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Indian Health Service takes improvement efforts into its own hands

Following months of disarray within South Dakota's Indian Health Service hospitals and several calls for action from local politicians, the IHS is answering the call.

In a letter released Wednesday, IHS Principal Deputy Director Mary Smith said the agency is working to improve access to quality health care for tribal members through a 60-day quality framework initiative.

According to Smith's letter, Indian Health Service's strategy to improve health care within the Great Plains region will begin by outlining key priorities and objectives required to enhance the availability of quality health care that "focus on strengthening the underlying foundation of the direct service health facilities within the IHS system of care."

The agency's plan comes more than seven months after the Rosebud IHS Hospital's emergency room was placed on diversionary status and patients were forced to seek care at emergency rooms several miles away. U.S. Rep. Kristi Noem, R-South Dakota, said in a legislative hearing last week that five babies were born in ambulances and nine people died in transit while being diverted away from the Rosebud emergency room.

Rosebud's emergency center reopened Friday, but the inadequate health care services at the Rosebud, Pine Ridge and Sioux San IHS facilities found itself in the spotlight after the initial notice of diversionary status.

Smith's framework will work to improve five priorities, including patient safety, boosting the processes and communications to identify risks within the IHS system and maintain accreditation of IHS services.

"With these priorities to guide our quality improvement efforts, IHS will work closely with our Area Offices and direct service facilities to strengthen capacity to provide patient-centered, timely, effective, safe, and reliable health care of the highest quality," Smith wrote.

To achieve these goals, IHS officials will meet with tribal leaders in person and in telephone consultations to hospitals like Rosebud, where U.S. Sen. John Thune, R-South Dakota, has said a mother gave birth prematurely on a bathroom floor and a man was sent home despite bleeding in his brain.

The IHS also announced Wednesday it will launch a new effort to expand Medicaid and Medicare enrollment of IHS patients at six health facilities in a total of four states, including the Pine Ridge, Rosebud and Sioux San hospitals.

"For our patients, having Medicaid or Medicare coverage means having more access to health care," Smith wrote in a separate news release issued Wednesday. "The goal of this pilot is to increase Medicaid and Medicare enrollment in the selected sites, help the IHS identify the best practices to increase Medicaid and Medicare enrollment in all of our communities and leverage resources to provide access to quality health care."

Since Rosebud was placed on diversionary status in December, Noem, Thune and U.S. Sen. Mike Rounds have all called for action within the IHS to improve services. Noem promoted the Helping Ensure Accountability, Leadership, and Trust in Tribal Healthcare (HEALTTH) Act, which would address funding, accountability and employee recruitment, and Rounds requested an audit of the IHS system.

Earlier this year, Thune helped propose the IHS Accountability Act of 2016, which would expand removal and discipline procedures for problem officials within the agency.