Fentanyl strikes Native communities as Indian Health Service stumbles
As drug abuse ravages America’s Native communities, the Indian Health Service faces its own calamities — facilities in such bad shape that patient health is threatened.
Two recent Senate Committee on Indian Affairs hearings examined “the fentanyl crisis that is devastating Native communities across the country,” as the chairman, Sen. Brian Schatz, D-Hawaii, said at last week’s session.
Citing National Center for Health Statistics data during the November meeting, he lamented “an alarming 33 percent rise in drug overdose deaths,” including by fentanyl, from 2020 to 2021 among American Indians and Alaska Natives. That’s the second-largest increase among ethnic groups in America, with Native Hawaiians and Pacific Islanders leading with a 47 percent rise in deaths.
“These overdose deaths rates are nothing short of staggering,” Schatz said in November.
The need for more and better law enforcement, along with health services and culturally based care, was repeated by Native American witnesses and senators.
“Drug traffickers . . . are specifically targeting our Native communities,” Sen. Lisa Murkowski, R-Alaska, said last week. Native American places with just 500 people are pursued by “organized multistate drug traffickers,” she added, because the Native communities “struggle with a lack of law enforcement.”
Meanwhile, most IHS facilities serving Native American and Alaska Native populations with drug abuse and other ailments are in poor, 32 percent, or only fair, 29 percent, condition, with equipment so old or broken that it threatens “exacerbating patients’ medical conditions” and risks the “ability to deliver high quality health care,” according to a Government Accountability Office report from November. The IHS goal of maintaining 90 percent of its facilities in good condition seems fanciful without the sustained improvements that have been lacking. The IHS provides health care for 2.8 million Native Americans and Alaska Natives.
These are not new problems. The GAO cited reports of the IHS’s “aging infrastructure and equipment” from 2016. Last year, the GAO found “physical infrastructure challenges . . . complicated the IHS’s ability to provide routine health care and treat patients with COVID-19.” Pipes froze, burst and flooded the IHS hospital in Pine Ridge, S.D., in the winter of 2021, closing the inpatient unit for two weeks and forcing the relocation of 17 patients. From 2018 to 2022, the IHS’s estimates of its deferred maintenance and repairs backlog more than doubled to $737 million.
The IHS did not respond to questions from The Washington Post, but it agreed with the GAO’s recommendations, including to better monitor medical equipment and implement a plan to correct problems. Some officials told the GAO the funds available for medical equipment “are insufficient for their needs.” The problems probably would not have gotten so bad, however, had the IHS management paid more attention to its facilities.
“The state of medical equipment at IHS federally operated facilities cannot be determined because IHS does not have complete or reliable data,” GAO auditors said. “. . . IHS leadership was not aware of these problems until GAO’s review and does not know the extent to which similar problems may exist” across its facilities. That indicates the IHS’s “current monitoring activities are not effective.”
Rep. Frank Pallone Jr. of New Jersey, the top Democrat on the House Energy and Commerce Committee, told The Post: “This report is alarming and underscores why Congress must increase funding for the Indian Health Service. We requested this report after hearing from tribal representatives and provider groups that old and inadequate facilities and medical equipment challenge IHS’s ability to provide quality care to tribal members, and this report confirms those challenges.”