The Indian Health Service has banked $72 million worth of funding to construct a new outpatient facility in Rapid City and is now seeking information from potential designers and builders.
The agency published a request for information Dec. 14. The request invites interested design-build companies or teams of companies to submit information about themselves to IHS by 3 p.m. Jan. 4.
The submissions are not intended to include architectural drawings, cost estimates or bids. Rather, the request for information seeks only to identify capable firms. Interested parties are asked to submit no more than five pages of basic information about their business, their experience and their past performance, along with a point of contact and proof of at least $75 million worth of bonding.
The request for information says the price of the project is estimated between $80 million and $120 million.
The request describes the desired structure as a 200,000 square-foot outpatient facility. The IHS has said it will be called Rapid City Health Center, and it will replace existing facilities on the campus of Sioux San Hospital at 3200 Canyon Lake Drive.
The request says the campus is currently home to “29 buildings and 3 structures, of which 19 of the buildings and 2 of the structures (root cellar and barn) are categorized with some historical significance.” The main building on the campus dates to 1938.
The request does not specify whether some, all or none of the historically significant buildings and structures will be demolished, but it does say that the contractor ultimately chosen for the project will be expected to “demolish/dispose of existing facilities and abandoned infrastructure.”
The IHS disclosure of the $72 million it has on hand for the project came in response to Journal questions submitted and answered by email after IHS published its request for information.
A Washington-based IHS spokeswoman, Jennifer Buschick, wrote that IHS received congressional appropriations in fiscal years 2016 and 2017 that total $42.5 million, and another $29.5 million was received in fiscal year 2016 from the Nonrecurring Expenses Fund of the U.S. Department of Health and Human Services, of which IHS is a part.
“The funding appropriated to IHS is no-year funds,” Buschick wrote, “meaning it will remain available until expended without a fiscal year limitation.”
Buschick wrote that IHS has incurred $1.5 million in costs so far, on a contract that was awarded in September to obtain a schematics-level design.
The request for information is the beginning of a process intended to culminate in an actual design and construction. The request does not mention a completion date, but a July announcement from the IHS said the new center is scheduled for completion in fiscal year 2022.
Construction of a new outpatient facility is part of a broader effort by the IHS to improve the objectively poor health care that is being delivered to Native American tribal members not only in Rapid City but throughout the Great Plains.
Several IHS facilities in the region have failed inspections in recent years by the federal Centers for Medicare & Medicaid Services, leading to potential and actual losses of Medicare and Medicaid funding. IHS encourages Native American patients to enroll in those government programs if they qualify, because the extra funding from the programs can be used to supplement regular IHS funding.
The crisis of poor care at IHS Great Plains facilities led U.S. Sen. Mike Rounds, R-S.D., to introduce a bill that would require an exhaustive audit of the IHS. That bill, the Independent Outside Audit of the Indian Health Service Act of 2017, received a hearing last month by the Senate Indian Affairs Committee but has not been acted upon.
In a statement to the Journal last week, Rounds reiterated his call for an audit and said the IHS has a "well-documented history of poor management, poor decision-making and delivering poor care to tribal members."
"As progress moves forward on IHS’ decision to close the Sioux San Hospital and develop an outpatient clinic, the agency must work in close consultation with the tribes to make certain they are putting the best interests of tribal members first," Rounds said. "Delivering timely, quality, adequate care to our Native population is the top priority. High-quality care also includes access to care provided by Rapid City Regional, and payment for their services should not be withheld from IHS.”
Sioux San Hospital has been among the Great Plains IHS hospitals under duress in recent years. In May 2016, the hospital was placed in immediate jeopardy of losing its Medicare and Medicaid funding, but that designation was lifted a month later. In September 2016, IHS temporarily closed the emergency department at Sioux San. In July of this year, IHS announced that the closure of the emergency department will become permanent as of July.
An IHS report to Congress on the closure said the upgrades necessary to bring Sioux San’s emergency department back up to snuff would cost $6.3 million, plus recurring costs of $2.2 million annually.
Instead of spending that money, IHS opted to transfer patients requiring emergency department services to Rapid City Regional Hospital, 4 miles away, where many patients requiring such services were already being transferred due to the inadequacy of the emergency department at Sioux San.
The care at Sioux San has since shifted to outpatient and urgent care services, and IHS intends to continue that dual focus at the proposed new Rapid City Health Center.
“By providing the services the vast majority of our patients require, we will be able to serve those patient populations more efficiently and effectively,” said a July statement from Jim Driving Hawk, acting director of the Great Plains Area of the IHS.