Rep. Kristi Noem

U.S. House of Representatives

It’s hard to believe that today there are medical facilities in South Dakota where staff are washing surgical instruments by hand because the sterilization machine has been broken for six months – where no infection control measures were taken for a patient with a history of an untreated, highly infectious disease – where a pregnant young woman was left to give birth unattended on the floor of the hospital bathroom.

But these situations have occurred. They’ve occurred within the last year at an Indian Health Service unit in South Dakota.

The federal government is responsible by treaty for providing health care to tribal members, and it does so through the Indian Health Service – or IHS. Sadly, there are deep-rooted problems within IHS that have gone unresolved for a decade or more, leaving tribal health care in the state of emergency we find it in today.

Over the last four years, funding for IHS has increased by more than a half-billion dollars, and yet the system as a whole stands in a state of disrepair.

What is needed more than anything is reform.

First, IHS priorities must be realigned. Too much money is being spent on administration, and anecdotal evidence of waste is extensive.

This question of where the money is going is something I’ve been aggressively working to uncover. I issued a formal request on this to IHS in December and I’m hopeful a response will arrive in the coming weeks.

I would like to see less of a financial emphasis on administration and more on mental health. I was glad IHS shifted another $1.8 million toward suicide prevention efforts recently, but still, questions remain about how they intend to use that money.

Currently, much of it is expected to go toward an intensive behavioral program in Rapid City, hundreds of miles from the people it is designed to help. Is this the best way to leverage these dollars? We’re still working through the answer to that question.

Second, we need to improve the physical condition of IHS hospitals. The broken equipment and crumbling infrastructure has a significant impact on care. Knowing this, we adjusted the budget breakdown for 2016 to reflect a 12 percent funding increase for maintenance and repairs. More will likely need to be done, but this is a necessary start.

Finally, patients deserve a dedicated and fully trained medical staff. In a 2010 Senate Indian Affairs Committee report, Senator Byron Dorgan described instances in which healthcare providers were under the influence of drugs or alcohol while on the job. More recent reports have shown physicians practicing with expired licenses and nurse practitioners without the proper certifications. While the problems are known, little has been done to improve the situation. This must change.

I recognize part of the challenge is recruiting the right individuals. We’re looking at multiple options in this area. For instance, currently if you work for IHS, the federal government helps pay your student loans. The employee, however, is then taxed on this benefit, diminishing the incentive.

Perhaps we could lift that burden and make the student loan repayment benefits tax free, as it is for employees at other agencies.

Fixing the situation at IHS is personal. As many of you reading this know, Bryon and I have three children. When they’ve gotten sick or hurt, we’ve been able to take them to a hospital that was clean and safe. The young people I’ve met in Rosebud and Pine Ridge don’t have that option. There are no excuses for the kind of care being delivered. The time to resolve this issue is now, and the faster we turn it around, the more lives we will save.