Weekly Column: The Health Care Crisis in Indian Country
Since taking office in January 2015, it has become clear to me that Indian Health Service (IHS), specifically in the Great Plains Area, which covers South Dakota, North Dakota, Nebraska and Iowa, is plagued with systematic problems affecting Native Americans in South Dakota. Tribal members have been suffering and, in some cases, dying due to inadequate or improper health care provided by IHS. It is time for IHS to get its act together and follow through on its trust responsibility to deliver quality health care to Native Americans.
My office has begun working on an in-depth profile analysis of IHS. We’re working with the Congressional Research Service and analyzing data and reports from the Government Accountability Office and the Department of Health and Human Services to find answers. What we have found so far says a lot about why IHS is failing so miserably.
We need to understand the organization itself before we can begin to solve problems. We know though, that if we don’t solve the problems at IHS, we will continue to see more examples of hospitals failing to meet basic requirements to provide safe health care, therefore losing essential services like emergency care. The Rosebud hospital’s emergency department has been on diversion—which essentially means it is shut down-- for four months, forcing patients to be diverted to facilities 50 or more miles away. The Winnebago and Pine Ridge hospitals have also been cited for serious safety deficiencies. We need to focus on why so many problems continue to occur at IHS, especially in the Great Plains Area, and why they aren’t getting fixed. I plan on finding answers to these questions and working with the tribes on solutions.
Earlier this year, I requested a Senate Indian Affairs Committee hearing to examine a number of reports of negligence at IHS hospitals in the Great Plains Area. We heard horrific stories of dirty or broken medical equipment, poor record-keeping, and in one inexcusable case, a woman gave birth to her baby on a bathroom floor with no nurses or doctors around to help her.
There is absolutely no excuse for hospitals not to reach basic benchmarks for providing proper health care. Tribal members have told my office that some IHS hospitals they visit are still working with outdated, inadequate and sometimes broken medical equipment. Through our research, we have found that IHS allocates less than 0.5 percent of their total $4.8 billion budget to equipment purchases.
The Great Plains Area IHS, which operates 35 of the total 153 IHS facilities, only receives $116 million for direct care, or 2 percent of the IHS total appropriation. We also learned that IHS has more than 15,000 employees, and only 750 are identified as doctors, yet more than 3,700 employees are dedicated to Medicaid billing. It’s hard not to come to the conclusion that the IHS system is more concerned about building and protecting a bureaucracy than taking care of people. IHS has no funding formula, no consistent qualitative reporting measurements, and too many of their “Area Directors” appear to be little more than temporary employees. Lastly, IHS spends less per capita than the Bureau of Prisons spends on each inmate’s health care. Looking at statistics like these makes it clear that IHS will never be able to function properly unless it undergoes major changes. More taxpayer money won’t solve the dysfunction. Consider this: if the president proposed and Congress supported doubling IHS’s budget, based on IHS’s current template they’d have 1,500 doctors, 7,400 bureaucrats billing Medicaid, and they would have 20,000 administration employees and only 10,700 healthcare providers. That will solve nothing. Both systematic and financial changes need to occur.
The state of IHS and the inability to fix these decades-old problems has resulted in a federal government-initiated crisis in Indian Country. The Great Plains Area ranks second highest in infant mortality rates among all IHS regions. We have the highest diabetes death rates, highest tuberculosis death rates and the highest alcohol-related death rates. Great Plains Area tribal members have the lowest life expectancy rate at 68.1 years, while the U.S. average is almost ten years more at 77.7. These statistics aren’t from a foreign country. These are South Dakotans and our neighbors. Frankly, all of us should expect more.
If we’re going to find a real plan to fix the problems at IHS, we need to fully understand the current organization. We can’t rebuild or repair something until we find out what is and is not working. I will continue working with tribal leadership, IHS administrators, Health and Human Services and others to identify key areas of reform and identify potential solutions to provide better health care to our tribal members. The current situation within IHS is unacceptable.
