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Regional seeks reset with new mission, updated goals

Make a difference. Every day.

That's the mission Regional Health CEO Paulette Davidson laid out earlier this week to a group of 20 community, civic and businesses leaders during an information session at the Rapid City Hospital.

That difference, Davidson said, extends to Regional's patients, employees and the communities where they reside. 

She said Regional Health has been working for months, holding dozens of focus groups with caregivers and patients, to develop a plan for the organization's future. 

Regional's leadership wants the organization to: "deliver high-quality care, provide a caring experience, be a great place to work, impact our communities and be here for generations to come." 

Regional Health is the largest private employer in western South Dakota, operating five hospitals and 24 clinic locations that employ nearly 5,000 physicians and caregivers. 

Davidson was named permanent CEO of the health care organization in September, but had been in the role of acting president and CEO since July after then-CEO Brent Phillips stepped down in a move the board would only describe as a "personnel issue." 

Phillips' tenure was marked by growth with several new construction projects started within a short time, but it wasn't without challenges. In 2017, 100 doctors called for his removal with a "no confidence" vote. More recently, despite repeated city warnings, medical waste from the hospital was showing up in common trash loads. Regional was then bypassing the city landfill and sending its trash to Nebraska. Regional officials now say they are working on a new plan with city government that will be announced later this year. 

Though Davidson didn't mention Phillips by name during the meeting, she said the organization needed to get back to a model called the "root of care" and fight a perception that Regional is a "business first" organization to move past previous issues.

Regional Health leadership held a similar meeting to the one on Wednesday with Regional employees a few months prior.  

What Regional's plans were to fix western South Dakota mental health care, diversions away from Rapid City hospital and employee recruiting and retention were all popular questions from the community group. 

John Pierce, President of Rapid City Hospital, talked about Regional's plans for improving West River mental health care. 

Pierce said areas of Regional's Behavioral Health Center have been remodeled to add eight more beds so staff there can see more patients. Those beds will open in March.

They have also partnered with the Care Campus downtown to help with the safe bed concept, and are working with other stakeholders in the area on a study assessing mental health needs. That study is being funded through the Leona M. and Harry B. Helmsley Charitable Trust. 

Pierce also said that a new psychiatrist, Dr. Susan Howard, was hired last month to help see more behavioral health patients.

Under previous leadership in 2017, Regional Health's Rapid City Hospital changed its admission policies for people suffering from mental illness, leading to a large outcry from the community and the formation of the West River Behavioral Health Alliance. 

Another issue of discussion from the group was the number of diversions away from the hospital. 

Because of a lack of available beds due to nursing shortages, communities outside of Rapid City had sometimes been diverted away from Rapid City. Patients would sometimes instead take ambulance rides to Gillette, Wyo., or even Colorado. 

The Regional Health team said changing that practice has been a priority. 

"Nursing shortages are a nationwide issue," Dr. Michael Statz, chief of staff for Rapid City Hospital and general surgeon at Rapid City Medical Center. 

Statz said diversions have gotten better after Regional Health hired 40 nurses from the Philippines late last year. Once construction is completed on the new emergency department connected to Rapid City Hospital, Statz said 20 to 30 more beds should be available, and the practice should become even less frequent. 

Statz also said Regional Health is working to recruit more doctors from a variety of disciplines so patients don't need to go to Denver or Sioux Falls for procedures. 

He gave the Regional Health Heart and Vascular Institute as a prime example, and said the goal is for that facility to become like the heart hospital in Sioux Falls. 

Rapid City Council President Jason Salamun said he could feel a "momentum change," coming from the meeting and Regional Health, which he described as encouraging. 

Salamun encouraged Regional and the Rapid City community to partner to recruit caregivers to the region.  

Addressing the ever-persistent rumors that Regional Health is up for sale, Davidson said, "We are not looking to sell this company; we want to be here for years to come." 

She did note that Regional would be glad to partner with other health care organizations, such as Avera or Sanford, on focused projects if it meant better health care for western South Dakotans. 

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Area of former Badlands Bombing Range could remain off-limits

KYLE | The last Defense Department-owned piece of the former Badlands Bombing Range has been made safer by extensive cleanup efforts, but it could remain closed indefinitely to all but official personnel.

That’s the gist of a plan presented Friday at the Kyle College Center by two civilian Air Force employees, a contractor and three officials from the Oglala Sioux Tribe. Although the public was invited to the meeting, nobody but the Journal attended.

The plan addresses the 4-square-mile parcel known as the Air Force Retained Area. It's a remote patch of prairie and badlands straddling the White River, several miles south of state Highway 44 between Scenic and Interior.

Shawn Swallow, a bombing range specialist for the tribe, said he wishes the parcel could be officially opened to livestock grazing and perhaps even returned to the ownership of the tribe or tribal members. But he acknowledged the potential danger from unexploded ordnance that could still lurk on or under the area's most rugged and inaccessible terrain, where cleanup efforts have been foiled.

"Unfortunately, this is probably the safest thing for now," Swallow said, referencing the plan to leave the area fenced-off and closed.

The plan for the Retained Area is the latest chapter in the nearly eight-decade-long story of the bombing range. The range was established by the federal government in 1942 on the Pine Ridge Indian Reservation, where some Native Americans who resided within the range boundaries were forced to sell or otherwise relinquish their land and leave.

The range comprised a rectangular area of 534 square miles, and it was used for bombing and gunnery practice by military planes during World War II. That activity left the ground littered with debris and some "unexploded ordnance," which is the term applied to bombs and shells that fail to detonate but remain a danger because of the explosives they contain.

Between 1948 and 1977, all but one 4-square-mile parcel of the bombing range was transferred out of the Defense Department's ownership. Some of that transferred land is now included in the South Unit of Badlands National Park, some is held in trust by the federal government for the Oglala Sioux Tribe, and some was sold back into private ownership. The transferred land has been subjected to government-funded cleanups, and all of it is open to at least some use, including grazing.

The 4-square-mile Retained Area was kept off-limits because it suffered especially heavy pummeling by explosives, and because it continued to be used for artillery training by the South Dakota Army National Guard during the 1960s and '70s.

Since the 1990s, the Air Force and the tribe have overseen extensive efforts to survey the Retained Area with sensory devices mounted on vehicles, helicopters and even one-wheeled, people-powered contraptions. Surface collection efforts and digs with shovels and backhoes since 1999 have harvested approximately 23,000 pounds of debris, plus dozens of artillery projectiles and cartridges. The unexploded ordnance was safely detonated where it was found.

Two especially steep and rugged areas alongside the White River and an area of sedimented bottomland were deemed too inaccessible to clean up, and a small bull's eye area could still be afflicted with debris or unexploded ordnance buried so deep as to be undetectable.

So, the Air Force is recommending that the Retained Area remain fenced-off and encircled by hundreds of signs that denote the area as dangerous and off-limits, even though everyone at Friday's meeting acknowledged that livestock is frequently let loose there. The extensive cleanup efforts have at least made the area safer for such trespassers, the officials said. The plan for the Retained Area also includes annual inspections and five-year reviews. 

Other alternatives for the future of the Retained Area have been studied, including further efforts to locate debris and unexploded ordnance, further excavation, and the eventual opening of the land to grazing. But those alternatives could cost up to an estimated $14 million.

The Air Force's recommendation to maintain the Retained Area's status quo is open to public comments through March 15 and will be the subject of three more public meetings on the reservation before a final decision is made.

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Thousands of kids struggle with poverty in South Dakota

More than 40,000 South Dakota children, from infants to teenagers, live in families with incomes low enough to qualify for the federal food stamp program, creating challenges to obtaining a fruitful childhood and a prosperous life in adulthood.

The number of children in South Dakota families receiving aid in the federal Supplemental Nutrition Assistance Program rose by 47 percent from 2007 to 2017.

Even with some recent improvements, the number of children living on food stamps is on a significant long-term rise in South Dakota. About 42,265 children lived on food stamps last year.

Studies show that people who grow up in poverty can face educational, social and health challenges in childhood and adulthood.

The number of children on food stamps in South Dakota spiked to nearly 50,000 during and after the Great Recession of 2008.

But as the rest of the state and nation have mostly bounced back, the food stamp data show that lower-income families have been largely left out of the economic recovery.

“When the recession hit, it just pushed them all into that abyss and they could no longer make ends meet,” said Matt Gassen, CEO of Feeding South Dakota, the largest charity food provider in the state. “There’s an even bigger portion of those who didn’t make it out of poverty and are still behind.”

The jump in food stamp enrollment since the mid-2000s came as other child poverty indicators also ticked upward in the state, according to a recent report compiled by South Dakota KIDS COUNT, an outreach center at the University of South Dakota.

The review showed an increase in eligibility in the National School Lunch Program for low-income students and a significant rise in the number of children in families qualifying for Medicaid and the Children’s Health Insurance Program during that period.

The income, wage and government assistance data from South Dakota mirrors a national trend over the past decade in which childhood poverty rose. Between 2005 and 2017, 46 of 50 states saw a jump in the percentage of children in families that received some type of public assistance. In 2005, fewer than one in five American children lived in a family receiving public assistance, while last year that figure had risen to one in four, about 18.6 million children in all, according to the Annie E. Casey Foundation.

Despite some recent improvements, the nation continues to grapple with helping what researchers recently called a “stubbornly high” number of children in poverty.

Small gains, but poverty still nags

Enrollment in the SNAP program has dropped slightly in each of the past five years in South Dakota, according to Tia Kafka, spokeswoman for the Department of Social Services that administers the federal food stamps program.

Meanwhile, Gov. Kristi Noem said during her budget address in January that the state saw a drop last year in the number of people receiving benefits under some programs supported by the Medicaid program funded by the state and federal governments.

Yet major challenges remain for thousands of families with children in South Dakota.

Individuals and families qualify for food stamp benefits based on federal poverty guidelines, meaning a single person would qualify with an annual income of $15,800 or less, while a family of four qualifies with a total annual income of $32,640 or less.

About two-thirds of SNAP recipients in South Dakota are children, elderly or disabled. The monthly benefits cannot be used to buy alcohol, tobacco, dry goods or household items, pet supplies, vitamins or medicines or take-out foods. In 2018, about $130 million in benefits were issued with an average payment of about $275 per family per month.

The premise behind food stamps is that obtaining nutritional food is critical to the viability of families and children, Kafka said. “Balanced nutrition is certainly important to child well-being, including physical health and cognitive development,” she wrote.

Georgia Christensen of Sioux Falls wants to welcome her new baby into a stable environment and couldn’t do that without aid from SNAP and other government programs.

Christensen has a learning disability that makes it tough to hold a job; she said she lost her $11-an-hour position cleaning offices last year because her boss said she moved too slowly. Her husband is also out of work.

Together, they are raising a teenage girl and have a baby due this month. Christensen said she isn’t sure how the family would get by without her $252 monthly food stamp allotment and the $741 monthly disability payment she receives from Social Security.

“We run out towards the end of the month. It’s a struggle, and I do worry,” said Christensen, 34, who also visits local food pantries if necessary.

Christensen said her mother was on food stamps while she was growing up.

“I don’t think people understand what it’s like to need food stamps,” she said. “Some people say that you guys are just living off the government or are too lazy to work, and that’s not true. There’s some people who can’t work or are disabled and they need the benefits.”

Christensen has no savings and receives medical benefits through Medicaid. She said her hopes for the future are limited by her inability to land and hold down a good job. “What I hope for in life,” she said, “is I hope that we can make it.”

Low wages, disabilities hold families back

Cathy Brechtelsbauer of Sioux Falls, state coordinator for the group Bread for the World that fights hunger, said low-income families in South Dakota were hit hard by the Great Recession of 2008 and continue to be hurt by stagnant wages that haven’t kept up with inflation.

“This whole time since that recession, we’ve never seen a great recovery among the lower incomes,” Brechtelsbauer said. “People have gotten jobs, but it’s not like incomes have picked up at that lower range.”

A recent News Watch analysis of wages in South Dakota showed that the state has the third-lowest average wage in the nation and that a great number of state residents who are employed full time are struggling to get by. According to federal Department of Labor data from 2017, roughly 71 percent of employed South Dakota residents, about 292,000 people, make under $40,000 a year.

Lisa Henley’s two children are well aware that their family is on government assistance, and the realization for them is painful.

The stress and stigma of poverty rise to the surface when they go to school and notice how their peers dress or when they sleep over at a friend’s home and see the abundance of technology, toys and food not present in their own home.

Her 9-year-old daughter and 12-year-old son are old enough to know that their mother is just getting by, she said.

“It affects them a lot,” said Henley, 39, who lives in Summerset in southwestern Meade County. “It’s hard for me, and them, when I have to tell them, ‘Sorry, honey, I can’t afford that right now.’”

Henley has recently worked as a waitress and pizza shop employee but became unemployed when she slipped in the shower and broke her wrist.

Even when she worked both jobs, Henley made so little that she qualified for the federal food stamps program. She receives about $400 a month in SNAP benefits, which helps but doesn’t provide full food stability. “Things cost so much that it never goes far enough,” she said.

Henley visits charity food pantries from Rapid City to Sturgis to stock up on staples when food stamps fall short. “We’ll eat just about whatever we can get, wherever we can get it,” she said.

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$3 million settlement proposed in local lawsuit
Class action against credit union, insurance company includes 4,461 loans

Black Hills Federal Credit Union and a Wisconsin-based insurance company have agreed to pay a total of $3 million to settle allegations that they improperly raised insurance premiums associated with 4,461 loans.

The proposed settlement, which is scheduled to be considered by a judge later this month, would resolve an eight-year-old class action lawsuit filed by Kathy Thurman — who died in 2016 — and her husband, Edward Thurman, of Rapid City.

The lawsuit has its roots in a 1995 home equity loan of approximately $30,000 that the Thurmans obtained from the credit union. At the same time, the Thurmans bought a credit disability insurance plan, which was offered by the credit union via CMFG Life Insurance Company (formerly known as CUNA Mutual Insurance Society).

The insurance was intended to cover the loan payments if Edward Thurman got hurt at his construction job and had to miss an extended period of work. The insurance premium was rolled into the monthly loan payments.

In July 1999, the credit union, after receiving advice from the life insurance company, placed a notice in the monthly credit-union newsletter stating that the premium for the credit disability insurance would increase as of July 1 that year. The notice also said the insurance would take effect after 14 days of disability rather than the previous 30 days.

The credit union did not send a notification of the changes directly to the Thurmans, who later said in lawsuit proceedings that they did not recall receiving or reading the notice in the newsletter. The Thurmans maintained that they were therefore unaware of the premium increase, which amounted to a 68 percent rate hike.

Despite the premium increase, the Thurmans’ monthly payment never changed. The credit union simply applied more of the Thurmans’ payments to the disability insurance and less to the loan principal and interest.

Thus, when Kathy Thurman inquired in 2009 about the payoff balance of the loan, she was surprised to learn that the balance was approximately $10,000, which was about $6,000 more than she thought. She pushed for an explanation and finally learned of the higher insurance premium.

In 2011, the Thurmans filed a lawsuit in local circuit court against the credit union and the insurance company, who jointly offered the Thurmans about $6,000 to drop the lawsuit and pledge confidentiality.

The Thurmans declined the offer, and their reasoning was later explained in a court document filed by their attorney, Jim Leach, of Rapid City: “They refused to sign the confidentiality agreement because they wanted to make other people aware of what happened to everyone who had credit disability insurance from BHFCU on July 1, 1999, so everyone could receive justice.”

The Thurmans sought to have their lawsuit certified as a class action, but a local judge initially denied that certification. The Thurmans appealed the denial to the South Dakota Supreme Court and won a reversal of the denial in 2013.

The case then proceeded as a class action, and it grew complex as the plaintiffs obtained from the defendants more than 500,000 copies of financial documents, which the plaintiffs hired a computer programmer to analyze.

CMFG Life Insurance — which has gross premiums of about $500 million per year — employed a legal team from Dentons, which describes itself as the world’s largest law firm. The credit union was represented by Frank Bettmann, of Bettmann Hogue Law Firm in Rapid City.

Leach, the attorney for the Thurmans and the broader class of borrowers, was assisted by fellow local attorneys Mike Wilson and Ken Barker.

CMFG Life Insurance’s parent entity, CUNA Mutual Financial Group Inc., is well acquainted with Leach. He helped win a $6.2 million jury verdict against CUNA Mutual Insurance Society in 2009, on behalf of the estate of a deceased woman whose credit disability insurance claim had been denied. A federal judge later reduced the award to $1.8 million. Leach also represented clients in two additional lawsuits against CUNA Mutual Insurance Society that were both settled confidentially in 2010 (the Thurman settlement is public because of its class-action status, which includes a requirement for a public hearing).

Kathy Thurman did not live to see the resolution of her case. She died of chronic health problems in 2016, but the lawsuit continued with her widowed husband, Edward, as lead plaintiff.

Several recent court filings have noted Kathy’s contribution to the case.

“Mrs. Thurman had to work hard to find a lawyer. She contacted a number of lawyers who turned her down,” said one document filed by Leach. “She displayed great determination, without which there would have been no case.”

The parties in the lawsuit participated in a mediation session in August 2017, and then a second session this past December, while a scheduled jury trial loomed in January. The trial was averted when the December mediation session, which lasted 12 hours, produced a settlement agreement. The agreement was preliminarily approved by Circuit Judge Robert Mandel on Dec. 21, and a hearing on the potential final approval of the settlement is scheduled for later this month.

Of the $3 million settlement, $1.73 million will be split among the customers associated with the 4,461 affected loans; $1 million will be split as fees among the plaintiffs’ lawyers, who have thus far received no pay; $170,764.29 will be used to cover the plaintiffs’ costs; $65,585 will cover sales taxes on the attorneys’ services; and $30,000 will be paid as a plaintiff’s incentive award to Edward Thurman.

According to the plaintiffs’ motion for final approval of the settlement, the $1.73 million to be split among the class members will cover all of their actual losses, plus 10 percent interest per year since the date of the loss, plus another additional 25 percent. The payout check will be mailed to the class members without them having to do anything, the plaintiffs’ motion says.

The settlement terms prohibit the parties from disparaging each other. The terms do not include any admission by the credit union or the insurance company that the plaintiffs’ claims were valid, or that the credit union or life insurance company violated any laws.

In response to an inquiry from the Journal, Black Hills Federal Credit Union sent a written statement about the settlement from Vice President of Marketing Carol Brown.

"Black Hills Federal Credit Union denies any wrongdoing; however, the parties agreed to settle because of the uncertainty, expense, and inconvenience associated with continued litigation," the statement said. "We believe the settlement is in the best interest of BHFCU and our members. We’re moving on and focusing our attention on the future and our mission to improve lives."

A spokeswoman for CMFG Life Insurance Company sent the Journal the following written statement.

"CMFG Life Insurance Company maintains it acted properly, but we believe this settlement is a satisfactory conclusion to this matter and in the best interests of all parties."

Leach and Edward Thurman declined to speak publicly about the case prior to the upcoming hearing on the settlement.

The plaintiffs’ motion for approval of the settlement says that as a result of the Thurman lawsuit, “CMFG would be foolhardy ever to tell a credit union again that it can switch its customers’ credit disability policy in this same manner.” If the insurance company ever repeats the action, the motion says, other lawyers could bring copycat litigation, and the company would be vulnerable to large punitive damages because of its recidivism.

“The deterrence of potential future misconduct that this case will result in is a substantial benefit to the public interest,” the plaintiffs’ motion says.