Dr. Mark Jackson, Chief Medical Officer of the Great Plains Regional Indian Health Service office, answered questions at a special council meeting held on December 5. Photo by Vi Waln

Rosebud Emergency Room Diverted
By Vi Waln
Lakota Country Times Correspondent

ROSEBUD – The Emergency Room (ER) at the Rosebud Hospital was diverted to an Urgent Care room on December 5, effective at 6pm by order of Ronald Cornelius and Dr. Mark Jackson.

Dr. Jackson is the Chief Medical Officer of the Great Plains Region. Ronald Cornelius is the Area Director of the Great Plains Region. Their offices are based in Aberdeen, SD. The decision to limit the care provided in regard to emergency room services was made late in the day on Friday, December 4, 2015.

“It was really disturbing to get a call at 4pm on a Friday afternoon, it was unreasonable, uncalled for and shouldn’t have happened,” President Willie Kindle told tribal council and community members who had gathered for a special meeting over the weekend.

Cornelius called President Kindle late in the day on December 4 to ask if it was okay to bring in Urgent Care to replace the current Emergency Room services being provided at Rosebud Hospital.

“I told him it was not my authority to give the okay for that,” continued President Kindle. “The Rosebud Sioux Tribal Council, as well as the Rosebud Ambulance Service and the Tribal Health Board need to be involved in making that decision. Our ambulance people have a big concern over this issue.”

Ambulance calls involving serious injuries or illnesses will likely be routed to other hospitals, such as Cherry County Hospital in Valentine, NE or Winner Regional Health Care Center in Winner, SD. It was not clear who would be financially responsible for ER visits by uninsured patients transported by Rosebud’s ambulance crews. In addition, patients discharged from an ER visit to an off-reservation facility, could find themselves without transportation back to their homes.

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“This news is difficult to share but I believe I am doing right,” Dr. Jackson told the tribal council at the special meeting on December 5. The Centers for Medicare and Medicaid Services (CMS) “did five surveys on November 19 and found problems with patient care in the ER. On November 23, I identified three cases that gave rise to immediate jeopardy, this was a serious situation.”

The three cases involved a cardiac patient, an OB patient and trauma on a pediatric patient.

“I had to make decisions, then recommendations. Then, from November 28 through December 1, we did additional reviews on care provided in the ER. I was still seeing cases that did not meet what I considered safe practice,” stated Dr. Jackson.

“It was a very difficult choice for all of us because patient safety was at risk,” Dr. Jackson continued. “The department did not have sufficient staff. Usually this is when we call in additional staff, but in this case there were no other medical staff to call.”

Rosebud is an acute care hospital, which means their “responsibility to see patients does not stop. But we are going on diversion [to urgent care] because the cases I was dealing with on Thursday night were all emergency level 1 cases. I don’t have the medical staff to back that up,” Dr. Jackson said.

The Rosebud police department is “still expected to bring patients to medically clear before taking them to jail,” Dr. Jackson continued. The Rosebud Ambulance Service is “not supposed to bring emergency patients, but it will be up to the trained medics to make the call regarding the level of care a patient needs.”

Local people who use the Rosebud Hospital are encouraged to keep going there for care.

“You are precious people, especially your babies and elders,” Dr. Jackson said. “My commitment is to be sure that this program is safe. The standard I would measure that safety by would be if I was willing to go there myself as a cardiac patient for treatment. I am not going to leave until I am sure I can go to your facility and be treated properly for my heart condition.”

The diversion of the emergency room came on the heels of a 23 day Notice of Intent to Terminate the Medicare Provider agreement, sent to the Rosebud Hospital from CMS. According to a press release issued by President Kindle’s office, the November 23 notice states that CMS has determined that the deficiencies identified in their recent survey are so serious that they constitute an immediate and serious threat to the health and safety of any individual who comes to the hospital to receive emergency services.

“If this agreement is terminated, our IHS unit will no longer be able to collect CMS reimbursements. The effect will be devastating,” President Kindle wrote in the press release. “We are working diligently with all responsible parties to ensure this situation is immediately corrected.”

“Our health is our most precious natural resource,” said RST Health Administrator Evelyn Espinoza. “The events over the last 150 years have created this perfect storm and we all have a stake in this and need to work together to not only ensure compliance with CMS Conditions of Participation at our facility, but also for compliance to be achieved with respect to our treaties and obligations of the US Government to our nations.”

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