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From Staff Reports

ROSEBUD—Rosebud IHS Hospital has been granted a reprieve until May 16 by the Centers for Medicare Services (CMS) to get its act together and show improvements in patient care or have its Medicare refunds discontinued.

CMS had set mid-March as the cutoff date, but negotiations with Health & Human Services and Indian Health Service persuaded CMS to grant a 60-day extension, according to a news release.

The hospital has come under increased criticism in recent months owing to patient complaints, poor management, and failed evaluations.

Some tribal officials have begun debating the merits of contracting all hospital services from IHS and working directly with Washington on funding.

The debate has surfaced on the floor of the Rosebud Sioux Tribal Council many times over the years, but the tribe has never had the political will to move ahead with the proposal.

Opponents argue that the tribe by contracting the hospital could risk or limit federal funding, and may cost the hospital in doctor recruitment. Taking on such responsibility with the tribe’s own history of corruption and mismanagement has also been cited.

According to those familiar with the current situation, Rosebud Hospital, since closing its ER, is the closest it has ever been to shutting down. ER patients are being asked to go to Winner or Valentine, Neb. if they need help.

CMS, in granting a May 16 reprieve, has insisted the hospital and IHS sign a Systems Improvement Agreement.

“The purpose of a Systems Improvement Agreement for the Rosebud IHS Hospital would be to effectively safeguard patient health and safety, enable the hospital to accomplish sustainable, systemwide improvements in the quality and safety of care, achieve and sustain compliance with the Medicare Conditions of Participation, and effectively address underlying systemic problems that have impaired the hospital's ability to achieve or sustain compliance in the past,” CMS explained in correspondence.

A number of tribal elders continue to push for a class-action lawsuit against IHS, which they believe would enhance any efforts to contract hospital services. They argue they want justice for the years of neglect, the high rate of preventable deaths, and the actions of certain health providers over the years.

RST Council approved a motion in 2013 to file a federal lawsuit, but the body has stalled at authorizing payment of the $50,000 retainer demanded by lead attorneys, according to a former council member.

Meanwhile, CMS believes an SIA will give Rosebud Hospital “reasonable time to implement a robust regimen of quality improvement to achieve full compliance with Medicare quality of care and safety requirements … (T)he commitments made by IHS and the recent actions by both IHS and HHS authorities ... is in the best interests of beneficiaries in Rosebud tribal areas to allow a short period of exploratory time to determine if a structured SIA would enable Rosebud IHS Hospital to achieve substantial compliance with hospital quality and safety standards that Medicare and Medicaid participation requires.”

A controversial new development is a growing consensus among tribal members that the RST Health Board be completely dismantled, new policy guidelines written, and new board members elected, complementing the new set of guidelines.

“At every stage in the last 15 years, as healthcare kept getting worse at the hospital, the Health Board has failed us us, the little people,” said one elder. “Why do we even need it? They never listen to us, and that’s our own people there.”


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