Dana Ferguson, and Mark Walker

Argus Leader

The top federal official in charge of providing health care to Native American tribal members will hear first-hand this week about problems plaguing South Dakota facilities.

Mary Smith, the principal deputy director for the Indian Health Service, is set to attend a two-day series of meetings with Great Plains tribal leaders in Sioux Falls beginning Tuesday.

Indian Health Service facilities in South Dakota have long been fraught with problems but some tribal representatives say the quality of service has reached a new low. The Rosebud IHS hospital emergency room has been shuttered for nearly four months since a federal investigation exposed dangerous deficiencies.

Smith is set to meet one-on-one with tribal delegates, many of whom are skeptical about the agency's ability to solve the problems.

“This is the worst I’ve seen it in all the years I’ve been involved with the committee," William Bear Shield, chairman of the Rosebud Sioux Tribe's Health Committee, said. “The bottom line is that the quality of health care that is supposed to be provided just isn’t happening."

Dangerous deficiencies

Reports from the federal investigations indicate employees at the Rosebud facility hand washed surgical instruments for six months while a sterilizer was broken, didn't communicate that a patient had an untreated case of Tuberculosis and failed to monitor a patient who delivered a baby prematurely on a bathroom floor.

The baby was picked up and swaddled in towels, but wasn't hooked up to oxygen or placed in a warming unit, according to the reports.

In November, the Centers for Medicare and Medicaid Services (CMS) cited the Rosebud and Pine Ridge IHS hospitals for poor sanitation and improper record-keeping and threatened to terminate some of their federal funding if they couldn't correct the problems.

While the Pine Ridge facility has since corrected its problems, the Rosebud hospital could still lose federal funding if IHS can't prove that it is moving to correct the problems before the end of the month.

Tribal leaders from across the state also say misdiagnosis, long wait times and inability to refer patients out to other facilities for care create serious and sometimes fatal repercussions for IHS patients.

IHS currently uses a system that allows IHS doctors to refer patients to another medical facility only if they are in critical or nearly critical condition. Tribal representatives say that allows health problems to worsen to the point of becoming critical in some cases before patients are able to receive adequate care.

Roxanne Sazue, Crow Creek Sioux tribal chairwoman, said she has personal experience with the long wait times and misdiagnoses at IHS hospitals that she plans to share with Smith.

Sazue's sister died after she was turned away from an IHS hospital that didn't diagnose her failing heart. Sazue said the doctors wouldn't listen to her sister when she told them she was experiencing stomach pain and as a result she died at 36.

“They wait too long, far too long," Sazue said. "And then they don't listen."

Robert Flying Hawk, Yankton Sioux tribal chairman, said the tribe has seen the standard of care decline and misdiagnoses persist.

"This should be a very high priority. This is life," Flying Hawk said. "We would like to know the services given to us are not going to stop that life.”

Frustration and distrust abound

Smith enters South Dakota at a time when tensions at IHS facilities are high and distrust for the agency abounds.

Tribal leaders say they've sought change from the agency's leaders, from Congress and from others for decades but have yet to see meaningful, long-term solutions.

“I’ve been around 25 years and it hasn’t gotten any better," Bear Shield said.

He and Jerilyn Church, CEO of the Great Plains Tribal Chairmen's Health Board, said they've been trying to communicate the same concerns to IHS officials and Congress for years. Both said they testified in February before the Senate Committee of Indian Affairs. They had similar dialogue in Congress six years ago, they said, but no action came out of that discussion.

“It’s almost like beating your head against the wall because no one is going to listen," O.J. Semans, a member of the Rosebud Sioux Tribal Health Board, said.

Church said despite the fact that Smith has been in the position for about a month, the region's tribal representatives wouldn't cut her any slack in solving the agency's problems.

“She’s inheriting a lot of distrust and skepticism about IHS’s ability to correct problems in the region," Church said. “Like every new relationship, that level of trust is going to have to be earned over time."

And many others have tried and failed to win that trust, Bear Shield said.

“We’re always hopeful that somebody new can come and make a change, but it hasn’t happened to date," Bear Shield said.

Sonia Little Hawk-Weston, chairwoman of the Oglala Sioux Tribe's health and human services committee, said that frustration has been there for years. She said this year, though, there seems to be more response from Washington.

“This time around I think we did get someone’s attention up there,” Little Hawk-Weston said. “Since our testimony in February we really have gotten the attention of the Indian Health Service."

Lewis Grass Rope, a Lower Brule Sioux Tribal member and former candidate for chairman, said giving tribes an opportunity to speak directly with Smith will likely be an "eye-opener."

"It’s going to be one hell of a job for her," Grass Rope said. "It’s going to be one hard deal to find a resolution to the problems that persist on the reservation."

Smith previously worked in President Bill Clinton's administration and more recently she worked as General Counsel at the Illinois Department of Insurance. In that role she was responsible for implementation of the legal aspects of the Affordable Care Act in the state.

Sazue said she hopes that this time her comments will stick and Smith will help bring solutions to South Dakota's IHS facilities.

“As leaders we have to have that same type of optimism,” Sazue said. “If we keep saying that over and over someone’s going to listen and something is going to change.”

Follow Dana Ferguson and Mark Walker on Twitter @bydanaferguson and @ArgusMWalker