‘Where you can legally kill an Indian’: Winnebago Treasurer on IHS Hospitals

Courtesy Office of Kristi Noem/ Rep. Kristi Noem, R-S.D., testifies before a House Natural Resources subcommittee on legislation to revamp the Indian Health Service.

People are dying.

That’s the message tribal leaders took to Congress one more time as a House subcommittee heard testimony on proposed legislation to improve the Indian Health Service.

Babies born on bathroom floors, stolen narcotics, surgical instruments washed by hand, nurses who cannot operate a crash cart or start a dopamine drip, unlicensed medical personnel, funds unaccounted for—the list of egregious violations of the Hippocratic oath, not to mention the law, at IHS facilities is long.

Some of these complaints go back to the 2010 Senate report on conditions at Aberdeen (now Great Plains) Area IHS hospitals, “In Critical Condition,” but many were documented well before that. And they continue, leading to the closure of the Rosebud Hospital emergency department in December after the Centers for Medicare and Medicaid Services (CMS) determined that conditions were so bad that they would no longer reimburse for services provided there.

Tribal leaders have taken these issues to Congress before. Even after years of testimony, leaders are describing the same conditions, and so far finding the same lack of effective response.

Not that there isn’t expertise in the room. Rep. Raul Ruiz, D-Calif., ranking member on the House Natural Resources Committee’s Subcommittee on Alaska Native and Indian Affairs, was an emergency room physician before he was elected to the House in 2012. He founded the Coachella Valley Healthcare Initiative in 2010. Rep. Dan Benishek, R-Mich., is an M.D. whose House website refers to him as “Dr. Dan.” He has worked part-time treating patients at the Oscar G. Johnson VA Medical Center for the last 20 years and now serves on the House Veterans Affairs Committee. Rep. Paul Gosar, R-Ariz., is a dentist from Flagstaff. Rep. Norma Torres, D-Calif., was instrumental in implementing the Affordable Care Act in California, according to her website.

Courtesy House Committee on Natural Resources/ Rep. Don Young, R-Alaska, chairman of the House Natural Resources Committee’s Subcommittee on Alaska Native and Indian Affairs, and Rep. Raul Ruiz, D-Calif., the subcommittee’s ranking member, listen to testimony at the July 12 hearing.

But that expertise, with a few exceptions, did not seem to extend to health care for Native Americans.

Benishek said he was “not aware of the severity of the problem. So this hospital [Rosebud] is run by the IHS? Is that the story?” He said he had not known that the federal government operated any hospitals outside of the VA. Gosar urged tribes to be more forceful in insisting that IHS answer to them until Rep. Kristi Noem, R-S.D., who authored the legislation under consideration, pointed out that lack of tribal consultation on the part of IHS was one of the fundamental issues.

William Bear Shield, Rosebud Sioux Tribe council member and chairman of the tribe’s health board, bluntly stated a fundamental issue: “Listening to the committee questions, there needs to be some education.”

And sensitivity. Susan V. Karol, Tuscarora Nation, who, according to Sen. John Barrasso, R-Wyo., said of babies being born without physician assistance at an IHS facility in South Dakota, “If you’ve only had two babies hit the floor in eight years that’s pretty good,” was just made Chief Medical Officer for the Great Plains Area.

Mary Smith, principal deputy director of IHS, parried many questions during the hearing by noting that she had been on the job for only a few months.

But the decision to make Karol CMO for the Great Plains Area was made on Smith’s watch. Asked by Noem to explain, Smith said, “I think the person in question [Karol] has publicly apologized. I know that she is committed to caring for the patients… there was no chief medical officer in the Great Plains and there was no full-time person and as I’ve said at this hearing, we have very serious recruitment and retention problems… I thought it was important to have a full-time chief medical officer there, so that was the basis of the thinking for that.” Karol did in fact apologize for the comment at a Senate Committee on Indian Affairs hearing in February on substandard care at IHS facilities in the Great Plains Area.

In an email to ICTMN, Noem said of Smith’s decision to appoint Karol to the CMO position: “Especially in a time of crisis, it’s important we have a Chief Medical Officer in place in the Great Plains region, but the comments that have been made are indicative of an IHS culture that needs to change. That is one of many reasons why my legislation includes cultural sensitivity training. We must ensure the people who are serving tribal communities respect tribal communities and their way of life.”

On July 14, CMS announced that after seven months, with five babies born in ambulances en route to hospitals 50 miles away and the deaths of nine people being transported to other facilities, the Rosebud emergency department was set to reopen July 15.

Bear Shield has called for an independent investigation of the deaths at the Rosebud facility. Victoria Kitcheyan, treasurer of the Winnebago Tribe of Nebraska, testified about conditions at the Winnebago Hospital, where her aunt and others died under poorly documented circumstances with no follow-up investigations.

“We’ll never know how many people died unnecessarily. We’ll never know how many people were misdiagnosed.” Until systematic changes are made within IHS, she said, “Winnebago Hospital will continue to be the only place where you can legally kill an Indian.”

Courtesy House Committee on Natural Resources/ Victoria Kitcheyan, treasurer of the Winnebago Tribe of Nebraska, talks about conditions at the Winnebago Hospital.

The Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare (HEALTTH) Act was introduced in June. A similar bill, the IHS Accountability Act of 2016, was introduced in the Senate in May. The bill was authored by Senate Committee on Indian Affairs Chairman John Barrasso, R-Wyo., who is also a doctor. An oversight/legislative field hearing on the legislation was held in June.

Noem has said her office and Barrasso’s staff are working to align the two pieces of legislation in hopes of being able to send legislation to President Barack Obama’s desk for his signature in the near future.

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