How IHS betrays its patients
Solutions elusive, promises unkept on Great Plains
Kathy Boyd, 57, had open heart surgery in 2015. Her doctor did not think she needed to be seen by another doctor, but her daughter Evie insisted.
PHOTOS BY BRIANA SANCHEZ/USA TODAY NETWORK
PHOTOS BY BRIANA SANCHEZ/USA TODAY NETWORK
Boyd shows her dancing shoes to her granddaughter Syncere Whirlwind Solider. Kathy can no longer dance at ceremonies because of her heart.
Boyd’s husband, Wayne, has had to help out more around the house and has to be attentive to her emotions and how she feels.
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Doctors pulled Kathy Boyd’s heart out of her chest.
Hundreds of miles from her home on the Rosebud Indian Reservation, the 57 year-old wife and mother lay cut open on an operating table.
It never should have reached this point.
Doctors at the Rosebud Indian Health Service hospital neglected to act when they received an echocardiogram four years earlier that showed a valve in Kathy’s heart was struggling to pump blood.
Instead of giving the longtime IHS patient the treatment necessary to heal the faulty valve, they told her not to worry. The red flags warning of her failing heart were shoved in a drawer and ignored.
Boyd, a native South Dakotan and enrolled member in the Rosebud Sioux Tribe, wasn’t the first to experience this kind of dangerously deficient care from the federal agency charged with providing treatment to 2 million Native Americans across the country.
Dozens of patients have died needlessly due to errors made in IHS hospitals in South Dakota alone. Thousands more in the state’s rural Indian reservations face limited access to primary care providers, long wait times for basic medical treatments and outstanding medical debt for necessary care sought outside the federally funded facilities.
The federal government has largely ignored the deplorable conditions. Even well-intentioned lawmakers representing states with significant Native American populations have failed to make meaningful change, including South Dakota’s congressional delegation.
Meanwhile, the U.S. government remains in violation of its treaty promise to provide health care to Native Americans.
“We’re a third-world country, you know, a third-world country with our health care,” former Rosebud Sioux President William Kindle said in July, when he learned the Rosebud hospital was again at risk of losing federal funding.
Over the course of a monthslong investigation, the Argus Leader reviewed hundreds of pages of federal hospital inspection records and legal filings that illustrated the horror stories at two South Dakota IHS hospitals. The results are staggering:
A 12-year-old girl attempted to hang herself after she was left alone in the Rosebud emergency room, using her broken call light cord and her shoelaces.
Doctors in the Rosebud emergency room restrained and pepper sprayed a man overdosing on meth, which caused a fatal heart attack.
Faulty temperature controls and mold growing on the Rosebud hospital’s walls made patients and hospital employees sick, at times preventing hospital staff from working.
Patients were put at risk of contracting disease when hospital staff failed to properly disinfect a blood sugar monitor between blood draws.
Patients reported opting not to go to IHS hospitals out of fear of misdiagnosis. They said they’d rather take their chances with illness or injury at home.
Inspection records combined with dozens of patient interviews reveal medical failures at the hospitals that have persisted for years, despite warnings from federal watchdogs.
Promises to improve care at the hospitals never came to fruition. Attempts to sue the government for violating its treaty requirement to offer health care to enrolled tribal members have fallen short or stalled in court.
As Kathy laid on the operating table with her chest split open, the odds were against her.
A perfect storm in South Dakota
A perfect storm of state and federal policy failures, underfunding, geographic remoteness and extreme poverty on the Rosebud and Pine Ridge Indian Reservations create unique health care challenges IHS has tried in vain to overcome.
"Congress has been in breach of contract for decades,” said Donald Warne, chair of the Department of Public Health at North Dakota State University. “They have not fully funded IHS, and they know it.”
The hospitals have been underfunded from the start. When federal officials signed the Fort Laramie Treaty in 1868, they promised to provide health care to the tribes in exchange for land and natural resources for white settlers.
By the 1880s, promises were already broken. The Bureau of Indian Affairs experienced a “chronic shortage of doctors” and offered only limited services to patients, David H. DeJong, Native American policy expert, wrote.
In 1955, the responsibility to provide care for Native American people moved to the Indian Health Service, housed under the U.S. Department of Health and Human Services.
Over the last decade, Congress has repeatedly flagged the conditions in the South Dakota facilities.
Late last year, the Pine Ridge IHS hospital lost its ability to bill to Medicare after it failed to meet the quality requirements for that program. The Rosebud IHS hospital faced a similar fate but made the improvements required to keep the funding stream late last month.
In recent months, IHS officials have set up new leadership teams in the hospitals and created procedures for reporting and correcting problems as they arise, Great Plains Area IHS Acting Director James Driving Hawk said.
“Those steps are in place now to really catch these things in advance,” Driving Hawk, an enrolled Rosebud Sioux tribal member, said in a phone interview. ‘We’re able to identify these things quicker.”
But tribal leaders question whether those improvements will stick.
Members of Congress echoed their concerns and vowed to bring legislation to fix long-standing problems at IHS. Despite bipartisan support, though, those efforts have flopped.
Most recently, a bill aimed at making it easier to fire problem doctors at IHS appeared poised to make it to the president’s desk. The bill had bipartisan support, but lawmaker apathy stalled its progress.
And South Dakota lawmakers have refused to expand Medicaid, eliminating another funding source for the facilities. Of the 49,700 adults who would have received coverage under Medicaid expansion, 30 percent were Native Americans.
With Gov.-elect Kristi Noem set to take over the governor’s office in January, that option is off the table. The Republican congresswoman has said she would oppose expanding the federal health insurance program for needy people in South Dakota.
"I believe that’s a much more appropriate way to do it,” Noem said. “(We’ll) make sure that we’re providing services to those who need it in Medicaid but making sure that IHS is actually paying the bill for Native American folks instead of having Medicaid constantly pick up that bill.”
Isolation worsens IHS problems
The policy problems are exacerbated by the geographic isolation of the two hospitals. The facilities are in extremely remote, impoverished areas, making it difficult for the agency to recruit doctors to send there.
Housing on the reservations is limited. Safety is a concern, and schools there are some of the worst-performing in South Dakota.
The nearest Walmart is 130 miles away.
And while doctors may be interested in IHS jobs, their families aren’t.
“The challenge we have is that we’re not only recruiting an individual for a position,” Driving Hawk said. “We’re recruiting a family, and that’s what our biggest challenge is to overcome.”
Doctor turnover is high, which makes it hard for patients to see the same doctors consistently.
There is one primary care provider for every 9,960 people in Todd County, a county on the Rosebud Indian Reservation with a total population of just over 10,000. That’s a doctor-patient ratio eight times that of the state average in what is one of the poorest counties in the nation.
And patients who walk through the doors bring unique health challenges.
They lack consistent preventative care, live in areas considered food deserts and experience diabetes at the highest rates in the state.
Median life expectancy among Native American people in South Dakota is 23 years shorter than among white people and 21 years shorter than the state median, South Dakota Department of Health statistics show.
Other tribes have escaped similar situations by contracting with the federal government to take over their hospitals, cutting IHS out. Federal funds for the hospitals go straight to the tribes to run the hospital, and tribal leaders can disburse them as they see fit.
It’s an option that’s worked for the IHS hospital in Winnebago, Nebraska. In June, the Winnebago Tribe of Nebraska used the funds to take over control of their previously embattled facility. Now, tribal members and appointed medical experts decide how to spend the hospital’s money and who should be hired to work there.
But it’s not an option the Rosebud Sioux and Oglala Sioux tribes see as viable. Tribal leaders said the move lets the government evade responsibility, and others said they don’t want to take on an endeavor that would be set up to fail.
‘Why would we want to take over when it’s in the position it is now?” said Lydia Bear Killer, an Oglala Sioux health board member. "The tribe will fail. And I don’t think we want to do that.”
Living with the scar
An eight-inch scar runs down the center of Kathy’s chest today.
With her index finger, she traced the line where doctors cut open her chest. Her artificial valve makes a distinct sound. One her heart didn’t make before.
“You can hear me ticking,” she said, ‘Tike water dripping.”
Hundreds of miles from her home on the Rosebud Indian Reservation, the 57 year-old wife and mother lay cut open on an operating table.
It never should have reached this point.
Doctors at the Rosebud Indian Health Service hospital neglected to act when they received an echocardiogram four years earlier that showed a valve in Kathy’s heart was struggling to pump blood.
Instead of giving the longtime IHS patient the treatment necessary to heal the faulty valve, they told her not to worry. The red flags warning of her failing heart were shoved in a drawer and ignored.
Boyd, a native South Dakotan and enrolled member in the Rosebud Sioux Tribe, wasn’t the first to experience this kind of dangerously deficient care from the federal agency charged with providing treatment to 2 million Native Americans across the country.
Dozens of patients have died needlessly due to errors made in IHS hospitals in South Dakota alone. Thousands more in the state’s rural Indian reservations face limited access to primary care providers, long wait times for basic medical treatments and outstanding medical debt for necessary care sought outside the federally funded facilities.
The federal government has largely ignored the deplorable conditions. Even well-intentioned lawmakers representing states with significant Native American populations have failed to make meaningful change, including South Dakota’s congressional delegation.
Meanwhile, the U.S. government remains in violation of its treaty promise to provide health care to Native Americans.
“We’re a third-world country, you know, a third-world country with our health care,” former Rosebud Sioux President William Kindle said in July, when he learned the Rosebud hospital was again at risk of losing federal funding.
Over the course of a monthslong investigation, the Argus Leader reviewed hundreds of pages of federal hospital inspection records and legal filings that illustrated the horror stories at two South Dakota IHS hospitals. The results are staggering:
A 12-year-old girl attempted to hang herself after she was left alone in the Rosebud emergency room, using her broken call light cord and her shoelaces.
Doctors in the Rosebud emergency room restrained and pepper sprayed a man overdosing on meth, which caused a fatal heart attack.
Faulty temperature controls and mold growing on the Rosebud hospital’s walls made patients and hospital employees sick, at times preventing hospital staff from working.
Patients were put at risk of contracting disease when hospital staff failed to properly disinfect a blood sugar monitor between blood draws.
Patients reported opting not to go to IHS hospitals out of fear of misdiagnosis. They said they’d rather take their chances with illness or injury at home.
Inspection records combined with dozens of patient interviews reveal medical failures at the hospitals that have persisted for years, despite warnings from federal watchdogs.
Promises to improve care at the hospitals never came to fruition. Attempts to sue the government for violating its treaty requirement to offer health care to enrolled tribal members have fallen short or stalled in court.
As Kathy laid on the operating table with her chest split open, the odds were against her.
A perfect storm in South Dakota
A perfect storm of state and federal policy failures, underfunding, geographic remoteness and extreme poverty on the Rosebud and Pine Ridge Indian Reservations create unique health care challenges IHS has tried in vain to overcome.
"Congress has been in breach of contract for decades,” said Donald Warne, chair of the Department of Public Health at North Dakota State University. “They have not fully funded IHS, and they know it.”
The hospitals have been underfunded from the start. When federal officials signed the Fort Laramie Treaty in 1868, they promised to provide health care to the tribes in exchange for land and natural resources for white settlers.
By the 1880s, promises were already broken. The Bureau of Indian Affairs experienced a “chronic shortage of doctors” and offered only limited services to patients, David H. DeJong, Native American policy expert, wrote.
In 1955, the responsibility to provide care for Native American people moved to the Indian Health Service, housed under the U.S. Department of Health and Human Services.
Over the last decade, Congress has repeatedly flagged the conditions in the South Dakota facilities.
Late last year, the Pine Ridge IHS hospital lost its ability to bill to Medicare after it failed to meet the quality requirements for that program. The Rosebud IHS hospital faced a similar fate but made the improvements required to keep the funding stream late last month.
In recent months, IHS officials have set up new leadership teams in the hospitals and created procedures for reporting and correcting problems as they arise, Great Plains Area IHS Acting Director James Driving Hawk said.
“Those steps are in place now to really catch these things in advance,” Driving Hawk, an enrolled Rosebud Sioux tribal member, said in a phone interview. ‘We’re able to identify these things quicker.”
But tribal leaders question whether those improvements will stick.
Members of Congress echoed their concerns and vowed to bring legislation to fix long-standing problems at IHS. Despite bipartisan support, though, those efforts have flopped.
Most recently, a bill aimed at making it easier to fire problem doctors at IHS appeared poised to make it to the president’s desk. The bill had bipartisan support, but lawmaker apathy stalled its progress.
And South Dakota lawmakers have refused to expand Medicaid, eliminating another funding source for the facilities. Of the 49,700 adults who would have received coverage under Medicaid expansion, 30 percent were Native Americans.
With Gov.-elect Kristi Noem set to take over the governor’s office in January, that option is off the table. The Republican congresswoman has said she would oppose expanding the federal health insurance program for needy people in South Dakota.
"I believe that’s a much more appropriate way to do it,” Noem said. “(We’ll) make sure that we’re providing services to those who need it in Medicaid but making sure that IHS is actually paying the bill for Native American folks instead of having Medicaid constantly pick up that bill.”
Isolation worsens IHS problems
The policy problems are exacerbated by the geographic isolation of the two hospitals. The facilities are in extremely remote, impoverished areas, making it difficult for the agency to recruit doctors to send there.
Housing on the reservations is limited. Safety is a concern, and schools there are some of the worst-performing in South Dakota.
The nearest Walmart is 130 miles away.
And while doctors may be interested in IHS jobs, their families aren’t.
“The challenge we have is that we’re not only recruiting an individual for a position,” Driving Hawk said. “We’re recruiting a family, and that’s what our biggest challenge is to overcome.”
Doctor turnover is high, which makes it hard for patients to see the same doctors consistently.
There is one primary care provider for every 9,960 people in Todd County, a county on the Rosebud Indian Reservation with a total population of just over 10,000. That’s a doctor-patient ratio eight times that of the state average in what is one of the poorest counties in the nation.
And patients who walk through the doors bring unique health challenges.
They lack consistent preventative care, live in areas considered food deserts and experience diabetes at the highest rates in the state.
Median life expectancy among Native American people in South Dakota is 23 years shorter than among white people and 21 years shorter than the state median, South Dakota Department of Health statistics show.
Other tribes have escaped similar situations by contracting with the federal government to take over their hospitals, cutting IHS out. Federal funds for the hospitals go straight to the tribes to run the hospital, and tribal leaders can disburse them as they see fit.
It’s an option that’s worked for the IHS hospital in Winnebago, Nebraska. In June, the Winnebago Tribe of Nebraska used the funds to take over control of their previously embattled facility. Now, tribal members and appointed medical experts decide how to spend the hospital’s money and who should be hired to work there.
But it’s not an option the Rosebud Sioux and Oglala Sioux tribes see as viable. Tribal leaders said the move lets the government evade responsibility, and others said they don’t want to take on an endeavor that would be set up to fail.
‘Why would we want to take over when it’s in the position it is now?” said Lydia Bear Killer, an Oglala Sioux health board member. "The tribe will fail. And I don’t think we want to do that.”
Living with the scar
An eight-inch scar runs down the center of Kathy’s chest today.
With her index finger, she traced the line where doctors cut open her chest. Her artificial valve makes a distinct sound. One her heart didn’t make before.
“You can hear me ticking,” she said, ‘Tike water dripping.”