By Lacey Louwagie, Courthouse News Service

ROSEBUD, S.D. (CN) — The Rosebud Sioux Tribe blames Washington for a health care crisis that led to the recent shuttering of an emergency room on the Rosebud Indian Reservation.

The tribe sued (pdf) the Department of Health and Human Services and the Bureau of Indian Affairs on April 28, citing the Dec. 5, 2015, closing of the Rosebud Hospital's emergency room. A bulletin from the co-defendant Indian Health Services that day said the emergency room was put on "divert status due to staffing changes and limited resources" on the Rosebud reservation. Patients were told to seek emergency services in Winner, S.D., or Valentine, Neb., both about 50 miles away from the Rosebud hospital.

There are 21,245 residents at the 1,970-square-mile Rosebud Reservation, and 91 percent are Native American. The median household income of the "capital" of the reservation, Rosebud, was $19,933 in 2013, according to city-data.com, just 39 percent of the statewide median of $48,947. The median price of a home or condo in Rosebud that year was $31,046, just 22 percent of the statewide median. The Rosebud Sioux are known as Sicangu Lakota in their own language, and also by the French term, Brulé Sioux.

In January, the Centers for Medicare and Medicaid Services told the Rosebud hospital it would terminate the emergency room's participation in Medicare for failing to provide appropriate screenings and stabilizing treatment to emergency room patients, among other issues, according to the tribe's complaint.

In February, federal surveyors cited noncompliance with seven Medicare conditions of participation, which were not publicly disclosed, and set March 16 as the termination date for emergency services at the hospital.

The Rosebud Sioux Tribe say the federal government's chronic underfunding of Indian health care is behind the emergency room's troubles.

"The Rosebud Hospital faces a number of administrative difficulties such as understaffing and underfunding that hinder patient care," the tribe says in the 23-page complaint.

"These administrative difficulties are partly the result of the Rosebud Hospital's challenges in attracting, hiring, and retaining medical staff. These challenges are mostly attributable to inadequate federal funding to offer competitive pay to emergency room providers and supervisors, as well as a lack of housing in the area."

The federal government is responsible for providing health care to Native Americans through several treaties and laws, including the Snyder Act, the Indian Health Care Improvement Act, and the Affordable Care Act.

Specific to the Sioux tribes, the 1868 Treaty of Fort Laramie was "entered into by the federal government and tribes of South Dakota to end hostilities and to cede tribal land to the government in exchange for the government providing health care and other necessities to the tribes," the complaint states.

Timothy Purdon, an attorney for the tribe, told Courthouse News: "All we're seeking is for the citizens of Rosebud to get what they've been promised here. We're not suing because the emergency room was shut down. We're suing because [the federal government] under law is required to deliver an open emergency room that provides reasonable medical care. The emergency room has been closed for five months — how long has the standard of care been below the acceptable standard and therefore below the promises that have been made to the tribe?"

The Sioux say these problems are "not new" to them or to other tribes: that "the federal government spends less on Indian health care than on any other group receiving public health care," including prisoners and veterans.

This contributes to the fact that Native Americans have a shorter life expectancy "than any other racial or ethnic group in the nation," the complaint states.

In 2015, Indian Health Services spent "$3,136 per capita on Indians, in contrast to $8,760 per capita on veterans' medical spending," according to the complaint.

The tribe says that since the Rosebud Emergency Room was shut down, "five individuals have died and two babies were born in ambulances in transit to the nearest hospital."

The government also violated due process by failing to follow proper procedure for closing a health care facility, which must include "submitting a written report to Congress one year prior to the date of the proposed closure outlining the impact of the closing on the population served by the hospital," the tribe says.

The Rosebud Hospital has 35 beds and serves a population of about 12,000 people. The closure has affected only the emergency room.

Attorney Purdon spent five years as the U.S. Attorney for North Dakota before going into private practice with Robins Kaplan in Minneapolis. He is co-chairman of the firm's American Indian Law and Policy Group, and says the firm is taking the case pro bono.

"This problem has been festering for almost five months as part of a larger problem across the Great Plains regions, and so far no one has been able to solve it," he said. "Sometimes it takes a federal court to step in, and that's where we're at now."

He said his firm is "honored" to represent the Rosebud Sioux Tribe.

Indian Health Services declined comment.

To Learn More:

Rosebud Sioux Tribe v. USA, et al (U.S. District Court of South Dakota) (pdf)

Pine Ridge Sioux Must Travel 27 Miles from Reservation to Vote (by Noel Brinkerhoff and Danny Biederman)

Judge Orders Compensation to Loyal Minnesota Sioux Tribe after 148 Years (by David Wallechinsky and Noel Brinkerhoff, AllGov)