Conditions that rise to the level of malpractice at Indian Health Services facilities in the Great Plains area are killing people, according to Senate Committee on Indian Affairs Chairman John Barrasso (R-Wyoming).
The Dorgan Report issued in 2010 “found atrocious evidence showing the lack of quality of care” at IHS facilities and nothing has changed—in fact, in some instances conditions have worsened, Barrasso said, as he opened a February 3 oversight hearing “Reexamining the Substandard Quality of Indian Health Care in the Great Plain,” based on new investigations by federal agencies and testimony from tribes.
“What we’ve found is simply horrifying and unacceptable,” said Barrasso. “In my view, the information provided to this committee and witnessed first hand can be summed up in one word: malpractice.” The IHS Great Plains Area office provides care to 122,000 American Indians.
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Barrasso alleged a “culture of cronyism and corruption” that shuffles incompetent, and sometimes criminal, employees from one site to the next. “Some have been involved in preventable deaths identified by CMS [Centers for Medicare and Medicaid Services],” he said. “One particularly egregious incident involves the Chief Medical Officer for IHS. In a recent phone call, the Chief Medical Officer responded to concerns from congressional staff about incidents involving unsafe pre-term deliveries by saying, ‘If you’ve only had two babies hit the floor in 8 years, that’s pretty good.’ This is a sad new low for IHS,” he recounted.
IHS Chief Medical Officer Susan Karol, Tuscarora Indian Nation, apologized during the hearing, saying the “totally unacceptable” comments were made after a long day. “My 100 percent priority is improving patient care. Providing quality is my highest priority,” she said.
Former Sen. Byron Dorgan, D-North Dakota, led the 2010 investigation that resulted in the Dorgan Report. Now chairman of the Center for Native American Youth, which he founded, Dorgan told the committee that Indian health care is underfunded by half and placed the blame for that squarely on Congress.
“This is about living and dying,” Dorgan said, citing a case where a woman having a heart attack was transferred to a non-IHS hospital with a note taped to her thigh saying IHS would not pay for her treatment.
Sen. Heidi Heitkamp, D-North Dakota, told the committee: “The average Medicare spending per beneficiary is almost $12,000 per year. The average spending on national health—that means everybody—is about $8,000. The average spending in the vet system $7,000, the average spending in Medicaid per enrollee is almost $5,600. In Indian health, it is barely $3,000.” She emphasized that any solution to IHS’s problems would require adequate U.S. government funding.
SCIA Vice Chairman Jon Tester, D-Montana, agreed, at times banging the table with his fist. “We can put forth the best words that we want here in this committee, but unless we back it up with money, it’s baloney. Some of the same folks who talk about the problems at IHS vote against IHS’s funding…. In the end we’re never going to be successful unless we talk about what it costs to treat people—you can’t do it with half [that amount].”
Mary Wakefield, acting deputy secretary for the Department of Health and Human Services, was the first federal representative to testify. She said her agency was addressing the problems noted in the CMS surveys, including persistent staffing shortages. In response to his question, she told Tester that HHS does remove incompetent practitioners.
Offering competitive pay and adequate incentives to get doctors to go to isolated IHS locations has been a problem, said IHS Principal Deputy Director Robert McSwain, North Fork Rancheria of Mono Indians of California. Recruitment and retention of medical personnel have been helped by IHS’s scholarship and loan repayment programs, according to Karol. She said the pay gap was significant; for example, emergency room doctors typically make $350,000 a year, compared to IHS’s starting salary of $220,000 for ER docs.
Andrew Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, detailed the agency’s role in ensuring medical facilities participating in Medicare are in compliance with federal safety and quality of care standards. The agency has told three IHS hospitals in the Great Plains area that they were in immediate jeopardy of losing their status as Medicare providers and one of those facilities has lost its certification.
Victoria Kitcheyan, treasurer of the Winnebago Tribe of Nebraska Tribal Council, was the first witness to testify on behalf of the tribes. “I am here with a heavy heart. I carry the burden of the countless tribal members who have been harmed at the IHS including the five defined in the CMS survey that died unnecessarily.
“My community believes [the hospital] is the dumping ground for poor administrators and unskilled providers. The back-to-back CMS findings have given our concerns some credibility.” She recalled a nurse who could not set up a dopamine drip and an ER that could not find the defibrillator as a patient lay dying.
“These things happened and are noted in the CMS reports.” She said the plan in place to improve conditions was useless because of “stupid decisions” being made on the ground. The tribe, she said, was considering taking control of the hospital, and that could not happen soon enough.
She alleged that nurses at the hospital were not admitting patients, even if there were empty beds, in order to avoid further CMS scrutiny. “Who can make these nurses work? These are federal employees, receiving paychecks, refusing service,” she said.
Sonia Little Hawk-Weston, chair of the Oglala Sioux Tribal Council’s Health and Human Services Committee told of a patient who was advised several times at the Pine Ridge IHS hospital that she needed a hysterectomy to relieve severe back pain. Fortunately, she consulted an off-reservation non-IHS hospital, which discovered that she had a herniated disk—no hysterectomy was needed. The problem of IHS’s inability to pay for non-IHS provided treatment creates life-threatening situations and makes tribal members vulnerable to debt collectors, Little-Hawk-Weston said.
William Bear Shield, Rosebud Sioux Tribal Council Representative, who spoke on behalf of President William Kindle and the Sicangu Lakota Oyate, said lack of funding, mismanagement and unethical practices at IHS facilities were “completely unacceptable and disrespectful to our ancestors and to our treaty with the federal government.” IHS leadership, he said, has ignored tribal concerns and failed to consult with the tribe. IHS closed the hospital’s ER with only one day’s notice in early December, even though the staff is still there, causing at least one death.
At the end of the hearing, Senate staffers stayed to hear another three hours of testimony from tribal leaders during a listening session.
Cheyenne River Sioux Tribal Chairman Harold C. Frazier was the first speaker at the “Listening Session on Putting Patients First: Addressing Indian Country’s Critical Concerns Regarding IHS,” that began after the oversight hearing. “Everybody knows the problems. Everybody knows the solutions. I can’t understand why we’re not fixing them.” Getting rid of the area director, as has been done so many times before, is not the solution, he said. Kevin Meeks, Chickasaw, unexpectedly took over leadership of the Great Plains area office on Monday, February 8, the same day as the hearing, meaning that Ron Cornelius, Oneida Tribe of Indians of Wisconsin, who had been in charge since 2012, would not testify.
Chairman Vernon Miller, Omaha Tribe of Nebraska, said his tribe diverts patients from the Winnebago IHS hospital and pays for their care elsewhere.
Winnebago Tribe of Nebraska Vice Chairman Vince Bass said his tribe was considering taking over the hospital, having completely lost confidence in IHS. “The solutions to problems in Indian country are best provided by Indian people,” he said.
Fort Peck Assiniboine & Sioux Tribes Vice Chairman Charles Headdress pointed out that the U.S. government could respond to the ebola crisis in Africa, but apparently cannot provide physicians to respond to the health crisis in Indian country.
Vice Chair of the Omaha Tribal Council Adriana Saunsoci wept as she retold how her 3-year-old daughter passed away as a result of an accident despite being taken to the Winnebago IHS hospital. “I come to you as a grieving mother,” she said. A year later she learned that had staff been properly trained and the crash carts working her child might have survived. “Be our voice and help us improve things,” she begged.
Donna Salomon, a member of the Oglala Sioux Tribe, described how excruciating it is for elders to die far from home because the kind of medical care they need is not available on or near the reservation. She also described how when the Medicare reimbursement period was over, non-IHS hospital personnel urged the family to turn off the machines that were keeping her father alive without telling them the reason.
Kathleen Wooden Knife, Rosebud Sioux Tribal Council representative and vice chair of the tribe’s Health Board, worked for IHS for 10 years. She told staffers about IHS hiring of physicians with “dings” on their credentials—such as having lost their medical licenses. She expressed, as did many others, frustration and anger that after innumerable assessments, investigations and CMS surveys, very little has changed at IHS since the 2010 Dorgan Report. She recommended that the next time SCIA has a hearing, they talk to IHS employees—and protect them from retaliation.
Brian Dillon, representative for the Rosebud Sioux Tribe out of Parmelee Community, spoke about his 13-year-old daughter who experiences extreme pain when playing sports because IHS has not approved the surgery she needs and he cannot afford to pay for it.
Other speakers at the listening session included James Steele Jr., chairman of the Confederated Salish and Kootenai tribal council; Rosebud Sioux Tribe Health Administration Evelyn Espinoza; Sarah Dakota, health coordinator for Sisseton Wahpeton Oyate Tribe; James Red Willow, a member of the executive committee of the Oglala Sioux Tribe; Jerilyn Church, CEO of the Great Plains Tribal Chairmen’s Health Board; C.J. Clifford, Oglala Sioux Tribal representative; and a Winnebago Tribal Council member who is fire chief for the volunteer fire department.