When Theresa Spry's son had a grand mal seizure on a Sunday early in July and she couldn't talk with the doctor in Sioux San Hospital's emergency room, she went straight to Rapid City Regional Hospital.
Now, more than two months later, she is still trying to mediate between Sioux San and Regional to get her bill paid. She just got a letter telling her the $250 bill is overdue, even though she wrote a letter to Indian Health Service explaining why her son had to go to Regional for treatment.
"There's no reason to have to do health care this way," said Spry, who is on the board of the Sioux San Task Force, an Indian Health Service oversight board that works for better services at Sioux San.
The U.S. Government Accountability Office agrees. In a report issued last Friday, the office outlines a study of federal funding adequacy for Indian Health Service's Contract Health Services program. The contract program funds referral services when patients must seek treatment outside an Indian health service facility.
Most contract health services programs that responded to the accountability survey reported that they did not have enough money to pay for all the referral services patients required. Some contract programs continued to approve services anyway, and some worked on ways to help patients find free or low-cost health services.
Part of the reason contract health services runs out of money frequently is that Indian Health Service does not collect complete or consistent information on how many patients are referred to other hospitals and what services they are referred for, according to the report.
Both of South Dakota's senators are frustrated enough by the issue that they signed a letter to Yvette Roubideaux, director of Indian Health Service, and Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, calling for a concrete plan to fix the situation.
"It seems like every year they run out of money, so all we're trying to say is, ‘Keep accurate data,'" said Sen. John Thune. "This is a fairly significant program with no apparent idea of what its true costs are or should be."
Frustration runs both ways, Thune said, and tribes are often uncertain what data to give Indian Health Service. A more accurate count of services patients needed and used will make it easier for the federal government to give the program enough money to help everyone who needs it, he said.
"It's been a point of contention for some time to try to determine what the actual need out there is," he said.
It's well-known that Contract Health Services runs out of its federally allocated funds before the end of the fiscal year in September, said Sen. Tim Johnson in an email interview. He called Indian Health Service data collection methods "erratic and insufficient."
Fred Koebrick, chief executive of Sioux San Hospital, would not comment on the study or Sioux San's referral services. In a federal response to the study, Indian Health Services agreed that its data collection methods are inconsistent and that a federal workgroup would look for technology tools to collect more accurate information without creating too much work for employees.
Inaccurate data and the resulting fund shortage have a tangible effect on local Native Americans who are denied referrals for services they need, or find out too late there's no money available, Spry said.
"The unfortunate part of this is the funding level. At this time of year they're out of money," she said. "Your services, after the fact, get denied - and it leaves us in a bind."
Contact Ruth Moon at 394-8418 or firstname.lastname@example.org.