Medical, Leadership Problems Persist at U.S. Indian Health Service Hospital, Report Finds

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July 22, 2019
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by Dan Frosch The Wall Street Journal
Christopher Weaver The Wall Street Journal

A long-troubled U.S. Indian Health Service hospital continued to be plagued by poor medical care, untrained staff and leadership turnover, despite improvements made there by top agency officials, a government watchdog said Monday.

A report by the watchdog documents the intractable nature of some of the federal health system’s problems, even when additional resources are poured in.

In a separate report, the watchdog found problems with how Indian Health Service hospitals prescribed opioids, saying that the agency’s failure to always follow its own regulations increased the risk of drug abuse and overdoses for patients.

The reports were released Monday by the Office of the Inspector General of the U.S. Health and Human Services Department. The HHS oversees the Indian Health Service, which provides health care to Native Americans and has been buffeted by recent scandals over dangerous care and its failure to stop a pediatrician from sexually assaulting young patients.

The IHS is also facing several investigations, including by a White House task force, after The Wall Street Journal and the PBS series FRONTLINE reported in February that IHS officials didn’t prevent an IHS pediatrician from sexually abusing Native American boys despite warnings. The pediatrician was convicted of sex-abuse last year and is appealing that verdict.

The inspector general’s report on the Rosebud hospital on the Rosebud Sioux reservation in South Dakota examined the agency’s response to the closure of the hospital’s emergency room for seven months in 2015 and 2016 due to low staffing and other problems.

The Journal wrote about substandard medical conditions at Rosebud and other remote IHS hospitals in the Midwest in a front-page story in 2017.

The report describes the chaos that followed the closure. Nearby hospitals off the reservation, unaware that the Rosebud emergency room was closing, were swamped with displaced IHS patients. Some IHS staff would still sneak tribal members into Rosebud for emergency care. Other tribal members stopped seeking emergency medical treatment altogether.

The report said IHS brought in teams of experts that overhauled hospital policies, fired problem staff and took over management of the hospital until it improved.

Even amid improvements, a constant leadership churn and the dearth of qualified staff remained problematic, inspectors said. A former IHS official involved in hiring new providers at Rosebud reported having to reject many candidates brought to them by a contractor because of their backgrounds, including one with a record of sexual abuse.

The report said conditions at the hospital deteriorated again after the emergency department reopened in July 2016 and IHS diverted its resources elsewhere.

Rear Adm. Michael Weahkee, now the agency’s acting director, oversaw the team that reopened the emergency room during a stint as Rosebud’s acting CEO in 2016.

Two patient cases from last summer drew the attention of hospital regulators, according to the report: An intoxicated 12-year-old girl tried to strangle herself with a call-light cord and shoe laces after being left unattended at the hospital. The next day, a mentally disturbed 35-year-old man died of cardiac arrest after being restrained by medical staff who didn’t follow proper procedures.

A follow-up survey uncovered problems the hospital had already seen several years earlier, the report said. IHS officials removed the agency’s new leadership team at Rosebud, concluding they weren’t following orders and had stymied improvements, the report said.

Federal hospital regulators told inspectors they had noticed a pattern at Rosebud where top IHS teams were brought in to solve problems quickly. “But once these teams were replaced with new and often inexperienced leadership, the problems would resurface,” the report said, citing the regulators.

Adm. Weahkee, in a written response accompanying the inspector general’s report, said the agency agreed with the report’s recommendations. The inspectors did their work between June 2017 and December 2018. He said IHS had developed procedures for temporary emergency-department closures and was looking for ways to recruit hospital leaders in remote locations.

In its second report, involving five Indian hospitals in Minnesota, North Dakota, Oklahoma, Arizona and New Mexico, the inspector general found IHS’s handling of opioids was haphazard.

In some cases, the report said, IHS pharmacists doled out prescriptions from nonagency providers to patients without reviewing records. In others, hospitals didn’t always appear to check or update state prescription drug monitoring programs — as required by IHS policy — to ensure patients weren’t “doctor shopping” to get medication.

Inspectors examining data between August 1, 2016, and July 31, 2017, found patients at all five hospitals were being prescribed amounts of opioids that appeared to exceed federal guidelines.

The report isn’t the first time the inspector general has scolded the agency for problems with opioids. Internal documents provided to agency administrators by inspectors in 2004 and 2014 and reviewed by the Journal raised similar concerns.

Adm. Weahkee, in a response to the inspector general, wrote that the agency concurred with the opioid report’s recommendations. He said the agency started working this year to better standardize how it tracked opioid prescriptions and was trying to shore up how IHS providers dispensed drugs to patients.

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