The Impact of Government Efficiency Initiatives on Health Care Services for Native American Communities
In a recent development at Gallup Indian Medical Center, employees were informed that overnight ultrasound services would be suspended due to a new review process mandated by an executive order issued by President Trump. The Presidential Appointee Approver and Departmental Efficiency Review (PAA-DER) process has resulted in delays in care, staffing cuts, and service reductions at Indian Health Service (IHS) facilities nationwide.
The PAA-DER process requires contracts and requisitions to receive final approval from a top official at the Department of Health and Human Services (HHS), causing bottlenecks and hindrances in the procurement of essential medical supplies and personnel. This has led to a significant slowdown in the acquisition of necessary resources, impacting emergency department staffing, general surgery, labor and delivery, imaging services, and infectious disease testing.
The delays in contract approvals have also affected staffing levels, with many positions remaining vacant due to the prolonged review process. This has exacerbated the existing staff shortages at IHS facilities, where clinics and hospitals operate with over a 30% vacancy rate in staffing. The inability to renew employment contracts in a timely manner has further strained an already understaffed system.
The consequences of these delays are far-reaching, with patients facing potential risks and health care providers experiencing moral injury and burnout. The inability to immediately diagnose conditions, procure essential equipment like ventilators, and maintain adequate staffing levels has resulted in restricted services, patient transfers, and compromised patient care at IHS facilities.
While efforts are being made to address these challenges, including exemptions for IHS from certain federal terminations and the appointment of a senior adviser on Indian health, the need for more efficient and effective health care delivery in tribal communities remains a pressing issue. Tribally operated facilities have shown success in providing quality care, but the transition to self-governance is complex and not feasible for all tribes.
As the government continues to pursue efficiency initiatives, it is essential to prioritize the health and well-being of Native American communities and honor the treaties that guarantee access to quality health care services. The current barriers to care must be addressed to ensure that all individuals have access to the care they need and deserve.
