IHS hiring practices led to malpractice, 66+ patient deaths, report says

The Indian Health Service hired numerous physicians with previous documented medical mistakes and regulatory sanctions, leading to at least 66 patient deaths in IHS' care and 163 malpractice cases totaling $55 million in U.S. government payouts since 2006, according to The Wall Street Journal.

For years, the federal agency, which provides healthcare to 2.6 million Native Americans, has been criticized by patients and government watchdogs for negligent and harmful care.  

In an analysis of 171 physicians identified in the lawsuits, the WSJ found IHS hired 33 physicians with multiple medical malpractice claims, 18 with sanctioned or revoked medical licenses and three with criminal records.

At least 44 physicians had pasts that should have been flagged by the IHS' own guidelines, the WSJ investigation found, which urge leaders to screen for medical-board sanctions, multiple malpractice cases and criminal sanctions.

The IHS' CMO, Rear Adm. Michael Toedt, MD, told the WSJ that its analysis wasn't representative of a broader workforce composed of "top quality physicians." Dr. Toedt added, "It's never appropriate to make a compromise on quality to fill a vacancy." 

As of May 2019, the vacancy rate for IHS physicians was 29 percent, according to agency data cited by the WSJ, compared to 18 percent, the national average according to AMN Healthcare's  2013 survey cited by WSJ.

IHS requires managers to check the National Practitioner Data Bank when hiring, but IHS officials said agency leaders don't follow up with local officials to make sure they comply with the requirement, according to the WSJ.

In most cases, the federal agency requires its physicians to have an unrestricted license, but even when a physician has been sanctioned, local officials can decide to overlook it.

IHS faces hiring scenarios where, "You get three candidates who come through and they all seem not great," Michele Gemelas, former IHS official and author of the agency's guide to credentialing, told the WSJ. "What you do is choose the lesser of three evils."

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