The Rosebud Hospital is located on the Rosebud Sioux Reservation in South Dakota. Photo by Crystal R. Leighton

Rosebud Sioux Tribe sues Indian Health Service over 'crisis' in care

The Rosebud Sioux Tribe of South Dakota filed a lawsuit against the Indian Health Service on Thursday, accusing the agency of violating its trust responsibility by shutting down the emergency room on the reservation.

The emergency room that's part of the Rosebud Service Unit was placed on "divert status" last December amid long-standing complaints about the quality of care at the facility. The closure was meant to be temporary but the leader of the IHS has indicated it will continue at least through the summer.

Meanwhile, reservation residents are forced to travel long distances for urgent care -- the nearest emergency rooms are 45 miles and 55 miles away. According to tribal leaders, six people have died since the diversion and two babies have been born in transit to area hospitals.

"IHS' actions in placing the Rosebud Hospital's emergency services on divert status have caused and continue to cause the tribe and its members immediate and irreparable injury," the complaint states.

YouTube: Sen. John Thune (R-South Dakota): We Will Hold The Indian Health Service Accountable

The IHS is taking steps to reopen the emergency room and has solicited bids for an outside company to handle emergency services as the hospital. Additionally, the agency is working with the Centers for Medicaid and Medicare Service to ensure that the facility won't lose its certification, which could lead to a loss of even more services.

The lawsuit does not question those actions but instead argues that the diversion is not as "temporary" as the IHS suggests. The complaint cites a provision in the Indian Health Care Improvement Act that requires the agency to consult the tribe and prepare a report detailing the impacts of a proposed closure before it actually happens.

Since the IHS has not done that in this situation, the lawsuit argues that the emergency room must be reopened and must be properly staffed in order to comply with the law, with the Treaty of Fort Laramie and with the federal government's trust responsibility to the tribe and its members.

"The United States breached and continues to breach its trust duty to the tribe and its members by providing health services to the tribe at a level that falls substantially below the highest standards of health care and that are inadequate to maintain the health of the tribe's members," the lawsuit states.

The problems at the Rosebud facility aren't unique. The Great Plains Area of the IHS, a region that includes South Dakota and Nebraska, has been under intense scrutiny on Capitol Hill due to what lawmakers describe as "substandard" level of care.

"One health service facility was in such disarray that a pregnant mother gave birth on a bathroom floor -- a bathroom floor -- without a single medical professional nearby, which shockingly wasn't the first time this had happened at this facility," Sen. John Thune (R-South Dakota) said in a speech on the Senate floor on Tuesday. He was referring specifically to the Rosebud hospital.

Thune noted that emergency room had been shut down for "143 days" as of Tuesday. He said the IHS is facing a deadline on Friday to come up with an agreement with the CMS that would keep the hospital from losing certification.

The hospital that is part of the Pine Ridge Service Unit on the Pine Ridge Reservation is also in the same situation. A 23-year-old man died after being discharged from the emergency room at the facility due to inadequate medical screening, Thune said.

"I am going to do everything I can within my power to get all of our tribal citizens the quality care they deserve," Thune said.

Mary Smith, the leader of the Indian Health Service, meet with Great Plains tribal leaders in Aberdeen, South Dakota, on April 5, 2016. Photo: Department of Health and Human Services / Twitter

A third facility in the Great Plains -- the Winnebago Service Unit in Nebraska -- lost CMS certification last summer. The hospital serves the Omaha Tribe and the Winnebago Tribe.

"It's been said in my community that the Winnebago Hospital is the only place you can legally kill an Indian," Victoria Kitcheyan, the treasurer for the Winnebago Tribe, told the Senate Committee on Indian Affairs in February. She said the CMS identified instances in which five people died "unnecessarily."

"It's 2016 and our people are still suffering at the hands of the federal government," Kitcheyan said.

Mary Smith, the acting director of the IHS, has made the Great Plains a priority and she traveled to the region earlier this month for a series of presentations, meetings and consultations with tribes. She has been at the agency since October 2015 and was elevated to the leadership position only a month ago.

"Discussions with our tribal partners were productive, but they were also tough, and we listened to hard truths from tribal members who were justifiably frustrated," Smith, who is a member of the Cherokee Nation, wrote on the IHS blog after the trip.

Senate Committee on Indian Affairs Report:
In Critical Condition: The urgent need to reform the Indian Health Service’s Aberdeen Area (December 2010)

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