A second troubled government-run hospital on a Native American reservation in South Dakota was given an extension Friday to reach an agreement with federal officials to make significant quality-of-care improvements to avoid losing its Medicare and Medicaid funds.
The CMS notified the administration of the hospital on the Pine Ridge Indian Reservation about the extension a little more than a month after the hospital on the Rosebud Indian Reservation received the same extension. The latest notification comes days after the top officials at the Indian Health Service, which administers the hospitals, met with tribal leaders and pledged to improve the services provided at the facilities.
Both hospitals have an April 29 deadline to reach an agreement to enter what constitutes a last-chance remediation program. If not, the facilities won't be allowed to bill the government for services provided to Medicare- and Medicaid-eligible patients after May 16.
The purpose of the agreement for the Pine Ridge hospital would be "to effectively safeguard patient health and safety ... and effectively address underlying systemic problems" that have kept the hospital from achieving or sustaining compliance with regulations, according to the letter from CMS addressed to IHS' top leader, Mary Smith, and Sophia Conroy, the hospital's acting administrator.
The funding cutoff warning for the 45-bed Pine Ridge hospital comes after federal inspectors found serious deficiencies during a series of unannounced visits, including one in late October in which they discovered that three of six sampled medical staffers lacked appropriate permission to practice at that hospital; unlocked cupboards with syringes, needles and other equipment; and unsecured drugs and medical records.
The CMS letter noted that a Feb. 25 inspection found deficiencies in the hospital's emergency department even though the hospital had claimed on Feb. 12 that it was complying with all applicable regulations. The inspectors reviewed the records of 26 patients and concluded that six of them had not received appropriate medical screening examinations.
Among the cases reviewed by inspectors was that of a woman who was discharged from the emergency room despite having a high blood pressure of 193/90 and a recent history of a stroke.
The record of a different patient, a 46-year-old woman, showed that she sought treatment at the emergency room after fainting and hitting her head, but left the hospital after a provider did not evaluate her for three hours. When she later returned to the emergency room, more than two hours went by before the first intravenous access was placed despite lab results showing that she had "critically low blood levels of hemoglobin."
IHS, which provides free health care to enrolled members of Native American tribes, said it will work with CMS "as expeditiously as possible" to reach the agreement, it said in a statement Friday.
IHS has been severely underfunded and its facilities bill Medicare, Medicaid and private insurance for care given to patients who have that coverage. Statistics from a 2005 government study show that reimbursements constituted between 7% and 58% of some hospitals' direct medical care budgets, with the average being 39%.
At a public forum earlier this week in Sioux Falls, S.D., Smith told the tribal leaders and senior-level IHS officials in attendance that the agency intends to meet the April 29 deadline given to the hospital in Rosebud, which is about 95 miles east of Pine Ridge. In addition, the agency is accepting bids for a contract to manage the emergency rooms at hospitals on the Winnebago Reservation in Nebraska, Pine Ridge, and Rosebud.