WASHINGTON – Despite glowing reviews supporting Dr. Yvette Roubideaux’ nomination to become director of IHS, some senators highlighted the health expert’s lack of managerial experience, saying she needs to focus on developing strong management of the agency.

There was little doubt that Roubideaux would receive recommendation for confirmation as director of the IHS after the Senate Committee on Indian Affairs deliberated her nomination April 23.

“I’m pleased to see a physician with on-the-ground experience,” Sen. Byron Dorgan, D-N.D., chairman of the committee, said early on during the hearing, noting that she would be the first Native woman to lead the agency if confirmed.

In addition to being a medical doctor, the Harvard-educated Roubideaux is an assistant professor at the University of Arizona College of Medicine. She has conducted extensive research on American Indian health issues, with a special focus on diabetes in American Indian and Alaska Native communities and American Indian health policy.

While impressed by the Rosebud Sioux tribal member’s resume, some senators asked whether her background would prepare her to lead an agency that has faced numerous accountability issues.

In his opening remarks, Sen. Jon Tester, D-Mont., said the lack of management experience “can be a blessing, and it can be a curse.” He wants Roubideaux to think about how she would tackle administrative challenges.

“The Indian Health Service is in desperate need of good management,” Dorgan later echoed. “Your experience, background would not be in managing a large organization.”

Dorgan said he had previously discussed the concern with Roubideaux. At the hearing, he recommended that she hire a strong number two person with significant managerial skills to make up for her lack of administrative experience.

Roubideaux was on the same page. “I agree with you,” she said. “I need to have the highest quality people working with me. … I know it’s a large, complex organization, and I know that there’s a lot to be done, and there are enormous challenges.”

The attention to management issues was in line with harsh words some committee members delivered to Robert McSwain, the outgoing IHS director, at a SCIA hearing in July. Several senators indicated that alleged management misdeeds at IHS were enough to warrant firings from McSwain at the agency. The member of the North Fork Rancheria of Mono Indians of California was hesitant to make such firings.

The senators’ concerns were heightened as a result of a June report by the U.S. Government Accountability Office, which identified more than 5,000 lost or stolen property items from 2004 to 2007 alone at just a smattering of randomly sampled IHS facilities. The items were estimated by the GAO to be worth almost $16 million. GAO attributed problems of loss, theft and waste at the agency to a “weak internal control environment.”

McSwain admitted to mistakes in management during his testimony, but also listed his reasons for them – among them, ongoing challenges in implementing new accountability systems. He added that some of the GAO research was flawed and that “not all concerns cited by the GAO in [its] report are current or defensible.”

Dorgan reacted particularly strongly to McSwain’s explanations.

“Your testimony. … seems all too defensive of the existing system,” the committee chairman said at the time, adding that he felt the behavior by IHS employees who may have fabricated documents “borders on criminal.”

Dorgan and other senators told McSwain that it would be more difficult to persuade members of Congress that IHS needs more dollars when the agency could not account for millions of dollars of lost and stolen property.

At the confirmation hearing, Dorgan warned Roubideaux about the accountability challenges McSwain faced.

“We can’t let these things continue,” Dorgan said, adding that McSwain made promises to fix certain problems in the agency, but did not end up doing so.

Dorgan told Roubideaux she should first be focused on improving American Indian health, and secondly, she should try to fix the broken agency. He warned her specifically about supporting the hiring of large numbers of contract workers, whose cost is much larger than that of permanent employees.

Not all senators felt the same about the need for managerial experience. Sen. Tom Udall, D-N.M., said that not having management experience may help Roubideaux “shake things up” at the agency.

Despite some concerns about Roubideaux’ managerial history, SCIA’s leadership confirmed her nomination April 30.

“I’m going to support the nominee,” Dorgan said during the hearing. “I’m very pleased that she offers herself to public service. I desperately want her to succeed.”

Sens. John Barrasso, R-Wyo., Tim Johnson, D-S.D., John McCain, R-Ariz., and Udall and Tester contributed similarly positive sentiments about the doctor. There was no indication that any SCIA member would vote against her nomination.

Roubideaux’ final step would be consideration by the full Senate.