Indian Health Service aims to save certification for troubled facility

Indianz.Com SoundCloud: Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies March 9 2016

The new leader of the Indian Health Service vowed to do "whatever it takes" to prevent more facilities in the troubled Great Plains Area from losing certification.

Appearing for the first time on Capitol Hill as the acting director of the beleaguered agency, Mary Smith said the IHS is working closely with the Centers for Medicaid and Medicare Service on a "systems improvement agreement" for the Rosebud Hospital on the Rosebud Sioux Reservation. If an agreement can be reached before the end of April, she said the facility will not lose its certification.

"We are heartened that they are at least talking to us and working with us on this agreement," Smith told Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies on Wednesday morning.

An agreement would prevent another black mark on the Great Plains Area, where the Winnebago Service Unit, which serves the Omaha Tribe and the Winnebago Tribe in Nebraska, already lost CMS certification. The IHS is no longer able to bill Medicare for services at the facility and Medicaid and other third-party sources of funding have been impacted as a result.


A patient and pharmacist at the Rosebud Indian Hospital on the Rosebud Sioux Reservation in South Dakota. Photo from U.S. Public Health Service Pharmacists / Facebook

A third facility -- the Pine Ridge Service Unit, which serves the Oglala Sioux Tribe in South Dakota -- also has been threatened. There was mixed good news on that front -- Smith said the hospital has successfully resolved one CMS notice but the emergency room is still awaiting evaluation.

"We are committed to doing whatever it takes to ensure that these hospitals are providing quality care," testified Smith, a member of the Cherokee Nation who was named the principal deputy director at the IHS just last week.

Despite the promise of improvement, lawmakers were worried about the underlying and long-running problems in the Great Plains. The agency, for example, was warned a year in advance of the CMS termination at Winnebago but did not take enough actions to prevent the loss of certification, which came last July.

"You don't get these notices unless there's been a long build up," said Sen. Lisa Murkowski (R-Alaska), the chair of the subcommittee. "What the long build up means is that these people have been left behind."

"Again, it is just not acceptable," Murkowski said.


A view of the Winnebago Hospital on the Winnebago Reservation in Nebraska. Image from Google Maps

Other regions also have been affected by lapses. Sen. Tom Udall (D-New Mexico), the top Democrat on the panel, noted that the emergency room at the Crownpoint Health Care Facility on the New Mexico portion of the Navajo Nation was placed under "diversion" -- a term the IHS uses for a temporary or extended closure -- for one month last summer.

"I think there are systemic problems, not just at those hospitals, but throughout our system," Smith admitted.

As for the Rosebud Hospital, CMS was planning to terminate certification on March 16. The agency cited violations in at least 7 categories, including those affecting medical staff, nursing services and emergency services, according to a letter posted by The Sioux Falls Argus Leader.

Smith said the IHS secured an extension until May 16. In order to meet that deadline and avoid a cutoff, the agency needs to finalize the "systems improvement agreement" by April 29, she told the subcommittee.

"We are committed to doing whatever it takes," Smith reiterated. "I think that is our top priority at the agency."


The Pine Ridge Hospital on the Pine Ridge Reservation in South Dakota. Photo from Dean Kurtz Construction

The substandard quality of care at the Rosebud Hospital was the subject of discussion at a Senate Indian Affairs Committee hearing on February 3. A pregnant woman was left unattended and was forced to deliver her baby, prematurely, on the floor, lawmakers said. It was the second incident of its kind at the facility in recent years.

"What has to be acknowledged here is that ... people’s lives are in jeopardy," Sen. John Thune (R-South Dakota) said at that hearing. "This is unacceptable. We cannot tolerate this."

The IHS replaced the director of the Great Plains Area just days before the hearing. Tribal leaders questioned the last-minute decision, which they said was made without consulting them.

"Was it because this hearing was going to happen and IHS didn't want him to testify?" Harold Frazier, the chairman of Cheyenne River Sioux Tribe, said at listening session following the hearing. "That's a question that Congress should ask IHS. Why was he transferred? Was an evaluation done on his performance?"


Mary Smith of the Indian Health Service speaks at the National Congress of American Indians executive council winter session in Washington, D.C., on February 23, 2016. Photo by NCAI / Twitter

As for Smith, she was named principal deputy director and acting director last Tuesday. She replaced Robert McSwain, a member of the North Fork Rancheria of Mono Indians, in that role. He continues to serve in another capacity at IHS, where he has worked since 1976.

Smith, an attorney, only joined the IHS last October after working for the Department of Insurance in Illinois, her home state. She previously served as a political appointee at the Department of Justice from 2009 to 2011 and was once nominated for top position there but was never confirmed by the Senate.

Committee Notice:
Hearing to Review the FY17 Indian Health Service Budget Request (March 9, 2016)

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