Indian Health Service Effort to Protect Patients From Abuse Needs Work, Report Says

The Northern Navajo Medical Center in Shiprock, N.M. The Indian Health Service, which runs the center, has been criticized for not doing enough to prevent patient abuse.

The Northern Navajo Medical Center in Shiprock, N.M. The Indian Health Service, which runs the center, has been criticized for not doing enough to prevent patient abuse. (Adria Malcolm for The Wall Street Journal)

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December 20, 2019

The U.S. Indian Health Service’s latest effort to protect patients from abuse falls short, federal inspectors said in a report Friday, despite a rush to overhaul policies this year following a sex-abuse scandal.

The new policies are too narrow and haven’t been implemented at some facilities, according to the Office of Inspector General for the Department of Health and Human Services, which oversees the health care agency. Obstacles remain, including fear among some IHS workers that they will be punished for reporting abuse and confusion over who is responsible for monitoring allegations, the report says.

Ruth Ann Dorrill, a regional inspector at HHS, said in an interview that top IHS officials had acknowledged they were in the early stages of implementing the new policies and didn’t feel they were fully integrated into how the agency operates.

“There are few issues more urgent than this one,” she said.

The inspector general’s review was announced by HHS Secretary Alex Azar days after an investigation by The Wall Street Journal and FRONTLINE showed that officials mishandled the case of an IHS pediatrician, Stanley Patrick Weber, who sexually abused boys in his care for decades.

Mr. Weber has been convicted of abusing six Native American boys in two states while working for the agency. He is appealing the conviction.

The day the Journal-FRONTLINE investigation was published, the IHS announced new child-protection policies. The agency later required employees nationwide to complete a new training program.

The new policies require employees to report any incident or suspicion of child sex abuse to law enforcement or child protective services within 24 hours, as well as to their supervisors the same day. An IHS official said agency leaders are now “finding out about things much more rapidly than ever before.”

Nevertheless, inspectors found that IHS staff at some facilities continued to fear retaliation over reporting and didn’t trust that their supervisors would respond appropriately if they spoke up. Agency officials also continued to grapple with confusion over how abuse cases are tracked and with concerns about the effectiveness of the system used to report those incidents.

Ms. Dorrill said the IHS clearly faces challenges in implementing the changes. In particular, she said, the agency continued to be hampered by leadership and staff turnover, which makes training difficult to coordinate and sustain. The agency also still needs to have more open and candid conversations among employees when patient abuse problems arise, she said.

She said her team interviewed 45 agency officials, mostly at IHS headquarters, and planned a second report examining whether employees at IHS facilities were adhering to the policy changes.

The IHS said in a written response to the inspector general that it will replace the software used to report and analyze patient safety incidents early next year. Top officials are trying to shift the agency’s culture so that employees are encouraged to report such incidents, with an emphasis on praising employees who speak out, the IHS said.

Inspectors also said the agency’s policies for protecting children from sex abuse by medical providers were sufficient at least on paper. However, they said they focused too narrowly on that particular type of abuse, causing workers to remain uncertain about how to handle other situations.

The inspectors cited the example of an adult patient who complained that a nurse repeatedly physically and verbally abused her. Regulators who investigated the incident found that staff were “not trained on how to recognize, report, and investigate abuse,” the report said.

The Journal detailed that incident, which occurred at an agency hospital on the Standing Rock reservation in North Dakota, in an article last week. The nurse in question didn’t respond to requests for comment.

The inspectors also said the IHS policies should cover all types of staff, citing another Journal report that detailed a 2016 incident at a youth substance abuse center in North Carolina where a maintenance man was accused of sexual misconduct. The maintenance man declined to comment but later denied the allegations in a Facebook post.

The agency said in its response to the inspector general that it plans to expand its policies by next May.

The IHS’s response to its patient-abuse crisis has become a major focus for its acting director, Rear Adm. Michael Weahkee, whom President Trump has nominated to lead the agency on a permanent basis. Adm. Weahkee has repeatedly faced questioning by lawmakers in Congress over his handling of the situation, including at his nomination hearing last week.

At that hearing, he said the agency would continue to take steps to prevent a repeat of the scandal over Mr. Weber. He also criticized the media for focusing too much on negative news about the agency and vowed to promote more positive stories.

Dan Frosch, The Wall Street Journal

Christopher Weaver, The Wall Street Journal

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