Fiddler case puts IHS on trial
EAGLE BUTTE, S.D. ? Of all men, Leonard Fiddler deserved a dignified death. But dying with dignity seldom takes place on South Dakota's reservations.
The strange circumstances around Fiddler's passing on Jan. 1, the rush to an Indian Health Service hospital that came to a dead halt on the outskirts of this capital of the Cheyenne River Reservation, the display of what was at the very least astonishing rudeness on the part of a federal official has the entire Lakota Nation in an uproar. It is an indictment of the whole of the Indian Health Service system.
Tribal Chairman Gregg J. Bourland demanded a full-scale Congressional investigation into the IHS when he first recounted this story in public in a face-to-face meeting with U.S. Sen. Tim Johnson, D-S.D. Indian voters who put Johnson in office six years ago are watching closely for his response during a tight re-election campaign that could shift the balance of power in the U.S. Senate.
But the horror of the story outweighs national politics. It concerns a highly respected Lakota elder, a descendant of Chief Sitanka (Big Foot), who in his last hours was treated with such little respect by the federal bureaucracy that the admitting doctor at the Eagle Butte IHS Hospital told an ambulance driver to leave his body by the side of the road.
Leonard Moses Fiddler, 66, was a major figure in the tiny but world-famous village of Green Grass, on the isolated road north of Eagle Butte. He was an active spiritual leader and former public official in the community that shelters the Sacred Pipe of the White Buffalo Calf Woman, who taught the Lakota their major rituals.
He was born May 7, 1935, in nearby Whitehorse. After attending St. Joseph's Indian School, he joined the U.S. Army and fought in Korea from 1952 to 1954. After an honorable and decorated discharge, he joined the Cheyenne River police department and served as chief of police for 26 years.
Fiddler stood out as well in religious life, whether singing Dakota hymns at the historic United Church of Christ (Congregational) mission or leading the decades-old International Sun Dance, one of the first modern revivals of the supreme Lakota expression of self-sacrifice.
When his body was laid to rest nearly two weeks after his death, the reservation remembered him for his teasing and his humor, his defense of Lakota culture and tribal treaties, his generosity toward his large family, including two adopted daughters. His prominence made his last hours as shocking in their way as the death of his ancestor Sitanka in another federal bungle 110 years earlier, at Wounded Knee.
Fiddler suffered from a number of medical conditions, including heart and kidney problems as well as cancer. He became ill late on New Year's Eve. He had just finished taking his regular dose of insulin by injection about 10 p.m. and prepared to retire for the night. A few minutes after he lay down on his bed, his wife, Marie, checked on him.
Mrs. Fiddler said she noticed he hadn't changed positions so she attempted to wake him, but he didn't respond. She called a relative and tribal police for assistance.
CRST Sgt. Sunny Garreau arrived around 11:08 p.m. and began cardiopulmonary resuscitation. He later wrote in a detailed narrative, "Mr. Fiddler was unresponsive and felt cold to the touch.? While checking a carotid pulse, I thought I could feel a faint pulse but was unsure at this time." Garreau continued the CPR while waiting the arrival of an ambulance.
Around 11:22, IHS Ambulance Services arrived at the Fiddler home. Paramedic Dodi Weller and Emergency Medical Technician John Meligan relieved Garreau. "Paramedic Dodi informed me Mr. Fiddler was flat-lined and nothing more could be done," Garreau wrote in his narrative.
This is the point at which a family tragedy turned into a national incident. Weller told Garreau that she had talked by cell phone with Dr. Janet Reid, a physician under contract to the IHS who was supervising admissions that night at the IHS hospital in Eagle Butte. "Dodi stated she was granted permission by Dr. Reid to go ahead and 'Pronounce' Mr. Fiddler."
An angered Chairman Bourland disagreed strongly with this procedure when he told the story to Johnson during the senator's recent tour of Eagle Butte. "Mr. Fiddler was to be transferred back to IHS where the doctor would then have to confirm whether or not he was deceased," Bourland said. "They should have continued work on him. They did not do so in a proper manner. Instead they transferred him up to the four-mile junction."
Garreau attempted to find the Dewey County Coroner. At 12:05 a.m. after helping place Fiddler in the ambulance, which he thought was heading to Eagle Butte, he left on another call. But half an hour later, while transporting a prisoner to headquarters, he saw the ambulance again. It was parked by the side of the road at the main junction east of Eagle Butte, where Highway 212 meets County Road 63 heading north.
Garreau stopped to see if the crew needed help. Instead he found them in a state of confusion. The admitting doctor at IHS was refusing to accept Fiddler at the Emergency Room.
"Dodi informed me," Garreau wrote, "Dr. Reid told them not to bring Mr. Fiddler's body to IHS. Dodi informed me, Dr. Reid's exact words were, 'Whatever you do, don't bring the body to IHS, I don't care if you take it back or throw it on the side of the road, just don't bring it here."
Dodi told the sergeant she didn't know what to do, "as she has never come across this situation before." While the crew talked, Garreau saw a familiar face passing in another car and flagged him down. It was Glenn Gunville, Deputy Dewey County Coroner, who had come to the Fiddler home just after the ambulance had left.
Gunville recounted the scene in a signed statement. "[Garreau] stated that IHS would not take the body. Paramedic Dody Wheeler [sic] told me that Doctor Reid said to dump the body in the ditch, because they were not bringing it there (IHS). He asked me what he could do. I then suggested calling the Chief of Police. I then left."
Fiddler eventually did enter the IHS facility, but the morgue not the Emergency Room. The hospital "Emergency Visit Record" gives an arrival time of 1 a.m. with the notation, "DOA Body to morgue. Body not viewed by RN. ID verified by paramedic. Body taken directly to morgue [not] to ER Room."
Fiddler was later transported to the Luce Funeral Home in Eagle Butte. The obituary reported that he passed away at the IHS Hospital.
Officials from the IHS Aberdeen Area Office have failed to return phone calls and refused to comment on the incident.
Thus ended the cold last ride of Leonard Fiddler, but the story is spreading widely. With each telling the indignation increases, crystallizing generations of resentment at perceptions of callous, indifferent treatment from the IHS. The Cheyenne River tribal government is pushing investigations at the federal level and demanding dismissal of the main figures in the incident.
"That ambulance crew sat there for almost an hour because Dr. Reid and IHS would not allow them to bring him into the emergency room," Bourland said in his meeting with Sen. Johnson. "He was never seen by an IHS doctor. The IHS doctor refused to even look at him. He was taken straight to the morgue and no coroner ever saw him.
"Mr. Fiddler was taken two hours later to a funeral home where his body was embalmed. No autopsy was ever performed. To date, nobody determined Mr. Fiddler's cause of death or even if he was dead," Bourland said in the public meeting.
In a later interview, Bourland said that a forensic pathologist was required to do an autopsy in order to determine the cause of death because embalming the body prior to an autopsy made it more difficult to determine the cause of death.
A pathologist was sent by the Office of the Inspector General, he said, but a formal report won't be available for several weeks or even a couple of months. The preliminary report suggested Fiddler died of a heart attack.
"I'm incensed by that and I think the family isn't very pleased," the tribal leader said. "I think IHS and the Department of Health and Human Services is doing everything they can to delay it thinking the press and everyone else is going to go away.
"IHS dropped the ball. It would be bad enough if this was an isolated incident, but it is not," Bourland said.
"I have several other incidents very similar in nature. Maybe not as derogatory as what that doctor said about one of our tribal elders. This council took action to remove Dr. Reid. They wanted Dr. Reid off our reservation. Also the council called for the removal of Kim Smith, director of the IHS ambulance crew and the suspension of Clayton Belgarde, head of the IHS service unit. We understand he has been suspended. Those actions are taken and a full investigation is going on," he said.
Bourland said the stories about poor quality health care, insensitivity to tribal members and failure to allow access to doctors are pervasive.
"I think it is high time somebody do something about this. No doctor, no federal agency is going to treat our tribal people like this," Bourland said.
Bourland said the tribe will file suit on behalf of the tribe and the
Fiddler family against the contracting company that was hired by IHS and the doctor. The legal issue may be muddied further. IHS assumes the legal liability for its doctors because doctors practicing within the federal health care system are not required to be licensed in a particular state. This arrangement gives the government more latitude for providing care, but the federal guidelines also shield doctors from legal liability for malpractice and misconduct.
Bourland fears the worst, believing that Fiddler might have not been the only case where a tribal member might have been treated so insensitively. "How many more are getting brushed under the rug or being swept away," Bourland said.
"What I would like to know are three things. When did he die, was there anything that could be done to prevent him from dying and why wasn't proper procedure followed? What assurances do we have in the future that IHS will use proper procedure?"
Fixing the problem
Although Bourland opposes dismantling the BIA in the reaction to the trust account fiasco, he said he has no concerns that asking Congress to investigate IHS incidents will result in a similar reaction.
"The problems with IHS are procedural in nature," he said. "Over the years because of finances," he said, IHS "has tried to adopt policies to economize. In their minds it makes sense, but in the minds of the Indian people that they serve it doesn't make sense."
Bourland said many tribal members are sent to Rapid City Regional Medical Center because IHS contracts with the facility.
"IHS has let its own systems fall down so badly that the majority of the dollars that come to the reservation for Indians is going to Rapid City Regional, Med Center One or various other big hospitals so Native American hospitals run by IHS are nothing more than taxi services. We need to do something to fix our hospitals back up, get them into a position available to treat people and provide a better economy in those hospitals so we can retain doctors and get some decent doctors," he said.
The policy concerning the transport of the remains of tribal members needs to be revisited, he said. "In the eyes of the people out here, they are very inhumane. I don't think we should ever sit on our hands because we fear they may do a BIA dismantlement due to the fact that this is health care. We need so much better. We can't allow people sitting in waiting rooms dying or not receiving services. Sometimes it is the very simplest services," he said.
The tribal chairman expressed frustration over a recent exit conference with a pair of physicians from IHS headquarters in Rockville, Md., who had visited the Cheyenne River hospital. He said it ended with the administrators defending the actions of the doctor instead of fighting for the rights of tribal members they serve.
"IHS officials in D.C. were real patronizing and they basically defended the doctor."