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Court says Yankton Sioux Tribe will lose emergency room

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SIOUX FALLS, S.D. - A federal judge has said he would allow an emergency room on the Yankton Sioux Reservation to close.

In September 2006, District Judge Lawrence Piersol ruled in favor of the Yankton Sioux Tribe, which had asked for a restraining order to stop the IHS from removing emergency room services at the Wagner IHS hospital and change it to an urgent care facility.

The town of Wagner is on the Yankton Sioux Reservation and is where the BIA and IHS offices are located.

On Aug. 5, Piersol reversed his earlier decision and said the emergency facility should be allowed to close.

The Yankton Sioux Tribe has fought since 1994 to keep the hospital, clinic and emergency room open. The hospital has become a political nightmare for many Yankton Sioux tribal governments that have devoted time and finances to fight for the facility.

The tribe spent much time in the courts and in negotiations with the IHS and has enlisted the help of the South Dakota congressional delegations over those years.

No word has come down from the Aberdeen Area Office to the local service unit as to a specific closing date for the 24-hour care.

Last fall, the South Dakota congressional delegation tried to convince the IHS to keep the facility viable. This time around, the same pressure comes from the congressional delegation.

''Continued 24-hour service at the facility is critical to the health and well-being of the Yankton Sioux Tribe and the surrounding community,'' the congressional delegation of Sens. Tim Johnson, D-S.D., John Thune, R-S.D., and Rep. Stephanie Herseth Sandlin, D-S.D., said in a letter to Dr. Charles Grim, director of the IHS.

The letter mentioned that a 2005 IHS-commissioned Sharpless report on the facility expressed the opinion that if the 24-hour facility closed, lives would be lost.

''The closure will mean that one of our people will lose their life. I hate to say that,'' said Dennis Rucker, Yankton Sioux tribal council member.

''When there is no available help they will go to the community hospital in Wagner; are they ready to take over? I don't think so. How are we going to pay them?'' he said.

To Rucker, the issue goes to the heart of the agreement made between the United States and the tribe when the treaties were signed.

''We gave a large portion of our land away, and our way of life, that we would receive these benefits. Somehow they neglect their federal obligations to us. All this talk to the senators and Herseth [Sandlin]; they seem to neglect that there is a treaty obligation the federal government made to my people,'' Rucker said.

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Last fall, the Wagner Community Hospital began to make plans to accommodate the additional emergency care. Connie Wagner, administrator of the Wagner hospital, said the hospital was prepared to receive additional emergency room patients. She also said she told the South Dakota congressional delegation that she supported the emergency services at the Wagner IHS facility.

Earl Cournoyer, CEO of the Wagner IHS facility, referred all inquiries to the Aberdeen Area, which did not respond to phone calls. There was also no response from the central office.

Funding has been the reason given for the closure of the 24-hour care because, as the IHS has stated in the past, the facility did not receive reimbursement from Medicare and Medicaid because the facility did not meet the emergency room criteria as defined by the Center for Medicare and Medicaid Services.

The congressional delegation confirmed that funding is the main obstacle to keeping the facility open for emergency care.

Rucker said that the IHS has allocated $2.2 million to build housing for doctors and nursing staff.

''They can build new quarters for new doctors, but yet they can't send down that $2 million to fund the emergency room? Where's the reasoning in that,'' Rucker said.

The IHS did not confirm the allocation of funds for the new housing.

What may save the Yankton Sioux Tribe is a possible Veterans Administration outreach clinic that could be housed in or attached to the current IHS facility. Rucker is on the American Indian advisory committee for the VA.

''We are trying to get that third-party billing if the clinic becomes a reality. The main problem is money; the bottom line is the money to fund it,'' he said.

The VA clinic would be a facility that everyone could use, and Rucker said he estimated that it could serve some 5,000 to 6,000 people from the local area and surrounding counties.

The Sioux Falls VA Medical Center is looking at all options for the possible Wagner facility that could possibly open next summer.

The Wagner IHS emergency care will remain open until the process is finalized by the IHS. Tribal members who choose not to use the Wagner emergency facility will be forced to travel to Yankton or Sioux Falls, where there are larger medical centers - but that would mean a more than 100-mile trip of a little more than two hours to Sioux Falls, or to Yankton, which is 60 miles away.

The Wagner facility is also used by tribal members from the Nebraska Ponca and Santee Sioux tribes.

''The current Wagner Service Unit is state of the art, pristine, well-staffed and a huge benefit to the community at large.

''The Wagner Community Hospital has also expressed support for the continuation of the 24-hour services to avoid being unjustly overwhelmed by the additional burden,'' the congressional delegation said in its letter.