April 6, 2016; Argus Leader (Sioux Falls, SD)

Indian Health Service (IHS) officials met recently with representatives of Native American tribes from Iowa, Nebraska, North Dakota, and South Dakota. Healthcare quality and access for tribal members in the Great Plains has always been a source of tension. Poverty, isolation, and the tension between Native and non-native culture are persistent factors affecting relations between the federal government and the Native Americans living on 326 reservations in the U.S.

The closure of the emergency room at the IHS hospital on the Rosebud reservation has lasted four months so far. According to the Argus Leader article, federal officials acted after “CMS reports revealed employees at the 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.” These concerns, coupled with staffing shortages, mean that tribal members must now travel 45 to 55 miles away for emergency care. Similar problems were found at the Pine Ridge IHS hospital and were addressed, but the Winnebago IHS hospital in Nebraska has already lost some federal funding for not taking sufficient corrective action.

Not surprisingly, IHS officials and tribal representatives agree that inadequate federal funding is a major factor affecting IHS hospital care throughout the country. A $2 million appropriation has been made to target improvements at the three hospitals, and in hopes Congress will approve a proposed $402 million budget increase in 2017. South Dakota’s Congressional delegation is supportive of improving IHS healthcare in the state because South Dakota has applied for a waiver to expand Medicaid by having IHS fulfill its treaty responsibility for Native American healthcare statewide, with the Medicaid savings from this move being used to pay the state’s matching share of Medicaid expansion costs.

There are no guarantees in these plans, which made tribal attendees at the meeting dissatisfied, citing several similar meetings over the past ten years that resulted in little, if any, change for tribal members’ access to quality health care.

“We are losing members within our tribe. People are dying,” Kathleen Wooden Knife, vice-chair of the Rosebud Sioux Tribe Health Board, said. “Sitting at this table it’s hard for me to be optimistic.”—Michael Wyland