U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Director's Blog

IHS Director Holds Tribal Consultation Session with Alaska Area Tribes and Visits Health Programs

Posted on September 7, 2010

I recently traveled to Alaska to meet with the Tribes in the IHS Alaska Area as a part of my goal to hold an in-person consultation session in all 12 IHS Areas. The Tribes presented their priority issues and made recommendations for how to improve our tribal consultation process at the national, Area, and local levels. Common priority issues included the need for more funding, self-governance issues, the challenge of remoteness and distance in delivering healthcare services, and how to improve consultation. I then met with tribal delegations throughout the afternoon, such as the Nome and the SouthEast Alaska Regional Health Consortium (SEARHC) delegations pictured below. I then visited the Alaska Area Office, the Dental Health Aide Therapist Program run by the Alaska Native Tribal Health Consortium (ANTHC), the Alaska Native Medical Center, and the Southcentral Foundation’s Traditional Healing Clinic. I also participated in the HHS Tribal Resource Day at which several HHS representatives met with Tribes. Here are some pictures:

Attendees of the Director's Tribal Listening Session in Anchorage, AK
Attendees of the Director’s Tribal Listening Session in Anchorage, AK.

Nome Tribal Delegation
Nome Tribal Delegation		   SEARHC Delegation
SEARHC Delegation

Alaska Area Office Staff
Alaska Area Office Staff

Dental Health Aid Therapist Training Program
Dental Health Aid Therapist Training Program		   Alaska Native Medical Center, with Chris Mandregan, IHS Area Director
Alaska Native Medical Center, with Chris Mandregan, IHS Area Director

Traditional Healing Clinic, Southcentral Foundation
Traditional Healing Clinic, Southcentral Foundation

Update on Aberdeen Area Investigation/IHS Director Meets with Aberdeen Area Tribal Leaders

Posted on August 27, 2010

As I mentioned in a previous blog, Senator Dorgan initiated an investigation of alleged mismanagement in the IHS Aberdeen Area. I received a letter from the Senator requesting information, and we are cooperating fully with the investigation. IHS recently provided numerous documents in response to the Senator’s requests as well as follow-up requests from his staff. I appreciate the fact that our staffs have been in continuous communication with each other when there has been a need for additional information to give context and background to the documents already provided or to clarify any remaining questions or concerns that Senator Dorgan may have. I recognize the importance of the Committee’s oversight and investigative responsibilities, and remain committed to assisting the Senator with his work.

I also met with Aberdeen Area Tribal leaders last week and updated them on our efforts to change and improve the IHS. Here's a picture from the meeting:

Dr. Roubideaux meeting with Aberdeen Area Tribal leaders

IHS Director Announces Upcoming Contract Health Services Program Listening Session and Best Practices Meeting

Posted on August 24, 2010

In July, I sent a letter to Tribal Leaders updating them on our consultation on improving the Contract Health Services Program and announcing a second listening session and best practices meeting to be held September 9-10, 2010 in Denver, CO. Please see the attached letter and agenda for more information.

Chickasaw Nation Medical Center Opening Ceremony

Posted August 10, 2010

I attended the Chickasaw Nation Medical Center Opening/Ribbon Cutting Ceremony in Ada, OK, on July 19, 2010. This beautiful hospital was built through our Joint Venture Program, which is one of our health facilities construction programs where the Tribe pays for the construction of the hospital and IHS seeks appropriations for the staffing of the new hospital. The hospital includes state-of-the-art equipment and furnishings, an emergency room, family medicine, internal medicine and pediatric outpatient clinics, inpatient, surgery, ICU, OB including the ability to do C-Sections on site, dental, pharmacy (with drive in service!) and both a CT and MRI on site. The hospital also includes a healing garden and walking paths, which is a wonderful addition to promote wellness. This is a great example of a successful tribal and IHS partnership. Congratulations to the Chickasaw Nation – here are some photos:

Chickasaw Nation Medical Center (CNMC)

CNMC ceremonial ribbon cutting

CNMC outpatient clinic waiting room

CNMC trauma room

IHS Director meets with the Tribal Self-Governance Advisory Committee

Posted August 10, 2010

I met with the Tribal Self-Governance Advisory Committee on July 21, 2010, at their quarterly meeting in Washington, D.C. I provided an update on my priorities and answered questions. The group was interested in various topics related to tribally-managed programs. Here’s a photo of the attendees:

Tribal self-governance advisory committee

Dear Tribal Leader Letter - Update on Indian Health Care Improvement Act Implementation

Posted July 27, 2010

On July 22, 2010, I sent a letter to Tribal leaders providing an update on implementation of the Indian Health Care Improvement Act. This letter is the first in a series of letters that will describe selected provisions that are self-implementing and some provisions that require minimal actions to implement. There are many more provisions in the law than are mentioned in the letter, and we will send another update shortly. Please note that 638 negotiations are a related but separate topic, and this is explained in the letter. This letter is focused on an update of the overall implementation of the Indian Health Care Improvement Act. IHS continues to work quickly to implement the provisions in this new law that will benefit our patients served by IHS, tribal, and urban Indian health programs. We also continue to consult with Tribes on implementation. Here’s a copy of the letter sent to Tribes. [PDF - 48KB]

IHS Director meets with VA Secretary

Posted July 12, 2010

On May 24, 2010, IHS met with the Secretary of Veterans Affairs Eric K. Shinseki and his staff. We discussed current joint efforts to serve American Indian and Alaska Native veterans eligible for our health programs and discussed how we can improve the coordination of care for "dual-eligible" veterans. We discussed best practices, and areas for improvement. Our goal is to update the IHS-VA Memorandum of Understanding and our respective staffs are working together to develop the ideas we discussed at our meeting. It was great to see the Secretary so interested in working with us to improve how we serve American Indian and Alaska Native veterans. Here are some pictures from the meeting:

IHS Director meets with VA Secretary

IHS Director with VA Secretary

IHS is Working to Address Issues in the Aberdeen Area, and to Promote Meaningful Reform across the Agency

Posted July 1, 2010

Chairman Dorgan has been a stalwart champion of the Indian Health Service (IHS) and the people it serves. IHS appreciates the strong commitment Chairman Dorgan has made to improving IHS and ensuring it provides high-quality, timely care. IHS looks forward to continuing to work with him to achieve this goal.

IHS is focused on changing and improving the IHS, which includes taking aggressive steps to address problems such as those identified at the Quentin N. Burdick Memorial Hospital located on the Turtle Mountain Indian Reservation in North Dakota.

With respect to the Quentin N. Burdick Hospital, while certain “convenience services” were briefly disrupted, I became personally involved to ensure that clinical services were restored to the levels of service prior to recent events at the facility.

While there have been problems at the facility, actions are being taken to address them in a fair and accountable manner. In addition, I sent IHS Deputy Director of Field Operations to the Turtle Mountain Indian Reservation last week to meet with the hospital staff and the Tribal council to further assess the situation. That visit identified additional steps that will be taken to help address local issues.

Aberdeen Area:

More broadly, I launched a series of intensive Area management reviews, including a review of the Aberdeen Area, which began in April 2010. In fact, the Aberdeen Area was the second IHS Area (out of 12 total) to undergo such a review.

The Aberdeen Area management review has now been completed, and a corrective action plan is being put into place. Both clinical and administrative areas for improvement have been identified. The corrective action plan will include measurable goals for performance – and Aberdeen Area leadership will be held accountable if reforms are not achieved.

I am sending experienced managers to the Aberdeen Area to help address the pending management issues, and they will help complete the corrective action plan to address the issues identified in the Area management review. The first step is to have specific and measurable results in 60-90 days.

While there is understandably a level of interest in the details of ongoing personnel and administrative reviews given the past management issues in the Area, under federal employment law, we are not able to discuss details of any ongoing reviews or investigations involving employees until they are completed. Employees have a right to due process and privacy. However, when inappropriate conduct is found to have occurred, the employees responsible will be held accountable.

Overall IHS Reform:

In the past year, I have brought a new leadership focus to IHS on providing better customer service, promoting ethical behavior, ensuring fairness and accountability in performance management, and improving the quality of services delivered to IHS' patients.

Many efforts to change and improve IHS are underway. For example:

  • Improvements to shorten timelines in the hiring process, which will help IHS in its efforts to recruit and hire well-qualified staff.
  • Improved financial management, better accountability, and enhanced program integrity throughout the system, including efforts to promote transparency and establish stronger partnerships and better consultation with tribes.
  • Improvements in the performance management process throughout IHS, by revising performance measures to include more specific, measurable goals that will hold managers accountable for achieving progress on agency priorities.

While the situation at IHS is improving every day, the transformative organizational change I am implementing will take time. I am fully committed to working on a continual basis with HHS leadership, tribes, and Congress to achieve significant progress at IHS as quickly as possible.

IHS Director Update: Health Reform and IHCIA Implementation

Posted June 16, 2010

IHS continues its planning efforts for implementation of the IHCIA and is directly participating in HHS' implementation activities for the Affordable Care Act (health reform law). IHS staff has reviewed each provision, and are drafting next steps, timelines, and determining which agencies we need to partner with on implementation of some key provisions.

I issued a letter last month to Tribes in collaboration with HHS to request Tribal input on the implementation of the Affordable Care Act and the IHCIA reauthorization. The letter included summary tables of the provisions that impact Indian country. Tribes are requested to provide input on the consultation process and priorities for implementation as soon as possible to assist implementation efforts. We are also incorporating Tribal input as we receive comments.

Some Tribes have asked why IHS is not ready to fully implement all of the new IHCIA provisions. The IHCIA contains numerous provisions with varying requirements as follows:

  • Some IHCIA provisions for the most part may be self-implementing – and would not require much additional staff work, funding or consultation. I plan to release a letter to Tribal leaders shortly with notification on these self-implementing provisions.
  • Some IHCIA provisions require additional staff work, planning, collaboration, consultation and/or potentially may require policies/regulations to implement. IHS staff is working to move forward on this important work as quickly as possible.
  • Some provisions will require additional funding/appropriations to implement, such as some of the provisions that authorize new programs or demonstration projects. IHS will consider these during our budget formulation process in the context of Tribal priorities, as well as other Agencies priorities, for future funding. I met with the IHS Tribal budget formulation committee by phone to begin gathering input on priorities for funding of IHCIA provisions in the context of existing Tribal budget recommendations for FY2012.

The IHS is proceeding with Tribes on the P.L. 93-638 contract and compact negotiations this year and is including new IHCIA authorities to the extent possible at the time of the negotiations. If IHS is not able to negotiate contract language regarding a specific provision yet, the IHS negotiation team is to discuss with the Tribe the fact that the Agency would like to revisit the negotiation on that provision in the near future when internal IHS planning is complete. Thank you to all the Tribes for their patience as we work quickly to implement provisions of the IHCIA. We know that Tribes are anxious to negotiate authorities for several provisions and we are doing everything we can to fully negotiate the transfer of these authorities to Tribes as soon as possible.

I encourage everyone to follow the Affordable Care Act implementation activities on www.healthreform.gov. New grant and funding announcements are posted there as well as on www.hhs.gov. Tribes are eligible for many of the new funding opportunities. In addition, items are posted for public comment, such as interim final rules on new health reform provisions, and Tribes are welcome to provide input. Speeches by President Obama and HHS Secretary Sebelius are regularly posted that explain aspects of the new health reform law that benefit all Americans, including First Americans. For example, this past week, the President announced new anti-fraud activities for Medicare and the initial mailing of checks to seniors with Medicare Part D coverage who have reached the “donut hole” level of drug expenses. Some American Indian and Alaska Native seniors do purchase or have Medicare Part D coverage and may benefit from this new provision.

I will continue to provide updates on this blog as we move forward.

IHS Scholarship Review Meeting

Posted on June 15, 2010

The IHS Scholarship Program is an investment in developing future American Indian and Alaska Native health leaders. It provides funding for American Indian and Alaska Native students to enter the health professions. Each year, a group of dedicated individuals gathers to carefully review applications and recommends which students to select for the scholarship. The scholarship program is highly competitive and the number of students selected depends on available funding. This year, the IHS Scholarship Reviewers met in Rockville, MD the week of May 17, 2010. I thanked them for their work as I know the huge difference this program can make in the lives of the students. I am the first IHS Director to have become a physician with the help of an IHS Scholarship. Here’s a picture of the group:

Dr. Roubideaux with scholarship group

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