Senator Mike Rounds, who sure as heck wouldn’t have wanted an audit of his EB-5 program and Future Fund grants when he was Governor, says he wants an audit of Indian Health Service. Rep. Kristi Noem says she’s going to “war” with IHS to solve the “crisis” she says “my tribes” are in. Rep. Noem also says she “did not realize until this came up in the last 8 to 10 months how bad it was.”
Last 8 to 10 months? asks Rep. Paula Hawks, Noem’s challenger in the race for South Dakota’s lone U.S. House seat, who apparently spends more time reading than our current Congresswoman:
Within weeks of Kristi Noem taking office, the United States Committee on Indian Affairs released a comprehensive study called “In Critical Condition: The Urgent Need to Reform the Indian Health Service’s Aberdeen Area” which visited three Aberdeen-area hospitals, interviewed over 200 individuals and analyzed over 140,000 documents related to the deficient care at Aberdeen-area Indian Health Service hospitals.
Senator Byron Dorgan said the report was commissioned after he and “his team had heard for years about poor health-care services and mismanagement of IHS facilities in the Aberdeen area.”
“It begs the question: where did the breakdown in communication occur? The warning signs were clear. They were entered into the congressional record. How could her office miss a report detailing a life and death emergency affecting over 10% of South Dakota’s population for six years? It shouldn’t take an emergency room closing and people dying for our congressional leadership to act,” said Hawks [Hawks for House, campaign press release, 2016.07.06].
The December 2010 report cited by Hawks offers these findings:
- Over the course of the last ten years, IHS repeatedly used transfers, reassignments, details, or lengthy administrative leave to deal with employees who had a record of misconduct or poor performance.
- There were higher numbers of Equal Employee Opportunity (EEO) complaints in the Aberdeen Area in comparison to the entire IHS, as well as insufficient numbers of EEO counselors and mediators.
- Three service units have a history of missing or stolen narcotics and nearly all facilities failed to provide evidence of performing consistent monthly pharmaceutical audits of narcotics and other controlled substances.
- Three service units experienced substantial and recurring diversions or reduced health care services from 2007 to 2010, which negatively impacts patients and quickly diminishes limited Contract Health Service (CHS) funding.
- Mismanagement of CHS program funding has resulted in some facilities having funding surpluses and the transfer of dollars to likely non-CHS programs.
- Five IHS hospitals are at risk of losing their accreditation or certification from the Centers for Medicare and Medicaid Services (CMS) or other deeming entities. Several Aberdeen Area facilities were cited as having providers with licensure and credentialing problems, Emergency Medical Treatment and Active Labor Act (EMTALA) violations, emergency department deficiencies or other conditions that could place a patient‟s safety at risk.
- IHS lacks an adequate system to detect instances of IHS health care providers whose licenses have been revoked, suspended or under other disciplinary actions by licensing boards.
- IHS health care providers treating patients with expired state licenses and/or other certifications on numerous occasions, which violates federal regulations and internal IHS policies.
- Particular health facilities continue to have significant backlogs in posting, billing and collecting claims from third party insurers (i.e., Medicare, Medicaid and private insurers). One facility repeatedly transferred its third party payments to other facilities in the Aberdeen Area.
- There were lengthy periods of senior staff vacancies in the Clinical Director and Chief Executive Officer positions, resulting in inconsistent management and leadership at Aberdeen Area facilities.
- The use of contract providers (locum tenens) is costly ($17.2 million in the last three years). While the overall cost of contract providers has decreased in comparison to last year, two facilities have increased their locum tenens expenses this year.
- IHS policies and directives discourage employees from communicating with Congress [Sen. Byron Dorgan, “In Critical Condition: The Urgent Need to Reform the Indian Health Service’s Aberdeen Area,” report to Senate Committee on Indian Affairs, 2010.12.28, pp. 5–6].
The problems at IHS were on the record before Rep. Noem took office five and a half years ago. She has throttled IHS’s budget throughout her tenure in Washington, starting right off in 2011 with a vote to cut IHS by $220 million.
Paula Hawks has evidently read the 2010 report on IHS. Unlike Noem, Hawks won’t wait for her third re-election bid to suggest doing something to bring better health care to out Indian neighbors.