Why Care at Native American Hospitals Is Often Substandard

SIOUX FALLS, S.D. — The internal watchdog of the Health and Human Services Department says the often substandard quality of care at hospitals serving Native Americans is the result of outdated equipment and technology, lack of resources, and difficulty attracting and keeping skilled staff.

The Office of Inspector General on Friday released two reports that looked into the longstanding challenges of the 28 hospitals directly operated by the federal Indian Health Service. The office, which acknowledged that reports of inadequate health care services for Native Americans had been of concern to the federal government for almost a century, criticized the agency’s limited oversight regarding compliance with federal regulations and quality of care, detailing how the agency’s regional administrators had few sources of information to assess the services provided at the hospitals.

The Indian Health Service, commonly referred to as I.H.S., is responsible for providing health care services to enrolled tribal members as part of the government’s treaty obligations to Native American tribes. But the agency has faced challenges for decades, and within the past year has been under increased scrutiny from Congress after inspections of hospitals in the Great Plains uncovered severe deficiencies.

The inspector general’s office said that the Indian Health Service’s eight regional offices conducted activities to monitor the quality of the hospitals, but that those efforts were minimal in some areas.

One of the reports stated that the primary source of information that the regional offices used to detect quality problems was a small number of complaints and patient-harm reports.

Advertisement

Continue reading the main story

“However, according to hospital administrators, most patient complaints relate to customer service and wait times, rather than medical care,” according to the report. “Further, most hospitals (20 of 28) receive fewer than 100 complaints per year for inpatient and outpatient visits combined, averaging about one complaint per 1,000 patient visits.”

The report continued: “Considering the quantity and subject matter of complaints and patient harm reports, they are unlikely to provide hospital staff with the breadth of information needed to identify and diagnose systemic quality or compliance breakdowns.”

The inspector general’s office, which gathered the information for the reports from April 2014 to October 2014, also said that only half of the regional offices conducted mock inspection surveys that provided insight to quality practices.

The watchdog also faulted the health service for staggering findings of outdated hospitals and the process taking several weeks that job applicants had to follow, even when one in three physicians jobs was open at the time the information for the reports was gathered.

According to the report, in 15 of the 28 hospitals, administrators reported that aging or inadequate physical environments affected their ability to give quality care. Corroded pipes in one hospital caused sewage to leak into the operating room.

The Indian Health Service had been under scrutiny for more than a year after inspectors from the Centers for Medicare and Medicaid Services found several quality-of-care deficiencies at hospitals in South Dakota and Nebraska. At one hospital, the alarming conditions of its emergency room led officials to close it for seven months.

The, watchdog, the inspector general office, on Friday recommended that inspectors survey Native American health facilities more frequently.

In a statement on Friday, the health service concurred with inspector general recommendations, including the need for more training for staff and new ways to monitor hospital quality.

The agency also said it began a mock survey initiative at 26 hospitals in May to assess compliance with the standards that hospitals must meet to be able to participate in the Medicare program.

The statement also said a team was formed in February “to ensure that dependable, quality care is delivered consistently across I.H.S. facilities.”

Continue reading the main story