Native Americans Fight Government-Run Healthcare

Warren Albrecht | @drw_albrecht

Native Americans take the first step in fighting the incompetence of government-run healthcare. In July 2019, Great Plains Tribal Chairmen’s Health Board, an organization representing many tribal communities in the northern midwest began operating the Sioux San Indian Health Service Hospital in Rapid City, SD.

Indian Health Services Healthcare

The Indian Health Services (IHS) met with representatives for the Oglala Sioux Tribe, Rosebud Sioux Tribe, and Cheyenne River Sioux Tribe to discuss the closure and replacement of the Sioux San Hospital in Rapid City, South Dakota  The next closest IHS- operated facility is the Pine Ridge Hospital. This is 97 miles away. Rapid City Regional Hospital, a non-IHS facility, operates an Emergency Department approximately 4 miles away from IHS Sioux San Hospital. The Indian Health Services is

an agency within the Public Health Service of the United States Department of Health and Human Services (HHS) whose principal mission is to provide primary health care for eligible American Indians and Alaska Natives throughout the United States.

The IHS provides healthcare by managing health facilities, contracting with tribes allowing them to operate a facility and funding and grants for services. This facility has 9 beds and 22 physician staff. From 2016 to 2017, IHS met with Tribal leaders about the closure of the hospital understanding the tribes were not in support of this. The history of Sioux Sans can be read here.

 Is Government-Run Indian Healthcare obsolete?

In 2018, originally, the three representing tribes authorized the Great Plains Tribal Chairmen’s Health Board to negotiate with IHS for the transfer of management of the Sioux Sans Hospital. They hoped at that time, that the 117 million dollars slated to help refurbish the hospital could go to a new facility in Rapid City on donated grounds. Those plans were then put on hold when one tribe had second thoughts. Then in July 2018, on behalf of 2 tribes, the Great Plains Board planned on managing the facility with an agreement with the IHS.

“IHS recognizes that tribal leaders and members are in the best position to understand the health care needs and priorities of their communities” and more than 60 percent of IHS funding across the country is administered by tribes, the release says.

Problems of Government-Run Indian Healthcare 

In an August 2019 USNews report documented concern over the care within the IHS. It stated problems such as pediatrician sexually abusing children, Emergency Department closings, and patients exposed to opioid problems. The report documented problems  of

Money, staffing, infrastructure, health disparities and a general lack of accountability all have played a part.

The report shows IHS has no formal structure or policies in place. The roles of IHS officials were not clear.  There is a “culture” within the HIS which makes it difficult to discuss problems and solutions. Though many interviewed for the report expressed a passion for the agency’s mission, doubt was widespread that the mission could succeed.

These Problems are Not New

The Commission on Civil Rights in 2004 developed a report about the inadequacies of Indian Health Services. In 1928, the Meriam Report documented the early problems with healthcare for Native Americans and as the Commission quoted,

much of the substance of that 1928 report issued by the Meriam Commission remains true to this day.

Though the commission report stated the support by the AMA for better Indian health services, during the same time, the AMA was actively fighting against the support of black hospitals and black physicians. The New York Times reported AMA racism,

By 1938, the situation had grown so dire that Dr. Louis T. Wright of Harlem Hospital declared, “The A.M.A. has demonstrated as much interest in the health of the Negro as Hitler has in the health of the Jew.”

In 2008, the AMA officially gave an apology for previous racism. But even though it “railed” against the disparities of Indian health in 1949, no change has been seen.

More Systematic Failures

In 2015, the Rosebud Hospital in Rosebud, South Dakota closed after the CMS found deficiencies and was placed on “Immediate Jeopardy” status. This was because of evidence of the failure of adequate and efficient treatment of 4 patients. After reopening, the Rosebud Emergency Dept. was closed for similar reasons. CMS documented the failure of IHS management.

Rosebud Hospital is a small 35-bed which is the primary source of healthcare for the Rosebud Sioux Tribe in South Dakota. During the closure, the nearest emergency departments were 45 and 55 miles away. This overwhelmed those systems. In 2017, Rosebud completed a System Improvement Agreement with CMS. This allowed Rosebud Hospital some more time. There was a possibility of losing Medicare reimbursement for compliance issues. During that time, a pediatric patient, intoxicated from alcohol, attempted suicide and another adult died of neglect in the ED. Through 2018, CMS repeatedly found problems and allowed Rosebud to try to complete improvements.

IHS is deemed the administrator of quality healthcare for millions of Native Americans and Alaskan natives. IHS had to create a separate Office of Quality in 2018.

Native Americans fight for Medical Independence 

The Argus Leader, a local Sioux Falls, SD news source, detailed many patient stories and IHS failures for Rosebud. Other native American tribes have been successful in contracting with the federal government and disconnecting from IHS completely. The Winnebago Tribe of Nebraska is an example. But the Rosebud and Oglala Sioux Tribes see this possibility as allowing the federal government to run away from their responsibilities of providing Indian healthcare. Sioux San Hosptial reveals a debate about independence and past and present dependence on the federal government.

Hope is Beyond Government-Run Healthcare

U.S Senator Mike Rounds (R-SD) speaking about the Rosebud Hospital closure,

While the report’s findings are disappointing, they are not surprising. For years, …we’ve heard countless stories from tribal members about the horrors of receiving treatment at an IHS facility…. the IHS has not made significant efforts to improve its facilities or the care it delivers to tribal members. IHS has a trust and treaty responsibility to provide proper health care to tribal members and it continues to fail in its duty.

Both Republican and Democratic administrations, including at times controlling of both houses of congress, allowed these failures to continue. Former Rosebud Sioux President William Kindle may say it best about the reservations and their medical facilities,

We’re a third-world country, you know, a third-world country with our health care

South Dakota Indian tribes are hoping they can change that. Local Native American control of how medical care is provided may be the future.

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