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Bill seeks random drug tests for Indian Health Service employees

Friday, June 10, 2016

Rep. Kristi Noem (R-South Dakota). Photo from Flickr

Rep. Kristi Noem (R-South Dakota) made good this week on her promise to seek reforms at the troubled Indian Health Service.

On Wednesday, Noem introduced H.R.5406, the Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare Act (HEALTTH Act). The bill encourages more partnerships with tribes, addresses recruiting of heath professionals, updates the Purchased/Referred Care Program and calls for greater accountability at the IHS.

“The government is required by treaty to provide healthcare to tribal communities. IHS has failed to uphold that duty,” Noem said in a press release. “The problems are pervasive, but my legislation is comprehensive. From care delivery to hospital administration, my legislation aims to dramatically improve the quality of healthcare while making the system more efficient, cost-effective, and accountable.”

But that wasn't all -- on Thursday, Noem introduced H.R.5437, a bill that requires the IHS to implement a random drug testing program for employees. That's currently not in place, according to the agency's manual, but just last week, Mary Smith, the acting director, announced an interim policy that requires drug testing in certain situations.

"The IHS is concerned with the well-being of all employees and the patients we serve, the successful accomplishment of our mission, and the need to maintain employee productivity," Smith wrote in a memo that addressed testing in instances when there is a "reasonable suspicion" of drug use by an employee.

A random drug testing program would bring the IHS in line with the Bureau of Indian Affairs and other federal agencies. Tribal governments also test employees and some have subjected elected leaders to tests.

"Big adjustments urgently need to be made, but I’m committed to working together on agency-level changes and my legislative reforms to ensure tribal members finally receive the care their families need," Noem wrote in her weekly column on Friday.

Noem's HEALTTH Act has bi-partisan support -- two of the five co-sponsors are Democrats. And four of the five co-sponsors represent tribal members in the Great Plains Area, a region that includes South Dakota, Nebraska and North Dakota.

“We cannot sit idly by and watch an entire healthcare system remain, at best, inadequate—or worse harm persons and communities,” said Rep. Jeff Fortenberry (R-Nebraska), whose district includes the Omaha Tribe and the Winnebago Tribe.

The facility that serves the tribes, the Omaha Winnebago Hospital, is considered one of the worst in Indian Country. It no longer has the ability to bill for Medicaid and Medicare services because the IHS failed to correct long-standing problems.

The agency has since hired an outside company to run the emergency room, a process that H.R.5406 would address. It requires the IHS to develop a contracting program for at least three hospitals and to ensure tribes have a role in the operation of the hospital.

“Access to quality health facilities is an important factor in the growth of tribal communities in Nebraska and across the country. We have an obligation to improve care for Native Americans, and we cannot, in good conscious, stand by and do nothing. I am proud to cosponsor legislation that will support Nebraska tribal communities by investing in healthcare,” said Rep. Brad Ashford (D-Nebraska).

Notably, the HEALTTH Act amends the Indian Health Care Improvement Act, a law that was made permanent by the Affordable Care Act. In the past, Noem has supported the repeal of the Affordable Care Act, a move that would undo the Indian Health Care Improvement Act.

Noem's legislation isn't the only IHS reform initiative on Capitol Hill either. The Senate Committee on Indian Affairs is holding a town hall and field hearing in South Dakota next week to discuss S.2953, the Indian Health Service Accountability Act.

Senate Committee on Indian Affairs Notices:
Town Hall Meeting "Discussing S. 2953: Improving the Indian Health Service." (June 16, 2016)
Oversight/Legislative FIELD Hearing on "Improving Accountability and Quality of Care at the Indian Health Service though S. 2953." (June 17, 2016)

Federal Register Notice:
Notice of Tribal Consultation and Urban Confer Sessions on the State of the Great Plains Area Indian Health Service (June 3, 2016)

Government Accountability Office Report:
INDIAN HEALTH SERVICE: Actions Needed to Improve Oversight of Patient Wait Times (April 29, 2016)

Senate Committee on Indian Affairs Report:
In Critical Condition: The urgent need to reform the Indian Health Service’s Aberdeen Area (December 2010)