The Senate Committee on Indian Affairs (SCIA) held an oversight hearing yesterday on "Re-examining the Substandard Quality of Indian Health Care in the Great Plains." Immediately following the oversight hearing, SCIA held a listening session on "Putting Patients First: Addressing Indian Country's Critical Concerns Regarding the Indian Health Service (IHS)." During the oversight hearing, there were ten U.S. Senators in attendance. The oversight hearing consisted of three panels before the SCIA designed to address all of the issues that plague the Indian health care system.

 

NIHB Board Rocky Mountain Area Representative Charles Headdress delivers remarks to the Senate Committee on Indian Affairs about the state of health at IHS

NIHB attended this hearing and participated in the listening session, calling IHS to account, but also calling on Congress to enact solutions that will ensure meaningful changes for Indian health.  You can read the whole statement of NIHB's Board of Directors Member, Charles Headdress here.

The first panel featured testimony from former Chairman of the Senate Committee on Indian Affairs, the Honorable Byron L. Dorgan (D-ND) The second panel featured testimony from Dr. Mary Wakefield, Acting Deputy Secretary at the U.S. Department of Health and Human Services (HHS); Mr. Andrew Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services; the Honorable Robert McSwain, Principal Deputy Director for the Indian Health Service; and Dr. Susan Karol, Chief Medical Officer for the Indian Health Service. The third panel featured testimony from the Honorable Victoria Kitcheyan, Treasurer for the Tribal council for the Winnebago Tribe of Nebraska; the Honorable Sonia Little Hawk-Weston, Chair for the Health and Human Services Committee of the Tribal Council of the Oglala Sioux Tribe; the Honorable William Bear Shield, Council Representative for the Rosebud Sioux Tribe; and Mr. L. Jace Killsback, Executive Health Manager for the Northern Cheyenne Tribal Board of Health.

 

Chairman John Barrasso (R-WY) declared the findings as horrifying and unacceptable, "the impacts of these deficiencies aren't theoretical. These persistent failures have led to unnecessary suffering by patients, by families, and by whole communities. In fact, they have led to multiple patient deaths." He noted that the Indian Health Service (IHS) presented a plan five years ago, and they have not seen the results from the plan.

 

The federal trust and treaty obligation to American Indians and Alaska Natives is to promote health and safety in Indian communities, while honoring Tribal sovereignty. IHS continues to be plagued by substandard medical facilities and constant problems attracting and retaining quality health professionals. Three Indian Health Service hospitals located within Great Plains area: the Winnebego Tribal reservation, the Oglala Sioux Tribe Pine Ridge reservation, and the Rose Bud Sioux Tribal reservation, have recently been found  deficient by the Center for Medicare and Medicaid Services.

In 2010, the Committee held an oversight hearing following the Dorgan Report investigation on the urgent need to reform IHS. The Dorgan Report found evidence on the lack of quality of care in the Great Plains area. Some issues have become worse over time and new issues have developed. The oversight hearing yesterday consisted of three priority issues: the quality of patient services in Indian Country; funding for IHS; and the recruitment and retention of medical personnel at IHS hospitals and clinics.

 

Charles Headdress, Rocky Mountain Region representative to the National Indian Health Board's Board of Directors stated, "there have been reports from other IHS Service Areas of patient misdiagnosis and subsequent death, lack of competent providers, and IHS' continued failure to provide safe and reliable healthcare for our people." Everyone in the listening session continuously emphasized that these are not new problems, they are not stories that haven't been heard before, and something needs to be done now because it is getting worse.

 

The Honorable Victoria Kitcheyan, Tribal Councilwoman of the Winnebago Tribe of Nebraska stated, "For decades and generations, IHS has had a notorious reputation in Indian Country, but it is all we have. It is all we have to count on.  We don't go there because they have superior health care.  We go there because it is our treaty right.  And we go there because many of us lack the resources to go elsewhere. We're literally are at the mercy of IHS." These conditions are not just representative of this Tribe, but these issues plague all of Indian Country. Ms. Kitcheyan continued, "It's been said in my community that the Winnebago Hospital is the only place you can legally kill an Indian. It is 2016 and our people are still suffering at the hands of the federal government.  Kill the Indian, save the IHS sounds appropriate."

Senator Heidi Heitkamp (D-ND) noted that it is not only the quality of care, but the access to care. More services need to be accessible for Tribes, financially and geographically. She discussed how the United States made a "sacred vow" when they signed treaties and every treaty shows that they are failing (to meet their treaty obligations).

 

One suggestion offered by several of the Tribal leaders present was that Tribal leadership should have voting positions on hospital governing boards.  It was reported yesterday, that Tribal leaders only service as ex officio members and the voting members typically consist of IHS area staff.  Tribal leaders also reported that they found out about deficiencies or key decisions affecting hospitals on their reservations after decisions had already been made. 

 

Annual funding per Indian patient has been running at a level of about $3,600 or less than half that per capita for Americans. Senator Heitkamp noted that the average Medicare spending per beneficiary is almost $12,000 per year, $7,000 in the Veterans Administration, $5,600 in Medicaid, and only $3,000 on Indian health care.   Speaking for NIHB, Mr. Headdress said, "We understand that federal budgets are tight, but the treaties that we signed are not discretionary and should not be held hostage to unrelated political battles in Washington.  NIHB and Tribes have consistently asked for budgets each year that would bring IHS up to the same status as other American health facilities.  Right now, this is $30 billion.  To begin a phase in of this amount over 12 years, we are requesting $6.2 billion for IHS in FY 2017."

 

Senator Tester (D-MT) recognized that despite the small increase in funding streams, funding is a challenge. He went on to note that when similar situations occurred in the Veterans Administration healthcare system, Congress altered the law to make sure that Veterans were receiving healthcare that they were promised.  However, American Indians and Alaska Natives are still waiting. Former Sen. Byron Dorgan (D-ND), who led the 2010 investigation said that the Indian health service is extremely underfunded by about half. The Dorgan report estimated that the health service budget for the Great Plains region was $293 million. In the FY 2015, it has increased by 14 percent over five years to approximately $362.8 million.

 

Jerilyn Church, Executive Director, Great Plains Tribal Chairmen's Health Board cited that the problem is the structure in which the federal government funds IHS, "Fund Indian Health Service at the level of need..." she said.   "I am not talking about throwing money at a broken system.  I am talking about funding systematic change from the top down. Congress is just as culpable as the person that was in the service unit that didn't respond in a way that was appropriate... Fund the region so that we can have systematic change and that we can expect and have care at a level that our region deserves."

 

During his testimony, Jace Killsback noted: "IHS is a broke system, and a broken system. Constantly having to deal with rescissions and budget cuts and never being able to fully recover from sequestration.  Tribes constantly ask for advance appropriations and to have our funds protected from the discretionary title.  We have an entitlement to these funds."

 

Ms. Church also stressed the need to put the investment into IHS, "Congress needs to be willing to put that investment into [IHS].  It is not asking too much.  We make up 2% of the entire population of this country.  We are the genocide survivors.  It is not a big ask for this country to fund schools, health, our judicial systems at a level that allows us to live functional healthy lives."

 

Chairman John Barrasso (R-WY), a trained physician and surgeon stated: "In my view the information provided to this committee and witnessed first-hand can be summed up in one word: malpractice." IHS reported to the Committee that the Great Plains area currently has over 250 vacancies for health care professionals and a physician vacancy rate of 37 percent. Medical staff corruption and criminal behavior has continue to be overlooked. IHS stated that the often the rural remoteness has posed special challenges for the IHS when it comes to recruiting medical professionals.  Ms. Church agreed: "I want people to be held accountable that need to be held to be held accountable, " she said.

 

Senator Tom Udall (D-NM) stated that the topics discussed were not new and staffing issues is becoming synonymous with IHS.  Ms. Kitcheyan discussed the personnel issue as well, by stating "The hospital is supposed to be a place of healing, but our people are leaving in worse condition or not at all...Since 2007, there have been documented deficiencies at the Winnebago Hospital.  My community believes that it is the dumping ground for poor administrators and unskilled providers."

 

IHS says they are working on transparency, leadership, accountability and resources. The Department of Health and Human Services has created an Executive Council on Quality Care and are focused on trying to implement that in several ways.  The agency wants to raise incentives such as salary, loan forgiveness and scholarships. Chairman Barrasso (R-WY) noted that there also needs to be jobs for spouses and good schools for children, or it will always be hard to have retention.

 

The National Indian Health Board (NIHB) passed a motion at the end of January that would call for our organization to form a special task force investigate the situation at IHS facilities across Indian Country, and embark on a path towards finding real, sustainable change at the IHS. NIHB will be conducting listening sessions with Tribal leaders, patients and medical professionals to determine new policy steps for IHS to achieve sustainable, long-term solutions.  "We are tired of treating symptoms, and must work to find changes that can positively impact Tribes across the nation," Mr. Headdress said.