SIOUX FALLS, S.D. — Members of Congress are questioning 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 July 12 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.
