Republican ‘Reform’ Without Money Won’t| Help Indian Health, Sioux Editor Says


     PIERRE, S.D. (CN) — Republican senators from South Dakota and Wyoming say their Indian Health Service Accountability Act will help cure the nation’s ailing Indian Health Service, but a Sioux newspaper editor says it won’t work without money.
     Senators John Thune, of South Dakota, and John Barrasso, of Wyoming, say Senate Bill 2953, the Indian Health Service Accountability Act of 2016, will “promote patient-centered care and accountability at the Indian Health Service.”
     The bill would require consultation with tribes before key staff members, such as directors and hospital CEOs, could be placed in Indian Health Services hospitals, and would give the secretary of the Department of Health and Human Services direct hiring authority, to prevent lengthy vacancies for important positions.
     It also lays out a plan for dealing with “problem employees,” which could include demotion or removal from civil service.
     The editor of Lakota Country Today, however, says the problem is that Congress has never fully funded the Indian Health Service, and that Thune has consistently voted against doing so.
     H.S. 2953 is a long-delayed response to a 2010 report from the Senate Committee on Indian Affairs, “In Critical Condition: the Urgent Need to Reform the Indian Health Service’s Aberdeen Area,” known as the Dorgan Report. Sen. Byron Dorgan, D-N.D., was a three-term senator and six-term congressman, who left office weeks after delivering the report.
     The report cited a laundry list of problems at IHS hospitals, including:
     failure to remove employees for misconduct or poor performance,
     failure to address theft of narcotics,
     deficiencies so severe they put hospitals’ accreditation at risk,
     deficiencies in emergency rooms that put patients’ safety at risk,
     no system to check whether service providers’ licenses have been revoked or suspended or expired,
     lengthy vacancies in senior positions, and policies and directives that discourage staff from reporting problems to Congress.
     Most tribes were promised health care by treaties, in exchange for giving up their traditional lands. Indian Health Service hospitals have difficulty hiring and retaining medical professionals for a welter of reasons, including pay scales and remoteness of the facilities.
     More immediately, SB 2953 is a response to a series of crises in IHS hospitals over the past year, including the closure of the emergency room on the Rosebud Sioux Reservation in South Dakota due to its failure to meet standards to qualify for Medicare funding.
     Investigations also revealed problems in hospitals on the Pine Ridge Reservation in South Dakota and the Winnebago Reservation in Nebraska, although those emergency rooms remained open.
     The Indian Health Service has temporarily handed over staffing and oversight of all three troubled facilities to AB Staffing, a private firm.
     Despite privatization, the Rosebud emergency room has not reopened since it closed in December 2015, and last week the troubled hospital also closed down its surgical and obstetrics departments after a key staff member died.
     Its patients are being sent to South Dakota and Nebraska hospital 50 miles away for emergency, surgical and obstetric services.
     The IHS-run Sioux San Hospital’s emergency room in Rapid City, S.D., also narrowly avoided losing its Medicare funding this month for failing to perform proper medical screening on patients. It remains open after formulating a plan of correction that includes submitting daily status reports to the area director of IHS, keeping a pediatrician on call around the call, and training all emergency room doctors and nurses in pediatric assessment.
     Mary Smith, head of the Indian Health Service, told The Associated Press on Friday that the IHS supports SB 2953. She said the bill “addresses issues about accountability, and it addresses issues about quality. I think we share the same goals to improve all those things at IHS with the Senate.” Smith spoke to the AP before a Senate Committee on Indian Affairs hearing in Rapid City.
     The Rosebud Sioux sued the federal government and IHS in late April, blaming chronic underfunding for the crisis.
     South Dakota politicians who are demanding reform are still skirting the issue of 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,” South Dakota Republican Sen. Mike Rounds wrote in an opinion column published by the Black Hills Pioneer on Friday.
     Rounds wants IHS audited by Health and Human Services.
     “There are funding issues that are associated with all these things, but overall funding for the IHS, year-over-year since 2008, it’s up 35 percent. My sense is — and I listen and hear from tribal officials — they don’t generally raise funding as being the principle concern that they have. It has a lot more to do with accountability, transparency, effectiveness in how the funds are used,” Sen. Thune told South Dakota Public Broadcasting on May 25.
     South Dakota Republican Congresswoman Kristi Noem has submitted a similar bill in the House.
     The editor of Lakota Country Times, however, doesn’t like either bill, and said that both Thune and Noem have consistently voted against properly funding IHS hospitals.
     “I Question the Intentions of Sen. Thune and Rep. Noem,” Brandon Ecoffey, an Oglala Sioux and editor of the Lakota Country Times, wrote in June 9 letter from the editor.
     “It is well understood that the system of healthcare currently in operation across the Great Plains Region is broken and inefficient,” Ecoffey wrote. “It is also very clear that there is plenty of political maneuvering occurring as Republicans are publicly expressing support for improving healthcare in Indian Country, but are refusing to actually commit to fully funding IHS.”
     Ecoffey said that in discussions with him, tribal leaders cite lack of funding as a primary concern.
     “Although funding might have increased by 35 percent [Thune’s] statement is a bit misleading as IHS has never actually been fully funded by Congress,” Ecoffey wrote.
     “I am in no position to question the intentions of both Sen. Thune and Rep. Noem, who have both been very vocal lately about their interest in improving care in Indian Country, but I have to wonder why both have consistently shot down legislation that would provide increased funding for healthcare on South Dakota’s reservations.”
     President Obama’s proposed budget for 2017 increased funding by $13 billion across the board for Native American issues, including the Indian Health Service, but Republican lawmakers refused to give the budget a hearing.
     Both Thune and Noem are up for re-election in November.

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