The Indian Health Service hospital on the Rosebud (S.D.) Sioux reservation made efforts to improve quality of care after its operating rooms shut down and its emergency department temporarily closed, but the hospital continued to face several challenges, including untrained staff and leadership turnover, according to The Wall Street Journal.
The IHS closed Rosebud Hospital's emergency department in December 2015 after CMS identified several patient safety issues at the facility. A report from HHS' Office of Inspector General identified several issues that led to the ED closure, including staffing shortages, changing and inconsistent hospital leadership, and lack of oversight by IHS.
The emergency department reopened seven months later after IHS provided additional resources to the hospital and entered into a systems improvement agreement with CMS, which required IHS to update certain policies and revise governing board bylaws. Despite the many improvements at Rosebud Hospital prompted by the systems improvement agreement, staff continued to report concerns about the frequent rotation in hospital leadership, according to the OIG.
The IHS has struggled to recruit and keep a CEO for the hospital in Rosebud. Since October 2016, the hospital has switched CEOs at least six times, according to The Wall Street Journal. The hospital also faces other challenges, including staffing and equipment shortfalls. Rosebud Hospital's operating rooms have been shut down since June 2016, and its vacancy rate for nurses was 40 percent as of May.
There are many factors contributing to the problems at Rosebud Hospital and other IHS healthcare facilities. The IHS hasn't had a Senate-approved director since 2015 and many of the IHS hospitals are in remote areas, making it difficult to recruit staff. The hospitals also have limited funding. In 2017, the IHS spent roughly $4,078 per patient, about one-third of the amount Medicare and the Veterans Health Administration spend per person, according to The Wall Street Journal.
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