Disapproving A Rule Submitted By the Department of Labor

Floor Speech

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Mr. THUNE. Madam President, if you asked Native Americans in my home State of South Dakota how they felt about the Indian Health Service, you would be hard pressed to find a positive review. Indian Health Service patients in the Great Plains area, which encompasses North Dakota, South Dakota, Nebraska, and Iowa, have been receiving substandard medical care for years. Too often, clean exam rooms appear to be a luxury for South Dakota's Native American patients. Dirty facilities and dirty, unsanitized equipment are common, and patient care is often slipshod at best.

One health service facility was in such disarray that a pregnant mother gave birth on a bathroom floor without a single medical professional nearby, which shockingly wasn't the first time this had happened at this facility. Another patient at the same facility who had suffered a severe head injury was discharged from the hospital mere hours after checking in, only to be called back later the same day once his test results arrived. The patient's condition was so serious that he was immediately flown to another facility for care.

A patient at Pine Ridge Hospital in Pine Ridge, SD, was discharged from the emergency department and died from cardiac arrest 2 hours later. An investigation by the Centers for Medicare and Medicaid Services found that the patient had failed to receive an adequate evaluation before his discharge.

The situation in South Dakota has gotten so bad that there is a real chance the Federal Government will terminate its Medicare provider agreements with--as of yesterday--three Indian Health Service facilities in my State.

Yesterday, my office was notified that yet a third IHS emergency department in the Great Plains area had been found in violation of Medicare's conditions of participation. In other words, these three emergency departments have been delivering such a poor level of care that the government isn't sure it can trust them to care for Medicare patients. The associate regional administrator for the Centers for Medicare and Medicaid Services noted that the problems at this third hospital are ``so serious that they constitute an immediate and serious threat to the health and safety of any individual who comes to your hospital to receive services.'' To describe the level of care at Indian Health Service facilities as substandard is an understatement. The government is failing in its treaty responsibility to our tribes.

I have been working on legislation to increase accountability and improve patient care at the Indian Health Service. Last week, my friend and colleague from Wyoming, who chairs the Indian Affairs Committee here in the Senate, and I introduced our bill, the IHS Accountability Act. Our bill takes a number of important steps to start the process of reforming the Indian Health Service.

First, we create an expedited procedure for firing senior leaders at the agency who aren't doing their jobs. The Indian Health Service has suffered from mismanagement problems for years. To name just one example, the Indian Health Service settled an $80 million lawsuit with unions that came about because IHS could not manage the basic administrative task of dealing with overtime pay. The money that IHS used to settle this lawsuit was, in part, from funds that should have been used for patients. Some $6.2 million alone came from money originally destined for IHS facilities in the Great Plains area.

Unfortunately, the Indian Health Service frequently responded to mismanagement by shifting staff between positions and offices instead of simply firing incompetent staff. We are not going to clean up the agency's problems that way.

If a member of the Indian Health Service's leadership is standing in the way of providing quality care to patients, then that person needs to find another line of work. The bill I drafted with my colleague from Wyoming will help make sure that happens. Our bill also streamlines the hiring process at IHS and ensures that tribes will be consulted when the agency is hiring for important positions. This will help IHS get dedicated, high-quality employees on the job faster.

Our bill also addresses the problem IHS has had in retaining quality employees. A provision in our bill gives the Secretary of the Department of Health and Human Services, which oversees the Indian Health Service, increased flexibility to reward employees for good performance and to set the kinds of salaries that will keep good employees on the job longer.

Finally, our bill directs the Government Accountability Office to review the whistleblower protections that are currently in place at IHS and determine whether we need to add any additional layers of protection.

One of the obstacles to improving care for our tribes has been less- than-honest reporting from the Indian Health Service. Time and again we found that conditions on the ground have not matched up to information reported to Congress.

On December 4, 2015, for example, officials from the Indian Health Service stated that a majority of the concerns at the floundering Rosebud Hospital in Rosebud, SD, had been addressed or abated. Yet mere hours later, I was informed that the Rosebud Hospital emergency department was functioning so poorly that emergency patients would be diverted to other hospitals beginning the next day. As of today, it has been 171 days since that emergency department was placed on diverted status--171 days. Clearly, the issues at Rosebud had not been addressed or abated on December 4.

In 2014, I requested a status update on the Great Plains area from the then-Acting Director of the Indian Health Service. In her response, she stated: ``The Great Plains Area has shown marked improvement in all categories,'' and ``significant improvements in health care delivery and program accountability have also been demonstrated.'' Yet we continue to receive frequent reports of abysmal patient care.

I am pretty sure that sending a man home with bleeding in his brain and having a mother give birth prematurely on a bathroom floor are not signs of significant improvement. Having a realistic picture of what is going on in Indian Health Service facilities is absolutely essential if we hope to start improving the standard of care that our tribes receive, and that is why whistleblower protections are so important.

Our bill will help make sure that the system protects those who come forward to expose the problems facing patients.

I am proud of the bill that my colleague and I have introduced, and I hope the Senate will take it up in the near future. While this is an important step, it is still just the first step. I will continue to consult with the nine tribes in South Dakota and with others to see what additional steps we need to take to fix the problems at the Indian Health Service once and for all. Our tribes deserve better than what they have been receiving, and I am not going to rest until all of our tribes are getting the quality care they deserve. Aviation Safety and Security

Madam President, before I conclude, I wish to take a minute to talk about some aviation security issues that were brought into sharp relief by the recent crash of an Egyptair flight.

Last week, 66 people died when Egyptair flight 804 from Paris, France, to Cairo, Egypt, crashed into the Mediterranean Sea off the Egyptian coast. With investigators still recovering evidence, it is too soon to come to any conclusions as to the cause of this tragic accident, but with the absence of evidence indicating an obvious technical failure, U.S. and Egyptian officials have suggested terrorism as a potential cause of the crash even without a credible claim of responsibility from any group.

Given the global risk environment and previous acts of terror, investigators are focusing their attention on anyone who may have had access to the Egyptair aircraft while it was sitting on the ground, including baggage handlers, caterers, cleaners, and fuel-truck workers.

At the Senate Commerce Committee, we have been very focused on this type of aviation safety and security issue over the last year.

In December of 2015, the committee advanced legislation to address insider threats posed by airport workers and enhanced vetting of airline passengers. As the Senate took up the FAA Reauthorization Act of 2016, we engaged in a constructive and open process to consider amendments. Ultimately, the Senate adopted a number of aviation security amendments, including a security amendment that I cosponsored with Commerce Committee Ranking Member Nelson, Senator Ayotte, and Senator Cantwell that would strengthen security at international airports with direct flights into the United States.

The amendment added a security title to the FAA bill that included legislation marked up in the Commerce Committee, as well as other initiatives. Among other things, the amendment requires TSA to conduct a comprehensive risk assessment of all foreign last-point-of-departure airports--foreign airports with direct flights to the United States. The amendment also requires TSA to develop a security coordination enhancement plan with domestic and foreign partners, including foreign governments and airlines, and to conduct a comprehensive assessment of TSA's workforce abroad. It also authorizes TSA to help foreign partners by donating security screening equipment to foreign last-point-of- departure airports and to assist in evaluating foreign countries' air cargo security programs to prevent any shipment of nefarious materials via air cargo. These provisions are similar to those of H.R. 4698, the SAFE GATES Act of 2016, and, together with the other security provisions adopted, take concrete steps to confront the real terrorist threat that we are facing.

I believe these provisions in the FAA reauthorization bill will help make air travel from foreign countries to the United States safer and more secure. The Senate passed this legislation in April, and now it is time for the House of Representatives to act. The House of Representatives should take up our FAA bill without delay so that we can get a final bill with timely security and safety reforms onto the President's desk before the summer State work period.

Every day countless terrorists are plotting their next attack against the United States. There are measures we can take today that will help make Americans safer at home and while traveling from destinations abroad. Several of those measures are included in the FAA bill that we passed with over 90 votes in the U.S. Senate.

I call again on the House of Representatives to take up this bill so that we can continue our work to keep Americans safe.

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