A lot has been written already about the problems rural hospitals have in finding competent doctors. Some medical schools even offer medical training specifically to practice rural medicine. The difficulties with finding and maintaining top quality care are multiple and complex, and some medical systems have either developed creative strategies or been extremely fortunate. Some medical systems, however, have gone the opposite direction and demonstrate how utterly disastrous these compromises can turn out to be. The Indian Health Services (IHS), a federal agency, falls into this second group.

A recent report by the Wall Street Journal has revealed a pattern of carelessness on the part of the IHS in hiring competent doctors to care for the 2.6 million Native Americans for whom it provides care. The result has been dozens of cases of malpractice that have resulted in devastating injuries, deaths, and millions of dollars in payouts. Some of these doctors were hired by IHS after troubling histories that had turned off private health care systems.

For patients receiving healthcare through IHS this pattern is extremely troubling, as they are subjecting themselves to doctors whom, it seems, could not be hired anywhere else. Worse, though, it turns out IHS was hiring some of these doctors without even having searched for them on the National Practitioner Databank.

We have recently written about the National Practitioner Databank, what it is meant to do, and, separately, the failings of HHS, the administrator of the NPD, in reporting their own providers. The NPD is in place in part to prevent bad actors from hopping from state to state with a wake of malpractice in their background. The thing is, it needs to be used to be useful.

The Wall Street Journal examined 163 malpractice claims against IHS since 2006. Twenty five percent of the doctors involved in the claims had a history upon hiring by HIS that should have raised red flags. And many of these providers had multiple red flags that IHS ignored or missed completely.

The healthcare need is strong in these rural communities, which presumably is driving IHS to cut corners and lower its standards. Tragically, the community has little say in the compromises IHS is making in providing competent care for its patients.

So, what good is the NPD system if clinics do not use them? Especially for patients who do not have the option to shop around for care, such as the case with many Native Americans in remote locations?

Good journalism like this should (ahem) spur changes in the system and improve the care for these captive patients. From plaintiffs’ attorneys perspective, the administration’s errors in hiring these doctors implicates what is called “corporate negligence,” that is, failure on the part of the hospital to properly vet the people they hire. Regardless of who bears the ultimate financial responsibility for these medical errors, it is tragic to see IHS has been, in effect, setting up their patients for increased exposure to harm through the agency’s inability to routinely adhere to appropriate standards for hiring their medical professionals.

Read the Wall Street Journal coverage here: [The US Gave Troubled Doctors a Second Chance. Patients Paid the Price. ](https://www.wsj.com/articles/the-u-s-gave-troubled-doctors-a-second-chance-patients-paid-the-price-11574439222)