Treating the IHS crisis

Late into the evening on July 22, 2015, a young woman arrived in the Emergency Room of the Indian Health Service hospital in Rosebud. She was having contractions -- each about two and a half minutes apart. The baby was coming. Still, nursing staf...


Late into the evening on July 22, 2015, a young woman arrived in the Emergency Room of the Indian Health Service hospital in Rosebud. She was having contractions - each about two and a half minutes apart. The baby was coming. Still, nursing staff allowed the young woman to leave and use the restroom. Minutes later, her boyfriend started yelling from the bathroom. He needed a doctor. The baby had been born on the floor.

The infant was not initially breathing. His color was "dusky." Once a nurse entered the bathroom, the baby was scooped up and run into a nearby room where they were able to start his breathing. It's a horrifying story, as told in a recent government review of the hospital. What's more - it's happened before.

I've heard stories like this over and over again from tribal members I've met with. For years, federal reports have documented shocking cases of mismanagement and poorly delivered care. There have been instances where medical staff saw patients while intoxicated, evidence of Indian Health Service (or IHS) employees stealing thousands of narcotics from the hospital pharmacy, and a time when a man known to have tuberculosis, which is highly contagious, was allowed to interact unsupervised with other patients.

IHS was left to make improvements on its own. They were given funding increases almost every year and yet, the agency produced increasingly poor care to South Dakota's tribal communities. Enough is enough.

This month, I led a bipartisan group of lawmakers in introducing comprehensive reform legislation. The Helping Ensure Accountability, Leadership, and Transparency in Tribal Healthcare Act (which we call the HEALTTH ACT) offers critical structural changes to how IHS operates, addressing both medical and administrative challenges.


Currently, IHS is empowered to make choices about hospital contracts without input from the tribes it serves or independent healthcare experts. My bill would change that and allow for a partnership among these three groups to better ensure contracts are designed to serve those they're intended to help.

I've also taken on the Purchased/Referred Care Program, which is the program that pays for care tribal members can't receive directly at an IHS hospital or clinic. To protect taxpayers, this program has limited funds. But the money is distributed according to an outdated formula that doesn't consider things like geography or population, leaving some areas with surpluses while others are unable to pay the bills. Through my legislation, we require IHS to make changes so the formula is based on factors that impact access to care, finally matching support with need. Additionally, because IHS currently pays a premium for these outside services, I've included provisions to help drive down prices and stretch every Purchased/Referred Care dollar further.

It's also been an incredible challenge to recruit competent medical staff and hospital leadership. These hospitals are typically in remote areas and the incentives to move there just haven't been offered. My legislation tries to make hiring a bit easier, while also giving additional help to medical professionals and administrators for things like paying back their student loans.

Critical accountability requirements are also included to make sure we can better monitor what is happening at IHS facilities in crisis.

The government is required by treaty to provide healthcare to tribal communities, but IHS has failed to uphold that duty. As it stands today, the Emergency Department at Rosebud is shut down until it can be made safe enough to see patients again. IHS facilities in Pine Ridge, Rosebud and Rapid City are in jeopardy as well. Lives have been lost because of what's happening. Big adjustments urgently need to be made, but I'm committed to working together on agency-level changes and my legislative reforms to ensure tribal members finally receive the care their families need

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