SIOUX FALLS, S.D. (AP) – Great Plains tribal leaders are demanding swift, transparent and substantial changes to remediate the quality of care provided at government-run hospitals responsible for caring for enrolled members of Native American tribes.

The leaders laid out their demands during the first of a series of meetings with Indian Health Service principal deputy director Mary Smith and other senior agency leaders on Tuesday in Sioux Falls.

The forum addressed issues affecting hospitals in the region, but significant time was devoted to the need for significant quality-of-care improvements at two facilities in South Dakota and a third one in Nebraska where federal inspectors last year found serious deficiencies.

Smith, who has led the agency for about a month, agreed with tribal leaders on the need for quick action and increased communication between stakeholders.