Feds threaten to terminate Rosebud hospital from Medicare

A notice published Nov. 27 said the federal Centers for Medicare and Medicaid Services, known by the initials CMS, determined that the hospital “was not in compliance with regulatory requirements.” The notice said the hospital’s Medicare agreement with the federal secretary of health and human services will be terminated Dec. 12.

The noncompliance was not further explained in the notice, and CMS Denver Regional Office spokesman Mike Fierberg declined to divulge specific examples of violations while the matter is pending.

“The deficiencies were serious enough to have to threaten a termination, which means that they were fairly serious,” Fierberg said.

Hospitals typically respond to termination notices by negotiating a plan of correction to keep them in the Medicare program, Fierberg said. The Rosebud hospital has submitted a plan and, as of earlier this week, was awaiting a follow-up inspection sometime before Dec. 12.

The hospital is a 35-bed medical and surgical facility on the Rosebud Indian Reservation in southwest South Dakota. The hospital serves more than 12,000 Native American tribal members in and around the reservation boundaries.

Decades-old treaties, laws and court decisions obligate the federal government to provide free health services to members of federally recognized tribes, and those services are delivered by the Indian Health Service, known by the initials IHS.

Because IHS funding from Congress is limited, IHS hospitals seek additional funding, including reimbursement for the care they provide to Medicare-eligible patients. Medicare is the federal government’s health insurance program for people 65 and older and for younger people with disabilities.

Fierberg said that if the Medicare termination is carried out, the state of South Dakota would also likely terminate the hospital from Medicaid, the federal government’s state-administered health insurance program for the poor.

“They don’t want to be terminated,” Fierberg said. “That could be a real serious financial mess.”

The IHS responded to an inquiry from the Journal with emailed statements. The first one said, in part, “IHS is taking the notification seriously and is working diligently to avert the termination.”

In response to follow-up questions, IHS spokeswoman Theresa Eisenman wrote that the hospital was cited Nov. 19 "for failing to meet the Conditions of Participation for Emergency Services." She did not disclose any further information about what was found to be wrong with the hospital's emergency services.

While the exact cause of the termination threat remains publicly unknown, there have been some public complaints against the Rosebud hospital and the IHS in recent years, including a cluster of complaints during the spring and summer of 2014.

In May 2014, a folder containing personal information of 620 patients from the Rosebud IHS service area was accidentally left in a public area at an IHS facility in Rapid City.

In June 2014, a Rosebud IHS employee was sentenced for stealing prescription drugs from the hospital.

In July 2014, representatives of the Oglala Sioux and Rosebud Sioux tribes met with staffers from South Dakota’s congressional delegation in Rapid City to air allegations of inadequate care received at IHS facilities including the Rosebud hospital.

This week, Jerilyn Church, the CEO of the Great Plains Tribal Chairmen’s Health Board in Rapid City, said pressure from the tribes may have contributed to the federal government’s focus on the Rosebud hospital.

“There has been a request by tribal leadership to take a closer look at operations in the Great Plains area,” Church said, “so I think the findings that were raised are a reflection of that closer look.”

Federal court records, meanwhile, show that since 2006 the Rosebud hospital has been sued at least four times by tribal members.

One of those four cases is still pending. Christy Red Bird, of St. Francis, claims she was the victim of a botched surgery at Rosebud that caused myriad physical problems and resulted in $75,000 in treatment expenses with $50,000 more anticipated. Various deadlines in the case extend into August 2016, after which time a trial could be held if a private settlement has not been reached.

Church said the lawsuits and criticism aimed at the IHS are indicative of chronic budget woes. The dependence of IHS facilities on Medicare to supplement their budgets is evidence, she said, of insufficient funding that has left Native American health care vulnerable to inadequate oversight and provider shortages.

“In an ideal world, IHS would be funded at 100 percent capacity,” Church said. “Unfortunately, we don’t live in an ideal world, so we have to try to find ways to meet the needs.”