Indian Health Service Story

[quezen]

The Indian Health Service is funded by the U S Public Health Service. It's budget is over 3 Billion US taxpayers dollars a year. It's operating expenses are from the medicaid, medicare, VA and private insurance rembursement for every patient that walks in the door. It has been managed by "Indian Preference" management for decades. They run dozens of hospitals and hundreds of clinics. These are government jobs (GS) or jobs through a little known uniformed service called the Commissioned Corps of the United States Public Health Service. Nowdays, like everywhere else, they are also going to contract hires. I am sure that many of the nurses belonging to this web site have stories about their experences in the Indian Health Service (IHS).

This is mine.

I went to work for the IHS a few years after nursing school by joining the US Public Health Service. I was very proud to be a "Commissioned Officer" for my country, even though I did not really know what that meant, and I never spent even one day in a "Basic Course", like every soldier does. After three years I 'interservice transfered' to the United States Army Nurse Corps. I had some long hard assignmnets in the Army, including Desert Storm, but all of them were a 'piece of cake' compared to the gruelling workload in an IHS hospital on the reservation.

Over five years passed. I had carreer status in the Army but when the Army 'downsized' in the nineties my mom was very sick so I took the bonus, got out, wnt to grad school and cared for my mom. After my mom passed away I went back to the Commissioned Corps. I had a wonderful assignmnet at Zuni, but I decided to go to Ft. Yuma because this was one of the few places in IHS close to the city where one could buy a house. When I got there the nurses told me that they triaged ,diagnosed and prescribed medication to afterhour, weekend and holliday patients in the 24 hour clinic, because there were not enough doctors to cover 24/7. They told me "we know it is not legal but management will not listen to us and change anything, they say they have always done it like that and we have to to". This clinic was less than 25 blocks form a major medical center, however the patients did not like to 'have to wait' to be seen after hours at the medcen so they came to the clinic. One of the nurses told me when I complained about the evey increasing workload, (we had inpatients to take care of also)' "just ask those people at the door if they are really sick or if they just want a 'sick slip' for their Civil Service or Casino job, if that's all they want just write them one, if you don't they will complain about you and, depending on who they are related to, management will be on your case". We staff nurses all tried again to get management to listen to us after we got a new DON who came from the Army and had a masters degree form UTSA. She knew which side her bread was buttered on and blew us off. Stupidly I volunteered to send the protocols to my Board of Nursing for an opinion, after I discoverd that this IHS hospital was also billing the insurances for our services as if we were PCP's, and we had an especially close call with an MI who could have gotten fast, complete care at the medcen. (Our protocols said that in the event of an emergency we were to call 911-I am not making this up,-but first we had to determine, with no lab and just an EKG machine and nitro, whether or not we had an emergency!) After a while the written opinion came back that these protocols were "perhaps legal for a nurse practationer but certaintly not legal" for us staff nurses to preform. I turned this in to managment and sent a copy to the US Commissioned Corps 'liaison' for that area of the country. With in 16 weeks, 20 weeks after my most recent 'excelent' evaluation I was told I was to be dismissed from the Commissioned Corps of the United States Public Health Service. I was even told by this 'liaison' that I was being given a 'dishonorable dishcarge' for the service of my country. I was a trained Army Officer, I had been to the Officer Advance Course and I knew the seriousness of a charge like that. I was horrified, she (a nurse) just laughed. A few weeks later I got the orders discharging me. I was told there coud be "no appeal and no review" of this decision by the director of the Division of Commisioned Personnel (DCP). I knew that I had done nothing wrong. I decided to fight. After hundreds of phone call and dozens of letters I found someone in the Public Health Service General Counsel's office who told me "if you feel you have been discharged in error all you have to do is appeal to the Commissioned Corps Board for Correction of Records. I did this. They accepted my case. When I was put out of the Service no one ever told me specifically why. Now I was going to be able to see, for the first time, a list of charges against me. This was to be sent by the Division of Commissioned Personal. The day after Christmas 2001 my husband went to the mailbox and brought me in a mangled USPHS envelope. "Finally", I thought. I opened it. Inside were seven (7) spent nine mm. bullet casings coverd in black powder. I took them straight to the sheriffs office. I called the Post Office and the FBI. A day or so latter they called me back. "Come pick up your bullet casings. There is no law against sending bullet casings through the mail, as long as there are no actual bullets and no postal employee is in danger". I called the USPHS who told me they knew nothing about any bullet casings and the correspondence I was waiting for had already been sent out, but, if I had not recieved it they would send me another one. When I got the list and saw the lies and the petty offenses I was charged with I knew that I could fight this. On the other hand I could feel how weak my spirt and sense of self was after what I had already been through. Now I was terrified because of the bullet casings. After thinking it over a few months I decided that I could not live with things as they were and again I decided to fight. For over two years I wrote to this board, the DCP would reply and I would reply to their reply and so on. All of this material was maintained and managed by the executive secretary of this Board. This Board is composed of a rotating list of retired high (above GS-I forget the term) government employees of the PHS who have agreeded to serve. In the meantime I wrote to the American Nurses Association. An attorney agreed to review some of the hundred of pages of material I submitted in my defense. Including copies of the illegal protocols and a copy of a statement from my nursing board that my licence was in good standing and had 'never been expired'-the USPHS had also charged me with working with an expired licence. I included the opinion from this attorney for the ANA in my correspondence to the Board. Her opinion was that 'this case involves issues of 1) Scopes of Practice 2) Licensure 3) Whistleblowing questions.

Finally, the Board voted on my case. I was so excited. Finally! Well they did vote but I was not allowed to see the results. I got a letter form the director of the Program Support Center, an agency that is above the PHS on the 'line chart'. He wrote 'this case involves nursing issues (duh) and therefore the Chief Nurse of the United States Public Health Service shoud weigh in with her opinion. She weighted in all right. This woman who I have never met or spoken to, and as far as I can tell has never met or spoken to anyone who has ever met me (none of my coworkers were ever asked for their opinion about anything that went on) wrote what can only be called a character assassination hate letter about me.She never addressed any of the nursing issues that were clearly spelled out by the ANA, she repeated the charge that my licence was expired and she totally ignored the fact that I had included a very nice letter about me from my former boss in the Army who by then had become the assistant Chief of the Army Nurse Corps. The Board voted again. This time they had to let me see the results. The Board voate 100% in my favor. They even stated that the letter from the Chief nurse had only "strengthened their opinion" that I had done absolutely nothing wrong. Enclosed with this was a little torn scrap of paper from the (new) director of the Program Support Center stating that he 'non concurred' with the Baords decision because the two and a half years of correspondence and the hundreds of pages of cocuments had 'added no new information' about my case! I was devastated! I appealed but of course it was denied. I did not have too long to cry about my staus though because the Iraqi invasion was being planned and one day while I was painting my kitchen the phone rang and a voice came on and said, "ma'am, no one in this unit knows who you are but you need to know that you have twenty four hours to report. You are being activated." I couldn't believe it! I reported in SRPed and served eighteen months on active duty with the Army in support of Operation Iraqi Freedom. During that time I was afraid that I was serving as an Army Officer when in fact I was a kicked out Commissione Corps Officer. I went to JAG and, with trembeling hands and fear in my heart told him the whole story. I figured I would be taken out of that room in chains after what I went through with the USPHS Commissione Corps. When I finished that JAG officer looked at me and laughed. "You know", he said, "every time we have these massive call ups we have people comming in here and telling us we made a mistake and they are not really in the Army. I have to admit that you have a pretty good story, but I hate to tell you, if you put on the uniform every day and go to work and get paid-you are in the Army now!"

When I got discharged I came home and looked through my PHS personned file that I had gotten via a freedon of information request. No where was there a permanent release from the Army allowing my Commission to be transfered to the USPHS Commissioned Corps. I called and I wrote to the PHS trying to get my status clarified. The new 'adverse actions officer' advised me to apply to the Board for Correction of Records. I told him I had done that and won-twice. "Well, isn't that binding" he asked. He did not seem to have a clue how his own system worked. I wrote to any and every one I could think of in Health and Human Services. They send all my correspondence back to the (new) director of the DCP, (a nurse) who wrote me, 'you may write and ask questions about your case but be aware that all correspondence will be sent to this office, we consider your case closed and we do not reply about closed cases'.

You know those stories of ruin in the Nationl Enquire? My story is just like that. I have lost my retirement. I signed my house in Yuma away on a quick claim deed. I could hardly get out of bed when all this started happining to me, I was so depressed, I did not work for almost a year because I was stupid enough to believe the USPHS Indian Health Service when they accused me of having an expired licence. I thought for almost a year that I had a dishonorable discharge from the service of my country, even though I am a decorated combat veteran and have never had a bad evaluation. I had faith that all those things they tell us nurses we shoud be aware of, Scopes of Practice, Standards of Care, honesty, loyalty, were all true and that someone would stand up for you. You know who judged, tried and sentanced me? 'Nurse Leaders'. I tried to get some advice from the senior attorney of the American Nurses association. I left her messages, once I was evev able to speak with her and tell her my sory, she said what they all say, "I am in a meeting and will call you back". Of course I never heard from her. I just colsed the account the AMA was dipping into for their monthly dues. Whats the point? Look at their fancy new headquartes, right down the road from the PHS. All these 'Nurse Leaders" probably lunch together everyday and get a lot of good laughes about us nurses out here in the field and our problems! (Although I do want to say a kind word about the junior attorney who was so nice and replyed to me. I hope she still has her job!) The Board, the JAG Officer, any 'non nurse' who has heard my story thinks the whold thing is just incredibily ridiculous. I used to love my work. I still work PRN as a nurse sometimes because I need the money. I am afraid of the nurse managers, even though I believe good management is very important and I know from experience that middle managemnet is not an easy job. I am afraid of the patients because they have the power to 'write you up' for any offense, real or percieved, and no one will support you. I takes me a long time to trust other nurses, espically the ones who act like self appointed 'police' like I did. I no longer take a lot of the self important Baloney that nursing puts out very seriously. I now learned to like the nurses who are up fromt about being 'in it for the money', the end result for the patient is the same, they get nursing care, and sometimes better care because these nurses expect hospitals to be run like a business with written rules and enough personnel to 'acclompish the mission'. I had to do a lot of soul serching about the Native Americans because of what happened to me. I knew that I worked for so long in the IHS because I liked the patients, and (most) of my Native American coworkers, but at the same time look what IHS did to me. I finally was able to realize that the people, the patients, are just people like anyone else and we all, myself included, are the victims of a system gone horribly wrong. I got the job description of the "Indian Preference in Hiring" diploma nurse 'executive director' of the hospital that started all of this against me. The job description itself is an eye dazzler with all the buzz words, GS 12 position, responsible for.., must maintain..., budget of over three million US taxpayer dollars.., ect, ect. The job requirement? "Must maintain a valid drivers licence". I believe that Native Americans have more money spent on their health care, per head, than any other group of people on the planet. Are they healthy as a group? No? I wonder why? Are there a lot of unhappy nurses out there? I wonder why?

[2ndCareerRN]

I can't tell if you got a bum rap or not. There is only one side to this story. I don't understand why the IHS would want to single you out when they have a lot more problems than what you alluded to.

Perhaps you should look into a lawyer who will work on a contingency, and take them to court where the story can be told.

One last thing, paragraphs are your friend. It got hard to follow your story at times with it all jammed together.

bob

[begalli]

Sounds like a good story for 60 minutes.

Also sounds like you need an ACLU attorney to help you with a whistleblower case (got any fight left in ya?).

IMO, you did the right thing in trying to blow that whistle as loudly as you possibly could. I don't think I would consider you "self-appointed police." You were doing what was right and not going along with the status quo...which was terribly, terribly wrong.

[Thunderwolf, MSN, RN]

Your story speaks for itself. After all that, I can understand your bitterness.

I'm sorry that you had to go through all of that to clear your name and your peace of mind. You are one incredible person, you know. It is a shame this happened to you.

Despite the nightmare, I do want to thank you for serving our Indian population and for serving your country. Your integrity, in and of itself, deserves a medal for which you so justly deserve. If I were you, I'd write a book about your experience, to educate others about a system that has gone terribly wrong. Who knows...maybe a movie. Anyway, take care. I hope things are better for you now. Thank you for your story.

[juschillin, MSN, RN, NP]

quezen,

I just read your post, it's now 2012. Thanks for telling your story. Most people would just turn tail. We stand up for our patients all the time and we have to stand up for ourselves, like you did, plus we have to help each other. Time goes by, and I hope you're doing better. How incredibly exhausted you must have been, including taking care of your mom. Something like that can stick with a person for a long time, and it can most def turn a nurse off from the profession. Sadly, there seems to be little justice in the world. Meditate, do yoga, drink lots of H20. Sleep. Play. Breathe. Be present.

:cheers: