Crow Tribal Leaders Call for Removal of IHS Hospital’s Clinical Director

Leaders of the Crow Tribe in Montana are calling for the removal of Dr. A. Scott Devous, clinical director at the Indian Health Service hospital on the reservation, after learning that he had been convicted of drug distribution charges 27 years ago in Wyoming, as reported by ABCMontana.com on Sept. 10.

Devous received his license to practice in Montana in 1989, but his Wyoming license was relinquished in 1983, just before he was indicted on federal drug charges, ABCMontana.com said. He had been found guilty of abusing Demerol and passing the drug to a girlfriend.

Facebook Group Provides a Forum for Disgruntled IHS Patients

Angel White Eyes never imagined her six-hour wait at an Indian Health Service facility would be of interest to so many. But her Facebook group about the experience – “I just spent 6 hours at IHS just for them to give me Tylenol” – has drawn more than 1,900 members since she started it in January.

The group’s name is a summary of what happened on her trip to the clinic. To date 1,946 people from throughout Indian Country have signed onto the group, most of them to share their own frustrations with the IHS.

To read the full story, click here.

H1N1 PSA Campaigns Targeting Native Americans Unveiled

On Jan. 12, the U.S. Department of Health and Human Services unveiled two new public service announcement (PSA) campaigns targeting American Indians and Alaska Natives, urging them to get vaccinated for the H1N1 flu.

At a press conference announcing the campaigns, HHS Secretary Kathleen Sebelius said the virus has hit Indian Country especially hard, citing a CDC report released last month that showed that Native Americans are four times more likely to die from H1N1 than the general population.

Sebelius said American Indians/Alaska Natives are at a greater risk because they have higher rates of conditions such as asthma, diabetes and heart disease. It is also due to the higher numbers that live in poverty and that lack access to medical care.

“And this message is really urgent in Indian Country,” she said.

The HHS and IHS hope that the PSAs, produced for radio and TV, get that message out. The announcements give strategies for preventing the virus, like hand washing, coughing/sneezing into a sleeve and staying home from work if sick. They also stress getting vaccinated.

The series of six TV PSAs feature Cherokee actor Wes Studi. There are also regional PSAs starring Sebelius and IHS Director Dr. Yvette Roubideaux.

In addition to getting vaccinated, Roubideaux encourages people to educate everyone on how to take precautions and prevent spreading the virus.

As of mid-November, there were 47 million H1N1 cases in the United States, with more than 200,000 hospitalizations and nearly 10,000 deaths, Roubideaux said. And she stressed that there may be a third wave, as influenza typically peaks from January to March.

For more information on H1N1, go to www.flu.gov.

Court Says Equitable Tolling Does Apply in ISDA Contract Support Cost Dispute

In a contract support claim against the Indian Health Service, the Civilian Board of Contract Appeals’ dismissal of several plaintiffs’ contract claims was affirmed in part and reversed in part by the U.S. Court of Appeals Federal Circuit yesterday. The case involved Arctic Slope Native Association; Confederated Tribes of Coos, Lower Umpqua, and Siuslaw Indians and the Metlakatla Indian Community.

The Civilian Board of Contract Appeals had dismissed the claims against the IHS on the ground that the appellants had failed to present them to a contracting officer within six years after the claims accrued, as required by section 605(a) the Contract Disputes Act (“CDA”), 41 U.S.C. § 605(a).

The plaintiffs argued that the CDA’s six-year presentment period was subject to equitable tolling. They pointed out that the Supreme Court had delayed all pending contract support litigation while it considered Cherokee Nation v. Leavitt, and that the statute of limitations should not apply to those cases. The Board of Contract Appeals held that the CDA’s presentment period is a jurisdictional requirement that is not subject to tolling, either equitable or legal.

The court held that the six-year presentment period is (emphasis added) subject to equitable tolling and remanded the case to the board to determine whether it satisfies the requirements of the equitable tolling doctrine.

For more information contact richard.phelps@falmouthinstitute.com

Tribes Overpaying for Medical Services

During just one three-month period in 2008, the Indian Health Service and tribes paid $14 million over the Medicare rate for medical services, according to a Health and Human Services Inspector General’s report released last week. The money for the services comes from the Contract Health Services program -- a program so cash-strapped every year that it cannot cover medical care for tribal members for a full fiscal year, giving rise to the wry admonishment frequently heard in Indian Country … “Don’t get sick after June.”

Between January and March last year, IHS and tribes paid above the Medicare rate for 22 percent of hospital claims, resulting in $1 million in overpayments. But most overpayments were for hospital outpatient claims. If IHS and tribal payments for non hospital claims were capped at the Medicare rate, they could have saved as much as $13 million between January and March 2008.

While 22 percent of hospital claims were paid above the Medicare rate, the resulting overpayments only accounted for 3 percent of the total $33 million that IHS and tribes spent on hospital claims between January and March 2008, according to the report. IHS and tribes paid above the Medicare rate for 71 percent of non hospital claims. Most of these claims paid above the Medicare rate were for physician services.

IHS Not Like Public Option Insurance, Says White House

The Indian Health Service (IHS) is not an example of how public option health insurance would work, says an Obama administration official.

Yesterday on the White House blog, Kimberly Teehee, a senior policy advisor for Native American Affairs at the White House Domestic Policy Council, posted a rebuttal to those who have used the Indian Health Service as an example of what could go wrong with a public option health insurance plan.

“The IHS system is not an insurance plan,” Teehee said in a video and written message. “And comparing the two is like comparing apples to oranges. IHS provides comprehensive health care services to approximately 1.9 million American Indians and Alaska Natives living on or near reservations in 35 states. Some of these health services include doctor visits and check-ups, dental and vision care, diabetes prevention and treatment, mental health and substance abuse treatment, and home health care. IHS also helps construct hospitals and clinics and provides safe drinking water and sanitation facilities to American Indians and Alaska Natives. Health insurance, by contrast, provides individuals a guarantee to a defined set of benefits for a price. While the IHS accepts insurance payments for care it provides, it is not an insurance plan.”

In a recent interview with the Rapid City Journal, South Dakota Gov. Mike Rounds pointed to the Indian Health Service to caution South Dakotans against supporting more government involvement in medical care.

"Right now in South Dakota, we've got one of the best examples of a health-care system run amok, and that is Indian health," Rounds said in an interview with the Journal. "And I wouldn't wish that health care on anybody. It would be an absolute disaster in America."

New IHS Director Dr. Yvette Roubideaux

Yvette D. Roubideaux (Rosebud Sioux), M.D., M.P.H., was confirmed as the director of the Indian Health Service by the U.S. Senate in May. Since then, she has been very busy. Sure, she has been putting a lot of time into administering a $4.3 billion national health care delivery system, but she has also been fielding loads of inquiries from the media. Roubideaux is, after all, the first woman to head the IHS in its 54-year history.

AIR caught up with Roubideaux this summer. We posed some questions on why she was picked to lead the IHS, what she hopes to accomplish, about the big boost the agency got from the Recovery Act and could get in the federal government’s FY 2010 budget and health care reform. [Read more]

Proposed IHS and BIA Budgets Include Contract Support Increases

The recently released proposed Indian Health Service and Bureau of Indian Affairs budgets show increases for contract support. IHS will have a 13 percent increase. The BIA’s increase is not yet known because it has not been finalized.

Tribes that will for the first time be negotiating 2 and 3 rate agreements should be aware of these increases as it will impact the approach that they decide to take when establishing these new rates. Careful planning and strategizing is imperative in order to maximize recoveries.

For additional information, contact Richard Phelps at 1-800 992 4489, ext. 101.

Recovery Act Funds Released for IHS Projects

On May 16, the U.S. Department of Health and Human Services announced in a press release that the Indian Health Service will release $500 million allocated for improvements in Indian health under the American Recovery and Reinvestment Act (ARRA) of 2009.

ARRA funds are to be expended by the IHS as follows: $227 million for health facilities construction, $100 million for maintenance and improvements, $85 million for health information technology, $68 million for sanitation facilities construction and $20 million for health equipment that will help improve health care in Indian Country.

“These Recovery Act funds will provide critical assistance to American Indian and Alaska Native communities,” IHS Director Yvette Roubideaux stated in the release. “These funds will help improve health care, create jobs and make our native communities stronger.”

To see a state-by-state list of all ARRA-funded IHS projects, click here.

Robideaux Indian Affairs Hearing Available

Yesterday's Senate Committee on Indian Affairs confirmation hearing for Indian Health Service nominee Dr. Yvette Roubideaux is available for viewing on the committee's website.

Dr. Yvette Roubideaux Nominated to Head Indian Health Service

President Obama has nominated Dr. Yvette Roubideaux, an Assistant Professor in the Department of Family & Community Medicine at The University of Arizona College of Medicine, to head the  Indian Health Service.

If approved by the Senate, Roubideaux will oversee an IHS budget of more than $3 billion dollars plus $500 million from the stimulus package. She'll also have the opportunity to spearhead the passage of the Indian Health Care Improvement Act, a bill she testified on nine years ago, but has yet to see enacted. 

Roubideaux previously worked in the Indian Health Service as a Medical Officer and Clinical Director on the San Carlos Indian Reservation and in the Gila River Indian Community.   She has conducted extensive research on American Indian health issues, with a focus on diabetes in American Indians/Alaska Natives and American Indian health policy.

Roubideaux, 46, is a member of the Rosebud Sioux tribe. She received her MD from Harvard Medical School and her MPH from the Harvard School of Public Health.

Roubideaux is not allowed to give interviews during the confirmation process, but you can gain some additional insight on her from this profile in the Changing the Face of Medicine online exhibit from the National Institutes of Health  and from her May 10, 2000, testimony before the Senate Indian Affairs Committee on the Reauthorization of the Health Care Improvement Act.

Budget has $4 billion for IHS

President Obama’s 2010 budget, released at 11 a.m., includes over $4 billion for the Indian Health Service. In a 140-page budget overview, Obama said the $4 billion would build on the $500 million in economic stimulus money already headed for health care in Indian Country.

The Bureau of Indian Affairs will see a $100 million increase for law enforcement and education. Additional funding through the department of justice is available. The budget overview also said there would be an increase in funding for tribal colleges and scholarships. The Bureau of Indian Affairs is also getting $490 million in stimulus money.

Obama is also proposing a 2 percent cap on pay raises for civilian federal employees and a 2.9 percent cap for the military.

Contract Appeals Board Cites Cherokee v. Leavitt Against the Tribe

Citing Cherokee v. Leavitt, the Civilian Board of Contract Appeals said recently that the Indian Health Service was justified in denying the Fort Mojave Indian Tribe’s claim for more money to cover services it was providing at its clinic under a 638 contract with the agency.

In this complex case (Fort Mojave Indian Tribe v. Department of Health and Human Services, CBCA 547-ISDA), the tribe charged that the IHS acted unlawfully by refusing to pay the tribe the full amount that the agency would have spent to provide services for the tribe’s service community, as required by section 106(a)(1) of the Indian Self Determination and Education Assistance Act (ISDEAA). Specifically, the tribe said that (1) the IHS refused to pay for patients it served from nearby communities, (2) for the tribe’s full share of the service unit’s funding unlawfully designated by the IHS as “contractible but not divisible funding” and (3) for the full share of the service unit’s “historical funding.”  

The agency contends that the tribe entered into a contract with the agency for specified services to be provided for a specified amount (emphasis added). The agency paid at least the amount requested in the contract and the tribe provided the services specified “and no other services” in exchange for the payments. “Therefore the contract has been fulfilled.”

 The board sided with the IHS, noting that in Cherokee v. Leavitt – a 2005 case that centered on whether the IHS had provided full contract support costs in light of limited appropriations – the Supreme Court said that an ISDEAA contract between a tribe and a government agency was the same as any other procurement contract.  “There can be no more straightforward application of this principal than to this situation:  where an offer and acceptance were freely made, an agreement was entered into, and each party has fulfilled its promise, nothing remains to dispute,” the board wrote.

IHS Becomes More Transparent with New Web Site

Want to know how your Indian Health Service facility is doing in terms of quality of care? Now you can find out instantly via its Health Transparency Website, its launch announced early this week.

Developed in support of Presidential Executive Order (EO) 13410, Promoting Quality and Efficient Health Care in Federal Government Administered or Sponsored Health Care Programs, the site allows IHS patients to compare the performance of the IHS facility where they receive care to the performance of other IHS facilities within their geographical area.

The site also provides information to help patients advocate for their own health care. It offers a checklist with important items to be discussed with the provider to ensure they are receiving the proper care, such as family history of disease, current medications and immunizations and procedures received at other facilities.

IHS Loses Millions in Equipment, Says GAO

The Indian Health Service has lost at least $15.8 million worth of equipment and later falsified documents to cover up some of those losses, the Washington Post reports today.

An investigation by the Government Accountability Office found that over a three-year period from 2004-2007, 5,000 pieces of equipment were lost or stolen, including a computer that contained more than 800 Social Security numbers and sensitive health information. Also missing are trucks, tractors, all-terrain vehicles and information technology items -- including computers, video projectors and digital cameras -- from the agency's headquarters in Rockville, Md. Read the report here.

Baucus Wants Investigation of IHS

The Associated Press reports that Montana Senator Max Baucus has added his voice to those calling for an investigation of the Indian Health Service and how it allocates its resources. Earlier this month, the Ft. Peck Tribal Executive board demanded an investigation into the IHS. Both come on the heels of a Senate Indian Affairs Committee hearing on the contract health services program. Witnesses there told committee members of how people in serious need of medical attention must go without because the program consistently runs out of money each spring and remains unfunded until the new federal fiscal year begins in the fall.

Ft. Peck Tribes Ask Congress to Investigate IHS

After declaring a health care emergency, the Fort Peck Tribal Executive Board has asked Congress to investigate the delivery of medical care by the Indian Health Service on the Montana reservation, The Associated Press reported this morning.

"The crisis we're talking about has been building for years due to a lack of funding and a lack of true leadership in the IHS," tribal Medical Director James Melbourne was quoted as saying in the AP report.

The tribes have spent $16,000 to $20,000 on kidney dialysis machines. Last week, Melbourne had to find $2,000 to buy a coloscope, needed to examine sexually abused children. Other equipment is still needed, including ultrasound machines. But Melbourne said IHS will not pay for any of the equipment because it is not a priority.

In addition to the equipment, the tribes’ health department has staff shortages and lacks vital services, such as addiction counseling and nutrition services.

At its Jan. 28 meeting, the Tribal Executive Board voted for a comprehensive review of the IHS, as it relates to the reservation, and to start gathering evidence to take over portions of it.

Dorgan Honored for Extending Special Diabetes Program

The Juvenile Diabetes Research Foundation International, the American Diabetes Association and the National Indian Health Board have honored Sen. Byron Dorgan, D-N.D., with the 2008 Congressional Leadership Award for his efforts in extending the Special Diabetes Program (SDP) in Congress.

The SDP has two programs: the Special Statutory Funding Program for Type 1 Diabetes Research, which funds Type 1 Diabetes research through the National Institutes of Health, and the Special Diabetes Program for Indians (SDPI), which funds prevention, treatment and education programs for Native Americans with Type 2 Diabetes through the Indian Health Service.

More than 60,000 people have been involved in clinical research supported by the Special Statutory Funding Program for Type 1 Diabetes Research program, and the SDPI has funded 66 prevention demonstration projects and over 300 tribal community-directed programs.

Dorgan has authored legislation to extend the SDP for an additional five years, and the bill currently has 48 co-sponsors in the Senate. As chairman of the Senate Indian Affairs Committee, he has also worked to raise awareness about the significant progress that has been made in tribal communities struggling with diabetes.

"I am deeply honored by this award from the Juvenile Diabetes Research Foundation, and the other organizations represented here today, and I plan to keep pushing for policies that will support innovative ways to deal with this disease," Dorgan said in a press statement. "Diabetes is a serious problem that hits our American Indian communities particularly hard. It's important that we find ways to educate the public about how to prevent diabetes and how to treat it effectively once they have been diagnosed."

IHS hospital limits hours, emergency services

The Indian Health Service has limited emergency services at the Crownpoint Hospital in New Mexico due to an acute shortage of technical staff, it was reported this week in the Farmington Daily Times. The limited hours are expected to last until mid-June.

The Indian Health Services hospital, which serves a population of about 20,000 Navajo people, will not offer emergency services during nights or weekends until more staff members are hired. In the meantime, patients needing emergency services at night or on weekends are instructed to go to nearby facilities in Gallup, Fort Defiance and Shiprock.

McSwain Confirmed as Director of IHS

This week, Mike Leavitt, Secretary of the U.S. Health and Human Services, made the following statement on the confirmation of Robert G. McSwain as director of the Indian Health Service:

“I applaud the Senate’s confirmation of Bob McSwain as Director of the Indian Health Service (IHS). Bob brings to this role strong leadership skills and more than 30 years of federal service. Throughout his tenure, he has shown a strong dedication and commitment to the health and well-being of the 1.9 million American Indians and Alaska Natives served by this Department. I know Bob will continue to be a tremendous asset to HHS and I appreciate his contribution to the leadership team.”

McSwain, a member of the North Fork Rancheria of Mono Indians of California, served as IHS deputy director from February 2005 until he was appointed acting director in September 2007.

McSwain has been honored with many awards, including the President’s Rank Award for Meritorious Service in 2002 and the President’s Rank Award for Distinguished Service in 2006.