Rosebud loses lives, hope as it waits for ER to re-open

Prairie Rose DuBray Chapin believes her brother should be alive.

In February, Mark DuBray fell to the floor of his Rosebud home. A cousin witnessed the collapse and called for help.

Paramedics arrived, but instead of shuttling him to the local hospital, they hit the highway for Winner, 55 miles east.

DuBray, 50, died from a heart attack in the ambulance before they arrived.

DuBray Chapin's brother is one of six who have died in the back of ambulances since Rosebud's only emergency room closed five months ago. The closure came in the wake of a federal investigation that revealed dangerous, infection-spreading deficiencies, including a broken sterilizer that left employees hand washing surgical instruments.

Since December, trauma patients from Rosebud have been diverted to emergency rooms in Valentine, Neb., and Winner, 44 and 55 miles away respectively.

"People are dying every day because we have to be transported so far away," DuBray Chapin said. "This isn't acceptable, but it is what it is."

A sense of resignation is once again setting in on the Rosebud reservation, where a decades-long health care crisis has affected countless lives. The problems reached a new low last fall when a report from the Centers for Medicare and Medicaid Services prompted the federal Indian Health Service to shutter its emergency room in Rosebud.

The report and the Centers' deadline for IHS to fix the problems briefly put the Rosebud hospital in the spotlight, ushering in a sense of urgency — even some optimism — that state, federal and tribal officials might finally make progress on the longstanding problems.

Five months later, though, nothing.

A deadline Friday came and went without an announcement. The federal Indian Health Service, which has an obligation under treaty to provide health care to Native Americans, was expected to have a plan in place for addressing problems in the CMS report or else risk losing its ability to be reimbursed for care it provides.

It's unclear whether any upgrades or renovations have been made. Hospital officials this week would not allow an Argus Leader Media reporter and photographer to see the facility.

An IHS spokesperson said Saturday night that conversations about the agreement were ongoing and that a deal is expected to be made. Without it, the hospital and another IHS hospital in Pine Ridge could lose their ability to bill to Medicare and Medicaid, a key source of funding.

Federal officials are now looking outside IHS for someone to turn the failing facility around, with IHS being pressured to privatize control of the emergency room and the management, signalling that federal officials don't think IHS can safely run the hospital on their own.

“We’re at a point in Rosebud where the federal government is telling the federal government, ‘You’re not providing good care so we can’t pay you anymore,’” said Evelyn Espinoza, the Rosebud Sioux tribal health administrator. "I cannot comprehend how this continues to be allowed or how this continues to happen and how it’s OK. It’s not OK."

The community has been here before. Rosebud tribal treasurer Wayne Boyd was optimistic about the chances for reform after the failing Rosebud IHS facility was the subject of a U.S. Senate committee's debate and a damning report by then Sen. Byron Dorgan, D-N.D.

That was six years ago.

“Everything on the report is still happening now," Boyd said. "Nothing has been done in all that time."

IHS officials said they've spent the last five months lobbying Congress for $2 million to upgrade the Rosebud facility and two others in the region that have been targeted for poor health care. They said they've also expanded urgent care hours and started a search for physicians to staff the ER.

In the long term, IHS Principal Deputy Director Mary Smith said she hopes Congress will approve a 2017 budget that aims to boost IHS funding $402 million over last fiscal year. And with that, the agency would work to recruit and retain staff, provide additional housing on reservations and would push for increased use of tele-health technology for emergency and behavioral health departments.

There are ways the agency could've kept the emergency room open and running safely, according to Mark Trahant, a University of North Dakota professor who has studied American Indian health care. IHS faces hurdles when it comes to hiring doctors, nurses and other hospital employees, he said, but regardless the agency has resources to get the emergency department opened sooner.

He said IHS officials could've called on a branch of the U.S. Public Health Service to deploy uniformed doctors to staff the emergency department, at least until the agency could find a more permanent solution.

“So it’s really not about resources and a question of will,” Trahant said.

Frustrated by the lagging pace of improvement and ongoing deaths that have resulted from the closed emergency room, the tribe sued the U.S. Department of Health and Human Services and IHS on Thursday in an effort to re-open the emergency room.

Espinoza said the greatest toll has been on the six families mourning the loss of family members who died on the way to emergency rooms in Valentine, Neb., and Winner, 44 and 55 miles away respectively.

“The families that are grieving and are having to live now without these people in their lives will always wonder, ‘What if Rosebud was open?’” Espinoza said. “There’s nothing that I can say to make them think otherwise, because I think that. That’s the reality.”

Tribal leaders say they were left out of IHS call for help

Tammi Young, Mark DuBray's cousin, sat in the Rosebud tribal headquarters lobby last week clenching her fists when she talked about the loss of her cousin, who she said was like a brother.

"People are dying. And we need help to get our emergency room open," Young said. "IHS needs to do the right thing."

Some have begun not calling for help at all, rather than risk a massive medical bill for ineffective care, tribal leaders say.

“We have people who are really sick, but they’re discouraged to go there and get diverted out,” Rosebud Sioux Tribal Vice President Scott Herman said. “So we’re at the point where people are dying because they don’t want to get stranded.”

Espinoza said the tribe is contemplating trying to take over administration of the hospital itself. The health administrator has opened conversations with private health companies from the triple-wide trailer office on the reservation. She said the tribe would be better equipped to ensure that facility remains in compliance with CMS standards.

William Bear Shield, chairman of the Rosebud Sioux health board, said he hopes a plan emerges to improve the hospital's care. Meanwhile, the only optimism he has is the sort that comes by default when things can't get worse.

“We’re at a crossroads in our health care," Bear Shield said, "from the worst-case scenario to it really can get nowhere but better."

Follow Dana Ferguson on Twitter @bydanaferguson