Norma Thomas, a resident of Owyhee, Ne.v, on the Duck Valley Indian Reservation, talks with Dr. David Simons at the Shoshone-Paiute Tribes Owyhee Community Health Facility in Owyhee in 2013. (Photo by Darin Oswald for The Washington Post) After killing much of the native population, then assigning survivors to desolate reservations, the U.S. government established a range of programs to serve American Indians. Now, a new report demonstrates government health care is another way they are disregarded. The study by the Department of Health and Human Services’ internal watchdog describes Indian Health Service (IHS) hospitals lacking operating rooms, sophisticated equipment and sufficient staffing. IHS also serves Alaska Natives. Many of the 28 IHS hospitals are small, with fewer than 50 beds. Another 18 hospitals operate under contract. While some facilities admit few inpatients on a daily basis, the number of outpatients increased 70 percent from 1986 to 2013 and exceed the hospitals’ capabilities. This results in long waiting times and difficulty in scheduling appointments, according to the Office of Inspector General’s (IG) report on “longstanding challenges.” Yet, despite the outpatient escalation, “most IHS hospitals have exceedingly low numbers of patients admitted to inpatient wards,” leading to depressed staff recruitment, retention and quality of care, the report said. The physician vacancy rate for IHS hospitals was 33 percent in 2014; nationally it was 18 percent in 2013. “Right now the government is doing a terrible job of providing health care for Native Americans,” said Brian Cladoosby, president of the National Congress of American Indians and chairman of the Swinomish tribe in Washington state. Patients can be referred to private facilities, but the budget for that is too small. In 2013, 147,000 referrals for private care were denied. The IG report says that “many hospitals are in remote locations,” but that’s an understatement for those facilities 200 miles from the nearest city. “One administrator reported that patients must travel 100-200 miles to receive post-acute care, which may be particularly problematic for patients at the end-of-life stage,” the report said. “Another hospital administrator described how the lack of resources (e.g., nursing homes, rehabilitation clinics) in the community and the ‘Third World’ living conditions (e.g., no running water or electricity) of many patients sometimes prevent the hospital from discharging patients, particularly during the winter months.” | 