Substandard care at hospitals operated by the Indian Health Service (IHS) isn’t a new issue, but a new report offered some specific reasons why the facilities have such severe deficiencies.

The regional offices of the IHS, which runs 28 hospitals providing service to Native American tribes, have to root out quality problems based on a small amount of complaints and patient harm reports, according to a report from HHS’s Office of the Inspector General (OIG).

“According to hospital administrators, most patient complaints relate to customer service and wait times, rather than medical care. Further, most hospitals (20 of 28) receive fewer than 100 complaints per year for inpatient and outpatient visits combined, averaging about one complaint per 1,000 patient visits,” the OIG report said. “Considering the quantity and subject matter of complaints and patient harm reports, they are unlikely to provide hospital staff with the breadth of information needed to identify and diagnose systemic quality or compliance breakdowns."

The regional offices make it worse, the report said, by not inspecting facilities often enough. This has led to significant quality issues going unaddressed—15 of the 28 hospitals reported care being affected thanks to inadequate physical conditions, including one hospital where sewage leaked into an operating room.

Increasing scrutiny of IHS hospitals has led to efforts to improve care in recent months, like expanding access to telemedicine services and CMS awarding a contract for a quality improvement initiative at those facilities.

Those efforts could be hampered by continuing problems with staff at IHS hospitals. At the time the information for the reports was collected, the facilities had a 33 percent physician vacancy rate, and attracting and retaining skilled employees were constant challenges.

“The dependence on 'acting' personnel and contracted providers to fill vacancies sometimes creates instability in IHS hospitals and weakens the continuity of care provided to patients,” OIG said in its report.

IHS and CMS concurred with all the findings of the report and promised to adopt its recommendations for more frequent inspections and simplifying the employee application process.