Dana Ferguson

dferguson@argusleader.com

A South Dakota senator and a band of American Indian tribes are demanding a federal audit of the Indian Health Service following reports of dangerously deficient health care in the Great Plains region.

Sen. Mike Rounds, R-S.D., told Argus Leader Media on Wednesday that within the week he hopes to send a request to the U.S. Government Accountability Office (GAO) to evaluate the Indian Health Service (IHS) and to determine whether it is operating effectively.

"This isn’t going to change unless we look at the big picture," Rounds said. "We can’t just go in and throw money at the crisis every time there’s a crisis. It’s time to look at the whole system because nobody’s doing that."

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Rounds' office tried to investigate the agency on its own but couldn't find financial documents or patient outcome data. The senator said he suspects the agency has failed to maintain many records, and that he hopes GAO can yield answers.

A GAO report released last week says IHS didn't consistently document wait times for patients, a metric health care providers are required to track under federal law.

Rosebud tribe sues feds over ER closure

IHS came under scrutiny last year when CMS officials flagged two of its South Dakota hospitals for inadequate health care services. CMS officials threatened to pull a key source of federal funding if IHS couldn't fix deadly problems at the facilities.

The deficiencies at the Rosebud IHS hospital paired with a staffing shortage led the agency to shutter the facility's emergency department in December. And after five months of diverting patients to the nearest emergency departments in Valentine, Neb. and Winner, 44 and 55 miles away respectively, the Rosebud Sioux tribe sued the U.S. Department of Health and Human Services and IHS in an effort to re-open the emergency room sooner.

While IHS and CMS have an agreement to improve health care at the facilities, Rounds said a broader review of IHS is needed. He pointed to the agency's employee break down of 65 percent working in administration and 35 percent in health care and said the numbers contributed to the problem.

"Clearly IHS is more of an administrative organization than a health care organization based on their funding," Rounds said. “People in Indian Country have a level of health care like that during the time of the Civil War. That’s how behind they are at providing health care at the Indian Health Service."

John Yellow Bird Steele, Oglala Sioux tribal president, in a letter to 11 congressional delegates from Nebraska, North Dakota and South Dakota, said the Great Plains Tribal Chairman's Association has for decades called for improved health care in the region. He wrote that tribal leaders in the three states support a GAO audit of IHS and want to see results within six months.

"The inadequate quality of healthcare in the Great Plains Region has resulted in actual genocide of our tribal members," he wrote.

Rosebud loses lives, hope as it waits for ER to re-open

IHS Principal Deputy Director Mary Smith, who has inherited substantial difficulties in her first two months in the position, said the agency is committed to improving IHS health care in the region and failings in the past are "unacceptable." Smith has said she will work with haste in the next few months to improve health care options at the state's IHS facilities.

In a statement, IHS officials said the agency has received approval to increase its pay tables and streamline recruiting processes to better attract qualified candidates for vacant positions. The agency has cited its low budget and lack of recruiting incentives as a key factor in its inability to attract doctors to the hospitals.

And in the meantime, the agency has deployed 20 uniformed federal health care experts to work on addressing the deficiencies at the hospitals and at another hospital in Winnebago, Neb.

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