IHS supports goals of bill addressing reservation hospitals

RAPID CITY, S.D. (AP) – The head of the federal agency responsible for providing health care to Native Americans believes legislation recently introduced in the U.S. Senate would help fix severe shortcomings at its hospitals nationwide.

Mary Smith, principal deputy director of the Indian Health Service, spoke with The Associated Press ahead of a U.S. Senate committee hearing that began Friday in South Dakota at which the proposed legislation is being discussed. The measure comes as the IHS implements a series of reforms, some aimed at addressing severe quality-of-care deficiencies that health inspectors recently found at hospitals on Native American reservations in the Great Plains.

“We are very supportive of the efforts by the senators on the Indian Affairs Committee to help address some of the challenges we have,” Smith said Thursday evening, speaking for the first time about the bill introduced in May. “(The bill) addresses issues about accountability, and it addresses issues about quality. I think we share the same goals to improve all those things at IHS with the Senate.”

The bill, introduced by Republican U.S. Sens. John Thune of South Dakota and John Barrasso of Wyoming, aims to increase transparency and accountability at the IHS, and improve recruiting and retention practices at the often remote hospitals – issues the agency has struggled with for several years.

Specifically, the bill would expand the IHS’ authority to remove and discipline problem employees, require tribal consultation when hiring hospital leadership, and provide flexibility to create competitive pay scales and offer temporary housing assistance for medical professionals. The legislation also would ensure that the inspector general of the U.S. Department of Health and Human Services, which oversees IHS, investigates patient deaths in which the IHS may have played a role.

Smith said IHS provided “technical assistance” to those drafting the legislation.

At Friday’s hearing in Rapid City, Barrasso said the bill attempts to solve long-standing issues that have affected the agency.

South Dakota’s U.S. Rep. Kristi Noem, who is also in attendance, said the IHS “should get out of the hospital business” as patients seeking treatment are provided “Third World” care. Dozens of people attending the hearing clapped at her remarks.

Deficiencies uncovered by federal inspectors at the hospital on South Dakota’s Rosebud Indian Reservation in November included the lack of immediate assistance for a patient who was having a heart attack.

Months earlier, an inspection report of a hospital in Winnebago, Nebraska, cited a patient who died at a relative’s house two days after he told hospital staffers about extreme back pain but 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.

Smith has acknowledged that hospitals beyond the Great Plains also face quality-of-care challenges.

The inspectors have consistently cited the government-run hospitals for lack of medical and nursing staff accountability, which they believe has been behind the failure to provide appropriate medical care over the years. At the same time, the agency has struggled to recruit and retain qualified health care providers amid pay scales that are below the private sector, reservations’ remote locations and a shortage of housing options for staff.

Smith said the agency has already created a search committee for the hiring of area directors, and for the first time, tribal members will be officially involved in the process.

This move is so that tribal leaders “can be involved in the process from picking senior leaders at IHS from the very beginning,” Smith said. The agency, which is divided into twelve regions covering the country, has openings for four area directors.

Other reforms include the outsourcing of the emergency rooms of two hospitals in South Dakota and one in Nebraska and the implementation of a workplace drug policy that applies to IHS staff, including medical providers.

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Online:

Senate bill: http://1.usa.gov/1USK8v2

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