IHS history makes doctors like Weber inevitable

Dr. Stanley Weber, of Spearfish, South Dakota, arrives at the Andrew W. Bogue Federal Building and United States Courthouse in Rapid City, South Dakota on Wednesday morning, Nov. 1, 2017. Weber was present for a hearing in relation to the allegations he is facing involving sexual abuse of minors. The alleged crimes were committed during Weber’s career at Indian Health Service’s Pine Ridge Hospital in Pine Ridge, South Dakota where Weber was the acting clinical director.
“CREDIT: Kristina Barker for The Wall Street Journal”
WEBER 49758

RAPID CITY— It took over a quarter century before the hammer of justice finally came down on pedophile pediatrician Stanley Patrick Weber, when he was found guilty of ten counts of child sexual abuse in recent court rulings, two counts occurring during the few years he spent at the Blackfoot Indian Health Service (IHS), in Browning, Montana, and eight, for the subsequent years he spent at the Pine Ridge IHS facility (1995-2011).
While the details of his crimes, and the incompetence or duplicity that facilitated those crimes, is often the subject of reporting when it comes to Weber, what isn’t often reported is the disturbing failure of the process that created a health service where a perpetrator like Weber could operate so destructively over the span of decades.
It is difficult to put the spotlight on the IHS when such a heinous serious of crimes are the catalyst for that spotlight. But now that the victims have some closure by virtue of these long overdue verdicts, how did the IHS become the underfunded, poorly staffed, bureaucratically addled mess that is currently responsible for Native American health care needs?
Before the Geneva Convention of 1929, which attempted to establish some humane ground rules for human conflict, there was the Doctrine of Discovery, defined by the Supreme Court in 1823. Basically, if the US invaded aboriginal homelands, they belonged to the US, but this carried a responsibility for the original inhabitants. It is understandable, then, that Indian policy based upon right of conquest and seizure is not going to be humanitarian in conception.
In 1849 the Bureau of Indian Affairs (BIA) was transformed out of the War Department to the Department of the Interior, and this was actually a fairly forward thinking decision given the tenor of the times. It took a quarter century, but the BIA decided to establish divisions for health and education. Problem then, as now, no funding. Despite treaties which stipulate that health care needs will be met, with no mention of their cost, health care needs are routinely not met, because of their cost. The health division was shut down in 1877. Not that they didn’t keep physicians, as promised in the Fort Laramie 1868 Treaty. They kept 77 of them in 1880, to service the entire treaty obligated population, in every state and territory the US controlled. That averages out to about one physician for every reservation.
It wasn’t until 1926 physicians from the Commissioned Corps of US Public Health Service were assigned to Indian health.
In 1928, the “Merriam Report,” was requested by the Secretary of Interior, to help define the extent of the problem, and what it would take to get the BIA to meet the minimum health standard for Indians. Although the report recognized the root causes of the poor health care, it provided a solution which is still the solution almost a hundred years later: increase funding and reorganize to optimize efficiency. Then, as now, this advice was not applied to the extent it changed much of anything.
The Johnson-O’Malley Act came along in 1934, and this allowed contracting for Indian health services. But for the next 20 years, progressive elements and tribal bodies lobbied for health care to be removed from the BIA because there wasn’t much improvement. Ideally, all tribes would have been enrolled for Medicaid, the most cost effective way to ensure the treaty obligated health care needs were met to the national standard. But Medicaid was not created until 1965.
By this time a disturbing mentality had set in, not only with the government, but with the tribes themselves, that health care not meeting treaty stipulated standards, was acceptable for Indians. Dysfunctional, underfunded institutional incompetence became the established norm.
And it began to take a horrific outcome to prompt the same changes minor outcomes prompted in non-Indian health care.
In 1954, Indian health care was transferred to the Public Health Service, and this seemed like a step into normalizing the quality of health care across all agencies. This was not to be the case. The IHS was established in 1955, and it undertook setting up an IHS health care network, establishing standards for IHS staff, and although health care improved, in the long run it became like the Merriam Report of 1926, basically laying out guidelines and ground rules for how health care should be, but not having a critical impact on fixing flaws in the operational reality.
The continued separation between the goals and procedures established by policy, and the ugly reality of the actual care received, reached its ruefully comical apex in 1976. The Indian Health Care Improvement Act was supposed to implement “the highest possible health status to Indians and to provide existing Indian health services with all the resources necessary to effect the policy.”
For those who depended on IHS after 1976, despite all the changes and expansions and improvements, health care continued to be substandard, clear up to the present day. An Act of Congress can have big teeth on paper, but be all gums in application.
In 1994, President Clinton attempted to reestablish communication between tribes and government agencies, revisiting the procedures of government-to-government consultation. His 1998 Executive Order defined the policy for consultation between agencies and tribes. It changed nothing. Agencies still make all decisions before ever consulting tribes, and the consultation is set up, tribal input is heard and filed, and the decision decided before the consultation, is applied.
This long history, of policies enacted, that look great on paper, but are never applied effectively in practice, created the IHS that allowed Weber to prey on young boys for a quarter century. The system of safeguards existed as policy, but it was never applied in practice.
The Wall Street Journal sent three reporters deep into Indian country, where they worked diligently for over two years, and the story they tell of getting the story on Weber, is a story worth telling in and of itself.
WS Journal reporter Christopher Weaver sums up the hundred-year-old reality, one his investigations not only revealed still exists, but one that made it very difficult to determine anything by investigation: “I mean, it’s a tough thing. The balancing act they are trying to achieve is real, right? They need to fill positions in their hospitals, and they need to keep those hospitals open because in many cases they are the only access that the people they serve have to health care. The pool of medical providers and administrative leaders they have to choose from is not always as good as you would hope. As one senior administrator in the agency told us, they just don’t get ‘the best of the best.’ They’re making compromises all the time because they want to keep their facilities operating.”
These compromises are the reality because IHS has been chronically underfunded since before it even existed, when it was a part of the BIA. From the beginning it became acceptable practice to not provide adequate health care to Indians. Whether this persisted because it was always the mentality of the government, or that substandard became standard, until the horrific became merely substandard, and quality care became something only non-Indians received or expected, the working reality is every Lakota tribe receives medical care that does not meet the needs standard clearly defined by treaty obligation, and since that is okay, and nothing is done to address this violation, everything else, however heinous, eventually becomes all right, too.