Native Sun News Today: Tribal takeover of troubled hospital questioned

Friday, November 30, 2018  

1973 Amendment may negate their authority
By James Giago Davies
Native Sun News Today Correspondent
nativesunnews.today

RAPID CITY— In 1954, the U.S. Congress enacted Public Law 568, called the Transfer Act, which transferred all maintenance and operation of hospitals and health care facilities to the Public Health Service.

In 1973, Congress amended 42 U.S. Code § 2001, of the Transfer Act, adding a subsection (b), and this amendment may fundamentally alter the battle over the Rapid City Indian Hospital, or Sioux San, rendering all involvement by any tribe, or tribal council, nugatory. “Nugatory” (meaning inconsequential or meaningless) is a term often applied to legal matters.

Three tribes, Cheyenne River, Rosebud and Pine Ridge have passed resolutions authorizing the Great Plains Tribal Chairman’s Health Board (GPTCHB), a Rapid City based health advocacy operation, to take control of the hospital, via a 638 contract or compact, halting the current Indian Health Service (IHS) plan to build a new $117 million facility at the present Sioux San location. But the language of the 1973 amendment may mean that these three tribes have no such authority, in fact, have no authority at all when it comes to determining any of the current changes proposed for the Sioux San.

This is how subsections (a) and (b) appear in the 1973 amendment:

“(a) All functions, responsibilities, authorities, and duties of the Department of the Interior, the Bureau of Indian Affairs, Secretary of the Interior, and the Commissioner of Indian Affairs relating to the maintenance and operation of hospital and health facilities for Indians, and the conservation of the health of Indians, are transferred to, and shall be administered by, the Surgeon General of the United States Public Health Service, under the supervision and direction of the Secretary of Health and Human Services: Provided, That hospitals now in operation for a specific tribe or tribes of Indians shall not be closed prior to July 1, 1956, without the consent of the governing body of the tribe or its organized council.

(b) In carrying out his functions, responsibilities, authorities, and duties under this subchapter, the Secretary is authorized, with the consent of the Indian people served, to contract with private or other non-Federal health agencies or organizations for the provision of health services to such people on a fee-for-service basis or on a prepayment or other similar basis.”

There is a distinct difference between the subsections. In (a), the “the governing body of the tribe or its organized council” gives consent. In (b), “the Indian people served” give their consent. The people served would be the patients.

Large concentrations of Indians have formed in many urban centers, where no reservation or tribal trust land exists. Many of these Indians came to these urban areas through the Relocation program discontinued almost fifty years ago.

Since that time, Indians have continued to relocate, on their own, to urban areas. Rapid City is classified as an urban area, as defined by the U.S. Census Bureau, and is ranked 352nd largest, with an urban area population of 81, 251, according to the 2010 census. The Rapid City urban area has an urban Indian population believed to be well in excess of 10,000 people.

In any event, the Sioux San patient numbers have been reported at 22,000. The Indian Health Service’s official website describes the Sioux San as follows: “The Rapid City Service Unit (RCSU) hospital provides health care to Indian people in Rapid City, South Dakota and the surrounding area, and is unique because it is located in an urban area and not on a reservation.”

The Indian Health Service defines Rapid City as “an urban area.”

Most of the urban areas are serviced by clinics, which exist in Pierre and Sioux Falls. Although Pierre is technically not an urban area, its centralized location services a large area of Indians who reside in off-reservation communities that collectively comprise an urban Indian population. Because Rapid City has an Indian hospital, there is no need for a clinic, but Rapid City is an urban Indian hospital, by every official metric used to establish urban status.

Subsection (b) provides a process whereby urban Indian health care facilities, through consent given to the Secretary of Health and Human Services (HHS), can contract with private companies for provision of health care service. In this case, HHS Secretary Alex Azar, in office for less than a year, may be unaware of his amendment mandated responsibility to designate contracts, once he receives the consent of the people served.

In 1969, four years prior to the 1973 Amendment, the Surgeon General of the U.S. came to Rapid City to help mitigate a controversy over the Sioux San, over how the board was selected, whether the community actually had any input into that selection. After 1973, the ground rules changed, but it is not unprecedented for a high ranking official, or his representatives, to come to Rapid City with the intent of direct intervention.

In this case, Azar has been expressly charged with the responsibility of settling these matters, and has been given authority to determine contracts and procedures, but only with the consent of those served. He would have to set up a referendum to determine if those served give him consent. During that referendum, he could ask those served if they want an outside group to administer the new hospital, or if they wish to proceed with the GPTCHB and their 638 plans, even if the tribal resolutions, previously authorizing GPTCHB participation, are nugatory.

The can of worms thus opened would be the acrimony between the GPTCHB, and many members of the Rapid City Urban Indian community serviced by the Sioux San. The GPTCHB is an advocacy operation, and has no experience managing a health care clinic, let alone a hospital. That they could subcontract that responsibility to yet another agency, renders their role in the process nugatory, since that could be done without their participation.

Recently, Robert Cook, a Lakota educator and Oglala Sioux Tribe member, told the NSNT: “Unfortunately, (the GPTCHB) did this behind the scenes. There has been a lack of consultation with the community, with the very people who fought and died to have quality health care here in Rapid City.”

Since July, as the controversy arose, repeated attempts to contact the GPTCHB by NSNT have not received response, and an agreed upon meeting with GPTCHB Director Jerliyn Church was not kept. A phone call to their media relations on Monday was not returned. A press release from Lindsay Huffman of GPTCHB was received by NSNT on Monday, for immediate release about a public awareness meeting scheduled for Tuesday, despite the common knowledge our paper published on Wednesday, the day after the meeting will be held.

Mark Lonehill, a lifelong Rapid City resident, has spent most of the last decade as a health care advocate for the Indian community of Rapid City. He is a member of a group called Concerned Native American Citizens of Rapid City, for brevity’s sake, hereafter referred to as Concerned. Other Concerned members are Charmaine White Face, Pat Lee and Theresa Sprye.

The GPTCHB had plans to move the Rapid City Indian Hospital east of Rapid City, to land which would be purchased from developer Hani Shafei. At a city council meeting to approve that move, Lonehill asked Rapid City Mayor Steve Allender to table the vote for “a couple of weeks until we had a meeting, but the mayor wouldn’t listen to us. They voted in favor of it anyway that night.”

James Giago Davies is an enrolled member of the Oglala Lakota tribe. He can be reached at skindiesel@msn.com

Copyright permission Native Sun News Today

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