Indian Health Service Improves on Sexual-Abuse Safeguards, Report Finds
The Indian Health Service’s Pine Ridge Hospital, in Pine Ridge, S.D. (Mike Shum, FRONTLINE/Wall Street Journal)
The U.S. Indian Health Service made sweeping changes to better protect patients from sexual misconduct but administrators at most agency facilities said barriers still exist that could deter staff from reporting abuses, federal inspectors said Monday.
In a report released Monday morning, the Office of Inspector General for the Department of Health and Human Services detailed new policies the agency has implemented since a pediatrician, Stanley Patrick Weber, was charged and convicted of sexually abusing Native American boys while he served at two IHS facilities.
The changes include mandatory training for employees, broader protections for patients and a new, more robust system for reporting misconduct. Still, inspectors noted that the IHS, which provides health care to approximately 2.6 million Native Americans, needed to make more improvements to keep patients safe from abuse — like better protecting the anonymity of staff reporting misconduct.
“What they promised to us last year that they were doing, they have, indeed, in large part done,” said Ruth Ann Dorrill, a regional inspector at HHS, which oversees the agency. “It’s modeling exactly what direction IHS wants to go. You develop clear policies, you give people tools, you train them, and then you normalize that within the culture. And then it’s also shed light on broader problems.”
An initial review was originally ordered by HHS Secretary Alex Azar after a Wall Street Journal/FRONTLINE investigation showed that IHS officials had for years ignored numerous complaints about Mr. Weber’s treatment of his male patients, which allowed him to keep abusing them for decades.
Mr. Weber has been convicted in Montana and South Dakota of abusing six Native American boys in those states while working for the IHS. He lost an appeal of the Montana verdict and is continuing to appeal his South Dakota conviction.
Last December, federal inspectors found that an initial slate of changes IHS made in the wake of Mr. Weber’s case was too narrow and hadn’t been sufficiently implemented across its facilities.
A year later, inspectors concluded the agency’s latest overhaul was more substantial. Most IHS facilities had incorporated the agency’s new patient protection policies, expanded the protections to include other types of patient mistreatment beyond sexual abuse and trained staff and contractors on these policies, inspectors found.
The agency’s outdated misconduct reporting system has also been replaced with an extensive new one. The new system requires suspected abuse to be reported within 24 hours to child protective services or law enforcement, the Inspector General’s Office, IHS supervisors and an agency hotline.
The new policies also make clear that chaperones need to be offered to patients who want them during medical exams. Most facilities had now posted signs to increase awareness of abuse for both staff and patients, a new requirement. And inspectors said that top officials were playing an active role in helping the agency’s facilities implement the changes.
“Several facilities reported a noticeable change in the organizational culture toward transparency following the Weber case,” the report stated.
Ms. Dorrill and her deputy Petra Nealy, who both visited numerous IHS facilities during their review, said significant hurdles remained.
Administrators at 88 of 97 facilities said there were still obstacles that could keep staff and patients from reporting abuse. IHS officials at 61 of the facilities said personal relationships between providers and patients may also discourage people from coming forward—especially at small, isolated locations. Many IHS officials also said there was still a fear that those reporting abuse would have their identities revealed.
The agency’s chronic staffing shortages also made it challenging to provide the chaperones. There was, at times, confusion among IHS facilities on some of the new policies, and leaders at nearly half of the facilities said that a lack of understanding on how to report abuse remained an issue.
The agency’s director, Rear Adm. Michael Weahkee, who has vowed to improve the agency following a series of Journal/FRONTLINE reports on patient treatment, said in a written response included in the report that he concurred with its recommendations.
A separate report issued by the Government Accountability Office this month found that additional employee training on patient abuse held by IHS’s area offices was too inconsistent. In addition, that report found local IHS officials needed to better document their reviews of provider misconduct and performance.
The Health and Human Services Department said IHS was taking steps to address the GAO report’s recommendations.