The GOP spin machine is acting like Senator John Thune, Senator Mike Rounds, and Representative Kristi Noem achieved some great breakthrough by standing around in Rapid City talking about how bad the Indian Health Service is. But not one word of the Thune press release or the excerpted media coverage or the bill Thune and Rounds are pushing (S. 2953) mentions the basic and obvious problem that keeps IHS from delivering on the health care we promised to our Lakota neighbors: Thune, Rounds, and Noem‘s failure to fully fund our treaty obligations.
The Rapid City Journal doesn’t fall for the misdirection. leads its summary of the IHS field hearing by putting blame on Congress:
Federal representatives seeking suggestions for improving the Indian Health Service heard repeatedly Thursday the problems start with their bosses in Congress.
“Money talks,” said Cheyenne River Sioux Chairman Harold Frazier, who complained all the legislation is meaningless without funding the promises for better healthcare [Mike Anderson, “Tribal Members: IHS Overhaul Starts with Congress,” Rapid City Journal, 2016.06.17].
SDPB lets Thune air his gripes, then turns to a tribal health care official who says Congress has given IHS less than half the money it needs to provide quality health care:
Wehnona Stabler is a tribal health director for the Omaha Tribe of Nebraska. She says she’s operated three IHS hospitals in the past and says the issue is about funding…
“If Congress would fund our need, the way they fund other programs… And I see a lot of money going overseas to cultures that we have had wars against. They go in and they rebuild their communities, they spend beaucoup bucks. And here we are, the first American’s and we can’t get any help. We’re only funded at maybe 40 percent at our hospitals,” Stabler says [Lee Strubinger, “Tribal Officials Point to Funding, Thune Points to Accountability over IHS Woes,” SDPB Radio, 2016.06.16].
South Dakota Democratic Party exec Suzanne Jones Pranger reminds us that accountability is for Congress as much as for IHS:
While IHS leaders must be held accountable for their agency’s failures, Republicans in Congress who supported the Budget Control Act of 2011 (also known as “the sequester”) and then steadfastly refused to address IHS funding until now – including Senator Thune – should be held accountable as well. This lack of action has denied much-needed resources to tribal communities, and helped bring about the current crisis [Suzanne Jones Pranger, press release, SDDP.org, 2016.06.17].
Senator Mike Rounds explicitly rejects increasing IHS funding:
The IHS needs major reform but more taxpayer money won’t solve the dysfunction, because what IHS lacks is an efficient system and accountability. I appreciate Health and Human Services Acting Deputy Secretary Mary Wakefield’s support for an independent audit and look forward to working with her to get the answers necessary to turn the agency around. From my standpoint, investing more taxpayer money in a dysfunctional system will only compound the problem [Senator Mike Rounds, press release, Black Hills Pioneer, 2016.06.17].
…but I’m not sure how IHS fills 1,550 vacancies with qualified health care personnel or updates its aging infrastructure and equipment without more taxpayer money:
Facility staff that we interviewed told us that they have been unable to fill some ongoing vacancies due either to salaries and benefits that are not competitive with tribal health centers, other federally funded health programs, or the private sector; or to IHS’s lengthy hiring process and the remote locations of some facilities. For example, staff at a Billings area facility told us that an optometrist position that was recently filled had been vacant for 5 years because four previous offers were declined due to inadequate pay. In addition, staff at this facility said that the facility is losing its family physicians because the IHS starting salary is about a third of what the competition can offer.
…According to IHS’s 2011 Facilities Report to Congress, the average age of federally operated IHS facilities is 31 years, and fourteen of the 35 IHS hospitals and 22 of the 61 IHS health centers are older than 40 years. In contrast, the average age of private-sector hospitals is 9 to 10 years. IHS officials and facility staff told us that several IHS facilities lack sufficient physical space to increase the number of available appointments, and stated that, even if they could recruit sufficient providers, there would be insufficient physical space or equipment with which the additional staff could work. For example, staff at a Billings area facility who hired an optometrist after a 5-year vacancy told us that they were unable to request equipment for this provider until the start of the new fiscal year when additional funds would be available. In addition, staff at a Bemidji area facility told us that, even though they had an insufficient number of providers, they were unable to hire any additional providers until they completed construction on a new facility because of a lack of space in the current facility….
…According to IHS, medical and laboratory equipment, which has an average useful life of 6 years, generally is used at least twice that long in Indian health care facilities. Documents provided by a facility in the Great Plains area stated that its mammography equipment is outdated but, in order to upgrade to digital mammography equipment, the facility would need to remodel its radiology room. In addition, staff at a Billings area facility told us that they have not used their radiology equipment since 2000 because it needs to be upgraded to digital technology. Documentation from a governing board meeting in 2014 showed that another Great Plains area facility was unable to upgrade any of its technology until the building was completely rewired. In addition, IHS facility staff reported challenges in providing timely primary care because of aging or outdated telecommunication systems. For example, staff at multiple facilities reported having a limited number of telephone lines, making it difficult for patients to make appointments and for staff to make reminder calls or provide services through telemedicine. Staff at a Billings area facility stated that the facility had only three telephone lines, so if a doctor and a pharmacist were on separate calls, there would only be one line left available for patients to call for appointments. As a result, some staff reported receiving complaints from patients unable to schedule appointments. The scheduling staff at this facility told us that they used their personal cellphones to call or text patients to remind them of their appointments so they did not occupy a phone line. In addition, the CEO of this facility told us that their telephone system was so outdated that they could no longer purchase new replacement phones or parts. As a result, she said that she spends time searching the internet for replacement parts to fix their phones [U.S. Government Accountability Office, “Indian Health Service: Actions Needed to Improve Oversight of Patient Wait Times,” Report to the Committee on Indian Affairs, U.S. Senate, March 2016].
Our Republican Congressional delegation likes to portray IHS as another corrupt government program that they are whipping into shape. But you don’t hire doctors and rewire hospitals with audits. It’s hard to hold doctors, nurses, and IHS administrators accountable for using resources if Congress isn’t providing them the resources they need to provide adequate care.