Wednesday, October 6, 2010

Where IHS funding goes...

Alleged misconduct puts IHS officials in hot seat
Senate panel grills leaders on Aberdeen office's problems

LEDYARD KING • Argus Leader Washington Bureau • September 29, 2010

WASHINGTON - Senators lambasted Indian Health Service officials Tuesday after investigators found that some workers in the federal agency had criminal records, stole drugs and embezzled money - all while patients endured long lines for medical services or were turned away.

Government inspectors have opened almost 300 investigations into IHS during the past decade for alleged violations including fraud, theft and employee misconduct, according to the inspector general of the U.S. Department of Health and Human Services.

At the same time, IHS supervisors often put disciplined employees on paid administrative leave, allowing them to stay at home and collect their salary for months.

Tuesday's hearing by the Senate Indian Affairs Committee focused on IHS' Aberdeen office, which includes 48 medical facilities in South Dakota, North Dakota, Iowa and Nebraska.

Committee Chairman Byron Dorgan, D-N.D., said his staff found numerous examples of mismanagement that contributed to a reduction or elimination of inpatient services at some Indian health sites. From 2007 to this year, there were 385 days at the IHS hospital in Rapid City and 244 days at the hospital in Eagle Butte on the Cheyenne River reservation when patient services were either reduced or unavailable. And while the Standing Rock Sioux reservation, which straddles North and South Dakota, was experiencing a spate of suicides, the mental health counseling position went vacant for months.

"This is a mess, and a big problem and a big bureaucracy that doesn't want to change," Dorgan told IHS Director Yvette Roubideaux. "It wants to not deal with problems. It wants to ship them to the next reservation, the next service unit. That's got to stop. That's got to stop now."

Health care is a chronic problem for Native Americans, particularly those on large, rural reservations where treatment options are scarce. As a result, Indians generally have a lower life expectancy and higher rates of diabetes, tuberculosis, alcoholism and suicide than other ethnic groups, according to federal data.

A series of Argus Leader stories in December revealed widespread frustration with reservation health care in the state. The reports pointed to insufficient funding, rationed care, difficulty hiring health care providers, millions of dollars in lost or stolen IHS property, and federal rules that keep ineffective leaders on the job.

Besides being underfunded and suffering from poor management, tribal leaders and many lawmakers say IHS, which serves 1.9 million Native Americans and Alaskan Natives, has been corrupt.

Investigators' revelations added to the agency's troubled record. Looking at the Aberdeen office, they found:
· Two employees on the payroll despite earlier convictions - one for drug theft, the other for embezzlement - that should have made them ineligible for IHS employment.
· Lax monitoring of pharmaceutical drug storage that allowed a Sioux San Hospital pharmacy technician in Rapid City to steal large quantities of narcotics in 2008.
· IHS employees tampering with medical records to defraud the government in 2005.
Federal "investigations have resulted in numerous criminal convictions relating to employee misconduct," said Gerald Roy, Health and Human Services deputy inspector general for investigations.

In addition, Dorgan was unhappy that Aberdeen's deputy director has been on paid leave for a year while her conduct is being investigated. And he pointed to a jump in employee complaints about the way management is running the agency as a sign that much needs to be improved.

Roubideaux acknowledged "severe challenges" but said her agency is starting to turn a corner and that the increase in employee complaints is proof that workers are finally - reluctantly, in some cases - being challenged to improve.

Roubideaux, an enrolled Rosebud Sioux tribal member, was appointed as IHS director last year by President Obama. She said she's trying to instill a new culture in the beleaguered agency, making employees more accountable, firing bad managers and keeping better track of lost equipment, the subject of a recent congressional probe. With the help of the Aberdeen regional director Charlene Red Thunder, five middle managers were forced out because of poor performance, she told the committee.

Problems remain, such as a lack of money for transportation to hospitals and the uneven way money is distributed to local health care agencies, said Ron His Horse Is Thunder, the former Standing Rock chairman who now is the executive director of the Aberdeen Area Tribal Chairman's Health Board.

But he congratulated Red Thunder for working with tribes on medical needs.
South Dakota Democratic Sen. Tim Johnson, a member of the Indian Affairs Committee, said he often hears about problems with IHS, which was created to fulfill the government's obligation to provide health care for Native Americans.

"It is critical to focus on moving forward and seeking a positive solution to solve these problems," he said. "We must do all that we can to uphold our treaty and trust responsibilities to American Indians."

Contact Ledyard King at