Indian Country Emergency Rooms Face Imminent Shutdown


Add Rapid City’s Sioux San Hospital to the list of Indian Health Service (IHS) hospitals threatened by the federal government with imminent closure and or critical loss of funding. In a recent surprise inspection, a team from the Center for Medicare and Medicaid Services (CMMS) found what they call serious deficiencies in the hospital, particularly in the emergency room.

This brings to four the number of emergency rooms in the IHS’s Great Plains Region threatened with closure in the last year. The three other hospitals, Omaha Winnebago Hospital in Winnebago, Nebraska, Rosebud Hospital in Rosebud, South Dakota and Pine Ridge Hospital in Pine Ridge, South Dakota have all been placed under private management. A May 17 IHS press release states “we are using short-term funding to provide health care in these hospital emergency rooms while IHS reviews the administrative and clinical operations of its facilities across the region…”

In a further action to alleviate the ongoing crisis, all Public Health Service Commission Corp medical personnel nationally have been notified they may be reassigned to the Great Plains Service Region. The letter was described as, “not just a suggestion.”

CMS said Sioux San Hospital must correct their problems in order to continue to charge the government for Medicare- and Medicaid-eligible patients.

It described the situation in the Sioux San Emergency Room as an “immediate jeopardy,” a category used to indicate the increased likelihood of imminent injury, serious harm, death or impairment to patients. The Sioux San Hospital’s emergency department is different from the other three in that crosstown Rapid City Regional Hospital provides emergency rooms services and it’s only 10 minutes from the IHS hospital.

After an IHS statement on Monday said “new leadership, expanded oversight, staff retraining and policy changes” were being instituted, Sioux San Hospital administrators and medical personnel took part in an emergency meeting on Tuesday morning.

All three Great Plains-area hospitals received funding cutoff deadlines for substandard care and conditions. In April, after a series of meetings between IHS, hospital staff and tribal leaders, Omaha Winnebago, Rosebud and Pine Ridge were all given a last chance to make things right, or lose critical funding.

The Rosebud Sioux Tribe sued the federal government in April for malfeasance when its emergency room was shut down. The lawsuit points to ongoing substandard conditions, including a report that the tribe’s 35-bed facility saw 13,000 emergency visits in the most recent calendar year.

In a September 2013 open letter to Pine Ridge Hospital’s then acting CEO, Oglala Lakota tribal members Mary Tobacco and Ann-Marie Amiotte were eerily prescient about the problems besetting IHS’s Great Plains region. But their focus was on a reality at IHS hospitals no one speaks about openly, and contributes greatly to survey failures and closed emergency departments.

“Narcotic analgesics, especially hydrocodone, flow from the hospital’s pharmacy like a toxic river, at times depleting the pharmacy’s monthly drug allotment before month’s end. Patients complaining of chronic pain, often addicted to narcotic analgesics … flood practitioners’ schedules each day and prevent the more seriously ill elders from receiving needed care,” the letter stated.

The letter addresses how patients who need to see a specialist or subspecialist fail to receive the proper level of care. The hospital’s Contract Health Department states limited funding is at the root of the issue.

Lack of funding, constantly changing leadership and harassment by addicts, lead to competent practitioners leaving the hospital only to be replaced by inadequate staff as needed.

“The emergency room sags under the weight of too many patients and the imminent threat of heavy sanctions for incompetence exposed by the Centers for Medicare and Medicaid Services,” the letter stated.

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