By REGINA GARCIA CANO, Associated Press

SIOUX FALLS, S.D. (AP) — Broken sanitation equipment, a baby delivered unattended in a bathroom, doctors operating without credentials and lack of immediate care in the emergency department are among the dozens of serious deficiencies federal inspectors found last year during unannounced visits to two federally administered hospitals that provide care to Native Americans.

The Associated Press obtained records of the inspections, which were conducted in October and November by the Centers for Medicaid and Medicare at hospitals on the Pine Ridge and Rosebud Indian Reservations, showing that patients were receiving substandard services — so much so in one emergency room that it put lives at risk.

In turn, tribal leaders and health care policy experts are questioning the federal government's commitment to provide adequate care for tribal members, who by law have guaranteed access to free health care.

"It's a treaty right, but I have too many Oglalas walking around that are physically, ailing sick and nothing at all is being done to treat them, at all," Oglala Sioux Tribe President John Yellow Bird Steele said. "When they go to a doctor at Pine Ridge, he says, 'We don't have the capability of servicing you, I'm sending you to another hospital.'"

The U.S. Department of Health of Human Services acknowledged in an email Thursday that the deficiencies cited in the report are "unacceptable."

"HHS, working with the Indian Health Service, has implemented a number of recent measures to ensure safe delivery of care for all patients, and we will take action in the coming days and weeks intended to further improve services at these facilities," the email said.

The inspections at the 45-bed Pine Ridge Hospital and the 35-bed Rosebud Hospital, both operated by the IHS, were conducted in late October and mid-November respectively.

The deficiencies at the Rosebud emergency room were so severe that the surveyors determined the failures constituted an "immediate jeopardy" situation, a term used when a hospital's actions — or lack thereof — have caused or are likely to cause serious injury, harm, impairment or death to a patient.

Of those deficiencies, records for a patient with a history of untreated tuberculosis didn't show that infection control measures were put in place while the person was treated, and when the patient was transferred to a different facility, no documentation was given about the person's infectious disease. And a patient having a heart attack was not seen by a medical provider, placed on telemetry or provided oxygen until 90 minutes after she arrived.

The regional office of the Indian Health Service closed the emergency department two weeks after the inspection. People in need of immediate care must go to hospitals outside of the reservation.

Other findings at Rosebud included:

— A sterilizer for the operating rooms had not been working for more than a year and a disinfecting machine had recently been fixed after six months of being out of order, forcing staff members to wash all surgical instruments by hand.

— A patient who insisted on walking to the bathroom on two occasions did so without nursing staff and ended up delivering a premature baby there. Only after the woman's boyfriend started yelling, "I need a Dr (doctor) the baby is on the floor," did a staff member find out.

Jerilyn Church, the Chief Executive Officer of the Great Plains Tribal Chairmen's Health Board, said the Indian Health Service for years has been grossly underfunded, which has resulted in staffing limitations and infrastructure deficiencies.

"For a while, you can cut corners and then there comes a point were equipment is obsolete, health management systems are out of date, facilities deteriorate, that's the consequence of a lack of funding and attention," said Church, whose board advocates for the health care needs of 18 tribes located in a four-state region.

In Pine Ridge, almost 100 miles from Rosebud, the findings included:

— Records from three of six sampled medical staffers lacked appropriate permission to practice at that hospital.

— A machine used to clean and sanitize dishware had been broken for three years, forcing patients and staff to eat their meals on disposable dishes.

— A patient's emergency room record from September contained information from two different patients. Inspectors were told "it was common knowledge," and "staff including provider would copy and paste information from old charts in current patient records" resulting in multiple errors in medical records.

CMS spokesman Mike Fierberg said the agency has approved each hospital's plan to correct the deficiencies and surveyors have conducted follow-up inspections, so they'll continue to receive Medicare reimbursements.

The hospitals' deficiencies will be discussed next week at a hearing of the U.S. Senate Committee on Indian Affairs, U.S. Sen. John Thune, a member of the committee, said in a statement.

Steele will be there.

"The whole system, their ineptness, their wastefulness boils down to that individual person on Pine Ridge having to suffer," he said. "Someone has to care. Somebody has to make them care about that individual patient."

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