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U.S. Department of Health and Human Services
Sexual Abuse Prevention

IHS Actions

The Presidential Task Force on Protecting Native American Children in the Indian Health Service System has recommended several policy, process, and culture changes to provide greater protection for Native American children. The IHS has already taken actions, outlined below, to address these recommendations. Where legislative changes are required, IHS has made legislative proposals that would address recommendations if passed by Congress and signed by the president.

Task Force Recommendations for IHS

I. Require annual, in-person, standardized training of IHS employees conducted by instructors with law enforcement and/or child welfare experience.

In June 2019, IHS announced the mandatory employee training on protecting children from sexual abuse in health care settings. All IHS employees were required to complete the training by September 30, 2019. The training included information on indicators of abuse and warning signs, organizational safeguards used to ensure patient safety, and the process for reporting suspected sexual abuse.

II. Make reporting of child abuse easier and more streamlined by creating and publicizing a centralized child abuse hotline.

IHS has publicized a central hotline and web reporting form, where allegations can be reported, including an option for anonymous reporting.

IHS legislative proposal: To Authorize the Indian Health Service to Establish Concurrent Federal and State Jurisdiction at IHS Federal Enclave Property (FY 2021 CJ pages 286-287).

  • Proposal: Amend the IHCIA to authorize IHS to establish concurrent federal and state jurisdiction at IHS federal enclave property by adding a new subsection (3) to 25 U.S.C. § 1661(d).

III. The Director should establish policies and procedures pertaining to allegations of child sexual abuse.

Indian Health Manual Part 3, Chapter 20 – Protecting Children from Sexual Abuse by Health Care Providers, 2/6/2019

  • The purpose of this chapter is to provide professional standards and guidance to protect against sexual abuse or exploitation of children by health care providers.

IV. Withhold retiree pay and benefits for civil service employees and USPHS Commissioned Corps officers convicted of sexual exploitation crimes against children.

IHS legislative proposal: Withholding Annuity and Retiree Pay for Retired Civil Service Employees Convicted of Moral Turpitude [PDF] (FY 2021 CJ page 301).

  • Proposal: Amend 5 U.S.C. § 8312 to allow for withholding or revoking of annuity and retiree pay for retired civil service employees convicted of moral turpitude, including crimes against children and rape, during the commission of their federal duties.
  • The IHS legislative proposal states that “The U.S. Public Health Service Commissioned Corps has proposed a related amendment of 42 U.S.C. § 212 to allow for the involuntary recall of an officer from retirement in order to potentially change the characterization of his/her service from Honorable to Other than Honorable and withhold retiree pay for crimes of moral turpitude.”

V. Designate all Federal employees, contractors, and volunteers at Federal facilities, including IHS, as mandatory reporters for reasonable suspicion of child abuse.

Indian Health Manual Part 3, Chapter 36, Child Maltreatment, 9/23/2019

  • The purpose of this chapter is to establish the requirements for identifying and responding to suspected child maltreatment. The scope of this chapter establishes clinical care guidelines for patients under the age of 18 presenting for services at Indian Health Service hospitals, youth regional treatment centers, health centers, and health stations and facilities.
  • If an IHS Health Care Provider is suspected of, or has engaged in, sexual abuse of a child, IHS staff will also follow the reporting requirements outlined in Indian Health Manual, Part 3, Chapter 20, Protecting Children from Sexual Abuse by Health Care Providers. [Refer to 3-20.2 RESPONSIBILITIES]

VI. IHS should explore the viability and benefits of expanded use of telemedicine.

VII. Bolster recruitment and retention of quality of healthcare professionals.

IHS legislative proposal: Provide the Indian Health Service Discretionary Use of all Title 38 Personnel Authorities [PDF] (FY 2021 CJ pages 299-300).

  • Proposal: IHS is seeking the discretionary use of all United States Code Title 38 authorities under Part V, Chapter 74, “Veterans Health Administration – Personnel”, that are primarily available to the Department of Veterans Affairs (VA) in relation to health care positions.

IHS legislative proposal: Provide Tax Exemption for Indian Health Service Health Professions Scholarship and Loan Repayment Programs [PDF] (FY 2021 CJ pages 297-298).

  • Proposal: IHS seeks tax treatment similar to that provided to recipients of National Health Service Corps and Armed Forces Health Professions scholarships, to allow scholarship funds for qualified tuition and related expenses received under the Indian Health Service Health Professions Scholarships to be excluded from gross income under Section 117(c)(2) of the Internal Revenue Code (IRC) and to allow participants in the IHS Loan Repayment Program to exclude from gross income payments made by the IHS Loan Repayment Program under Section 108(f)(4) of the IRC.  

IHS legislative proposal: Meet Loan Repayment/Scholarship Service Obligations on a Half-Time Basis [PDF] (FY 2021 CJ pages 293-294).

  • Proposal: Permit both IHS scholarship and loan repayment recipients to fulfill service obligations through half-time clinical practice, under authority similar to that now available to the National Health Service Corps Loan Repayment Program and Scholarship Program.

VIII. Develop and implement a uniform credentialing and privileging policy.

The IHS Credentialing Program provides national leadership and promotes consistent medical staff credentialing and privileging across the agency with the support of a high quality Medical Services Professional team spread across each Area and Facility, as well as, through the use of the IHS centralized credentialing system. IHS has hired a Credentialing Program Manager at headquarters to directly support and provide oversight for the IHS centralized credentialing system.