Indian Health Hospitals to get care quality council after group complains at Senate hearing

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The Department of Health and Human Services is looking at ways to improve the quality of care at facilities operated by the Indian Health Service, focusing especially on the Great Plains area.

The focus on improvement comes in light of several published reports suggesting that tribal and Congressional leaders are unhappy with the care being provided, with both groups expressing their frustration at a recent hearing held by the Senate Committee on Indian Affairs.

HHS Secretary Sylvia Burwell announced she is establishing an executive council on quality care to bolster the seven IHS hospitals, 15 health centers and numerous satellite clinics operating in the Great Plains. The council will implement both long- and short-term plans.

At the hearing, Senate committee members were presented with extensive documentation of IHS employees working under the influence of drugs and alcohol, a recurring pattern of mismanagement, discrimination and retaliation against employees who complained, and a lengthy history of incompetent behavior by IHS employees who faced no disciplinary action.

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"For decades and generations, IHS has had a terrible reputation in Indian Country," Victoria Kitcheyan, treasurer of the Winnebago Tribe of Nebraska, said at the hearing. "We don't go there because they have superior healthcare. We go there because it's our treaty right, and we go there because many of us lack the resources to go elsewhere. We're at the hands of a dated bureaucratic system that doesn't offer quality healthcare to many of the deserving Native American patients that it serves."

Sen. Al Franken, D-Minn., has said the issue is largely one of funding, with IHS spending per capita, less than half the national average on healthcare spending.

As part of the new council's, plans, they will be charged with "executing a rapid-response process, including deploying resources from across the Department when a facility needs immediate, systematic improvement," said a statement issued by HHS. "It will include providing technical assistance, developing policy and training proposals to bolster the safety culture, and identifying solutions to address workforce recruitment and retention challenges."

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The council, led by Acting Deputy Secretary Mary Wakefield, includes leaders from HHS, the IHS, the Office of the Surgeon General, the Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention.

Meanwhile, the Surgeon General has deployed four Commissioned Corps Officers to the Great Plains area to assist IHS personnel in their efforts to correct deficiencies found by CMS during reviews of the Omaa-Winnebago, Pine Ridge and Rosebud hospitals. Among the officers of the United States Public Health Service are an expert in quality assurance, a nurse leader focused on outpatient and urgent care, and a medical officer. They'll work alongside providers at IHS hospitals for at least the next three months.

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The IHS Quality Consortium has developed what it calls the "Blueprint for Quality Improvement," which it hopes will implement lasting changes. Among its initiatives is the establishment of a National Quality Managers Council to develop strategies aimed at alleviating the perceived deficiencies. It will also provide training for medical leadership and facility governing boards, and standardize the credentialing and privileging process in IHS so that staff can track provider licenses and other certifications through a centralized software system.

Staffing shortages will also be addressed.

"As part of its executive council, HHS is establishing a working group tasked with generating innovative approaches and engaging with the public and private sectors to help address longstanding medical provider recruitment and retention issues in rural IHS facilities," said HHS' statement.

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Through the Health Resources Services Administration, HHS has expanded the availability of providers supported by the National Health Services Corps by making all IHS facilities eligible to have clinicians work in their communities.

"In July 2011," said HHS, "prior to eliminating the requirement for tribal sites to apply to be NHSC sites, there were approximately 110 approved sites with 15 NHSC clinicians working at those facilities. Today, there are more than 670 approved tribal sites and more than 420 NHSC clinicians providing primary healthcare  to American Indians and Alaska natives."

Other improvements are in the works, including a 7,100 square-foot facility will soon be constructed on the Raid City Service Unit Campus, staffed by at least 11 full-time behavioral health professionals who'll provide intensive outpatient therapy to suicide referrals from the Great Plains area. The project will also include a separate housing facility for patients, chaperones and family members for group therapy sessions. The project is estimated to be completed by April.

HHS' "Zero Suicide Initiative" is being implemented "to ensure that individuals seeking care in IHS facilities receive evidence-based suicide care and appropriate follow-up," said HHS. The initiative includes pilot projects effective from December 2015 to December 2016 to ensure a model of care in Native American communities is "culturally appropriate."

In addition, new leaders have been brought onboard at IHS on the regional and national level, including new IHS Deputy Director Mary Smith, a tribal advocate and enrolled member of the Cherokee Nation; and IHS Deputy Director for Quality Health Care Dorothy Dupree, an enrolled member of the Fort Peck and Assiniboine and Sioux tribes.

Twitter: @JELagasse