Congress questions Indian Health Service staff, management

SIOUX FALLS, S.D. (AP) – Members of Congress on Tuesday questioned the longstanding staffing and management shortcomings that have led to poor health care services at government-run facilities caring for Native Americans across the country.

The hearing in Washington of the House subcommittee on Indian, Insular and Alaska Native Affairs focused on proposed legislation that would expand the authority of the Indian Health Service to remove or demote employees and would also allow it to offer incentives to recruit well-trained administrators and health care providers. This was the second time in less than a month that the IHS' top leader, principal deputy director Mary Smith, tribal leaders and health care advocates testified before members of Congress regarding proposed measures to overhaul the embattled agency.

“We are here because of a crisis,” said U.S. Rep. Kristi Noem, a Republican from South Dakota who is sponsoring the legislation. “The Indian Health Service is beyond broken, and fixing it is literally a matter of life and death.”

Noem's bill and another proposal introduced in the U.S. Senate come after health inspectors over the past 14 months have uncovered serious quality-of-care deficiencies at hospitals run by the IHS in South Dakota and Nebraska. Smith said the agency faces “severe operational and staffing challenges.”

“We welcome this attention and momentum that it creates for lasting quality improvements for these facilities because we are on the front lines of medical care in some of the most remote parts of our country,” Smith said.

The agency's longstanding inability to hire and retain well-qualified administrators and management is due in part to the remote location of many of its hospitals, housing shortages in those areas and lack of competitive pay. At the same time, tribal leaders for years have complained about the agency's decision to keep in its staff mediocre providers and ineffective managers.

At the clinician level, for example, the hospital in South Dakota's Rosebud Indian Reservation had to stop offering surgical and obstetrics services last month after a staff member died. Its emergency room closed seven months ago in part because the agency struggled to maintain appropriate staffing levels. Since then, nine people have died and five babies have been delivered in ambulances on their way to other facilities.

Meanwhile, the management challenges were exemplified during the hearing using the case of a physician whose recent appointment as acting chief medical officer for the Great Plains region came weeks after she publicly apologized for comments made regarding the birth of two babies in the bathroom of that hospital.

“That official clearly has disdain for our people and should work elsewhere,” said William Bear Shield, chairman of the Rosebud Sioux Tribal Health Board.

Noem's bill specifically provides guidelines to remove or demote employees for poor performance or misconduct; forces the agency to implement mandatory cultural competency training for health providers; and offers relocation reimbursements for certain employees who move to work at facilities that are “located in a rural area or medically underserved area.”

The dire problems at IHS-run facilities began to surface in May 2015 with a report from inspectors from the Centers for Medicare and Medicaid Services who toured a facility on Nebraska's Winnebago Reservation. Following inspections of facilities in South Dakota's Pine Ridge Indian Reservation, Rapid City and Rosebud uncovered similar quality-of-care deficiencies.

Victoria Kitcheyan, tribal treasurer of the Winnebago Tribe of Nebraska, pleaded to Congress on Tuesday to continue to work on the issue even if the legislation becomes law.

“It's going to take a team effort, additional resources, consistent congressional oversight. And furthermore we have 10,000 people back at home who need their hope restored. ... Until those systematic changes are made within the IHS system, Winnebago hospital will continue to be the only place where you can legally kill an Indian.”

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