RAPID CITY, S.D. - Anger, frustration, suspicion and despair over substandard medical care at Sioux San Hospital here boiled over into heated comments at an emotional public meeting.
It was made clear that problems with dispensing health care to American Indian clients goes well beyond any local hospital straight to the halls of power in Washington, D.C.
Hospital and Indian Health Service officials and representatives of South Dakota's legislative delegation were treated to calls for immediate action by way of heart-wrenching stories from some of the 100 persons the meeting. Stories about health problems caused by slow service, refused treatment, lack of adequate facilities and denial of coverage for costs of treatment obtained at other facilities were frequent.
The Sioux San Hospital Task Force seeks to hold IHS accountable and responsible for delivering high-quality and reliable health care to the mostly-Lakota Indian population in this area.
It tries to facilitate complaints about past injustices and poor treatment and deal with the prospect of services further decreasing because of budget shortfalls and funding cutbacks while lobbying for a new, full-service hospital.
Chairman Joe Valandra, a Sicangu Lakota, said efforts to gather information met with little response or acknowledgement from either the hospital administration or the government agency. "We haven't had any contact from them. We've asked for specific documents seven times and never gotten them."
A primary target was Service Unit Director Michelle Leach who became the brunt of at least part of the anger, which grew out of comments she made in a newspaper article about patient complaints. She said about unavailability of medicine through the Sioux San pharmacy, that "We're just not stocking everybody's medicine cabinets. Health care's changing for IHS now because we're really held accountable."
She said dispensing over-the-counter medications like Tylenol has been restricted and now requires a physician's order.
Many people said her remarks were demeaning and insulting and helped give credence to racist stereotypes of American Indian people.
Carl McKenzie of Rapid City said he wanted her dismissed or transferred out of the area. "I'm sure the (Rapid City) Journal gets around throughout the nation and the country and goes especially to our representatives in Washington, D.C. ... We need someone here that will help us with our health needs, support us, and understand the needs of the community."
Community member Gene War Bonnet attacked Leach's qualifications for her position, saying she "came from Rosebud as a secretary" and denied him coverage for $1,000 in medical expenses for carpal tunnel syndrome surgery.
"Are you in a medical field to make decisions on people's lives?" he asked Leach. "... You didn't help me one bit ... . I haven't got a job. How am I going to pay that bill. How many others have you done that to?"
Leach responded that she had started as a staffer in environmental health services but had worked hard, came up through the ranks, "learned everything the hard way, I have worked five times harder than somebody with a degree. If you think that you can get me out or ask me for my resignation, I will tell you right now, you will not get it."
She said many hospital service problems derive from being "regulated to death" and attacking her was not going to change their health care.
An IHS policy statement distributed at the meeting described five levels of priority for treatment needs: 1. emergent/acutely urgent care services; 2. chronic primary and secondary care services; 3. acute primary and preventative care services; 4. chronic care services, and 5. excluded services." The statement is available at Sioux San.
Many services may not be available at many IHS facilities and referral to an outside provider requires approval by the local contract health services committee or clinical director before treatment services are rendered.
"Pharmacy is one of the highest cost areas that we have," Leach said, explaining that the facility faces a $1.3 million budget deficit and trying "less-expensive alternatives"' was one way to cut back, such as the use of generic drugs. Most people didn't believe generics were "the real stuff."
Dr. Rodney Larsen, a physician at Sioux San for more than 11 years, tried to reassure people generics are not substandard medicine and that none of the physicians would risk their patients' health.
People said many illnesses and health problems go undetected or addressed until there has been a significant loss in quality of life, that people have to become critical to receive reasonable care.
"We need medicines for prevention before our diseases or sicknesses start or when they're first diagnosed," McKenzie said.
Health care is guaranteed by the treaties.
"The United States government has an obligation to the Indians to provide health care services, education and all the rest," said Marie Randall, Lakota elder. "We can go after it. That's a moral issue and I think we can get it under treaty rights."
Marie Lambert said, "Congress and the tribal councils who hold all that money ... they need to look at us up here! We are getting death and despair."
Renovations at Sioux San triggered rumors of a new hospital. While construction will provide 14 new examination rooms, inpatient capacity is limited and there is no expectation of that increasing.
The IHS thinks of the facility as more of a clinic than a full-service hospital and doesn't seem to believe a full-service hospital is warranted, task force members said.
The audience pointed out that census figures show the American Indian community in Rapid City and the Black Hills area is growing.
Leach said repeated efforts to justify a full-service facility with an emergency room and mental health unit ultimately have been stymied. Complicating the picture are budget allocations that have not been increased in five years while the costs of equipment, staff, services and medications have increased by more than 15 percent per year.
"We don't have enough money," Leach said. "We haven't had enough money in this facility since way before my time. Budget deficits were projected here since way before I came, and we've been on a flat-line budget for years and years.
"I've talked to the congressional aides. I let them know what's happening. People know what our situation is. I have the responsibility to give you as much as I can give you with what I have."
Dr. Charles LaRoque, a Sisseton-Wahpeton who will soon leave for another facility, said he had never seen such a strangulating tangle of regulation as the hospital and physicians are subjected to.
"We are so regulated you would not believe. I was in the military, I was in basic training ... and let me tell you, that was a breeze compared to what we have to deal with in this hospital."
LaRoque paused to gather himself then tearfully related the story of a patient who came to the hospital needing equipment ruled a low priority. Physicians attempted to donate the money needed to get the equipment only to be told any money they donated must be diverted to the Aberdeen IHS office.
"Are you really here to help us?" LaRoque asked congressional representatives. "What (do) Sens. Daschle and Johnson and Rep. Thune feel about Indian Health Service? Are we going to get increases in funding? ... we are barely getting half, one half, of what we need."
He noted allocation to American Indian health is approximately 30 to 40 percent less than costs to care for non-Indian people in the private sector.
Members of the task force said they heard much of this information in previous meetings but the concerns had never been aired in public. Laurette Pourier pledged to make herself readily available as a contact, volunteering to take calls at home (605) 399-1802 and 388-3388. She said these stories need to be taken to the IHS chain of command above Leach because "that's where the decisions are made."
Valandra chided Leach for scheduling monthly meetings during daytime hours when most people have to work.
On the matter of an alleged extension of the accreditation review period, Leach acknowledged a request was made because "we're in the middle of construction ... we were told 'no' so they will be here in August."
Cecilia Montgomery, 90, devoted many years to American Indian health. Barely able to stand with the aid of a walker, she reminded the group, "The name of the game is Indian health, let's not forget that. When I first came to Rapid City in the middle '40s, we didn't have any health care. Many of our Indian people that got sick were never accepted in a hospital unless they had that almighty dollar to pay down for their treatment. You had to have money ... and many of our people had to go back to their own reservation for health care and some of them died.
"My own daughter, we had to take her back to Pine Ridge and she had a ruptured appendix on the way. That's what happened in those days. So my dear people, remember this is Indian health. Time tells the tale."