Crisis at Indian Health ServiceThe Indian Health Service is the federal agency responsible for delivering health care to 2.3 million American Indians and Alaska Natives. Yet it's gone without a permanent and accountable leader for more than four years. The leadership crisis at the Indian Health Service started in the Obama era and it has continued through the Trump administration.
Yvette Roubideaux, a citizen of the Rosebud Sioux Tribe, was the first woman to serve as director of the Indian Health Service, having been confirmed by the Senate to a four-year term in 2009. But she ran into troubles after then-president Barack Obama nominated her for a second term in office. The Senate failed to take action and she was forced to serve as the "acting" director until February 2015. Four months later, she abandoned her nomination and left federal government altogether.
Robert McSwain, a citizen of the North Fork Rancheria of Mono Indians, became acting director of the Indian Health Service in February 2015. It was a familiar role for him -- during the George W. Bush administration, he served as acting director from September 2007 through May 2015, when he became the permanent, Senate-confirmed director before Yvette Roubideaux eventually replaced him. But his second stint wasn't a long one -- he left the position in March 2016 for another one within the IHS.
Photo: Cherokee Nation
With no one lined up to take the job as the clock ticked down on the Obama era, Mary Smith, a citizen of the Cherokee Nation, assumed the director's position in an acting capacity in March 2016. She was gone by January 2017 as a new president arrived in the nation's capital.
Photo: Mary Smith
As President Donald Trump took office, Chris Buchanan, a citizen of the Seminole Nation became the new "acting" director in January 2017. He only served in the role through June.
In June 2017, Michael Weahkee, a citizen of the Pueblo of Zuni, became second acting director of the Indian Health Service of the Trump era. He took the role as Indian Country awaited an announcement of a permanent director. Tribal advocates and key Congressional aides expected to hear a name by the end of the summer but nothing emerged from the White House.
In October 2017, President Donald Trump nominated Robert Weaver, a citizen of the Quapaw Nation, to serve as director of the Indian Health Service. The delayed announcement, though it came 10 months into the new administration, was not unusual, as former president George W. Bush waited more than a year to name his permanent pick for the agency.
What was different was Weaver's background. Unlike prior directors, he did not have direct clinical experience, though he worked in a hospital in administrative and support capacities, and also ran a health insurance business that at one point provided services to his tribe. He also lacked a college degree.
Amid these doubts, Weaver never secured a confirmation hearing, though one was anticipated in late 2017. As questions mounted in early 2018, the White House unceremoniously backed away the nomination. Weaver immediately lashed out, saying he was forced to do so as a result of media reports into his qualifications.
Photo: Courtesy Robert Weaver
A New Figure?
Seven months after the implosion, the Association of American Indian Physicians said it supported the potential nomination of John Molina, who is Pascua Yaqui and San Carlos Apache, to serve as director of the Indian Health Service. "It was encouraging to see that the White House is interested in the opinion of AAIP with regards to filling the vacancy," the organization said in a September 20, 2018, news release. There's been no word from the White House since then.
Photo: National Institutes of Health
Still No Movement
As 2018 drew to a close, Siobhan Wescott, MD, MPH, reported on Twitter that the American Medical Association voted to support a list of desired qualifications for a new director of the Indian Health Service. The qualifications, she said, were the same ones suggested by the Association of American Indian Physicians.
In November 2017 -- as the examination of Robert Weaver's nomination was still in the early stages -- the Association of American Indian Physicians released a list of "minimal qualifications" for the IHS director position. While Weaver has demonstrated a commitment to Indian health and has worked with at least one tribe, he lacked the types of professional experience sought by the organization.
New in Federal Register: Reimbursement Rates from Indian Health Service. The notice was signed by Michael Weahkee, principal deputy director at IHS. President Trump has failed to nominate new director:his first pick was forced out a year ago. #DontGetSick https://t.co/EUMXA7JPuU pic.twitter.com/bq8sLQujqE— indianz.com (@indianz) February 6, 2019
As the new year dawned, the Indian Health Service dropped all pretenses of having an "acting" leader. Michael Weahkee went back to being just the Principal Deputy Director, as evidenced by a Federal Register notice published on February 6, 2019. His had been "acting" through at least September 2017, but his official title resurfaced by November.
And there's still no word of permanent director for the IHS.