvement Act
1989 – tribal Self-governance legislation passed by Congress; Cherokee Nation opened and began operating Nowata Indian Health Center in Nowata, Oklahoma; opened an outpatient clinic in the former hospital facility in Jay, Oklahoma; and, established a partnership with the Northeastern State University College of Optometry to provide vision services in rural areas of the Cherokee Nation from a mobile eye clinic purchased with funding from the Kellogg Foundation
1990 – Cherokee Nation signed an historic agreement becoming one of six tribes to participate in the Self-Determination Demonstration Project; and, initiated a feasibility study for determining the merits of contracting to provide more of the tribe's health service
1991 – Jay clinic renamed the Sam Hider Jay Community Clinic in honor of Reverend Sam Hider's spiritual healing and community leadership among Cherokees in the 1940's
1992 – Cherokee Nation acquired the services of a full-time professional advisor on health care delivery systems and continued the process of health care planning through consultation with an expert in information systems management
1993 – Cherokee Nation initiated the development of an integrated, automated health care information system to interact with the IHS system (i.e. RPMS-Resource and Patient Management System); first newly constructed tribal health clinic (Redbird Smith Health Center) dedicated in Sallisaw, Oklahoma, and named in honor of the nineteenth century Cherokee traditionalist Redbird Smith
1994 – Cherokee Nation entered into a compact with the U.S. Secretary of Health and Human Services under the Self-governance Demonstration Project
1995 – Cherokee Nation began operating Contract Health Services for outpatient care in the tribal jurisdictional service area; Wilma P. Mankiller Health Center (a state-of-the-art outpatient clinic) opened in Stilwell, Oklahoma, expanding tribally operated clinical service sites to five; Health management initiated an in-depth evaluation of operations and the delivery of care provided through the Cherokee Rural Health Network (i.e. all facilities providing care with funding from the Indian Health Service within the Cherokee tribal jurisdictional service area (TJSA)
1996 – Cherokee Nation began administrating inpatient component of Contract Health Services in the TJSA; constructed new outpatient facility at Salina, Oklahoma, without additional funding from the IHS and named A-Mo Community Clinic for the Cherokee "by the water"
1997 – Cherokee Nation Health Service established an Institutional Review Board to guide the process of proposed clinical research involving Cherokee people as subjects; opened a new clinical service site in leased space at Muskogee, Oklahoma; added a mobile unit to the Nowata clinic, extending service one day per week to four additional rural towns in the northern area of the TJSA
1998 – ground broken on comprehensive Emergency Services facility at Tahlequah; expansion of dental services at Jay; Cherokee Nation received a grant from IHS for specialized, targeted diabetes prevention and disease management at all eight clinical access points; expansion of clinical service at Salina begun