Another Indian Health Service facility in Great Plains threatened

The Sioux San Hospital is an Indian Health Service facility in Rapid City, South Dakota. Photo by Colorado National Guard Medical Detachment / Flickr

The Indian Health Service has been given five days to come up with a plan to address substantial problems at yet another facility in the troubled Great Plains Area.

The Centers for Medicaid and Medicare Service on Monday identified deficiencies that pose an "immediate threat to the health and safety" of tribal members who seek care at the Sioux San Hospital in Rapid City, South Dakota. Unless the problems are corrected, the facility will lose its ability to bill for Medicaid and Medicare on June 15.

"These deficiencies substantially limit the hospital's capacity to render adequate care and constitute and immediate and serious threat to the health and safety of patients," Steven Chickering, an associate regional administrator at the CMS, wrote in a letter to the IHS.

The IHS said it is already taking steps to address the deficiencies. A meeting was being held with tribal leaders in the region to discuss the matter.

"The IHS Sioux San Hospital remains open and patients are receiving care, including inpatient, outpatient, and all other current hospital services," the agency said in a statement.

The letter is the latest in a series of threats from the CMS regarding health care in the Great Plains, a region that includes Nebraska and South Dakota. Last summer, the IHS failed to resolve problems at the Winnebago Service Unit, which serves the Omaha Tribe and the Winnebago Tribe, so it lost the ability to bill for Medicaid and Medicare there.

"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

A cut-off was averted at the Rosebud Service Unit and the Pine Ridge Service Unit, both in South Dakota, after the IHS reached agreements with the CMS. The emergency room at the Rosebud Hospital, however, remains closed after being placed on diversion in December.

Since then, six members of the Rosebud Sioux Tribe have died while being transported to urgent care facilities 45 miles to 55 miles away.

"Six families are left wondering whether their loved ones would be alive today if the IHS had not failed in its responsibility to provide safe and quality care," Sen. John Thune (R-South Dakota) said at another committee hearing on May 11 "This is a disgrace."

In hopes of fixing long-standing problems in the Great Plains and other parts of Indian Country, Thune and Sen. John Barrasso (R-Wyoming), the chairman of the committee, introduced S.2953, the Indian Health Service Accountability Act, on Thursday. The bill includes provisions to improve tribal consultation, address staffing needs, expand the removal of discipline of problem employees and investigate patient deaths.

"We have heard appalling testimonies of the failures at IHS that are unacceptable and will not be tolerated," Barrasso said in a press release. "We must reform IHS to guarantee that all of Indian Country is receiving high quality medical care."

The Sioux San Hospital serves a large urban Indian population in Rapid City. Tribal members from other parts of South Dakota and from neighboring states also go there for services that may not available in their communities.

In 2012, the Native Sun News reported about long-standing management woes at the hospital. According to the hospital, at least nine chief executive officers worked there in the decade prior.

The full statement issued by the IHS regarding the CMS letter follows:
Today, IHS received a notification from the Centers for Medicare & Medicaid Services (CMS) identifying issues primarily related to medical screening of patients at the IHS Sioux San Hospital in Rapid City, South Dakota. IHS will establish a corrective action plan addressing the issues identified within 5 days to allow CMS to determine compliance.

IHS has already initiated actions to begin to address the issues CMS has identified. The IHS Sioux San Hospital remains open and patients are receiving care, including inpatient, outpatient, and all other current hospital services.

IHS will work with CMS to establish a corrective action plan and timelines to correct deficiencies identified in the notice of “Immediate Jeopardy.” Partnership is key to the success of these efforts, which is why IHS is meeting with tribal leaders today to discuss next steps.

IHS immediately began instituting improvements at IHS Sioux San Hospital, including new leadership, expanded oversight, staff retraining and policy changes. This builds on IHS’s broader effort to improve care in the Great Plains by:
  • Focusing on assessment
  • Immediately strengthening service delivery
  • Strengthening IHS Great Plains Area management
  • Infusing quality expertise
  • Engaging local resources

All hospitals participating in the Medicare program, including those operated by IHS, are subject to site visits to monitor for compliance with Medicare rules.

Government Accountability Office Report:
INDIAN HEALTH SERVICE: Actions Needed to Improve Oversight of Patient Wait Times (April 29, 2016)

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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