As if voters didn’t have enough reasons to question government-run health care, the Wall Street Journal provided yet another last week. The paper ran a lengthy expose highlighting numerous cases of doctors previously accused of negligence receiving “second chances” in the government-run Indian Health Service (IHS), resulting in incidents wherein at least 66 patients died in IHS care.
Earlier this year, the Journal ran a separate investigative article explaining how the Indian Health Service repeatedly ignored warnings about a physician accused of sexually abusing patients, moving him from hospital to hospital. Together, these articles describe a broken culture within the Indian Health Service, demonstrating how government-run health systems provide poor-quality care, often harming rather than helping vulnerable patients.
Examples of Negligent Physicians Harming Patients
The Journal examined records from the Treasury’s Judgment Fund, which pays awards in malpractice cases wherein the federal government — in this case, the Indian Health Service — functions as the defendant. The reporters then cross-referenced the physicians involved in those cases with prior malpractice cases and disciplinary actions taken prior to the doctors joining the IHS. The results should shock patients:
- A doctor “thrust into medical exile” after five medical malpractice settlements in five years, including a rejection by a Nevada licensing board, ended up finding work in the Indian Health Service, where the federal government had to pay an additional five malpractice claims on his behalf. The physician, who had previously left a sponge inside a patient’s breast (among other incidents) before going to work with the Indian Health Service, gashed an IHS patient’s bile duct, causing four liters of digestive fluid to leak into her abdomen and sending her into septic shock.
- An obstetrician with a history of five malpractice settlements totaling $2.7 million, and sanctions from the California medical board stemming from a patient who bled to death following a caesarean section, found employment in the Indian Health Service. A year after his hire, a baby died in the womb because this doctor failed to treat his mother’s high blood pressure. IHS officials later concluded that the doctor’s history “forshadow[ed] the tragic events that transpired in October 2017.” The physician admitted to the Journal, “I just did not address patients’ primary medical needs in a satisfactory way.” But he still applied for and received a position with the IHS.
- A surgeon sued for malpractice 11 times over an eight-year period while living in Pennsylvania later got a job with the Indian Health Service in New Mexico. There he “allegedly cut a tube connecting a patient’s liver to his stomach and punctured the man’s intestines during a 2008 gallbladder surgery.” The patient later died.
- A physician disciplined in both Florida and New York for prescribing pain pills for her boyfriend — up to 1,350 oxycodone pills in a single day — was hired by the Indian Health Service because she had a “clean” medical license in Pennsylvania. While working for the IHS, she sent a patient complaining of dizziness home with a diagnosis of pink-eye. Days later, the patient suffered a stroke that has left him confined to a wheelchair and unable to speak. The federal government settled the subsequent malpractice case for $1 million because “hospital officials said in interviews that the doctor’s background made the case hard to defend.”
- Another surgeon with nearly a dozen malpractice suits and a suspension for sexually abusing a patient during an exam received a job with the Indian Health Service. During his time as an IHS employee, the federal government paid a judgment exceeding $600,000 “over a colostomy the doctor performed that spilled fecal matter under a patient’s skin” and a $500,000 settlement for a botched hernia repair.
- An obstetrician with at least seven reports in the National Practitioner Data Bank, including North Carolina sanctions over a potential sexual relationship with a patient, got a job with the Indian Health Service. In 2013, the doctor “struggled to deliver a baby” at an IHS facility. The baby developed an irregular heartbeat and died. The federal government paid a $900,000 malpractice claim because “a medical board reprimand later said [the doctor] should have resorted to a [caesarean] section ‘hours earlier.’”
- A surgeon who lost his medical license in Illinois for “gross negligence” got another chance at a New Mexico IHS facility. “Two months after he arrived as the [IHS] hospital’s chief of surgery, he allegedly punctured a patient’s intestines during a surgery.” The patient ended up needing a dozen surgeries — which she wisely obtained outside the Indian Health Service — and a four-month hospital stay to recover.
The Journal article also explained the circumstances by which all these physicians with histories of multiple malpractice claims or disciplinary actions came to work in the Indian Health Service. First, while the agency’s policies require hiring managers to consult the National Practitioner Data Bank for a physician’s history of malpractice claims or sanctions, the IHS does not monitor compliance with that requirement.
In one case, the CEO of a hospital who fired a surgeon for negligence said she “encourag[ed] him to consider another field of medicine than surgery.” However, the CEO didn’t know the surgeon had ended up practicing at an IHS facility until the Journal contacted her — because IHS apparently failed to investigate the surgeon’s history before hiring him.
Second, the federal government covers physicians’ malpractice claims through the Treasury’s Judgment Fund (the way the Journal reporters researched the hysicians’ history). Because IHS doctors don’t need to pay for malpractice insurance themselves — what one survey of IHS physicians considered the top benefit of working at the agency — it has become an effective “dumping ground” for physicians whose history of prior malpractice claims means they cannot obtain insurance on their own. IHS patients and federal taxpayers often end up paying the price, both literally and figuratively.
Poor Reimbursements Equal Poor Care
Poor pay is the biggest obstacle for the Indian Health Service and the reason the agency has hired so many physicians with checkered histories. As the Journal noted, the IHS faces “a conundrum: How to recruit badly needed doctors — often into remote areas where pay is low compared with private practice — without hiring people so troubling they endanger patients.” The agency faced a 29 percent physician vacancy rate as of May, well above the industry average of 18 percent.
One former IHS official admitted that hiring managers have to make compromises when hiring physicians: “You get three candidates who come through and they all seem not great. But what you do is choose the lesser of three evils.” Hiring those “lesser evils” led to disastrous and often fatal consequences for dozens upon dozens of Indian Health Service patients.
Sen. Elizabeth Warren, D-Mass., says she wants to extend government-run health care to the rest of the United States. But rather than apologizing to Native Americans for DNA tests, she should instead apologize for the horrid conditions within the Indian Health Service, promise to replace that broken system with something that works, and vow not to wreak on the rest of the American health-care system the kind of havoc Native populations have faced for years.