The Indian Health Service is still in turmoil

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