Winnebago Tribe asserts self-determination in hopes of fixing troubled hospital

Wednesday, November 15, 2017

Indian Health Service facility lost key funding sources in 2015

The Winnebago Tribe is moving to take over management of the hospital on its reservation in northeast Nebraska, more than two years after federal officials cut off key funding sources for the troubled facility.

The tribal council voted November 9 to initiate the self-governance process under the Indian Self-Determination and Education Assistance Act of 1975. The tribe plans to enter into negotiations with the Indian Health Service in order to operate the Omaha-Winnebago Hospital.

The council’s action follows a July 2015 decision by the Centers for Medicare and Medicaid Services (CMS) to terminate the hospital’s certification after finding numerous deficiencies, including the death of a patient. The decision resulted in the loss of Medicare and Medicaid funding to the hospital.

“The Winnebago Tribe has been working toward this day for more than two years,” said Chairman Frank White in a news release on Monday. “We believe the tribe can improve the quality and access to care at the hospital, and stabilize the management of the health system.”

White criticized IHS for failing to restore the hospital’s certification following the CMS decision. The tribe hopes to assume operation of the hospital by July 1, 2018, nearly three years after the termination.

As part of the effort, the tribe has established a committee to prepare for the transition to tribal management of the hospital. The committee will help tribal leaders make decisions, build internal tribal capacity for management and prepare for negotiations.

Winnebago Tribe on YouTube: IHS Self Governance Initiative

“Committee members have been working since June to plan and develop materials that support the assumption of the hospital,” said Victoria Kitcheyan, a tribal council member whose aunt died after being sent to the facility. “It is a critical endeavor for Winnebago to raise the level of health care available to all tribal citizens in our area.”

Winnebago leaders already met with the neighboring Omaha Tribe regarding the planned transition, and the two bodies are expected to meet again later this week.

Omaha Chairman Michael Wolfe said his tribe likely will support the Winnebago Tribe’s efforts, though the two governments still must negotiate details of the arrangement.

“Anything that we do will be an improvement over what IHS has done for our people,” Wolfe said Tuesday. “We lost people because of the system they (IHS) have done."

“They don’t care about our people,” he said.

The loss of CMS certification represented a serious financial blow to the IHS, which suffers from chronic underfunding. In the fiscal year prior to the July 2015 decision, Medicare and Medicaid accounted for 77 percent of third-party billing at the hospital.

Nationwide, IHS expects 88 percent of collections at all facilities to come from Medicare and Medicaid, according to a budget justification for the current fiscal year.

Indianz.Com on SoundCloud: Senate Committee on Indian Affairs November 8, 2017

The situation isn't unique to Omaha-Winnebago, either. Earlier this month, CMS terminated the certification of the IHS hospital on the Pine Ridge Reservation in neighboring South Dakota after finding problems. A patient who had been admitted there in October died the next day at another hospital.

The IHS failed to provide the man with "appropriate, timely, and safe medical care" based on acceptable standards of practice, according to CMS documents.

IHS has been slammed repeatedly for failing to resolve long-standing problems in the Great Plains Area, a region that includes Nebraska and South Dakota. A 2010 investigation by the Senate Committee on Indian Affairs warned that five facilities in the region were in danger of losing access to Medicare and Medicaid funds.

In addition to the Omaha-Winnebago and Pine Ridge hospitals, CMS placed two more facilities in the Great Plains -- Rosebud and Sioux San --- in jeopardy status and is working with IHS to correct deficiencies there.

The emergency room at Sioux San has since been shut down completely. Emergency services at Rosebud were cut for seven months, which took a heavy toll on citizens of the Rosebud Sioux Tribe.

“Tribal members are suffering and even dying due to inadequate and disgraceful care,” Sen Mike Rounds (R-South Dakota) said last week at a hearing to consider S.465, the Independent Outside Audit of the Indian Health Service Act.

The bill, which Rounds introduced in February, requires an independent audit of the IHS to determine where improvements can be made in budget, staffing and management. The Great Plains Tribal Chairman’s Association, whose members include the Winnebago Tribe and the Omaha Tribe, supports the measure.

"We know that health care is a treaty right," Dave Flute, the chairman of the Sisseton Wahpeton Oyate, another tribe in the Great Plains, said at the committee's hearing on November 8.

"We strongly feel that the IHS is failing," Flute said. "They are failing to meet that treaty obligation."

Other members of Congress from Great Plains states have introduced the Restoring Accountability in the Indian Health Service Act -- S.1250 and H.R.2662 -- in hopes of fixing what they have said is a "broken" federal agency.

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