Indian Health Service remains on defensive as troubles continue

Rep. Kristi Noem (R-South Dakota) speaks about H.R.5406, the Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act (HEALTTH Act), at a hearing before the House Subcommittee on Indian, Insular and Alaska Native Affairs on July 12, 2016. Photo from Rep. Kristi Noem / Twitter

The new leader of the Indian Health Service continues to face fire as tribes and lawmakers question whether progress is being made in the troubled Great Plains Area.

Mary Smith, a member of the Cherokee Nation, has made the region a priority since taking control of the agency in March. She met with tribes at the Great Plains regional office and has traveled to reservations in the area, including all of the three that have been affected by cutbacks in service.

Yet Smith's focus has been undercut by decisions that tribal leaders and members of Congress say could have been entirely avoidable. She just appointed a new chief medical officer for the region even though that official made negative comments about the treatment of pregnant women and their newborns at the Rosebud Hospital in South Dakota.

"No tribal leaders were consulted. Rosebud certainly was not," William Bear Shield, a council member for the Rosebud Sioux Tribe, told the House Subcommittee on Indian, Insular and Alaska Native Affairs at a hearing on Tuesday.

"That official clearly has disdain for our people and should work elsewhere," Bear Shield added.

Indianz.Com SoundCloud: House Subcommittee on Indian, Insular and Alaska Native Affairs July, 12 2016

The official wasn't mentioned by name but it was clear it was Susan V. Karol, a member of the Tuscarora Nation. She had to apologize during an appearance before the Senate Committee on Indian Affairs Committee in February for making light about the circumstances in which two infants were born without any medical assistance on the floor of the Rosebud Hospital.

"Those comments [were] totally unacceptable," Karol said at the time. "I really am sorry I made any reference to negativity in patient care."

That apology was more than enough for Smith, who defended her decision to send Karol to the Great Plains about a month ago. She said the region lacked a medical officer and the position needed to be filled even if it was by someone with baggage.

"I certainly agree that our tribal patients and partners need to have respect and rapport with medical staff at each of our facilities," Smith said.

In another decision, Smith touted the hiring of an outside contractor to run the emergency rooms at the Rosebud Hospital, the Pine Ridge Hospital and the Omaha Winnebago Hospital. Yet that same company, AB Staffing Solutions, has contributed to deficiencies at those facilities in the past, tribal leaders said.

"So we're recycling this problem again," Vernon Miller, the chairman of the for the Omaha Tribe of Nebraska, told the House subcommittee.

The Centers for Medicaid and Medicare Service took the extreme step of terminating certification to the Omaha Winnebago Hospital in July 2015. Miller said the presence of AB Staffing, an Arizona-based company that was not represented at the hearing, does not bode well for efforts to bring the facility back into compliance.

"I would not be surprised if CMS came in and found those same issues that existed a year ago when that certification was taken," Miller testified.

Those kinds of recurring issues prompted Rep. Kristi Noem (R-South Dakota) to introduce H.R.5406, the Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act (HEALTTH Act). Her bill would ensure that tribes are consulted about decisions that affect their communities. It also includes provisions to address employee recruitment, hiring and discipline policies.

"The Indian Health Service is beyond broken," Noem said at the hearing. "Fixing it is literally a matter of life and death. Nowhere is this truer than in the Great Plains region."

Noem's bill has bipartisan support and the Obama administration has expressed a willingness to work with Congress on reform efforts. But even those sentiments have been called in question -- Smith had to offer an apology of her own because the IHS didn't provide a copy of its testimony for the hearing until late on Monday night.

And Rep. Don Young (R-Alaska), the chairman of the subcommittee, complained that the document was nearly identical to testimony that was presented at a field hearing in South Dakota last month.

"I'm just saying that's a no-no," Young said.

The two documents indeed contain numerous similarities even though Noem's bill is substantially different from S.2953, the IHS Accountability Act, the bill that was the subject of last month's Senate hearing.

H.R.5406 and S.2953 represent the first attempts to bring comprehensive reform to the IHS. With the exception of the Indian Health Care Improvement Act, which was made permanent through the Affordable Care Act in 2010, Congress hasn't taken on such a big endeavor.

"I want to move this legislation," said Young, who thanked Smith for her dedication to the Great Plains.

The hearing went into recess for a series of votes on the House floor related to H.R.5538, the fiscal year 2017 Interior appropriations bill. It was nearly derailed when the U.S. Capitol was placed on a brief lock-down due to a shooting incident nearby.

The lock-down nearly prevented Jerilyn Church of the Great Plains Tribal Chairmen’s Health Board from returning to the committee room in time for the remainder of the hearing. But she was still able to present her testimony.

House Subcommittee on Indian, Insular and Alaska Native Affairs Notice:
Legislative Hearing on the "HEALTTH Act" (July 12, 2016)

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