The impact from Rosebud Hospital’s reduction in emergency room hours continues to expand as sexual assault victims on the Rosebud Reservation struggle to find services at local hospitals.

Janet Routzen, executive director of the White Buffalo Calf Women’s Society, Inc., a nonprofit organization providing services to domestic violence and sexual assault victims on the Rosebud Reservation in South Dakota reports that local victims of sexual assault are being diverted from the Rosebud Hospital to off reservation hospitals located up to 100 miles away.

“We are concerned that women won’t go through with reporting sexual assault if they are forced to run all over the place to report a rape,” Routzen said.

According to the U.S. Justice Department, Native American women are 2.5 times more likely to experience sexual assault crimes compared to all other races.

Routzen reported that sexual assault victims from the Rosebud Reservation were recently denied rape kit services at the Cherry County Hospital in Valentine, Nebraska. A December 5 press release issued by Indian Health Service advised patients seeking emergency room services at the Rosebud Hospital from midnight to 7 a.m. to go to hospitals in Winner, South Dakota or Valentine, Nebraska.

Cherry County Hospital CEO Brent Peterson reported that in one case since the IHS services reduction, the hospital was “at capacity” when a victim from Rosebud sought services and was told to go to hospitals in Winner or Martin, South Dakota. In the other case, the staff member on duty was not familiar with the process of conducting a rape kit so the victim was “diverted” to another hospital.

The diversions, according to Peterson, have nothing to do with race. “This is about whether or not we are able to provide needed services,” he said.

Rosebud Hospital reduction in emergency room hours has brought significant changes to the Cherry County Hospital according to Peterson.

“We have brought on extra providers to our emergency room and are doing our best to step up our services,” he said.

The woman who answered the phone at the only sexual assault services non-profit organization in Valentine, Nebraska affirmed that they have not had any problems accessing rape kits for victims seeking services at Cherry County Hospital during December. She asked that her name and name of organization be withheld.

The reduction of Rosebud Hospital’s emergency room hours was shocking news for reservation residents according to Routzen. “We were not given any heads up. I happened to be watching the Rosebud tribal cable channel that was broadcasting the council meeting in which IHS said they would be reducing hours. That was how I found out,” she said.

According to Routzen, there have been 39 reported rapes in Rosebud so far this year. Eight of the assaults occurred during the past two weeks.

The White Buffalo Calf Woman Society shelter has been providing backup help to those victims who don’t need immediate medical attention. Trained advocates bag and seal victim’s clothing, provide clean clothing and allow them to stay at the shelter until the emergency room opens. The bagged and sealed clothing is then given to police for use as evidence if the victim chooses to press charges.

Fortunately, according to Routzen, the Four Directions Clinic in Kyle, South Dakota on the Pine Ridge reservation has offered to help victims needing services. Four Directions provides 24 hours 7 days a week service to sexual assault victims who don’t require medical services for physical injuries.

Even at full capacity, however, the Rosebud Hospital has serious limitations regarding its services for rape victims according to Routzen.

“The Hospital has one Sexual Assault Nurse Examiner (SANE) on staff and does not require non-staff, contracted doctors to conduct rape kits,” she reported.

“We’ve had victims wait over 8 hours in the emergency room for services,” she said.

The decision to reduce emergency room hours at the facility comes shortly after a notice was sent to the Acting CEO of Rosebud Hospital by the Health and Human Services, Centers for Medicare and Medicaid Division (CMS) describing the agency’s intent to terminate the Medicare provider agreement with the hospital.  According to a November 23 press release from Rosebud Tribal President Willie Kindle’s office, “The notice states that the CMS has determined that the deficiencies identified in their recent survey are so serious that they constitute an immediate and serious threat to the health and safety of any individual who comes to the hospital to receive emergency services.”

“If this agreement is terminated, our IHS unit will no longer be able to collect CMS reimbursements. The effect will be devastating,” President Kindle said in the press release.

President Kindle added, “The Rosebud Sioux tribe has met several times over the past 15 months with local, regional and national Indian Health Service leadership, U.S. Health and Human Services leadership, South Dakota congressional leadership voicing our concerns and demanding improvements. Unfortunately our concerns were ignored.”

Rosebud Hospital is a 35 bed medical and surgical facility serving more than 12, 000 tribal members in and around the Rosebud Reservation in Southwest South Dakota.

According to a December 4 letter sent to President Kindle from Ron Cornelius, Great Plains area director of Indian Health Service, “Rosebud Hospital remains open to provide outpatient services. The hospital will offer 24 hour Urgent Care Services, 7 days a week. Patients will continue to be seen for inpatient care, OB surgery and all other current hospital services. The Great Plains Area Indian Health Care Service is working to resume Emergency Room services in Rosebud.”

CMS spokesperson Mike Fierberg told the Rapid City Journal that hospitals typically respond to termination notices by negotiating a plan of correction. The Rosebud Hospital has submitted such a plan and is awaiting a follow up inspection later in December.

In a written statement from Indian Health Service  regarding the impact on sexual assault victims on the Rosebud reservation, IHS spokesperson Britt Erhhardt wrote, "IHS continues to work with local police and other organizations to help ensure appropriate care for individuals who have experienced sexual assault, including those who report assault outside the hours that Rosebud Hospital Urgent Care Services are available."

U.S. Representative for South Dakota’s at large congressional district, Republican Kristi Noem detailed recent problems at the Rosebud Hospital in a December 18 press release to constituents. The press release included a letter sent by Noem to IHS Principal Deputy Director Robert McSwain describing incidents within recent weeks such as hospital staff washing surgical instruments by hand because of a sterilization machine being broken for past six months and no infection control measures taken for a patient with history of untreated highly infectious disease. Noem also described a situation in a pregnant woman left unattended, gave birth on the floor of a hospital bathroom.

“Sadly the experiences of my constituents in South Dakota indicate that the IHS Great Plains Area facilities are failing to provide quality care and tribal members are paying the price,” she wrote.