Health care horror stories reveal need for changes

EAGLE BUTTE, S.D. ? Patients and their relatives who have suffered through Indian Health Service treatment rose and told their stories one by one to Cheyenne River Sioux tribal officials in a series of hearings to document the failures of a crumbling health care system. They told of a system that has threatened and cost the lives of tribal members and left others desperately trying to safeguard their health and going in debt to private clinics to survive.

More than 80 tribal members gathered to give taped testimony about the state of medical care on the northern South Dakota reservation.

Cheyenne River Sioux Health Committee Chairman Harold Frazier and Tribal Attorney Rebecca Kidder sat and listened March 12 as tribal member after tribal member tell of failures in critical situations at the Eagle Butte IHS Hospital where time might have made the difference.

Tribal members detailed misdiagnosis, misconduct, failures by physicians to examine charts, the dispensing of medications deadly to those suffering from particular health conditions, pharmacy personnel dispensing the wrong prescriptions to tribal members and tribal members being given bags of Motrin and Robitussin to pacify them as a substitute for treatment. Some said they were given the over-the-counter medicines even if they did not need them.

Others complained of physicians refusing to see them when immediate care was needed in life-threatening circumstances. Some said tribal members sat waiting for hours before anyone would respond. Often the response was to simply send them home. In some cases, just a few hours later they would have to return for emergency care.

Frazier said the hearings were to provide testimony for the U.S. Senate Indian Affairs Committee to assist the tribe in obtaining the necessary funding for a new facility, provide more staff for the facility and allow families to tell their stories to determine if their cases should be further examined by malpractice attorneys.

While the tribal Health Committee has been looking at health care for the past year, it was not until the death of a widely respected tribal elder that it came to the forefront of issues facing Cheyenne River Sioux officials.

Leonard Moses Fiddler, 66, of Green Grass, S.D. died on New Year's Eve in the midst of confusion while an ambulance service was ordered not to take him to the hospital. Although an Emergency Medical Technician pronounced him dead at his house, the time and cause of his death has still not been officially determined. (See related story on this page) According to written reports by a deputy county coroner and a responding tribal police officer, the doctor on call, who is no longer at the facility, told the ambulance drivers to take him back to his residence or dump him in a ditch.

Tribal members have demanded investigations of the incident from Sen. Tim Johnson, D-S.D., the IHS Aberdeen Area office and IHS director Michael Trujillo, M.D. According to Tribal Chairman Gregg Bourland and Health Committee Chairman Frazier, they have received no response.

"I have been on the committee for a year and half. There have been a lot of horror stories. Enough is enough. It is time to stand up as a tribe and our rights for what is owed to us," said Frazier.

Tribal Attorney Rebecca Kidder told tribal members their testimony was important because most of the nation's congressmen are unaware of life on the reservations.

"They are living in the big city have no idea what we live with every day," she said. "This tribe is trying very hard to get a new facility. Not only a new facility, but to staff it with the doctors."

Congress has only funded 40 percent of the need based on 1996 figures, she said.

Meanwhile, she told tribal members not to fear retaliation from hospital officials despite apparent threats some tribal members have received that if they testified at the hearings they would be denied medical care.

"They have no legal right to deny you health care. If they do, you need to call us immediately," Kidder said.

Another tribal member told of a woman suffering from a brain tumor who was denied contract care due to a lack of funds.

"The IHS hospital said, 'We're sorry Nina, we don't have the funds. Come back next fall, and maybe we will have the money,'" she said. "Looks like they are just letting all the elderly go."

Lois Spotted Bear, a retired nurse who returned to the reservation to be near her relatives, said many tribal members receive poor medical care because they do not know what questions to ask. Spotted Bear had a heart attack in 1999. Although her emergency care at the hospital met with her approval, the follow-up care she received in the clinic fell short.

"Everything was done because I knew what to ask and what medications to take. When I got back to clinic there was a big mix-up," she said.

Spotted Bear said she saw nearly a dozen doctors, never seeing the same one twice and her medications were changed, causing her to become dehydrated. Her husband Danny suffers from diabetic neuropathy, a condition that effects the nervous system.

"He's in pain, but they don't have any sympathy," she said. "The ambulance workers don't want to transport him any more. The doctors hired here are temporary. You are forever telling them the same story. They never look at the chart."

Tribal members gave numerous accounts of people who came to the emergency room with appendicitis only to be sent home until their families made return visits to IHS. Many were not taken into emergency surgery until the appendix ruptured.

Patients said they have been turned away for care because a doctor employed at the facility says he has an allergy to latex gloves.

Betty Come Crow, who worked at the hospital for many years, said, "They come and all they give them is pain killers," she said. Come Crow said her son is suffering from leukemia.

"IHS wouldn't write a statement. He is suppose to be getting medication, but he can't afford it because his wife divorced him and he isn't on her insurance anymore," she said. "You are practically dead before they admit you."

Germaine Means, 69, wondered how non-medical personnel could control the decision on who would receive a referral. Those reviewing who should be referred for further treatment, she said, are picked by non-medical staffers.

"This is where it gets frustrating. Who allows for non-professional people making these determinations when our doctors refer us? A lot of our lives are at stake here," she said. "How can I diagnose this is life or death? What is the criteria for priority or should there even be such a measure? One person's needs can't outweigh another person's needs."

Simple lab services which help in diagnostic work and patient treatment are contracted requiring patients to wait for days for the results.

"We used to have lab services," said Raylene M. Lebeau. The contracting of the services delayed treatment, LeBeau said. "They told me 95 percent of IHS budget goes for staff salaries. Somewhere we are getting the short end of the stick. They somehow lose their compassion. Once they lose their compassion, they may as well not be in the medical field."