Illustration: Sarah Grillo/Axios

The Indian Health Service remains deeply troubled, according to two new reports released yesterday from the Department of Health and Human Services' Office of the Inspector General.

Why it matters: The IHS is responsible for more than 2 million Native Americans — a population that tends to need a lot of care, much of it specialized. Yet the IHS has been beset for years by underfunding and mismanagement.

Driving the news: IHS hospitals often do not follow protocols for dispensing opioids, and they don't use states' prescription drug monitoring programs to track opioid prescriptions, the OIG said.

  • Hospitals within the IHS system also don't have strong cybersecurity protections in place, according to the audit (although that's not unique to IHS facilities).

A separate audit details one of the highest-profile examples of the IHS' shortcomings — the staffing shortages and safety problems that prompted the government to temporarily close the emergency department in IHS' Rosebud hospital, in South Dakota, in 2015.

The other side: Some tribes seem to be able to do better on their own.

  • Kaiser Health News spotlights Cherokee Indian Hospital in North Carolina — a new, 20-bed facility practicing an integrated care model that's performing well on metrics like controlling tribal members' blood pressure and blood sugar.

Yes, but: The Eastern Band of Cherokee Indians, which operates the North Carolina hospital, was in a unique position to opt out of the IHS, thanks to a casino whose revenues largely paid for the new hospital.

  • “Not all tribal communities have access to the economic opportunities that we have,” Casey Cooper, the hospital's CEO, told KHN. “Some tribes are in these desolate, remote locations where there are no natural resources or economic development opportunities. I get that.”

Go deeper: Government shutdown hits Native Americans especially hard

Go deeper

Updated 53 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 12:45 p.m. ET: 30,838,610 — Total deaths: 958,090— Total recoveries: 21,088,552Map.
  2. U.S.: Total confirmed cases as of 12:45 p.m. ET: 6,777,026 — Total deaths: 199,352 — Total recoveries: 2,577,446 — Total tests: 94,211,463Map.
  3. Politics: Testing czar on Trump's CDC contradictions: "Everybody is right" Trump's health secretary asserts control over all new rules.
  4. Education: What we overlooked in the switch to remote learning
  5. Health: The dwindling chances of eliminating COVID-19.
  6. World: Guatemalan president tests positive for COVID-19 — The countries painting their pandemic recoveries green.
Updated 58 mins ago - Health

7 states set single-day coronavirus case records last week

Data: Compiled by Axios; Map: Danielle Alberti/Axios

Seven states set new highs last week for coronavirus infections recorded in a single day, according to the COVID Tracking Project and state health departments. Wisconsin and Nebraska surpassed records set the previous week.

Why it matters: Problem spots are sticking in the Midwest, although the U.S. is moving in the right direction overall after massive infection spikes this summer.

Murkowski says she opposes voting on Ginsburg replacement before election

Photo: Greg Nash/Pool/Getty Images

Sen. Lisa Murkowski (R-Alaska) said in a statement Sunday that she opposes holding a Senate confirmation vote on President Trump's nomination to replace Supreme Court Justice Ruth Bader Ginsburg before the election.

Why it matters: Murkowski joins Sen. Susan Collins (R-Maine) as one of two Republican senators who have thus far said that they do not support rushing through a confirmation vote before November. Two more defections would likely force Senate Majority Leader Mitch McConnell (R-Ky.) to resort to holding a vote in the lame-duck session, which neither Murkowski nor Collins have addressed.