The Sioux San Hospital is an Indian Health Service facility in Rapid City, South Dakota. Photo by Kevin Abourezk

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Tribes prepare for historic management of troubled Indian Health Service hospital

Thursday, July 18, 2019

By Acee Agoyo

A troubled Indian Health Service facility in South Dakota is transitioning to tribal management this weekend.

Starting at midnight on Sunday, the Sioux San Hospital will be known as the Oyate Health Center in recognition of the Oyate, or the people, it serves. A late night ceremony will mark the historic takeover, which has been more than a year in the making following long-running complaints of substandard service at the facility in Rapid City.

"The Great Plains Tribal Chairmen’s Health Board is excited to announce the successful assumption of the Rapid City Service Unit which will occur at midnight on July 21st, 2019,” said Jerilyn Church, a citizen of the Cheyenne River Sioux Tribe who serves as chief executive officer of the Great Plains Tribal Chairmen’s Health Board.

“We will be hosting a reception at 11pm, July 20th, as we await the keys being turned over to us," Church added. "A ribbon-cutting ceremony will be held at midnight on July 21st, 2019."

GPTCHB Invites Community To Inaugural Opening RAPID CITY, SOUTH DAKOTA – The Great Plains Tribal Chairmen’s Health...
Posted by Great Plains Tribal Chairmen's Health Board on Tuesday, July 16, 2019

On behalf of the Cheyenne River Sioux Tribe and the Oglala Sioux Tribe, the Great Plains Tribal Chairmen’s Health Board entered into a self-determination contract with the IHS to manage the facility. The agreement, however, only covers 80 percent of the operations there, meaning the federal government will still play a role in providing care to urban Indians who live in and around Rapid City.

The Rosebud Sioux Tribe had been a part of the coalition seeking to run the hospital but withdrew amid opposition in Rapid City. Native Sun News Today, an independent newspaper with a wide following among urban Indians, covered the controversy extensively over the last year, with local patients citing concerns about treaty rights as well as the legality and effectiveness of tribal management.

As result of the friction, the IHS last December, declined to enter into a self-determination contract as originally proposed and also refused to entertain a move of Sioux San to a new site in Rapid City. A second negotiating request was rejected in February for procedural reasons.

"The Rapid City area has many tribal members that call it home, but very few of them know what is happening at the Sioux San," Rosebud Sioux President Rodney Bordeaux said in a statement in May. "They do not have a voice, and the Rosebud Sioux Tribe believes that they should."

But after Cheyenne River and Oglala renewed their efforts earlier this year, negotiations picked up again. The new agreement was announced in June, with the Great Plains Tribal Chairmen’s Health Board set to manage 80 percent of the operations at Sioux San on account of Rosebud's absence.

The main entrance to the Sioux San Hospital, an Indian Health Service facility in Rapid City, South Dakota. Photo by Kevin Abourezk

Under IHS management, Sioux San has suffered serious setbacks in patient care. At one point, the hospital almost lost federal certification due to substandard services.

The IHS later informed Congress of plans to permanently close the inpatient and emergency departments and revert the hospital to a clinic. The self-determination contract is part of an effort to prevent future cutbacks though there are some signs of turbulence as the transfer nears.

Some patients have been told their appointments are being canceled as a result of the transition, GPTCHB said in a post on social media on Wednesday. Anyone with issues is urged to call (605) 721-1266.

"It is extremely important to us here at GPTCHB that our people do not experience any delays when attempting to access care," said Brandon Ecoffey, a citizen of the Oglala Sioux Tribe who serves as communications director for the organization.

In neighboring Nebraska, the Winnebago Tribe assumed control of the hospital on its reservation in the northeastern part of the state a year ago this month. The Twelve Clans Unity Hospital also suffered significant setbacks under IHS management.

The hospital, which also serves citizens of the Omaha Tribe, lost certification more than four years ago, a move that resulted in the loss of critical federal funds. The IHS was unable to regain footing despite being repeatedly pressured by the tribes and by key members of Congress.

Winnebago health executives have since moved to regain certification on their own as they plan a celebration later this to month to mark the first year of successful operations.

The IHS facilities in both states are overseen by the Great Plains Area of the agency, whose headquarters are located in Aberdeen, South Dakota, far from the tribal populations being served. The region, which also includes North Dakota and Iowa, has been called the worst in Indian Country due to widespread patient care, leadership, financial and other issues that have gone unresolved through Democratic and Republican administrations.

"When I go into the area director's office, the desk is almost bare, like the person in charge is not planning on being in the job very long," Chairman Harold Frazier of the Cheyenne River Sioux Tribe told members of Congress who write the IHS funding bill in March. "This is disturbing because of the serious medical related problems that we continue to face in the Aberdeen region."

The Sioux San Hospital is an Indian Health Service facility in Rapid City, South Dakota. Photo by Kevin Abourezk

In hopes of alleviating the situation, lawmakers have directed the IHS to ensure that self-determination funds can be used to help tribes regain certification and recover revenues lost as a result of lapses in certification from the Centers for Medicaid Services, a federal agency that has repeatedly uncovered shortcomings in patient care in the Great Plains.

"The committee considers the loss or imminent loss of accreditation to be an emergency," members of the House Committee on Appropriations wrote in a report to accompany the IHS funding bill.

The report continued: "Funds allocated to a facility may be made available to Tribes newly assuming operation of such facilities pursuant to the Indian Self-Determination and Education Assistance Act of 1975 and shall be used by such tribes to cover the following: replacement of third-party revenues lost as a result of decertification, replacement of third-party carryover funds expended to respond to decertification, and reasonable costs of achieving recertification, including recruitment costs necessary to stabilize staffing."

The Democratic-controlled U.S. House of Representatives passed H.R.3055, a "minibus" appropriations bill that includes the IHS, on June 25. It includes a record level of funding for the agency, which is responsible for providing care to more than 2 million American Indians and Alaska Natives around the country.

The measure still has to be taken up in the Republican-controlled U.S. Senate and signed into law by President Donald Trump, who has failed to nominate a permanent director for the IHS after his first pick was forced out amid controversy, before the larger amounts make their way to Indian Country.

The IHS provides direct health care services in 25 hospitals, 50 health centers, two school health centers, and 26 health stations. Through self-determination contracts and self-governance compacts, tribes and tribal organizations like the Great Plains Tribal Chairmen’s Health Board operate 22 hospitals, 280 health centers, six school health centers, and 62 health stations, along with 134 Alaska Native village clinics.