John Thune: Tribal citizens suffer at hands of Indian Health Service

Sen. John Thune (R-South Dakota), second from right, is seen here meeting with leaders of the Rosebud Sioux Tribe in February 2016. Photo from Facebook

The following is the text of remarks delivered by Sen. John Thune (R-South Dakota) on the Senate floor on April 26, 2016. He discussed the need to hold the Indian Health Service accountable for the substandard level of care in the Great Plains Area, a region that includes South Dakota.

Mr. President, for years now, patients on Indian reservations in the Great Plains area have been receiving substandard medical care.

The most recent example of the Indian Health Service's failure occurred in December of 2015, when I was notified that two federally operated Indian Health Service facilities in my State were at risk of losing their Medicare provider agreements. In other words, these two facilities have been delivering such a poor level of care, the government isn't sure it is willing to continue paying these facilities to care for Medicare patients.

In February, at the request of several Senators, myself included, the Senate Committee on Indian Affairs held a hearing to address the state of patient care at the Indian Health Service in the Great Plains area. Thanks to the graciousness of our colleague from Wyoming, Senator Barrasso, who chairs the Indian Affairs Committee, I was able to participate in this hearing and question several Indian Health Service officials. I wish I could report that this hearing reassured me that the Indian Health Service is on track to solve the problems facing patients on the reservations, but it just left me more concerned. The hearing underscored the government's massive failure on this issue: its failure to deliver quality care, its failure to ensure patient safety, and its failure to live up to treaty responsibilities.

I have read the reports from the Centers for Medicare and Medicaid Services, and some of the stories really are beyond comprehension. Incredibly, a report of dirty, unsanitized medical equipment left exposed in an emergency room isn't even the most shocking of those stories.

One patient who had suffered a severe head injury was discharged from the hospital mere hours after checking in, only to be called back later the same day when his test results arrived. The patient's condition was so serious that he was immediately flown to another facility for care.

YouTube: Sen. John Thune (R-South Dakota): We Will Hold The Indian Health Service Accountable

One health service facility was in such disarray that a pregnant mother gave birth on a bathroom floor--a bathroom floor--without a single medical professional nearby, which shockingly wasn't the first time this had happened at this facility.

I wish I were able to stand here today and report that conditions are getting better. Unfortunately, I cannot. Since February's hearing, we have been made aware of another tragic event that occurred at Pine Ridge Hospital. Reports from the Centers for Medicare and Medicaid Services indicate that a 23-year-old patient complaining of nausea and cramping in his hands and lower extremities died from cardiac arrest 2 hours after he was discharged from the emergency department. An investigation conducted by CMS verified that this young man failed to receive an adequate medical screening evaluation before his discharge. Even worse, the report indicated that there was no documentation showing nurse and doctor communication.

It hasn't helped that Congress's attempts to address these problems have been hampered by less-than-honest reporting from the Indian Health Service. Time and again, we have found that conditions on the ground have not matched up to information reported to Congress.

In 2014, I requested a status update from the then-Acting Director of the Indian Health Service. In her response, she stated that ``the Great Plains Area has shown marked improvement in all categories'' and that ``significant improvements in health care delivery and program accountability have also been demonstrated.''

Significant improvements? Sending a man home with bleeding in his brain and having a mother give birth prematurely on a bathroom floor are not signs of significant improvements.

The Pine Ridge Hospital on the Pine Ridge Reservation in South Dakota. Photo from Dean Kurtz Construction

On December 4, 2015, officials from the Indian Health Service stated that a majority of the concerns at Rosebud Hospital had been addressed or abated. Yet, mere hours later, I was informed that the Rosebud Hospital emergency department was functioning so poorly that emergency patients would be diverted to other hospitals beginning the next day. It has now been 143 days, and the Indian Health Service leadership has been unable to reopen the Rosebud Hospital's emergency department.

For the last 143 days, incoming emergency patients have had to travel between 44 and 55 miles to receive care. That is similar to requiring a resident of Harpers Ferry, WV, to travel to Washington, DC, to receive emergency services. And to date, the Indian Health Service has been unable to tell us when it anticipates emergency department services will resume.

The Rosebud Sioux Tribe informs me that since this emergency department has been on diverted status, six individuals have lost their lives in ambulances while being transported to a hospital farther away. Six families are now left to wonder whether their loved ones could have been saved if the Indian Health Service had been doing its job. This is unconscionable.

The Indian Health Service has one last chance this Friday to reach an agreement with CMS to set the Rosebud Hospital back on a path to compliance with basic safety and administrative requirements. If the Indian Health Service fails to do so, Rosebud will lose its status as a Medicare provider.

Additionally, the Indian Health Service has until Friday to address Emergency Medical Treatment and Active Labor Act violations found at Pine Ridge Hospital.

The Rosebud Hospital is located on the Rosebud Sioux Reservation in South Dakota. Photo by Crystal R. Leighton via Facebook

The administration has drafted report after report promising to correct these issues, yet time and again it has failed to follow through. During the recent Indian Affairs Committee hearing, the former Principal Deputy Director of the Indian Health Service could not remember that he was in charge of implementing a 2011 report. Where is the accountability? Who is in charge? We have got to do better.

Simply shifting staff between positions and offices, as the Indian Health Service has done in response to these problems, is not enough. It is time for action. We must do everything within our power--we will do everything within our power--to hold the Indian Health Service accountable and to make sure this never happens again.

I continue to work with my colleagues in the Senate on a path forward to demand accountability from an agency that, by all accounts, is disconnected and unresponsive to the needs of our Native Americans.

I will also continue to consult with the nine tribes in South Dakota. Our tribes are in the best position to help figure out the path forward for their own health care, and I believe the Indian Health Service must do a better job of consulting with our tribes when it comes to the care they receive.

I am going to do everything I can within my power to get all of our tribal citizens the quality care they deserve.

Mr. President, I yield the floor.

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

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