U.S. Threatens to Cut Off Funds at South Dakota Hospital

SIOUX FALLS, S.D.— The U.S. government on May 23 threatened to cut off Medicare and Medicaid funding to a government-run hospital in Rapid City — the third South Dakota hospital serving Native Americans that’s been found to have serious deficiencies in recent months.

Inspectors with the Centers for Medicare and Medicaid Services, which administers the government’s health care programs for the needy, disabled and elderly, found problems at Sioux San Hospital in Rapid City during an unannounced survey earlier this month. The hospital is run by Indian Health Service, which provides health care to tribal members through a network of hospitals on and off reservations as part of the U.S. government’s treaty obligations to Native American tribes.

CMS said the IHS has until June 15 to correct the deficiencies at Sioux San Hospital to avoid losing its ability to bill the government for services provided to Medicare- and Medicaid-eligible patients.

It’s the third IHS-run hospital in South Dakota to receive such a threat this year; a fourth hospital in Nebraska was found deficient last year. The problems have prompted tribal leaders and health care policy experts to question the U.S. government’s commitment to provide adequate care for tribal members.

At Sioux San Hospital, inspectors determined that patients in the emergency department were not receiving appropriate medical screening examinations. The failures were so concerning that inspectors determined they 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 Hospital failed to provide a medical screening examination (MSE) that was, within reasonable clinical confidence, sufficient to determine whether or not an Emergency Medical Condition (EMC) existed,” according to the report of the inspection conducted between May 10 and 12. The inspectors based their findings on emergency department logs, review of medical records and policies, and interviews with patients, patient representatives and staff.

The IHS in a statement on Monday said it has already begun addressing the issues and has instituted changes including “new leadership, expanded oversight, staff retraining and policy changes.”

CMS handed down funding cutoff deadlines earlier this year to IHS-run hospitals on the Pine Ridge and Rosebud Indian Reservations in South Dakota after substandard conditions were uncovered during inspections. Those facilities agreed to last-chance remediation plans in April so they could continue billing Medicare and Medicaid.

Before that pair of facilities came under scrutiny, the IHS-administered hospital on Nebraska’s Winnebago Reservation was the subject of “immediate jeopardy” findings during a survey last May.

The report on Sioux San Hospital cites the case of a 6-month-old baby who was taken to the emergency department in April with complaints of congestion, cough, runny nose and watery eyes. The attending provider did not ask the mother for the patient’s history and diagnosed the boy with a “viral respiratory infection.” When the mother brought the baby back 12 hours later, another provider discovered the boy had been born prematurely and had a history of respiratory distress. The boy spent time in intensive care at another facility after having a seizure.

The first provider acknowledged during an interview with inspectors that he would have treated the patient differently had he known about the baby’s medical history, the report said.

Members of Congress, including U.S. Sen. John Thune, have begun proposing ways to overhaul the IHS.

“It’s completely unacceptable and highlights the pervasive problems that have prevented the IHS from focusing on its core mission of providing quality health care to tribal citizens throughout the area,” the Republican from South Dakota said.

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