Associated Press Review of HHS’ Indian Health Service Finds Problems With Funding, Access to Care, Quality

The Associated Press on March 3 examined the "substandard" and "usually less comprehensive" care that Native Americans receive from the Indian Health Service, the federal agency responsible for providing health care to 60% of Americans who identify themselves solely as American Indian. Through an analysis of court and government records and interviews with outside experts, agency officials and patients, the Associated Press found many shortcomings with IHS. According to a review of physician disciplinary records, at least 21 of more than 900 physicians who worked for IHS in the past six years were punished by state medical boards for "administrative, ethical or competence problems, including chronic drug abuse, negligence involving patient deaths and sexual misconduct with patients." In addition, about 2.6% of doctors had been sanctioned by the medical boards, more than four times the average for physicians employed by the federal government. The Associated Press also found that since 1997, 16 of the 49 hospitals run by IHS were cited as being "among the worst in the nation" because they failed to meet the minimum quality standards in one or more areas set by the Joint Commission on Accreditation of Healthcare Organizations. The Associated Press reports that some of IHS' problems are due in part to a lack of funding. The agency has a $2.9 billion budget this year, but IHS Director Michael Trujillo said that it "really needs about $15 billion a year to adequately serve Indian health needs." IHS spends only $1,300 per patient per year, compared to a national average of $3,800. Craig Vanderwagen, IHS' chief medical officer, said, "We're way underfunded, but we do well with what we have." The Associated Press reports that because of the funding shortage, IHS must ration specialty care, often causing patients to forego some services such as mammograms or gall bladder surgery. In addition, the "strain" on the health service is increasing with rising numbers of potential patients, the AP reports. The Indian population in areas served by IHS facilities increased by 27.6% from 1990 to 2001 (Kelley, AP/Salt Lake Tribune, 3/3).