ROSEBUD | Even as the Indian Health Service hospital in Rosebud recovers from problems that led to the temporary closure of its emergency room, new problems have been detected.
Mike Fierberg, spokesman for the federal Centers for Medicare and Medicaid Services, acknowledged by phone Friday that new violations of Medicare requirements have been discovered, and a new corrective plan is being negotiated. He declined to divulge details of the problems until the plan is complete.
At the hospital Friday, Kathleen Wooden Knife, a member of the Rosebud Sioux Tribal Council and vice chairwoman of the tribe’s Health Board, said the violations had apparently been turned up in a recent inspection.
The new violations come on the heels of October and November inspections that produced reports of broken-down sterilizing and disinfecting equipment, a woman giving birth to a premature baby on a bathroom floor, and a heart-attack victim waiting 90 minutes to receive care, among other things.
Fierberg said the problems from the October and November inspections have been addressed.
“Those are closed,” Fierberg said. “A plan of correction was agreed to, and inspections have been accomplished.”
There was little sign of progress Friday at the hospital, where U.S. Sen. John Thune, R-S.D., took an hour-long tour. The small tour group walked through a series of unused rooms and corridors in the facility, which was all quiet except for one waiting room that appeared to contain about 50 people.
The hospital’s obstetrics area is temporarily closed because of inadequate staffing, and pregnant reservation women, many of whom lack trustworthy transportation, are being diverted to Winner (55 miles away); Valentine, Neb. (45 miles); Rapid City (175 miles) and Sioux Falls (220 miles).
The hospital’s emergency room is closed while work continues to restore it to acceptable working order, and ambulances are being diverted elsewhere. Evelyn Espinoza, the tribe’s health administrator, said a dialysis patient from Rosebud died Thursday night in an ambulance 15 miles from Valentine.
Thune listened to that and several other grim stories during the tour.
“These are life-and-death issues,” he said.
The problems at Rosebud and similar problems at the IHS hospital in Pine Ridge have caught the attention of the media and government officials in Washington, D.C. The scrutiny has resulted in promised reforms to address staffing shortages and other problems. A new interim director was named for the Great Plains Area office of the IHS, and a Senate committee conducted hearings on the issue.
Earlier this week, Thune requested monthly updates from the IHS regarding the state of its facilities in the Great Plains Area, and U.S. Rep. Kristi Noem, R-S.D., met with a top IHS official to discuss what she termed a “health emergency” on South Dakota’s Native American reservations.
Thune’s Friday tour of the Rosebud hospital was led by a contrasting mix of people: tribal members Wooden Knife and Espinoza, who told numerous stories about the problems at the hospital, and a crew of three federal officials in Navy-like uniforms who appeared uncomfortable with the media’s presence and spoke only in hushed tones directed at Thune.
The uniformed officials were from the U.S. Public Health Service, which is under the direction of the U.S. Department of Health and Human Services. Federal officials this month announced that a four-member team would be deployed to try to solve problems at Rosebud, Pine Ridge and on the Winnebago Reservation in Nebraska.
Wooden Knife said the uniformed officials were sent “to help us get on track.”
If the hospital cannot get on track, the federal government could terminate its Medicare agreement, which would result in a loss of financial reimbursements for the care that the hospital provides to Medicare-eligible patients. Fierberg, of the Centers for Medicare and Medicaid Services, said federal officials are working to make sure that does not happen.
Around the small, remote community of Rosebud on Friday, residents interviewed by the Journal expressed a mix of gratitude for the hospital’s presence in their community and disappointment about its recent problems.
Jolene Arcoren, a tribal member who lives in White River, said she recently took her daughter to the Rosebud hospital for a sore throat and waited a week for the result of a strep test.
“The response time was horrible,” Arcoren said.
Another time, Arcoren said, physicians at the Rosebud hospital diagnosed her son with appendicitis and sent him to Winner for surgery, where other doctors said he was misdiagnosed.
Lenard “Shadow” Wright, a longtime former member of the Rosebud Tribal Health Board, is undergoing a physical therapy regimen at the Rosebud hospital as he recovers from a fall that shattered his pelvis. He has been happy with his care but said the hospital is chronically understaffed. During his time on the health board, he said, there were 22 positions at the hospital, and typically only half of them were filled.
During Friday’s tour, Thune asked if telehealth — technological connections with doctors at other locations through videoconferencing technology — might be helpful. Espinoza said the telehealth equipment at the hospital is old and inoperable, and the uniformed officials said some functionality should return as the hospital’s corrective plan is carried out. Digital medical record-sharing technology at the hospital, meanwhile, is only partially functional and is also targeted for improvement.
The nature of the complaints lodged by Espinoza and Wooden Knife during the tour ran the gamut from life-threatening to irksome. Wooden Knife, for example, said the televisions in patient rooms are as old as the 1989 hospital and alleged that previous donations of flat-screen televisions ended up in physicians’ homes.
Espinoza said she wants to look forward from the past problems and work with others to get the hospital functioning appropriately again for the people of the tribe, who have treaty rights to health care from the federal government.
“I don’t want to point fingers,” she said. “I want us to come together and use each other’s strengths.”
Contact Seth Tupper at firstname.lastname@example.org
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