January 3, 2016

Barrasso Opening Statement at SCIA Oversight Hearing on Substandard Care at IHS Facilities

WASHINGTON, D.C. — Today, Senate Committee on Indian Affairs (SCIA) Chairman John Barrasso (R-WY) delivered the following remarks at a committee oversight hearing on “Reexamining the Substandard Quality of Indian Health Care (IHS) in the Great Plains.”
The first panel of the hearing featured testimony from the Honorable Byron L. Dorgan, former U.S. senator from North Dakota, and founder and chairman of the Center for Native American Youth.
The second panel featured testimony from Dr. Mary Wakefield, acting deputy secretary at the U.S. Department of Health and Human Services; Mr. Andrew M. “Andy” Slavitt, acting administrator of the Centers for Medicare & Medicaid Services; the Honorable Robert G. McSwain, principal deputy director for the Indian Health Service at the U.S. Department of Health and Human Services; and Dr. Susan V. Karol, chief medical officer for the Indian Health Service at the U.S. Department of Health and Human Services.
The third panel of the hearing featured testimony from the Honorable Victoria Kitcheyan, treasurer for the tribal council for the Winnebago tribe of Nebraska; the Honorable Sonia Little Hawk-Weston, the chair for the health and human services committee of the tribal council of the Oglala Sioux tribe; the Honorable William Bear Shield, council representative for the Rosebud Sioux tribe; and Mr. L. Jace Killsback, executive health manager for the Northern Cheyenne Tribal Board of Health.
Immediately following the oversight hearing, the SCIA will hold a listening session on “Putting Patients First: Addressing Indian Country’s Critical Concerns Regarding IHS.”
Click here for more information on the witnesses’ testimony and to watch video of the entire hearing.
Senator Barrasso’s remarks:
“Today the committee will hold an oversight hearing entitled Reexamining the Substandard Quality of Indian Health Care in the Great Plains.
“In 2010, the committee held an oversight hearing entitled In Critical Condition: The Urgent Need to Reform Indian Health Service’s Aberdeen Area. At this hearing the committee listened to testimony detailing an investigation led by the former Chairman Byron Dorgan and his report on the Indian Health Service.
“The Dorgan Report found atrocious evidence showing the lack of quality of care by the Indian Health Service in the Aberdeen area, now called the Great Plains area, to Indian tribes.
“Over five years later, the very problems identified in the Dorgan Report have not been resolved. In fact, some issues have become worse over time, and new ones have developed.
“After hearing loudly from the tribes on the lack of quality of health care in the Great Plains Area, I dispatched committee staff to the field, to understand what is really is happening in the Great Plains Area.
“What we’ve found is simply horrifying and unacceptable.  In my view, the information provided to this committee and witness first hand can be summed up in one word: malpractice.
“But you don’t have to take my word for it.  As you’ll hear today, IHS has known about these issues all along.  The Centers for Medicare & Medicaid Services – another agency within the Department of Health and Human Services – has confirmed not only that these same problems continue to fester, but that they pose immediate risk to patient safety.
“The impacts of these deficiencies aren’t theoretical.  These persistent failures have led to unnecessary suffering by patients, by families, and by whole communities.  In fact, they have led to multiple patient deaths.
“The administration is responsible for providing and delivering health services to American Indians and Alaska Natives across the country.  Their federal obligation mandates that they promote health and safe Indian communities while honoring tribal governance.  This is not happening.
“The Indian Health Service has failed their patients. This committee knows it, the congressional delegations joining us today know it, the tribes know it all too well, and every single witness here today knows it. Without question, this is a tragedy and a disgrace.
“I stress to the administration that the status quo will not be tolerated. How can we take your word that these issues have been resolved, when 5 years ago, you said to this committee you had a plan?  How can we trust information coming from Health and Human Services or Indian Health Service or others in the administration? 
“This committee will not accept any more cover-ups or politicking. This is not a game. People’s lives are at risk.
“We are now at a place where you must prove to us, each step of the way, that you are living up to your word and fulfilling your responsibilities.  
“Last year, I wrote to Secretary Burwell about the need for leadership at the Indian Health Service. To this day, the Director position remains unfilled. The administration’s failure to act on such important matters speaks volumes.
“Testimony submitted by the administration references many plans. But we need– the people in the Great Plains need– concrete results. Simply changing an area name from “Aberdeen” to “Great Plains” will not suffice.
“I urge the administration to listen to the Indian tribes and witnesses here today. Listen to their testimonies. Listen to their statements.
“These are the people you serve, and they know what their communities need. I hope you will treat them with the respect they deserve, and work with them honestly and openly.
“As a physician, I know that more can and must be done to ensure safe, quality healthcare is delivered at Indian Health Service facilities in the Great Plains area. I believe positive change is possible. It will be difficult and, at times, uncomfortable. This cannot stand in the way of real reform.
“We must put patients first, and that’s exactly what we are here to do. We need both short-term and long-term solutions, not only to the problems identified by the CMS surveys, but also to the many other problems identified by patients, tribes, the brave Indian Health Service employees who have spoken to the committee and others.
“I will continue to press the administration for answers and real solutions. I will continue investigate and convene hearings here in Washington or in the field until we are sure patients are safe in the facilities that were built to provide them care.
“I’d also like to say that although this oversight hearing will focus on the Great Plains area, the committee has also heard concerns from tribes in other areas served by the Indian Health Service.
“We have been told that conditions are most dire in the Great Plains, but again, we are not going to take the administration’s word for it.
“We realize that these and other issues impacting patients may plague other regions, and will demand answers and action in these areas as well.
“When my committee staff visited the Great Plains area recently, they saw firsthand the culture of cronyism and corruption that permeates the system. Many Indian Health Service personnel have come to the conclusion that they are untouchable; that they are accountable to no one. As far as I can tell, until now, they’ve been allowed to act with impunity.
“Instead of being reprimanded for failing to appropriately care for patients or for retaliating against providers who report deficiencies, these “untouchable” employees are being recycled throughout the Great Plains area. Some are being promoted, even though they are not qualified for the positions they hold. Some have been involved in preventable deaths identified by CMS.
“These “untouchable” employees have continued to see patients and collect taxpayer dollars, without fear of being held accountable for the many lives they were hired to protect and care for.
“I fear that some members of the IHS leadership think they are untouchable as well.
“One particularly egregious incident involves the Chief Medical Officer for IHS.  In a recent phone call, the Chief Medical Officer responded to concerns from congressional staff about incidents involving unsafe pre-term deliveries by saying, “if you’ve only had two babies hit the floor in 8 years that’s pretty good.” This is a sad new low for IHS.
“Another example involves a young toddler lost her life to a preventable infection because the IHS facility in her community repeatedly failed to provide proper care, and by the time they referred her out of the IHS system, it was too late. This is a heartbreak that no parent, no family, no community should have to bear.
“And yet, tragically, this story is all too familiar. Too many lives have been lost because no one was held accountable for their actions. The same mistakes are being made again and again. This must change immediately.
“To be clear, the total lack of accountability is just one of many problems identified during my staff’s visit to the Great Plains area last month, and relocating troubled staff will not be enough to effect real and lasting improvements.
“True reform will require a culture change at IHS, from the top officials responsible at department headquarters, down to the employees at each facility.
“The information we have uncovered is overwhelming and disturbing, and it will be an important part of addressing the problems we discuss here today. 
“We must work together to stop the bleeding in the Great Plains, and find permanent solutions, so that we are not here again in another five years facing the same problems, after an untold number of additional preventable deaths.”