Feds outline reforms for hospitals on reservations

SIOUX FALLS, S.D. (AP) – Federal officials outlined a plan Wednesday to improve care at hospitals that treat Native Americans in four Great Plains states, including creating a multi-agency group to focus on quality and patient safety and developing a single credentialing process for doctors working at Indian Health Service hospitals.

The U.S. Department of Health and Human Services detailed the steps to The Associated Press hours ahead of a U.S. Senate committee hearing in Washington that discussed the quality of care at IHS hospitals in the region. The hearing and promised reforms came weeks after federal inspections highlighted serious problems on a pair of hospitals on South Dakota reservations and months after inspectors uncovered inadequate care for a man who died of kidney failure two days after seeking care from a hospital in Nebraska.

HHS Secretary Sylvia Burwell is establishing a group that will include leaders from IHS – which administers the hospitals that provide free care for Native Americans – the Centers for Medicare and Medicaid Services, the Centers for Disease Control and Prevention and other agencies. The group will address persistent staffing shortages and develop policy and training proposals to “bolster the safety culture,” HHS said, as well as provide immediate assistance to hospitals in need, focusing first on the region comprising the Dakotas, Iowa and Nebraska.

This group of executive-level employees will “augment IHS’s efforts to ensure that sustained, quality care is delivered across IHS facilities,” HHS acting deputy secretary Mary Wakefield said during the hearing of the U.S. Senate Committee on Indian Affairs. The initiatives given to the AP said that council will be charged with executing “a rapid-response process, including deploying resources from across the Department when a facility needs immediate, systematic improvement.”

Federal officials also plan to implement a single, standardized credentialing process within IHS that they said would ensure that facilities can accurately track not only the licenses of medical staff, but also other certifications required based on their specialty.

Lawmakers at the hearing questioned whether the proposed reforms will lead to actual changes, and repeatedly referred to a 2010 Senate report that concluded that the Great Plains Area IHS office was in a “chronic state of crisis.”

“What’s really frustrating is that it seems like it’s déjà vu all over again. We continue to go down the same path,” U.S. Sen. John Thune, who attended the hearing, told the AP in an interview. “There’s got to be accountability, there’s got to be oversight, there’s got to be someplace where the buck stops to ensure that these types of conditions are kept out of IHS facilities in South Dakota and other places around the country.”

Earlier this week, federal authorities assigned a new acting director to the Great Plains Area office and said they’ll deploy a four-member team to address problems at the hospitals in the Pine Ridge Indian Reservation and Rosebud Indian Reservation in South Dakota and the Winnebago Reservation in Nebraska.

In October, inspectors visiting the hospital in Pine Ridge in western South Dakota cited safety deficiencies including unlocked cupboards with syringes, needles and other equipment; unsecured drugs and medical records; an isolation room without gowns and masks; and doctors without proper credentials.

An inspection of the Rosebud hospital in November found conditions so alarming the emergency room was shut down. A patient having a heart attack wasn’t treated until 90 minutes after she arrived. Serious staffing shortages in the emergency room included vacancies for the supervising medical officer, a medical officer, two physician assistants and three clinical nurses.

Months earlier, an inspection report of the hospital in Winnebago cited the case of a patient who told hospital staffers about extreme back pain on Dec. 30, 2014. He was sent home. A hospital staff member then left him a voicemail telling him his kidneys were failing, but the staffer did not attempt to make additional contact. The patient died Jan. 1 at his sister’s house.

“It’s had a horrible impact on the trust,” Victoria Kitcheyan, treasurer of the Winnebago Tribe of Nebraska, during the hearing said of the effects that the inadequate care has had in her community. “Our people don’t want to go to the facility ... They look at it as a death trap.”

IHS provides services to about 130,000 people through seven hospitals, 15 health centers and several smaller satellite clinics in the four-state area. At the emergency room in Rosebud alone, 6,595 patients were seen between May and October.

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