A sign at the Santa Fe Indian Hospital in Santa Fe, New Mexico. Photo by Adam Archuleta / Facebook

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Indian Health Service faulted for lengthy waits in patient care

Friday, April 29, 2016

The Indian Health Service has no way of knowing how long patients must wait to secure appointments or complete visits, the Government Accountability Office said in a report on Thursday.

The agency does not require facilities in the system to track access times, the report said. But even those that want to measure patient times can't do so due to an inadequate electronic records system, according to the GAO.

Despite the lack of data, investigators uncovered lengthy wait times in visits to hospitals throughout the country. At one facility on the Navajo Nation, staff said it can take three to four months for a new patient to get an appointment with an internal medicine specialist and two to three months for internal medicine.

The delays are attributed to lack of physicians, dentists, nurses, pharmacists, physician assistants, and nurse practitioners throughout the IHS. According to the report, over 1,550 such positions are vacant and 20 percent of physician positions are vacant.

Aging infrastructure and equipment also contribute to long waits, the GAO said. IHS facilities, on average, are much older than those in the private sector and medical and laboratory equipment are long past their useful lifespans, according to the report.

"American Indians and Alaska Natives continue to die at higher rates than other Americans from many causes, including preventable diseases— such as cirrhosis of the liver and lower respiratory infections—that can be mitigated through access to timely primary care services," the GAO wrote. "Based on our past work, patient wait times have historically been a problem for some IHS facilities—particularly those located in poor, rural areas—but staffing vacancies and aging infrastructure and equipment have created obstacles for facilities working to provide timely primary care."

Some of the key findings from the Government Accountability Office report, INDIAN HEALTH SERVICE: Actions Needed to Improve Oversight of Patient Wait Times

The report comes as the IHS faces critical deadlines to improve the quality of care in the Great Plains Area. The Centers for Medicaid and Medicare Service has threatened to withdraw certification for the Rosebud Service Unit and the Pine Ridge Service Unit, both in South Dakota.

To avoid a cut-off, the IHS is planning to enter into agreements to let outside companies manage the emergency rooms at both facilities, KOTA reported, citing comments from John Yellow Bird Steele, the president of the Oglala Sioux Tribe.

"What we came up with is by April 29 Indian Health Service will sign an agreement with Medicare and Medicaid,” Steele told KOTA. “And they're going to contract out both the management and the personnel of our emergency department here.”

IHS officials told Brian Dillon, a council member for the Rosebud Sioux Tribe, that more than 10 groups responded to the contract request, The Sioux Falls Argus Leader reported.

The emergency room at the Rosebud Hospital was shut down in December and the tribe filed a lawsuit on Thursday to have it reopened. Six people have died and two babies have been born in transit to area hospitals since the diversion.

"IHS' actions in placing the Rosebud Hospital's emergency services on divert status have caused and continue to cause the tribe and its members immediate and irreparable injury," the complaint states.

The contract request also applies to the emergency room at the Winnebago Service Unit in Nebraska. The facility serves the Omaha Tribe and the Winnebago Tribe.

The hospital there lost CMS certification last summer, a major blow that limits the services that the IHS can provide. In comparison, William Bear Shield, the chairman of the Rosebud Health Board, said the hospital there billed about $15 million to Medicare and Medicaid last year.

"We can't afford to lose that," Bear Shield told The Argus Leader.

Get the Story:
GAO: Health care access hard to measure for Native Americans (AP 4/28)
South Dakota tribe sues feds over ER closure (AP 4/28)
IHS to surrender emergency room management, tribal leader says (KOTA 4/27)
Agreement on IHS hospital could hinge on privatization (The Sioux Falls Argus Leader 4/27)

Government Accountability Office Report:
INDIAN HEALTH SERVICE: Actions Needed to Improve Oversight of Patient Wait Times (April 29, 2016)

Senate Committee on Indian Affairs Report:
In Critical Condition: The urgent need to reform the Indian Health Service’s Aberdeen Area (December 2010)