S. HRG. 111–873 IN CRITICAL CONDITION: THE URGENT NEED TO REFORM THE INDIAN HEALTH SERVICE’S ABERDEEN AREA HEARING BEFORE THE COMMITTEE ON INDIAN AFFAIRS UNITED STATES SENATE ONE HUNDRED ELEVENTH CONGRESS SECOND SESSION SEPTEMBER 28, 2010 Printed for the use of the Committee on Indian Affairs ( U.S. GOVERNMENT PRINTING OFFICE 63–826 PDF WASHINGTON : 2011 For sale by the Superintendent of Documents, U.S. Government Printing Office Internet: bookstore.gpo.gov Phone: toll free (866) 512–1800; DC area (202) 512–1800 Fax: (202) 512–2104 Mail: Stop IDCC, Washington, DC 20402–0001 VerDate Nov 24 2008 12:56 Feb 28, 2011 Jkt 063826 PO 00000 Frm 00001 Fmt 5011 Sfmt 5011 S:\DOCS\63826.TXT JACK PsN: JACKF COMMITTEE ON INDIAN AFFAIRS BYRON L. DORGAN, North Dakota, Chairman JOHN BARRASSO, Wyoming, Vice Chairman DANIEL K. INOUYE, Hawaii JOHN MCCAIN, Arizona KENT CONRAD, North Dakota LISA MURKOWSKI, Alaska DANIEL K. AKAKA, Hawaii TOM COBURN, M.D., Oklahoma TIM JOHNSON, South Dakota MIKE CRAPO, Idaho MARIA CANTWELL, Washington MIKE JOHANNS, Nebraska JON TESTER, Montana TOM UDALL, New Mexico AL FRANKEN, Minnesota ALLISON C. BINNEY, Majority Staff Director and Chief Counsel DAVID A. MULLON JR., Minority Staff Director and Chief Counsel (II) VerDate Nov 24 2008 12:56 Feb 28, 2011 Jkt 063826 PO 00000 Frm 00002 Fmt 5904 Sfmt 5904 S:\DOCS\63826.TXT JACK PsN: JACKF C O N T E N T S Page Hearing held on September 28, 2010 ..................................................................... 1 Statement of Senator Dorgan ................................................................................. 1 Statement of Senator Franken ............................................................................... 6 Statement of Senator Johnson ................................................................................ 7 WITNESSES His Horse Is Thunder, Ron, Executive Director, Great Plains Tribal Chair- men’s Health Board ............................................................................................. 32 Prepared statement .......................................................................................... 35 Red Thunder, Charlene, M.S., Area Director, Aberdeen Area Indian Health Service ................................................................................................................... 17 Prepared statement .......................................................................................... 18 Roubideaux, Yvette, M.D., M.P.H., Director, Indian Health Services ................. 9 Prepared statement .......................................................................................... 11 Roy, Gerald, Deputy Inspector General for Investigations, Office of Inspector General, U.S. Department of Health and Human Services .............................. 20 Prepared statement .......................................................................................... 22 APPENDIX Dorgan, Hon. Byron L., report dated December 28, 2010 .................................... 50 Garcia, Gerard P., Psy.D., Licensed Psychologist, prepared statement .............. 46 Miller, Dr. Steven, Business Manager, Indian Health Service National Coun- cil Laborers’ International Union of North America, prepared statement ...... 46 Response to written questions submitted to Gerald Roy by: Hon. John Barrasso .......................................................................................... 119 Hon. Byron L. Dorgan ...................................................................................... 117 Warne, Donald, MD, MPH, Senior Policy Advisor, Great Plains Tribal Chair- men’s Health Board, prepared statement .......................................................... 43 Written questions submitted to: Charlene Red Thunder ..................................................................................... 120 Yvette Roubideaux, M.D., M.P.H. ................................................................... 122 (III) VerDate Nov 24 2008 12:56 Feb 28, 2011 Jkt 063826 PO 00000 Frm 00003 Fmt 5904 Sfmt 5904 S:\DOCS\63826.TXT JACK PsN: JACKF VerDate Nov 24 2008 12:56 Feb 28, 2011 Jkt 063826 PO 00000 Frm 00004 Fmt 5904 Sfmt 5904 S:\DOCS\63826.TXT JACK PsN: JACKF IN CRITICAL CONDITION: THE URGENT NEED TO REFORM THE INDIAN HEALTH SERVICE’S ABERDEEN AREA TUESDAY, SEPTEMBER 28, 2010 U.S. SENATE, COMMITTEE ON INDIAN AFFAIRS, Washington, DC. The Committee met, pursuant to notice, at 10 o’clock a.m. in room 628, Dirksen Senate Office Building, Hon. Byron L. Dorgan, Chairman of the Committee, presiding. OPENING STATEMENT OF HON. BYRON L. DORGAN, U.S. SENATOR FROM NORTH DAKOTA The CHAIRMAN. I am going to call the hearing to order. This is a hearing of the Indian Affairs Committee. Today we are going to hold an oversight hearing entitled In Crit- ical Condition: The Urgent Need to Reform the Indian Health Serv- ice’s Aberdeen Area. We have focused, as many in this room know, on an investigation of the Aberdeen Area of the Indian Health Service. Two months ago, this Committee began this formal inves- tigation. I initiated this investigation with the consent of the Com- mittee after years of hearing about poor performance and mis- management within the Area. The investigation has focused on facilities operated by the IHS over the past five years especially, and today’s hearing is going to discuss some of the initial finds and will give us the opportunity to hear from the Director of the IHS and others and understand what the Agency is doing at this point to address the problems. Many of the allegations heard throughout these years were sub- stantiated in the investigation. The Committee found increasingly high numbers of EEOC complaints and other workforce grievances being filed in this region, transfers and administrative leave com- monly being used as a remedy for problem employees, doctors and nurses treating patients with expired licenses and certifications, several facilities on the brink of losing their accreditation or certifi- cation, frequent diversion of healthcare services and substantial amounts of missing or stolen narcotics, questionable management of contract health service funds, and mismanagement of billing Medicare, Medicaid or other private insurers. I recognize these problems are not new and, in fact, have fes- tered in some cases for decades. I know Director Roubideaux and Aberdeen Director Red Thunder inherited many of these problems (1) VerDate Nov 24 2008 12:56 Feb 28, 2011 Jkt 063826 PO 00000 Frm 00005 Fmt 6633 Sfmt 6633 S:\DOCS\63826.TXT JACK PsN: JACKF 2 and only had a short time to address them. I believe, however, that it will take more than two Directors to make significant change to the system and it is my hope that Secretary Sebelius will make im- proving the Indian Health Service a priority during her tenure. We have met and talked about that and she has given me that commit- ment. Let me say there are clearly many dedicated and hardworking employees in the Aberdeen Area working for Indian Health Service. I recognize that. I have said it publicly. I want it to be said again today. There are people I am sure working in the units who got up this morning and all they care about is treating patients. God bless them for their good work. This is not to cast aspersions on dedi- cated, loyal, good people who are working today in the Indian Health System. Lives are being saved because of their work. But, it is the case and I know it to be the case and I have watched the Indian Health Service juggle all of these things around, that there are poor performing employees who, in my judg- ment, ill serve the very patients they are supposed to help. And I am convinced that problem employees are able to wreak havoc and demoralize those who fight so hard to provide quality healthcare. And I just think it is time to stop. We found instances of employees working under impaired condi- tions, in some cases perhaps under the influence of alcohol. In one horrendous incident, a nurse was found to be assisting in a C-sec- tion in such an impaired state that she could not even hold the pa- tient’s skin for staples. And the nurse kept her job following this incident. In 2002, this goes back some while, the former Service Unit Di- rector of the Quentin Burdock Memorial Hospital was found by the Inspector General, the Office of the Inspector General, to have a pattern of mismanagement, discrimination and retaliation against employees, resulting in grievances and unwarranted civil suits. This is the report by the Inspector General. Though several suits against this Director cost the Agency over $106,000, despite this the Service Unit Director did not receive a demotion or a suspension and in fact was reassigned to the Aber- deen Area office only to retire seven years later in 2009. Sadly, this Committee found many, many more stories just like this one. Some employees repeatedly engaging in bad behavior or even illegal activity facing little or no disciplinary action. Instead, administrative leave or transferring employees is a solution. The Committee found that 176 employees in the Aberdeen Area were placed on paid administrative leave in the past five years for a period of times that totals eight years. This chart will show the paid administrative leave at three facilities in the Aberdeen Re- gion, Aberdeen, Sisseton and I cannot see the third, I guess it is Winnebago. [The information referred to follows:] VerDate Nov 24 2008 12:56 Feb 28, 2011 Jkt 063826 PO 00000 Frm 00006 Fmt 6633 Sfmt 6633 S:\DOCS\63826.TXT JACK PsN: JACKF 3 Employees