The Indian Health Service has hired AB Staffing Solutions of Arizona to run the emergency room at the IHS hospital in Rosebud. IHS closed the Rosebud ER last December due to low-quality care. Since that closure, Indianz.com reports that six tribal members have died while being transported to other emergency rooms. The IHS–AB Staffing Solutions contract does not specify when the Rosebud ER will reopen.
The new contract also puts AB Staffing Solutions in charge of IHS ERs at Pine Ridge and Winnebago, Nebraska. AB Staffing Solutions has numerous other contracts to provide health care staff for IHS, the Department of Defense, the Department of Veterans Affairs, the federal prison system, and the National Institutes of Health.
The Rosebud Sioux Tribe would have preferred a local provider:
“We know Avera (Health), we know Sanford (Health),” Rosebud Sioux council representative William Bear Shield said referring to two health systems based in South Dakota. “If it would have been any one of those two, I would have said ‘Great. I feel comfortable.’ But we are going to have to see what this AB Staffing Solutions is about. We are concerned, that’s for sure” [Regina Garcia Cano, “Feds Hire Contractor to Run ERs at Hospitals on Reservations,” AP via ABC News, 2016.05.17].
Democratic candidate for U.S. House Rep. Paula Hawks would have preferred something other than more privatization:
“I am concerned that we are shifting responsibility, not holding ourselves accountable to deliver the type of visionary leadership needed to improve living conditions in Indian country. We’ve seen through the privatization of EB-5 and the Gear Up education grants, these shifts result in less accountability, not more. To me—this is a Washington solution, pass the buck and affix blame elsewhere,” said Hawks.
…“These are complex situations that require comprehensive solutions. Education, health care, economic development—all are so interrelated that you can’t begin to tackle problems in one area without quickly stepping into them in another. Contracting to a private entity might deliver a Band-Aid, but it doesn’t provide the type of long-term planning needed in tribal communities,” Hawks said [Hawks for House campaign, press release, 2016.05.17].
But whoever provides the services, IHS’s first priority is to get qualified doctors and nurses in place to offer the quality emergency care Rosebud residents are entitled to under treaty.
I am extremely pleased that Native Americans will now receive some badly and critically needed emergency services.
Paula is 100% correct in her assessment of government contracting for health services, IHS actually contracts many needed services that they don’t provide on reservation to places like Rapid City already.
Of course the biggest consideration for the government will be costs for maintaining ER’s on the reservation, contracting will likely cost more in the long run.
IHS has the money and the needed resources to solve these problems, they have an obligation to just do it right.
let us hope these AB people are a quality operation and the payments to them are all monitored so the services get delivered to the people who need them.
oh grudz, you don’t care one little bit.
This qualifies as one big mess. Why IHS couldn’t po artery with Avera Sanford or Regional is beyond me. But IHS barely communicated with Winner and Valentine Nebraska hospitals where IHS ‘diverted’ to. Those facilities were put in tough positions. As we’re the people of Rosebud. This is government mismanagement at its finest. Management of a hospital from afar will never work. It’s an absolutely broken system. Dental care is non existent on the rez. IHS dental service is an embarrassment. People must travel to outlying towns and the costs are too much. There is a great dental clinic ran by the St. Francis catholic mission that is staffed by volunteer dentists that donate their time. Providing great help. It’s an example of success. No federal funds involved. Locally ran by people that understand the issues is the key. AN example of locals collaborating we it outside entities.
South Dakota and Nebraska have failed miserably in helping to provide medical care to these indigenous people…as fourth year surgical resident at UNMC in 1980 I spent a 4 month rotation at Pine Ridge performing general surgery and obstetrics – backed up by Dr. Panzer who would drive up from Gordon NE to help me and the other residents who followed…that experience has haunted me ever since…I will never forget the gratitude and hospitality of these people, their living in a virtual ghetto, and their stolid resignation…
Does Hawks not know the Indians prefer access to private care, veterans want access to private care? Both groups are fleeing government run care and she is calling for doubling down. Running for office is not rocket science.
What is up with what appears to be a contest between Hawks and Williams to see which can get a lower % than Wismer got last election? Does the one who gets lowest get to be SDDP Chair?
pretty sweet on kristie, eh troy?
You bring up a good point Lars, there are lots of pipelines that could help to address these issues. Residents are a good option as it gives them a good look at community medicine and providing health care under challenging circumstances. Unfortunately, our medical education system does not place a heavy emphasis on this style of rural training (Supporting rural areas oftentimes in name only). It would be a great opportunity to provide a semi-independent, broad experience to help hone the skills of soon to graduate residents and provide desperately needed care to a vulnerable population.
You may find it interesting to read the staff reviews of current and former employees from treatment of nurses to pay for sales staff etc. You will have to skip through the job ads that are included on the site.
https://www.glassdoor.com/Reviews/AB-Staffing-Reviews-E843887.htm
Here is another site with employee reviews.
http://www.indeed.com/cmp/Ab-Staffing-Solutions/reviews
Here is a site that rates companies in this industry,
http://tinyurl.com/h5zxrck
In reading reviews by various people in this industry, it appears that housing is a pretty important element. One of the reviews that I read said that she was paying $1800 a month at the hotel/motel at which she stayed. She also said that the other motels were not acceptable because of the poor access to WIFI.
On that note, I know that when The IHS built the new hospital at Sisseton, they also built new housing for staff. This maybe something that needs to be looked at. I can’t imagine that it is cost effective to pay 1800 a month or more for housing one person.
LVS makes a good point. From what I have heard, nurses, et al will pay a premium and drive for miles just to get out of Pine Ridge filthy housing, vandalism, theft and harassment.
Another private company middle man taking care of SD’s government funds. What could possibly go wrong??
Spike makes an even better one. I’ll bet that if they had partnered with Sanford, T Denny could have been persuaded by his staff, when they told about how bad conditions were, to build new quarters and maybe even new facilities.
I don’t know that he would be the decider, but it would certainly go through him. When they bought the system in Fargo, Sanford had a pretty fancy bus going daily between SF and Fargo with Doctors and nurses, so that they did not have to stay over.
Lanny,
I think the bulk of the people riding the bus were management/administrative people responsible for the integration of the two hospitals into one system. Because of the volume, I think it was cheaper than paying mileage.
Thanks Troy, makes sense.
Sounds like an awful lot of money to just keep an emergency room open on three reservations. One of the hospitals is not too many years old and was a beautiful facility. Haven’t heard what it is like now however.
I know good doctors and other practioners that would work on the rez if the system would get its crap in a pile. Some have and they are not fans of the IHS system at all. And realistically, the elephant in the room nobody wants to mention… tribal political intervention sometimes negatively affects the local hospital administration.
Pine Ridge has nice IHS housing. I believe people like Lars are out there. Some working on the rez now. I know for a fact IHS is not reaching out to these possible partners. Messed up. Bad. Further complicating the issue is the poverty of many of the patients seen. Ground and air ambulances leave these facilities constantly. Hell they are parking planes at the airports in Rosebud and Pine ridge. Booming business. The IHS does not always pay for the outside services provided from these referrals.
T Denny helped Pine Ridge IHS build an addition. He’s also given 15 million to Crazy Horse monument.
I’ve lived within a mile of the Rosebud facility and the pine ridge facility, used both, also used Sioux San. N also used Mayo, Rapid City Regional and some interesting native ran hospitals in Alaska. IHS model and management in South Dakota is terrible. You can’t run hospitals on the rez from Aberdeen, Rockville Maryland, Oklahoma etc.
Spike,
You have absolutely stated correctly the problem with IHS and doctors.
When I lived on the Pine Ridge Reservation I became friends with many of the doctors and they came and went.
So many of these doctors fell in love with the Lakota and would have done anything to stay had the Aberdeen Area IHS office allowed it.
The young doctors that were assigned to Pine Ridge were specialists in so many areas of medicine.
As Spike pointed out, Aberdeen and Washington, D.C. were not conducive to keeping these doctors because of every year of their service meant that the government would have to pay them more. You can’t tap into the bureaucrats budget even if it means losing good doctors.
The same is true of Sioux San in Rapid City, I have seen some excellent providers forced out the system there by minion bureaucrats.
IHS needs to understand that you can’t provide quality medical care without providers, it as simple as that.
$1800 a month? My mortgage isn’t that high, and I’m living in metropolitan mecca Aberdeen. What should IHS do to provide more affordable housing for hospital staff? Is land available for IHS to buy and develop for quality housing for all of its medical staff in Rosebud? Would all staff want to live in Rosebud?
Roger and Spike, let me combine your concerns about Aberdeen administration. Do we have two issues to solve there: first, trading out experienced staff for new, cheaper staff, and second, getting a main administrative office geographically closer to the rez? Do we need to split the regional management? Great Plains Area is ND, SD, NE, and IA; would creating smaller regional management areas help, or would it just bloat the system with administration?
You miss the point Cory. It isn’t the staff that is paying the $1800. It is the IHS as an expense against the IHS healthcare system.
LOL AB Staffing Solutions has been and continues to provide temps to the IHS. They are part of the problem.
In addition Willie Bearshield’s wife is an ER nurse at the Rosebud Hospital and has some culpability in the service or lack of, in the Rosebud Service Unit.
Ridge! How long as has AB Staffing been there? How much of Rosebud’s IHS staff have they provided in the past? What specific things have they done to contribute to the problem?
Ah! IHS pays housing allowance, right? I get it. Then certainly IHS could save money by using that housing allowance to build several houses
IHS staffing is a mixture of career federal employees, contractors, commission corps. Commission corps are given housing allowances and they may sometimes live in IHS built housing at the hospitals,, IHS employees may or may not live in that housing. Depends on availability.
Really difficult to change the model that exists apparently. All I can say is when Sanford, regional and Avera say there has been no communications something is wrong. People working in Aberdeen don’t want to move to Rosebud, or Pine Ridge generally.
I remember in the 90’s BIA wanted to close the Aberdeen area office as a result of pressure from the tribes and Tom Daschle stopped it. Thats a true fact. IHS and BIA are Big business up there in Aberdeen. And as they say down on the rez…what about the poor Indian?
The people I know in the medical field believe it can be managed better, like all rural health care is being transitioned to better technology. I don’t believe for a minute that Sanford, Avera, or others wouldn’t step up if things were planned better. Heck Regional runs 22 clinics and i think 6 hospitals. And services thousands of referals from the Eagle Butte, Pine Ridge and Rosebud rez.
A friend of mine that is a brilliant doctor says this is all BS. Sheis totally familiar with IHS as well as the private sector. She said the military solves these problems here in America and all over the world every day. The government isnt living up to its obligations.
Will AB Staffing people get a housing allowance? Where will they live?
Is there any merit to the regional management model? Or instead of Aberdeen being the management center for four states, should each state have its own center, on a reservation?
We have always felt decentralized management is necessary. The transition is the challenge. Alaska and other tribes have “self governance” which is a more direct type funding where the tribes run the hospital more independentry and with a funding formula that takes out the mid management level federal administration and sends the money doen. They do this in conjunction with other care units/or on their own. I believe this works better as ra the process has evolved.
The great plains tribes have not done this. But are attempting to analyze the feasibility of it.
As far as the contractor. There are many on the different rez’s now. Depends on their contact on housing. Most are reimbursed for living expenses. Stay in local hotels. Some may stay on site if the facility has available housing. That varies from rez to rez also.
I had a friend work as a contractor on Rosebud. Did 3 two week stints. Stayed in an apartment on site. Had visited there many times and decided to try to help there.
My friend had worked with Doctors Without Borders all around the world, hiked to remote villages, worked in a big hospital in Boston that served low income community. Also worked in small clinics in rural areas. She is a top of the line pediatric general practioner. Perfect for the rez..
She could NOT work with the administration there. They cared less about the patient. ..it was about money. She was prudent and aware of that issue. But was treated like a poor administrator. Even though she was very capable and wanted to be there. Messed up.
Cory,
I can’t address the current housing needs at the IHS facilities except to say that housing is likely available and is not being used properly. That is other IHS employees occupy those quarters and do not leave space for doctors.
I have been a longtime advocate of abolishing both the BIA Area Office and the IHS Service Center in Aberdeen. Both management systems have been a money pit and do directly serve any needs of Indians.
As Spike stated, when the subject of abolishing the area offices it is always met by strong political opposition of both parties. Aberdeen’s economy thrives on this government waste and has done so for years.
In this technological age, management of IHS and BIA reservation facilities should be easily managed by a team in Washington, D.C.
I will have to give your regional management suggestion so more thought, but it seems that decreasing the number of management levels saves time and money that could be used at the reservation level
The second problem you identified, retention of providers, is a major one that IHS seems to continually overlook.
The wages for providers is good and they have good benefits, so that isn’t so much of the problem.
Spike or Ridge mentioned a local staff member that the source of some problems at the Rosebud ER, this too has been an ongoing problem. Local career employees that let personalities into their jobs can also drive good providers away.
I have no expertise or knowledge in this area but curiously, recently was told that despite the needs and desires of local vets, Hot Springs Vet Hospital is no longer efficient and except for political expediencies of Hot Springs, better service would occur with closure and expansion in RC and/or Sturgis.
Is this too like waste incurred because we refuse to let the military close unneeded bases to cut costs because communities rely on the economic activity a base generates for the community?
Aberdeen IHS seems like it is not serving the needs of the Indian people. That is probably an understatement. just thinking out loud. What do Thune, Noem and Rounds, and Daugaard do effectively to assist?
It really annoys me that Daugaard has conditioned Medicaid expansion on the likely unnecessary complication that the tribes must agree with the state.
Spike: Doctors Without Borders would be an interesting solution. It would be humiliating to the United States, to have to call in a group that focuses on aid in third-world areas ravaged by combat and poverty… but it could also be a vivid wake-up call.
So we could get rid of the regional administration and directly fund hospitals managed by the tribes? Do VA hospitals have any sort of regional management akin to the IHS system?
It is odd that the IHS administration is in Aberdeen, but there is not IHS health care facility in Aberdeen.
What if we folded IHS into the VA? Could we have one U.S. Federal Health Service serving all individuals promised medical care by the government? Soldiers and their families, veterans, Indians… anyone else?
Yes Cory, the VA has what they call VISNs. South Dakota or at least Eastern SD is under the Minneapolis VISN. But as long as you are thinking out of the box, why not Universal Single Payer Healthcare. That eliminates the need for travel for Vets and others who have to travel to the VA for healthcare as they could then get it at home in most cases.
It would also have the added benefit of helping to keep hospitals and nursing homes open in smaller communities.
https://en.wikipedia.org/wiki/Alaska_Native_Tribal_Health_Consortium
This could be what South Dakota needs.
Doctors Without Borders (Médecins Sans Frontières) was suggested, unofficially (and embarassingly) as a step to address the lack of adequate medical care on some of Canada’s most remote and troubled First Nations and Inuit communities a couple years ago.
MSF responded by pointing out that Canada, with it’s financial resources and government mandated provision of services did not qualify for the type of work they are doing in areas of almost unimaginable need – in bombed hospitals and tents in actual war zones and devastating natural disasters where there is no government or other infrastructure able to provide medical care. Not saying that there wasn’t a need on these reserves, but that the responsible governments should step up to meet that need.
Well, if all else fails, maybe they should contact Fidel Castro. Cuba has the largest contingent of doctors per population of anywhere in the world. They send doctors to natural disasters all over the world.
Even though they were the first in and with the largest contingent of any country, at the Haitian disaster a few years ago, they got little recognition, because the US got all the attention with the hospital ships.
Even though they are from a subtropical climate, their doctors were the last one to leave the Himalayas after the earthquakes there several years ago.
And another socialistic leader, Chavez provided heating oil on the reservations when no one else would several years ago.
DWB got the beejeezus bombed out of them in Afghanistan by friendly? US forces not too long ago.
Good point, Barbara: we have the resources. We can solve our own health care problems.