tultxʷ · where two rivers meet

A nurse who answers. Who already knows who you are.

TULQ is a 24/7 nurse advice line for Indian Health Service beneficiaries. Every call is answered the moment it connects and triaged by a licensed RN. No voicemail, no hold queue, no explaining your whole history before someone can help.

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Capability statement available now.

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

It never even rings.

Whether you're calling from your ancestral lands, your cousin's house, the road, or the parking lot outside the clinic, your call is answered the moment it connects. AI assisted intake gathers the basics, then a licensed RN takes over. The nurse runs the same Schmitt-Thompson protocols that 95% of U.S. medical call centers use, with one difference: our nurses already understand the cultural context of the call. Every call ends with a plan: stay home and here's how, see the clinic tomorrow, or go now.

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 triages RN Every clinical decision is made by a multi-state licensed registered nurse. AI handles intake, never judgment.

What you don't get 0 Voicemail. Hold music. 'Press 2 for...'

The call ends with a plan, not a transfer.

tultxʷ · the confluence of two rivers

Who picks up

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

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

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. Spent three years helping manage the Tribe's Health and Wellness clinic.

Clinical director · RN, BSN

Jayson Forrest Minagawa

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

Eleven years and a dozen ICUs deep: Level 1 trauma, cardiovascular intensive care, travel assignments across the country. He has delivered hospital-level care into patients' homes as lead nurse for a telehealth company, answered every emergency alarm as the rover RN inside a supermax prison, and held the line through the COVID surge. Most recently he ran a 142-bed skilled nursing facility as its Unit Manager and MDS Coordinator.

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.

IHS beneficiaries, nationwide.

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

~2.8M people

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

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

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 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.

Eleven years across ICU, telehealth, corrections triage, and SNF leadership. A clinical director who has worked every setting the calls come from.

RN · WA · CA · OR · BLS · ACLS

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 protocols · Culturally adapted

The numbers worth knowing

The numbers, plainly.

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

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^%

The suicide rate among AI/AN people is 91% higher than 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 built the line.

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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