Dana Ferguson

dferguson@argusleader.com

Federal agents said a third American Indian hospital in South Dakota is in "immediate jeopardy" after an investigation revealed problems there that pose a serious threat to patients.

The Centers for Medicare and Medicaid Services (CMS) flagged the Rapid City - Sioux San Indian Health Service (IHS) hospital Monday after a survey earlier this month found that patients were misdiagnosed or not treated in the facility's emergency department.

"These deficiencies are so serious that they constitute an immediate and serious threat to the health and safety of any individual who comes to your hospital to receive services," Steven Chickering, CMS associate regional administrator, wrote in a letter to the hospital's administrator Monday.

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The hospital has five days to submit a plan of correction or risk losing a key funding source in its ability to bill to Medicare. If it doesn't submit a satisfactory plan, CMS officials will terminate the hospital's ability to bill to Medicare beginning June 15.

Nine of 32 patients in sample cases reviewed weren't given appropriate medical screening examinations when they arrived at the hospital's emergency department, the report found. Some left the facility to get better care elsewhere and others had to return on multiple occasions before being admitted to another facility.

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IHS officials in a statement said they are working with CMS to create a plan that will fix the hospital's deficiencies. They said the agency started work at the hospital immediately to improve quality of care by putting in place new leadership, expanding oversight, retraining staff and changing policies.

Two other hospitals in Pine Ridge and Rosebud were flagged last fall for fatally flawed health care. Agents reported that 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 hospital's emergency room was closed in December as a result of those reports.

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Patients have since been diverted to the nearest emergency rooms 44 miles and 55 miles away. Six people have died in the back of ambulances en transit to those facilities.

IHS contracted with a private group to take over the emergency rooms in those hospitals as well as at another ailing IHS hospital in Winnebago, Neb. They're also looking to contract for additional services, at least on a short-term basis.

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.

IHS officials have 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.

Follow Dana Ferguson on Twitter @bydanaferguson

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