Indian Health Service


The Indian Health Service is an operating division within the U.S. Department of Health and Human Services. IHS is responsible for providing direct medical and public health services to members of federally recognized Native American Tribes including American Indian and Alaska Native people. IHS is the principal federal health care provider and health advocate for Native people in the United States.
The IHS provides health care in 37 states to approximately 2.2 million out of 3.7 million American Indians and Alaska Natives. As of April 2017, the IHS consisted of 26 hospitals, 59 health centers, and 32 health stations. Thirty-three urban Indian health projects supplement these facilities with various health and referral services. Several tribes are actively involved in IHS program implementation. Many tribes also operate their health systems independent of IHS. It also provides support to students pursuing medical education to staff Indian health programs.

Early history and organization

"The provision of health services to members of federally recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship, established in 1787, is based on Article I, Section 8 of the Constitution, and has been given form and substance by numerous treaties, laws, Supreme Court decisions, and Executive Orders."
Health services for American Indian and Alaska Natives in the United States were first assigned to the Department of War in 1803 and later the Office of Indian Affairs in 1824. With the creation of the Division of Indian Health in 1924, field nurses were hired and Public Health Service officers filled positions to address staffing shortages. Policy changes as a result of the Meriam Report led to funding and the first preventive medicine program. While resources increased in the 1930s, both staffing and funding declined with the start of World War II. Calls to improve health, sanitation, and facilities continued after the war as Indian termination policy shaped postwar debate.
Following the Indian Health Facilities Act of 1954, the IHS was established in 1955, transferring departmental authority to the Public Health Service. At the same time, former surgeon general Thomas Parran published a report which detailed health problems among Alaska Natives. The IHS's report to Congress in 1957 and the Parran Report presented the first comprehensive study of health conditions and recommendations based on the findings. There were four priorities or functions identified:

Employment

IHS employs approximately 2,650 nurses, 700 physicians, 700 pharmacists, 100 physician assistants, and 300 dentists, as well as a variety of other health professionals such as nutritionists, registered medical-record administrators, therapists, community health representative aides, child health specialists, and environmental engineers and sanitarians. It is one of two federal agencies mandated to use Indian Preference in hiring. This law requires the agency to give preference to qualified Indian applicants before considering non-Indian candidates for employment, although exceptions apply.
IHS draws a large number of its professional employees from the U.S. Public Health Service Commissioned Corps. This is a non-armed service branch of the uniformed services of the United States. Professional categories of IHS Commissioned corps officers include physicians, physician assistants, nurses, dentists, therapists, pharmacists, engineers, environmental health officers, and dietitians.
Many IHS positions are in remote areas, including its headquarters outside of Rockville, Maryland, and at Phoenix Indian Medical Center in Phoenix, Arizona. In 2007, most IHS job openings were on the Navajo reservation. 71% of IHS employees are American Indian/Alaska Native.
The IHS also hires Native/non-Native American interns, who are referred to as "externs". Participants are paid based on industry standards, according to their experience levels and academic training, but are instead reimbursed for tuition and fees if the externship is used for an academic practical experience requirement.

Legislation

The Snyder Act of 1921 was the first formal legislative authority allowing health services to be provided to Native Americans. The Indian Health Facilities Act of 1954 transferred responsibility from the Bureau of Indian Affairs to the Public Health Service within the recently created Department of Health, Education, and Welfare. After the creation of the IHS in 1955, the Department of the Interior still controlled funding for new hospitals. The Indian Facilities Act in 1957 authorized funding for community hospital construction. This authority was expanded in 1959 with the Indian Sanitation and Facilities Act, which also authorized construction and maintenance of sanitation facilities for Native American homes, communities, and lands.

Indian Self-Determination Act of 1975 (Public Law 93-638)

The Indian Self-Determination and Education Assistance Act of 1975 enabled tribal governments to administer programs previously operated by the BIA and the IHS.

Indian Health Care Improvement Act of 1976 (Public Law 94-437)

The passing of the Indian Health Care Improvement Act of 1976 expanded the budget of the IHS to expand health services. The IHS was able to build and renovate medical facilities and focus on the construction of safe drinking water and sanitary disposal facilities. The law also developed programs designed to increase the number of Native American professionals and improve urban Natives' health care access.

Other legislation

Title V of the Indian Health Care Improvement Act of 1976 and Title V of the Indian Health Care Amendment of 1980 have increased the access to healthcare Native Americans living in urban areas receive. The IHS now contracts with urban Indian health organizations in various US cities in order to expand outreach, referral services, and comprehensive healthcare services.

Administration

The Indian Health Service is headed by a director., the acting director is Benjamin Smith, an enrolled member of the Navajo Nation.
Reporting to the director are a chief medical officer, deputy directors, and Offices for Tribal Self-Governance, Urban Indian Health Programs, and Direct Service and Contracting Tribes. Twelve regional area offices each coordinate infrastructure and programs in a section of the United States.
A 2010 report by Senate Committee on Indian Affairs Chairman Byron Dorgan, D-N.D., found that the Aberdeen Area of the IHS is in a "chronic state of crisis". "Serious management problems and a lack of oversight of this region have adversely affected the access and quality of health care provided to Native Americans in the Aberdeen Area, which serves 18 tribes in the states of North Dakota, South Dakota, Nebraska and Iowa," according to the report.
Between 2015 and 2017, the agency saw five different directors. Rear Admiral Chris Buchanan, a Seminole, served as acting director from January–June 2017. Prior to Buchanan, the office was headed by attorney Mary L. Smith. Yvette Roubideaux, was appointed director of IHS by President Obama in 2009; she was re-nominated for a second four-year term in 2013 but was not re-confirmed by the Senate. After she stepped down in 2015, she was briefly replaced by Robert McSwain. Roubideaux was also preceded by McSwain, who had served as director for eight months. Trump's nominee for the post, Robert M. Weaver of the Quapaw Tribe, withdrew from consideration after questions arose about his resume. In June 2017, HHS Secretary Alex Azar appointed Rear Admiral Michael D. Weahkee, a Zuni, to be acting director.
In July 2017, Weahkee was severely chastised during the United States Senate Appropriations Subcommittee on Interior, Environment, and Related Agencies budget hearings by Senator Jon Tester. Weahkee refused to answer repeated direct questions about whether the 2018 IHS budget proposal was adequate to fulfill the Service's remit. In the December 11, 2019 Senate Committee on Indian Affairs hearing on the nomination of Weahkee as director of the Indian Health Service, Sen. Tester, a former chairman and former vice chairman of the committee, told Weahkee, "I think you're going to get confirmed... And you should get confirmed." Weahkee was finally confirmed to the post on April 21, 2020, by a voice vote in the Senate. In a letter dated January 11, 2021, Weahkee informed tribal and urban Indian leaders that he had been asked to tender his resignation by January 20, "to allow the incoming administration to appoint new leadership".
In 2009, Indian Health Service pediatrician Stanley Patrick Weber was accused of sexually abusing boys under his care at IHS facilities across a two-decade span. Weber resigned in 2016 and in 2020 was sentenced to five life terms in prison for the crimes. A 2019 report commissioned by IHS found that IHS officials did not properly investigate or follow up on the accusations against Weber, promoting him to medical director of the IHS hospital in Pine Ridge, South Dakota after the accusations were made.
In January 2021, Elizabeth Fowler of the Comanche Nation, was named as Acting Director. Ms Fowler had been Executive Director of the IHS Oklahoma City Area since 2019. The previous director, Roselyn Tso, was nominated to the position by President Joe Biden in May 2022, and was confirmed by the United States Senate in September 2022.

Areas

A network of twelve regional offices oversee clinical operations for individual facilities and funds. As of 2010, the federally operated sites included 28 hospitals and 89 outpatient facilities.
  • Alaska Area: Director, Christopher Mandregan, Jr., M.P.H.
  • Albuquerque Area: Director, Leonard Thomas, M.D.
  • Bemidji Area: Director, Daniel Frye, M.H.A. Sault Ste. Marie Tribe of Chippewa Indians
  • Billings Area: Director, Bryce Redgrave
  • California Area: Director, Beverly Miller, C.P.A.
  • Great Plains Area: Director, James Driving Hawk. The name of this area was changed in 2014 from the Aberdeen area.
  • Nashville Area: Director, Dr. Beverly Cotton
  • Navajo Area: Director, DuWayne Begay
  • Oklahoma Area: Director, Rear Adm. Travis Watts
  • Phoenix Area: Director, Rear Adm. Charles Ty Reidhead, M.D., M.P.H.
  • Portland Area: Director, Dean Seyler, B.S.
  • Tucson Area: Director, Dixie Gaikowski