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Yankton Sioux Tribe ER closes

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MARTY, S.D. – Signs on the doors and bulletin boards of the IHS facility on the Yankton Sioux Reservation inform people of a reduction in services – no more emergency room services.

The change from an ER facility to urgent care occurred on Oct. 2, after a temporary restraining order issued by a federal district court judge expired.

The health care facility located in Wagner on the Yankton Reservation has a sordid history and one tribal government after another have been forced to commit time to saving the facility.

The facility has changed over the years from a hospital to an emergency facility, with promises for another hospital, to what it is now: an urgent care facility.

Instead of offering 24-hour service, the new hours will be 7 a.m. to 11 p.m., Monday through Saturday.

“The new hours are consistent with the IHS’s long-held concerns that the current operating hours of the Emergency Room are not supported by a hospital or sufficient utilization of patients,” the IHS press office stated in an e-mail.

Tribal health care advocates and tribal officials stress that the change may cost lives, with the argument that many lives had been saved because the emergency room was open 24 hours a day. The change will mean the urgent care facility will be open only during the day.

Despite threats of lawsuits and pressure from the South Dakota congressional delegation, the IHS stuck to its guns and made the change, mostly for economic reasons, according to Stephen Cournoyer, vice chairman of the Yankton Sioux Tribe.

The IHS written statement also said that the Wagner Service Unit does not receive reimbursement from the Center for Medicare and Medicaid Services for emergency services provide by the unit because it does not meet emergency room criteria as defined by CMS.

“Closing the emergency room is going to be devastating. There are a lot of people who utilize it,” Cournoyer said.

The IHS, Cournoyer claims, has advised people to use the emergency room at the local Wagner Community Memorial Hospital. He said the community hospital does not have the staff to handle the numbers that go through the IHS facility after hours and on weekends.

The community hospital is ready to accept the additional emergency room burden, CEO Connie Wagner said.

“We may see some of the patients with emergencies come through; we are prepared for that.

“I don’t know the numbers right now, but we’ll be able to tell in six months. We have an idea, but can’t give exact numbers,” Wagner said.

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Cournoyer said he thought that some of the emergency patients would be turned away.

The Yankton Sioux Tribe has attempted to negotiate to have the hospital reopened. The hospital closed in 1992 because the patient numbers were down. Cournoyer said the numbers were down because prior to that date, the hospital did not have up-to-date equipment.

In 1992, a promise from the area director to do everything possible to bring back in-patient care “never happened,” Cournoyer said.

The South Dakota congressional delegation addressed a letter to Dr. Charles Grim, director of IHS, and to Don Lee, Aberdeen area director in opposition to the facility change.

“In past fiscal years, the IHS has demonstrated an ability to find the resources to maintain 24-hour access to emergency care at the service unit. We ask that you do so again to allow the tribe, the congressional delegation and the IHS to continue to work towards a long term solution that is more acceptable than a simple service reduction,” the three congressional delegates stated in the letter.

A 2005 report commissioned by the IHS stated that lives had been saved by the emergency room facility. The Sharpless report acknowledged that a closure could result in the loss of lives.

Other options being looked into by the tribe and congressional delegation include the possibility of tribal contracting of the emergency room service, co-location with a new Veterans Administration community-based outpatient clinic or the addition of IHS-funded positions at the 20-bed Wagner Community Memorial Hospital.

Wagner Community Memorial Hospital was asked to support the tribe to keep the ER open.

“We are here to cooperate with the IHS and the Yankton Sioux Tribe. We did not take a stand but did give a statement to the congressional delegation. We are empathetic to the concerns of the tribe,” Wagner said.

“I think we can absorb the traffic.”

She said the community hospital had done some upgrading in anticipation of this IHS facility reduction.

Without an IHS hospital facility, tribal members will have to either go to Wagner Community Memorial Hospital or be sent to surrounding hospitals, which are at least 20 – 60 miles away.

The hospital and emergency room are needed for the Yankton people because, Cournoyer said, most of the people do not have the resources to travel great distances to be with their family members who are ill.

The Yankton Sioux Tribe cannot fund a 24-hour emergency facility, otherwise it would be considered, Cournoyer said.

“It’s a real essential part of health care on the reservation. When we lose anything in Indian country we very seldom get it back. We lost way too much up to this point,” Cournoyer said.