The federal government is required to provide the Rosebud Sioux Tribe with “competent physician-led health care,” a federal judge in South Dakota has ruled.

That requirement is a component of the 1868 Treaty of Fort Laramie, of which the Rosebud Sioux was a signatory, Judge Roberto Lange ruled on Monday. The treaty, “in exchange for mutual peace and vast forfeiture of land by the Sioux Nation,” Lange wrote, guaranteed that the federal government would provide some level of health care to the tribes.

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The tribe sued the U.S. Department of Health and Human Services and Indian Health Service in 2016 after the Rosebud IHS Hospital emergency room was shut down following a host of problems at the hospital. Tribal members were being diverted to hospitals in Winner or Valentine, Nebraska, both about 50 miles away.

In addition to diverting patients because the Rosebud hospital didn’t have enough doctors and nurses, IHS reduced the hours of operation at its urgent care.

While problems at Rosebud were ongoing, the troubles that IHS had in providing decent health care across its system were well documented in congressional testimony and government watchdog audits.

Some of the claims in the original lawsuit had already been dismissed by Lange in a previous ruling. The government sought judgment on the remaining portion of the lawsuit, arguing that it was not required to provide health care, despite the treaty and federal legislation. It also suggested that Lange should take the literal meaning of the words contained in the treaty, which said the government would “furnish annually to the Indians the physician,” and also make appropriations “as will be sufficient to employ such persons.”

Lange noted that the language in treaties is supposed to be construed in favor of Indians, and he said the meaning at the time of its signing to Indians and the government was that the United States would provide physician-led health care.

“If this court were to adopt a truly literal interpretation as the government suggests, the government could satisfy its duty by employing and furnishing a physician and housing him on the reservation without the physician providing any sort of services,” Lange wrote. “This interpretation could not have been the intended result of the negotiating parties.”

Ace Crawford, a spokeswoman for the U.S. Attorney’s Office in South Dakota, declined to comment.

Brendan Johnson, a lawyer representing the tribe, said he was pleased that Lange ruled the government has a treaty duty to provide medical care to the tribe.

“This is a significant victory,” Johnson wrote in an email. “The finding that there is a judicially enforceable treaty duty is a win for the tribe.”

The ruling didn’t go as far as the tribe had hoped. The tribe had argued that federal legislation used a standard of health care to the “highest level.” Lange called that language use by Congress “aspirational.”

“This court,” he wrote, “cannot accept the tribe’s conclusion because it overstates the government’s duty.”

Reach reporter Jonathan Ellis at 605-575-3629 or jonellis@argusleader.com. Twitter: @ArgusJellis