IHS leader: Bill would help reservation hospital system


RAPID CITY, S.D. (AP) — The head of the federal agency responsible for providing health care to members of Native American tribes believes legislation recently introduced in the U.S. Senate would help the department fix severe shortcomings at its network of hospitals across the country.

Indian Health Service principal deputy director Mary Smith spoke with The Associated Press hours ahead of a U.S. Senate committee hearing scheduled for Friday in South Dakota during which the proposed legislation was expected to be discussed. The measure and the hearing come as the agency implements a series of reforms, some of which are in response to severe quality-of-care deficiencies 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 he have,” Smith said Thursday evening, speaking about the bill introduced in May for the first time. “(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.”

Smith added that the Indian Health Service has provided “technical assistance” to those drafting the legislation.

The measure, introduced by Republican U.S. Sens. John Thune, of South Dakota, and John Barrasso, of Wyoming, aims at increasing transparency and accountability and improving recruiting and retention practices — issues the agency has struggled with for several years.

Deficiencies uncovered by inspectors from the Centers for Medicare and Medicaid Services during an unannounced survey of 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 the case of a patient who died at a relative’s house two days after he told hospital staffers about extreme back pain and 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 region face quality-of-care challenges.

The inspectors have consistently cited the government-run hospitals for the 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 providers for various reasons, including pay scales that are below the private sector, the remote location of the reservations and a shortage of housing options for staff.

The bill’s provisions include expanding the authority to remove and discipline problem employees; requiring tribal consultation before the hiring of area directors, hospital CEOs and other leadership positions; giving the secretary of the U.S. Department of Health and Human Services, which oversees IHS, the flexibility to create competitive pay scales and provide temporary housing assistance for medical professionals; and ensuring that the inspector general of the Health and Human Services Department investigates patient deaths in which the IHS may have played a role.

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.