SIOUX FALLS, S.D. (AP) – A government-run hospital on an Indian Reservation in South Dakota where federal health inspectors found serious deficiencies leading to people receiving substandard care – to the extent that the lives of emergency room patients were at risk – will no longer be able to bill the government for services provided to those eligible for Medicare and Medicaid.
The Centers for Medicare and Medicaid Services notified the administration of the 35-bed hospital on the Rosebud Indian Reservation on Tuesday that the funding cutoff will take effect March 16. The move, which comes after the November findings and a follow-up inspection in February that found remaining problems, is a blow to an already-underfunded facility operated by the federal Indian Health Service.
Citing the “serious nature and circumstances of this involuntary termination,” the Centers for Medicare and Medicaid Services said in a letter addressed to Duane Marcellais, the acting administrator of the hospital, that if the facility wanted to re-enter the program it must provide “reasonable assurance of its capacity to maintain compliance with the Medicare requirements for certification.”
An unannounced inspection of the Rosebud hospital in November found conditions so alarming the emergency room was shut down two weeks later. Inspectors determined the failures constituted an “immediate jeopardy” situation, a term used when a hospital’s actions – or lack thereof – have caused or are likely to cause serious injury, harm, impairment or death to a patient.
The inspectors found that records for a patient with a history of untreated tuberculosis didn’t show that infection-control measures were put in place while the person was treated, and a different patient having a heart attack didn’t receive treatment until 90 minutes after she arrived. A patient who insisted on walking to the bathroom on two occasions did so without nursing staff and ended up delivering a premature baby there.
IHS provides free health care to enrolled tribal members as part of the government’s treaty obligations to Native American tribes. The agency historically has been severely underfunded and its facilities bill Medicare, Medicaid and private insurance for care given to patients who have that coverage. Statistics from a 2005 government study show that reimbursements at the time constituted between 7 and 58 percent of some hospitals’ direct medical care budgets, with the average being 39 percent.
IHS said Tuesday it wants CMS to allow the hospital to enter into what constitutes a last-chance alternative to termination that would extend the proposed funding cutoff date and allow to hospital to make significant quality improvement changes.
“The agency is committed to making improvements to ensure the safe delivery of care for patients at Rosebud Hospital and to implement reforms to stabilize, strengthen and raise the overall quality of care in the IHS Great Plains Area,” IHS said in a statement.
Representatives from CMS, IHS, the U.S. Department of Health and Human Services and the Rosebud Sioux Tribe met Tuesday. O.J. Semans, a member of the Rosebud Sioux Tribe Health Board who attended the meeting, said the termination “is making IHS accountable for what we’ve been telling them for years.”
“CMS is only telling them what we already told them for years,” Semans said. “The service that we are being provided is heartbreaking. It is an atrocity that hasn’t happened anywhere in the United States, except for Indian Country.”
