Tribal leaders and U.S. senators from across the Great Plains blasted the quality of care provided by Indian Health Services during a U.S. Senate oversight hearing Wednesday.
Multiple speakers addressing the Senate Committee on Indian Affairs spoke of a health care system that is underfunded, understaffed, unresponsive and which delivers a substandard quality of health care that frequently results in a compromised quality of life for its patients.
“For decades and generations, IHS has had a terrible reputation in Indian Country,” said Victoria Kitcheyan, treasurer of the Winnebago Tribe of Nebraska. “We don’t go there because they have superior health care. We go there because it’s our treaty right, and we go there because many of us lack the resources to go elsewhere. We’re at the hands of a dated bureaucratic system that doesn’t offer quality health care to many of the deserving Native American patients that it serves.”
Montana Sens. Jon Tester and Steve Daines both sit on the Indian Affairs Committee and were in attendance at Wednesday’s hearing.
Republican Daines summarized the experience of Terri Long Fox, an enrolled member of the Assiniboine Tribe living on the Fort Belknap Indian Reservation.
“She drove 35 miles to the closest IHS facility, she spent four hours there waiting for medication, and then she drove all the way home to find out she had been administered the wrong medication,” Daines said. “In fact, when she called and told them she had the wrong meds, they told her to flush them down the toilet.”
This is in the context of where we have abuse of prescription drugs and sometimes a lack of control,” he added.“Problems like this have been happening for decades, and the fact that they are happening today is unacceptable.”
This most recent Senate review is a near duplication of one that took place in 2010.
At that hearing, Senate committee members were presented with extensive documentation of IHS employees working under the influence of drugs and alcohol, a recurring pattern of mismanagement, discrimination and retaliation against employees who complained, and a lengthy history of incompetent or even criminal behavior by IHS employees who faced no disciplinary action.
Despite a series of action plans produced by IHS over the intervening years, based on Wednesday’s testimony it appears there have been few substantial changes since 2010.
“It has become normal and OK to be misdiagnosed by locums (health care workers who temporarily fill in for physicians who are unavailable) who are contacted on the weekends to work in our ERs,” said L. Jace Killsback, executive health manager for Montana’s Northern Cheyenne Tribe in Lame Deer. “To wait until you’re going to lose your leg or your life in order to be referred out to receive the right health care you need. For a baby to be born in a car on the way to the Northern Cheyenne hospital because IHS no longer delivers babies at the Crow hospital.”
Sen. John Thune, R-S.D., reflected upon the lack of progress at IHS.
“After the 2010 report there was a paper put out that had a strategy that was going to be implemented,” he noted. “In 2013 we had another report about all the things that were going to be done and none of the stuff gets implemented.”
“There has got to be accountability,” Thune said. “There has got to be a chain of command. The buck has to stop somewhere to prevent these sorts of things from happening.”
When asked why so many IHS medical facilities have failed to meet targeted improvement standards, IHS Deputy Director Robert McSwain said improvements had been made but were difficult to sustain.
“There were times where we actually achieved satisfaction,” McSwain said, “… then we failed again, we fell back. We achieved and then we failed.”
Though there was nearly uniform criticism of IHS performance at Wednesday’s hearing, several Democratic senators turned to their Republican colleagues on the committee to note the inadequate funding IHS has received in recent decades.
“We have a situation where the system is dysfunctional because it doesn’t get enough funding,” said Sen. Al Franken D-Minn. “I think that’s the nub here. Average spending per capita in the United States on health care is $8,097 – that’s in 2014. Average for IHS per user: $3,600 – less than half. Add to that everything we’ve talked about in this committee in terms of housing, in terms of education.”
“We can put forth the best words that we want in this committee, but unless we back it up with money it’s just that – it’s baloney,” Tester, D-Mont., added. “Some of the same folks that talk about the problems of the IHS vote against the budget. They vote against IHS’s funding.”
“We can talk about the challenges out there of people that are harassing and nepotism,” Tester said, “… and the folks who are not doing their jobs and how we should fire them. But in the end we’re never going to be successful if we don’t deal with what it costs to treat people in medicine, what it takes to have good schools and good housing and good water.”
Daines viewed the situation differently.
“Under this administration funding for IHS has increased by 43 percent,” he said. “The issues we are addressing today are not the result of underfunding. Plain and simple this is an issue of oversight, it’s an issue of accountability, it’s an issue of failing to follow through on promises of basic responsibilities to Indian Country. I don’t think it is a health care system, I think this is a health care tragedy.
“We’re dealing with real lives, with real people, with grandmas and grandpas and children and moms and dads who are suffering and dying prematurely.”