Temporary directors are currently in charge of four of the Indian Health Service’s 12 regional offices, including in Billings, which U.S. Sen. Jon Tester said is hampering the struggling agency’s ability to improve.
The agency’s Billings office has come under scrutiny this year after patients reported entrenched dysfunction and poor care. Area Director Anna Whiting-Sorrell resigned in April after less than 18 months on the job, citing deep-rooted problems in the agency.
Last week, Tester sent a letter to Secretary Sylvia Burwell of the U.S. Department of Health and Human Services, which oversees IHS, urging that permanent replacements be named for Whiting-Sorrell as well as directors at the other regional offices.
“The ability of these Regions to deliver quality health care to this population is impacted by the kind of leadership they have, and it would appear to me that the Agency is satisfied with temporary leadership,” Tester wrote. “I can assure you that I am not satisfied.”
Tester and U.S. Sen. John Walsh have called for the Government Accountability Office to formally investigate the agency’s operations.
During a recent field hearing in Billings, IHS Director Dr. Yvette Roubideaux pointed to the agency’s low funding levels as a source of its struggles. Per-patient spending by the IHS amounts to less than $3,000 annually, compared to $7,000 for military veterans and $12,000 for Medicare beneficiaries.
Patients and other tribal members said poor management and administrative bloat is also contributing to inadequate care.
In a nod to tribal concerns, Tester’s letter said lack of leadership in IHS has led to “ineffective communication, lack of a strategic vision, uncertainty of purpose and low employee morale.”
“If you don’t have a director, you can’t plan for the future,” Tester said in an interview this week.
“They’re not cutting it. They’re just not getting the job done,” he said of the agency. “We’ve got to kick them in the butt a little bit to get them moving.
“Maybe more than a little bit, actually,” he added.
Regional offices in Tucson, Ariz., and Bemidji, Minn., haven’t had a permanent director since 2011, according to an IHS spokesperson, though interviews were recently completed in Tuscon and should be scheduled within 45 days in Bemidji.
In June, Dorothy A. Dupree was named acting director in Billings after transferring from the Phoenix-area office, where she has been the director. The Billings Area IHS currently has a $226 million budget and serves about 70,000 Indians across Montana and Wyoming.
The Billings director position is currently advertised, and interviews should be scheduled in the next month and a half, the agency said. IHS anticipates permanent directors will be named in every region by the end of November, the spokesperson said.
Dupree was traveling Wednesday and could not be reached for comment.
While Tester said he hopes to light a fire under IHS and DPHHS, the senator stopped short of calling for an overhaul of the agency. He said IHS can “redeem” itself before the GAO report is conducted, which he said should begin in September and conclude by the end of the year.
“What it says to me, is with challenges come opportunity, and there’s an incredible opportunity within IHS to get the health care out there that the federal government is paying for,” Tester said.
Darrin Old Coyote, Crow Tribal chairman, is less hopeful that the agency will change. He said the pending GAO review and other ongoing calls for reform feel more like a Band-Aid, but added that “only time will tell.”
Old Coyote has met with Dupree and said he believes she and other area directors want to do right by the tribes. However, temporary leaders are not in a position to root out a pervasive “good old boys club” that’s concerned more with self-preservation than saving lives, he said.
“Administration-wise, it’s too top heavy,” he said, adding that only a fraction of the agency’s budget goes directly towards patient care.
“It has to be more about health care, and not some individual’s retirement or benefit from the federal government,” he said.