New reports say Indian Health Service still deeply troubled

The struggling Indian Health Service still has major issues, according two reports released yesterday from the Department of Health and Human Services' inspector general.

"The IHS is responsible for more than 2 million Native Americans — a population that tends to need a lot of care, much of it specialized. Yet the IHS has been beset for years by underfunding and mismanagement," Sam Baker reports for Axios.

The first audit analyzed and compared opioid prescribing and dispensing practices at five IHS hospitals. It also examined cybersecurity, which is important for protecting information and keeping patients safe. It found that the hospitals often don't follow federal guidelines for dispensing opioids and don't fully use states' prescription-drug monitoring programs to track opioid prescriptions. It also found that the IHS's decentralized IT management structure made it more vulnerable to hackers. 

The second audit is a case study of what went wrong at South Dakota's perennially troubled Rosebud Hospital, which was forced to shutter its emergency department for more than seven months starting in December 2015. Though IHS has made "significant improvements" at Rosebud since the ED reopened, the hospital continues to struggle with hiring adequate numbers of staffers and leadership. 

The Sioux Falls Argus Leader investigated Rosebud and another South Dakota IHS hospital in 2018. At Rosebud, the newspaper found that faulty temperature controls and mold on the walls sickened staff and patients, sometimes preventing staff from working. Dozens of patients died from errors at the hospitals. The federal government had mostly ignored bad conditions at the two hospitals or had failed to make meaningful change, the paper found.

Some tribes seem to do better funding their own hospitals, Baker notes, citing the example of the newly opened 20-bed Cherokee Indian Hospital in North Carolina, which seems to be performing well. But, Baker acknowledges, most tribes don't have access to the kind of financial resources the Eastern Band of Cherokee Indians do; revenues from their casino mostly paid for the hospital.