Bringing Some Much-Needed Accountability to the Indian Health Service
By Sen. John Thune
The crisis plaguing the Indian Health Service (IHS) and its facilities throughout the Great Plains area isn’t new. In fact, if you ask Native Americans in South Dakota to share their personal experiences dealing with the agency, you’d be hard-pressed to find any positive reviews. The stories they’ve shared with me are heart-wrenching and call into question the commitment of the IHS leaders who are responsible for ensuring our tribal citizens get the quality care they deserve, but unfortunately haven’t been receiving.
It’s hard to imagine walking into a medical exam room that is anything less than clean and orderly, but based on some of the stories I’ve heard, a clean exam room would be a luxury for many IHS patients in South Dakota. The idea that medical professionals are sometimes relegated to using dirty and unsanitary equipment is hard enough to fathom, but we’ve also heard of patients being prematurely discharged from hospitals. This substandard environment is unacceptable, it’s dangerous, and it’s having a real and oftentimes devastating impact on Native Americans, their families, and their communities.
It is clear the IHS is ineffectively managed. For example, it settled an $80 million lawsuit with unions, $6.2 million was taken from Great Plains area service units alone. This all occurred because IHS could not properly manage an administrative task like overtime pay, and IHS took money that would have been better suited for patient care.
In February, Sen. John Barrasso (R-Wyo.), the chairman of the Senate Committee on Indian Affairs, invited me to participate in a hearing he organized to examine a number of these ongoing issues and try to determine what can be done to finally fix them. During the hearing, we heard from witnesses, including representatives from the Oglala and Rosebud Sioux tribes, about the abysmal conditions they’d been exposed to. The hearing was a good opportunity for my Senate colleagues to hear about these experiences firsthand, and it provided us with more than enough information to help craft a comprehensive bill that would address this crisis head on.
Sen. Barrasso and I have been working together for months to craft the right kind of bill that tackles patient care and safety issues and emphasizes the need for greater transparency and accountability at the agency. The IHS Accountability Act of 2016, which Sen. Barrasso and I just introduced, does just that. This bill would address some of the systemic failures at IHS by implementing several key, common-sense reforms.
Most importantly – it says it in its name – the IHS Accountability Act increases accountability. It creates an expedited procedure for the U.S. Department of Health and Human Services (HHS) secretary, who oversees IHS, to terminate senior leaders at the agency who aren’t doing their jobs. Leadership starts at the top, so if an underperforming member of leadership is creating a barrier to fulfilling the agency’s core mission of providing quality care to patients, then it’s time for them to find a new line of work.
The bill also streamlines the hiring process so we can get more dedicated, hard-working people on the job faster and keep them there longer. Tribal input is key, which is why we built in a provision to the bill that ensures tribes are consulted during the hiring process for area directors, service unit CEOs, and other key officials. Retaining good employees has always been a problem, which is something we sought to correct by giving the HHS secretary greater flexibility to create competitive pay scales and reward employees for good performance.
Protecting whistleblowers was also an important goal of ours, which is why the bill requires the Government Accountability Office to review the protections that are currently in place and determine whether or not any changes are required to create additional layers of protection. And in the spirit of complete transparency, the bill requires the HHS Office of Inspector General to investigate each and every patient death in which the IHS is involved.
The IHS Accountability Act is hands-down the most comprehensive IHS bill introduced this Congress. And while this is an important step, it’s just the first step. Our effort will mean nothing unless we continue to engage with the tribes, solicit their input, and improve this bill where we can. I look forward to continuing that conversation and building on the important groundwork we’ve laid together.