Tribes face obstacles at troubled Indian Health Service facility

Monday, July 16, 2018  

Sioux tribes are tired of the Indian Health Service
By Kevin Abourezk
@Kevin_Abourezk

Three years ago, Gloria Brown Eyes-One Feather broke her wrist.

Like she had so many times before, she visited Sioux San Hospital in Rapid City, South Dakota.

And like so many times before, she waited several hours before a doctor at the hospital would see her. And even after a doctor met with her, the hospital refused to put a cast on her broken wrist.

The hospital had run out of funds for casts. She had to send a letter to the hospital’s management asking to have her broken wrist treated.

“Those are the hoops you’ve got to jump through,” said the 60-year-old woman.

That's why she likes the idea of three Sioux tribes taking control of the hospital from the Indian Health Service and managing it themselves.

“Anything is better than what is going on now,” she said.

In April, the Cheyenne River Sioux Tribe, the Oglala Sioux Tribe and the Rosebud Sioux Tribe announced plans to assume management of Sioux San through the Great Plains Tribal Chairmen’s Health Board (GPTCHB). The three tribes each passed separate resolutions to allow the health board to assume management and begin negotiations with IHS.

The action followed a decision by IHS to notify Congress of its intention to permanently close the hospital’s inpatient and emergency departments and revert the hospital to a clinic, a change that the three tribes opposed.

Jerilyn Church, chief executive officer for the health board, said the tribes are seeking self-governance as set forth by Title V of the Indian Self-Determination and Education Assistance Act of 1975, which allows tribes to assume control over health care funding and programs that the IHS would otherwise provide.

A tribe must enter into a compact, as well as a funding agreement, with the federal government that sets forth the terms of their nation-to-nation relationship.

However, IHS has informed the tribes that they must first manage Sioux San employing Title I of the federal law before they can operate the hospital through self-governance, Church said. Under Title I, a tribe enters into a contract with IHS to manage certain programs, but IHS retains significant control over the management of the funding for those programs.

Church said the tribes have asked the federal agency to reconsider its decision requiring the three tribes to pursue the Title I process first. She said Title I would limit the GPTCHB’s ability to make innovative improvements at Sioux San.

“While we can still do many of the things that we want to do, the process is much more difficult,” she said.

The tribes recently received a donation of 20 acres of land closer to Interstate 90 in northeast Rapid City that they want to use to build a new hospital to replace Sioux San, which sits on a hill in the city’s western section. Under Title I, accepting the land donation would be a complex process, Church said.

Also under Title I, any savings from the construction of a new facility would flow back to IHS, whereas the tribes would be able to use any extra funding to expand or improve the building as they saw fit, she said.

“There is just way more opportunity to be innovative under Title V,” Church said.

Sioux San had 15,147 patients in Fiscal Year 2015 and projects that it will have 20,668 by 2025. Church said she expects the actual number of patients in 2025 to be much higher based on Census figures. The hospital has 120 employees and an annual operating budget of $12 million.

GPTCHB is slated to assume control of the hospital by February 2019. The Mni Luzahan Wicozani Advisory Committee is guiding the planning and negotiations. The advisory committee consists of two tribally appointed members from each of the three tribes, who also serve on the Unified Health Board, and the committee also plans to select three community representatives from the Rapid City area.

Two years ago, Sioux San’s emergency department was closed after the Centers for Medicare and Medicaid Services placed the hospital in “immediate jeopardy” status, making it the fourth hospital within IHS’s Great Plains Area to have lost certification from the CMS.

Hospitals on the Rosebud, Winnebago, and Pine Ridge reservations also have lost certification from the CMS. On July 1, the Winnebago Tribe took control of the hospital on its reservation employing the self-governance process.

While IHS attempted to take corrective action at the other three hospitals within the Great Plains Area, the federal agency decided instead to permanently close its emergency and inpatient departments, diminishing services at Sioux San rather than address the emergency and inpatient shortfalls, Church said.

She said she’s hopeful that GPTCHB, under the vision of the three tribes, will be better equipped to provide health care to their people who live in the Rapid City area.

“There’s so much bureaucracy in federally run systems,” Church said. “They’re not designed for innovation and change. They’re designed for federal regulations.”

Ryman LeBeau, a Cheyenne River Sioux council member, said tribal management of Sioux San will allow the tribes to increase pay for doctors, whose salaries are currently capped by IHS. That would allow the tribes to recruit more qualified physicians, he said.

The tribes also would be able to focus more on preventative health care.

“IHS is a really reactive model, and it’s failing us,” he said. “It’s failing our people.”

Like many Native people, LeBeau starts each day with prayer. Often, he said, his prayers include pleas for better health for his people.

For him, the move to take control of Sioux San is an answer to his prayers.

“To me, it’s the creator,” he said. “It’s Tunkasila answering my prayers to put this opportunity in front of us.”