Tultxʷ · The confluence of two rivers

Confluence of Cultural Care.

A 24/7, culturally competent nurse advice line for Indian Health Service beneficiaries. Licensed RNs. Evidence-based triage. Care that already knows who you are.

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The line is open · 24 hours · 7 days
tultxʷ · where the waters meet
The premise

You shouldn't have to explain your whole history before someone knows how to help you.

TULQ is built for that call.
How the line works

Three rings. A clear next step.

Whether you're calling from your ancestral lands, your cousin's house, the road, or while you wait outside the clinic — a licensed RN picks up. The protocol is the same one 95% of U.S. medical call centers use. The judgment already knows the room.

The line 24/7 Every hour. Every day. Every year.
Protocol coverage 95% U.S. medical call centers run on the same Schmitt‑Thompson framework.
Who picks up RN Multi state licensed registered nurses. Not a bot. Not a tree.
What you don't get 0 IVRs. Voicemail. Hold music. Menu trees.
01   You call. T + 0:00

You call.

From anywhere. Any hour. A licensed RN picks up. No menu trees, no callback queue, no portal to register for first.

Person, not a tree From anywhere No IVR No portal No hold music
02   A licensed RN listens. T + 0:08

A licensed RN listens.

Clinical triage grounded in evidence, shaped by the communities it serves. AI captures intake before the handoff — so the nurse opens with context, not questions.

Schmitt‑Thompson Multi state RN Cultural competence Clinical depth
03   A clear next step. T + resolved

A clear next step.

The call ends with a plan. Not a transfer. Not a callback. Not a maybe.

Anatomy of one call It doesn't ring. AI captures the basics, the RN takes over.
AI Phase 01 · Intake AI captures the basics
  1. T + 0:00 Line connects. No ringing.
  2. T + 0:05 "Where are you calling from?"
  3. T + 0:20 "What's happening right now?"
  4. T + 0:40 Urgency check. Red flags noted.
RN Phase 02 · Care A licensed RN takes over
  1. T + 0:50 RN picks up, context in hand.
  2. T + 1:30 No repeat questions. Targeted clinical exchange.
  3. T + 2:30 Triage decision. Plan forms.
  4. T + resolved A plan in your hand.

The call ends with a plan, not a transfer.

TULTX™ · THE CONFLUENCE OF TWO RIVERS

Who picks up

A tribal operator and a nurse who's actually carried the pager.

Built to satisfy both the contracting officer at IHS and the patient on the other end of the call.

Michael Chavez Ross
Founder · CEO · President

Michael Chavez Ross

Snoqualmie tribal citizen · Government & tribal enterprise leader

Enrolled member of the Snoqualmie Tribe and former Vice Chairman of the Snoqualmie Tribal Council. Worked on Capitol Hill in Washington, D.C., advocating for all tribes on keystone legislation, including the reaffirmation of the Violence Against Women Act, Savannah's Act, and the tribal provisions of the CARES Act. Partnered with the Snoqualmie Tribe and local communities to protect and preserve elders' assistance programs. Helped manage the Tribe's Health and Wellness clinic for three years.

Jayson Forrest Minagawa, RN, BSN
Clinical director · RN, BSN

Jayson Forrest Minagawa

Multi-state ICU veteran · 11+ years acute & critical care

Eleven years and a dozen ICUs deep, from a Level 1 Trauma Center float ICU to cardiovascular intensive care across the country as a travel ICU nurse. He delivered hospital level care into patients' homes as a lead nurse for a telehealth company, answered every emergency alarm as the rover RN inside a maximum security supermax prison, held the line through the COVID surge in the ICU, and now runs a 142 bed skilled nursing facility as its Unit Manager and MDS Coordinator. He has actually carried the pager.

Who we serve

The patients the system keeps losing track of.

TULQ is built for the populations that mainstream telehealth has consistently underserved, and the institutions trying to reach them.

01

IHS beneficiaries, nationwide.

Eligible AI/AN patients across the 12 IHS Areas, from urban centers to the most remote service units.

~2.8M people
02

Tribal nations & 638 facilities.

Tribal health programs operating under the Indian Self-Determination and Education Assistance Act, looking to extend after-hours and surge capacity.

Tribal sovereignty
03

Urban Native communities.

Urban Indian Organizations and the ~70% of AI/AN people who live in cities, where access falls through the cracks between federal and state systems.

~70% of AI/AN
04

Underserved & rural populations.

Communities where the nearest ED is a long, expensive drive, and a phone call to a competent nurse changes what happens next.

Rural access
Why TULQ

Native-owned. Clinically deep.

TULQ is structurally and culturally aligned with how Indian Country actually works, not retrofitted to look the part.

Pillar 01

Buy Indian Act qualified.

Wholly owned by Michael Chavez Ross, enrolled citizen of the Snoqualmie Indian Tribe. Eligible to compete as an Indian Economic Enterprise under 25 U.S.C. § 47.

25 U.S.C. § 47 · 2022 IHS final rule
Pillar 02

Cross-system clinical depth.

Ten years of ICU, telehealth, corrections triage, and SNF leadership, directed by a nurse who has actually carried the pager.

RN · WA · CA · OR · BLS · ACLS · AWEP
Pillar 03

Culturally competent by design.

Cultural competency built in at the protocol level, not bolted on at training. Informed by tribal governance experience, lineage, and lived understanding.

Schmitt-Thompson aligned · Culturally adapted
The numbers worth knowing

Plainly. Without celebration.

The numbers below are why the line exists. They are not decoration.

Population
2.8M
AI/AN beneficiaries the Indian Health Service is responsible for.
Coverage
12
IHS Areas across the United States, plus ~170 service units.
Urban
~70%
Of AI/AN people who live in urban areas, often outside direct IHS coverage.
Diabetes
3×
Type 2 diabetes prevalence in AI/AN adults vs. non-Hispanic White adults.
Suicide
+91%
Higher likelihood of suicide death in AI/AN people vs. the general U.S. population.
The line
24/7
When TULQ picks up. Every hour. Every day. Every year.
Sources · IHS · KFF · OMH-HHS · 2022 to 2024 reporting
Our story · in brief

The name comes from the confluence.

TULQ takes its name from tultxʷ, which means the confluence of two rivers in Lushootseed, the native language of the Snoqualmie People. It is a word about meeting. A confluence of cultural care.

Michael's great-grandmother, Ollie Moses, was a direct descendant of signers of the 1855 Point Elliott Treaty. As a child she was taken to Chemawa Indian Boarding School.

TULQ exists, in part, because of what it took to survive that. The line we answer today is part of how that gets repaired.

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Contact & capability

Reach the people who'd actually pick up.

For contracting officers, partnership inquiries, and clinical questions: reach out directly. We answer our own phones.

Capability statement

Available on request, for contracting officers.

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