Mary L. Smith, Cherokee, took over as principal deputy director of the Indian Health Service in March, succeeding Robert McSwain, North Fork Rancheria of Mono Indians. An agency of the U.S. Health and Human Services Department, IHS serves the health care needs of 2.2 million American Indians and Alaska Natives through hospitals, clinics and other facilities.
Smith talked with ICTMN about some of the challenges the agency faces.
What is your vision for the Indian Health Service?
I want to improve access to health care for American Indians and Alaska Natives and I want to focus on a comprehensive approach so we are providing quality healthcare for all our patients, because the priority for IHS is always the patients we serve. I truly believe that our [collaborations] with our tribal partners will help us transform the agency.
What are some of the immediate steps you’ll be taking?
First of all, there’s a new deputy director [for Quality Health Care] at the agency, Dorothy Dupree, [Assiniboine and Sioux Tribes,] who is developing a quality program that is going to focus on workforce development, data analytics and standards of care.
We want to ensure that quality is infused throughout our system.
I’m also focusing on staffing and recruiting and retaining high-quality staff. We’re also focusing on Native rural health because that’s probably the big issue for Indian country. There are a lot of substance abuse and behavioral health issues such as suicide. We say about suicide that every one is one too many. So we are working on a number of programs that are in our FY2017 budget and making sure that behavioral health is integrated throughout our system.
You testified before the Senate Committee on Indian Affairs just a few days after you took up your new position. What do you need Congress to do to make your job possible?
I fully appreciate that certain conditions that have happened at IHS are unacceptable, and we take responsibility for that. As I said, I want to create a culture of leadership, accountability and quality, and I want everyone at IHS to adhere to the highest standards and be accountable.
But we operate with a number of challenges in terms of recruiting and retaining staff and having a lack of housing for our staff, a lack of staff quarters. And we are challenged in funding. We operate in a system where we have a number of challenges and I would like Congress to be aware of those.
Could you say a little bit about your background?
I grew up in Chicago. I am an enrolled member of the Cherokee Nation. My grandmother grew up in Oklahoma, but I grew up in Chicago. I went to both college and law school in Chicago.
I worked with HHS Sec. [Sylvia Mathews] Burwell in the Clinton White House and on the Domestic Policy Council. I was the main person responsible for Native American policy in the Clinton White House and during that time I worked across all agencies, but I particularly worked with IHS, helping them work on health issues and access to quality health care and issues of health disparities.
I also have a background in the Affordable Care Act. I was general counsel to the Illinois Department of Insurance, and I helped to implement the ACA in Illinois.
With that background, I came back to try to help because I care deeply about the mission. IHS is trying to improve health care for Native people.
What is happening with the Great Plains hospitals that have been so much in the news recently?
We’ve gotten citations from CMS regarding a number of deficiencies at three hospitals in the Great Plains. One hospital, Omaha Winnebago, has been terminated from the Medicare program and we have notices from CMS also with respect to Pine Ridge and Rosebud.
With regard to all three hospitals, we are moving aggressively to correct the deficiencies, and specifically, with respect to Pine Ridge and Rosebud, we are working on some of those systemic issues that I said I want Congress to know about, the challenges we face including retaining staff and the lack of adequate staff housing. We’re working on what’s called the Systems Improvement Agreements, long-term agreements that will allow us to work on addressing systemic challenges.
Simply put, we’re moving aggressively to remedy the situations at those hospitals.
I think I read recently that you’re contracting out the emergency room services?
We actually put out a request for proposals to contract out the emergency departments at all three hospitals and we’re currently reviewing bids. The Rosebud Emergency Department is the only emergency room that is not open right now. Pine Ridge and Omaha Winnebago are open.
Teenage suicides have been a tremendous problem on Pine Ridge. Can you tell me what IHS is doing to deal with that problem?
We have taken a number of actions with respect to teen suicides on Pine Ridge. Pine Ridge is designated a Promise Zone, which essentially brings to bear resources across the federal government, including, for example, HUD and USDA and other agencies.
Particularly with respect to IHS’s contributions to the Promise Zone, we have installed behavioral health specialists in several of the schools on the Pine Ridge Reservation to provide behavioral health counseling right in the school setting. That’s one of the things that we have done.
One often reads that there are serious complaints about individual doctors in the IHS system. Can you tell me what you’re putting in place to deal with some of those personnel problems?
We are working on establishing new procedures for credentialing doctors and as I said we are establishing a quality program, and part of that will be training for providers to adhere to standards that provide quality health care and then holding them accountable. And also professional development [to make sure] they have the knowledge and skills for their job.
Has the Affordable Care Act been helpful to the IHS?
The way in which I think the Affordable Care Act has had the biggest impact on the IHS is with Medicaid expansion. Basically, IHS is essentially a primary care system, so for any specialty medicine, you look for outside care. And we have limited dollars, but in states where there is Medicaid expansion, we are able to leverage our dollars and provide more care for our patients and it has made a tremendous difference.
So one of the other areas I am going to make a priority is to make sure that we enroll in Medicare and Medicaid any eligible Native Americans so that we can leverage our dollars so that people can get more access to quality health care.