Heads roll at Sioux San

RAPID CITY— Keeping things simple when it comes to convoluted issues, like the Great Plains Tribal Chairman’s Health Board (GPTCHB) 638 contract takeover of the Rapid City Indian Hospital (Sioux San), is not easy. Understandable fears, hostile communication, and escalating mistrust between the community and the GPTCHB, have worsened the conflict over this takeover.

Much of the community animosity is directed at the director of the GPTCHB, Jerilyn Church, and she was willing to face that animosity at a community meeting held last week by the GPTCHB.

The top community fear is patients having to pay for their health care, particularly: will they be billed for referrals and have to fork out a co-pay for every visit? Church directly addressed this concern and clearly stated that the idea was not to impose this cost on the patient.

“Tribal sponsorship,” Church said, “allows us to take a certain portion of the PRS (Purchased and Referred Care) funds and purchase insurance on behalf” of the patient. She added that this “allows us to pay the co-pay and the premium.”

Church did not say, once this system is in place, should the PRS funds not be available, or should prove inadequate, that the patient would be responsible for the co-pay and premium, but this is a possibility, and a burden, thousands of Sioux San patients, could not meet.

The second fear is the Reduction in Force (RIF), employees that were let go in the takeover. At present, RIF’d employees number 50, many let go after a quarter century working at Sioux San, but there are a number that have contacted the NSNT, and wish to remain anonymous for fear of retaliation, who are currently seeking employment elsewhere. The atmosphere of fear and mistrust, which many think exists only in the community at large, is much more extreme at the Sioux San itself.

Church had a detailed chart which did not address specific reasons for RIF’d employees, but she implied they were let go for poor performance reviews or because they declined to sign a contract or were unresponsive.

The third fear is that the Pharmacy will close, but Church had a chart which clearly listed the pharmacy as a service that the GPTCHB will continue providing at present. She did not speak to the long term plan for pharmacy.

Church also reassured people at the meeting last week that all services, although some initially less than optimum, because the new system will “take time” developing to its full capacity, would be available. She did not say they would not be reduced at a later date.

Despite having run a gauntlet of opposition from Rapid City Indian Community advocate groups, repeated Indian Health Service (IHS) rejection letters, and the rescinding of the Rosebud Sioux Tribe (RST) tribal resolution, and the near rescinding of the Cheyenne River Sioux Tribe (CRST) supporting resolution, the GPTHB continues to proceed with 638 plans to take over operation of the Sioux San.

Initially, three resolutions were required for the 638 takeover, one from each of the managing partner tribes, Oglala Sioux Tribe (OST), CRST and the RST. The GPTCHB got those resolutions, and then things started going wrong for them. RST rescinded their resolution over fears that the GPTCHB was not communicating with the community, that their affairs were not transparent, and that the GPTCHB may be unqualified to manage a health care facility.

“We now have seven years of clean financial audits,” Church said. “We have very transparent and impeccable financial checks and balances in place. We are the only organization that has the capital and expertise to take on a project of this size.”

Although GPTCHB has an excellent reputation for professionalism, their expertise is well in contention, as they have zero experience at managing a hospital.

Church explained that GPTCHB plans to base their operation on the “Alaskan Indian Health System,” which is justifiably considered a model system. She did not explain how adopting a health care plan based upon another excellent health care plan conferred that excellence on her plan.

The situation becomes even more complicated from there. Church’s initial plan to move the Sioux San to the Shepherd Hills location east of Rapid City was denied by the Indian Health Service (IHS). After this denial, Rosebud rescinded their resolution supporting the GPTCHB 638 takeover. A second plan was resubmitted which IHS again rejected on January 19. In that rejection document, IHS detailed concerns about the Shepherd Hills move: “a significant amount of preparation would be required to prepare the Shepherd Hills site for construction.” They added that “the Sioux San site was ready for construction,” and that “unlike the federally owned Sioux San campus land, the Shepherd Hills land would be donated to the GPTCHB, raising tax and other legal issues that would further delay the construction of a replacement facility.”

The community concern becomes, if the GPTCHB showed such poor judgement in the preference for a Shepherd Hills relocation, not doing their homework, not considering the negative impact, how much different would they be managing the Rapid City IHS facility?

Church has not gotten discouraged to the point of throwing in the towel. Flexible and creative, she got both the OST and CRST on board in amending their resolutions so they could proceed individually, without RST participation. Apparently, this was enough for IHS, and they approved the final GPTCHB proposal and the 638 takeover is slated to begin in mid-July.

While many Indian Community members express grave concerns that Church is a haughty, hubris-addled leader, that unnecessarily alienated the Indian community with the way she communicated with them over this takeover, there can be no doubt the GPTCHB is respected as a health care advocate, and that they skillfully prevailed over a gauntlet of obstacles, and still have the full confidence of the OST.

Another threat looms on the horizon: the close vote last week by the CRST, 5-4, to amend, not rescind their resolution. Former tribal councilman Bob Chasing Hawk expressed concern that this violates a 1977 CRST resolution, which stated that there will be no abstaining when voting on such critical matters. The CRST has 15 council members, and six abstained. This allowed Church to proceed with her plans by the narrowest of margins.

As is, the Sioux San will undergo drastic change, in addition to extensive construction plans. According to Church, the second floor, will be IHS operated, and service the RST and any other tribes not OST or CRST. The first and third floors will be GPTCHB controlled and service OST and CRST tribal members. Church assured the gathering that “we have an agreement that neither one of us is going to turn anybody away.”

On the horizon, GPTCHB must shore up their support with the CRST. They came within one vote of having their 638 takeover plans once again squelched. If another support resolution is rescinded, GPTCHB will have to proceed with two of the three original tribes in opposition to their presence, and resubmission of such a plan back to IHS stands a good chance of another rejection letter from the Aberdeen office.

(James Giago Davies is an enrolled member of the Oglala Lakota tribe. He can be reached at skindiesel@msn.com)

 

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