Failure at one Indian Health Service hospital reveals a system in crisis

More than 10 months have passed since that committee hearing. It’s been more than a year since the hospital was stripped of its right to bill Medicare and Medicaid. And it’s been six years since former Democratic Sen. Byron Dorgan of North Dakota unveiled a scathing report acknowledging that IHS’ lapses have festered for decades and called the IHS bureaucracy in the Great Plains a “big morass of glue.”

Legislation introduced in May by Republican Sens. John Barrasso of Wyoming and John Thune of South Dakota, which would make some changes to IHS management and discipline without offering new funding, languishes in Congress. “After years of inaction at IHS, there are still more questions than answers for the tribal members who depend on the agency for their healthcare needs,” Thune said in May. A Barrasso staffer said the committee is “optimistic” the bill will pass eventually.

In other words, nothing has changed, tribal advocates say.

Many Winnebago and Omaha tribe members who live on and off their reservations still go to the IHS facility, but they do so out of necessity, not choice. Many can’t go to a private hospital because they don’t have transportation, or they don’t have private health insurance, Medicare or Medicaid.

More than a quarter of Native Americans nationwide are uninsured. Many don’t have money to pay for care out of pocket and don’t have access to private financial assistance programs.

That makes them dependent on the federally funded IHS for basic services, much like veterans in many parts of the country are dependent on the Veterans Health Administration. Yet while poor care or long wait times at VHA facilities ignited a national furor, few people pay attention to even worse conditions at the IHS.

“My level of trust and respect for IHS went from good to poor to pitiful,” says Terry Medina, an adult probation officer who is enrolled in the Santee Sioux tribe and whose wife and kids are Winnebago.