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Tim Giago: Indian Health Service fails to live up to treaty obligation

Filed Under: Health | Opinion
More on: ihs, south dakota, tim giago, treaties

The Sioux San Hospital is an Indian Health Service facility in Rapid City, South Dakota. Photo: Colorado National Guard Medical Detachment

Notes from Indian Country
Don’t get sick after March
By Tim Giago (Nanwica Kciji – Stand Up For Them)

The much maligned Indian Health Service is too often blamed for things beyond their control. Not getting enough money to carry out the dictates of the Indian treaties for healthcare is one of them. However, as an entrenched bureaucracy there are some occasional screw ups that are in their purview.

Tribe after Tribe surrendered millions of acres of rich lands, water and natural resources to the federal government under treaties guaranteeing them health care in perpetuity. Those rich lands have contributed greatly to the economic growth and continued wealth of the United States and all that was asked in return was guaranteed health care and an education for the children and in other cases to retain possession of some tribal lands.

The Indian Health Service was the tool put into place to carry out the dictates of those treaties. But over the years they have had to fight tooth and nail to get the bare minimum of funds to keep the Indian health service hospitals and providers operational.

With little political clout the Indian people have seen their healthcare funds slashed time and again and we are left to the whims, fancies and ignorance of any and all incoming administrations. Barack Obama was gentle to us as president and he dramatically increased the funds to take care of the Indian people’s health needs. And now with a new administration that is about to slash funds for the “Meals on Wheels” a program that supplies meals to the elderly, disabled, poor and veterans, what lies in store for the Indian Health Service is anybody’s guess.

Let me lay out a small scenario. My headline teases the old saying in Indian Country; “Don’t get sick after June” because that is usually when the funds run out. The funds are allocated on October 1 of each fiscal year and should be sufficient to carry out their objectives until October 1 of the following fiscal year, but that never seems to be the case. I added, “Don’t get sick after March because of a letter I just received from the Indian Health Service.

I recently went to the I.H.S. Hospital in Rapid City, locally known as the “Sioux San,” for my annual checkup. My care provider is a nurse practitioner named Genie Ellis, a hardworking and dedicated woman. She checked my records and said it was time for me to see my heart doctor at the Rapid City Regional Hospital for an ultrasound to check my carotid artery etc. And so she called my heart doctor, and then made the appointment. She then sent a request for the funds to cover the test.

Two weeks pass and I get a letter from a Captain Francis Frazier, MSN/FNP, MPH (whatever that gobbledygook means), Area Director, Acting, Federal Building, Room 309, 115 4th Avenue SE, Aberdeen, SD 57401. The letter was signed off by a Bernie Long, ACEO, Sioux San. This hospital has had about 13 acting CEO’s in the past two years.

The letter goes, “We have been requested to authorize payment for medical services received from the above provider (s). Please understand that after careful review of the Contract Health Service rules and regulations, we must advise you the Rapid City Hospital will not authorize payment. Amount denied: $100.00.

The reason: Contract Health Services is limited to services that are medically indicated and within the established Indian Health Service Medical Priorities. The medical service (s) you were provided did not fall within these priorities based on the medical information received and reviewed by the I.H.S. medical provider. Therefore your request for payment of these services is not approved.

Of course the Captain Frazier left me an out in that I can appeal this judgement.

My first thought was, “You’ve got to be kidding me.” A facility 400 miles from my hospital knows more about my care and health than my own nurse physician?”

My second thought was, “Can it be that the Indian Health Service is already very low on funds or broke so that they can’t even come up with $100.00 for the health care of an 82 year old Lakota man?”

Thank God I have Medicare and supplemental health insurance as do many other elderly Lakota and even though our healthcare should be provided to us under the Fort Laramie Treaty of 1868, the Indian Health Service still deducts charges from our Medicare and how they can get away with this is another question that needs to be answered and another story. It is totally unfair to elderly Native Americans to lose their health coverage in the Indian Health Service just because the I.H.S. has discovered they can now charge your Medicare or Medicaid for their services.

The money allocated to the Indian Health Service each year is not predicated on how much can be recovered from Medicare or Medicaid or from veteran’s health benefits which are also charged. It is predicated upon how much they will need to provide service to the Indian people. If I wanted to go the a veteran’s healthcare center I am entitled to go there, but I choose to go to my healthcare provider in Rapid City because it is close to home and I feel comfortable going there because many of my own people work there. And I know all of the Indian employees there do the best job they can under the worst circumstances.

I have neither the time nor the money to appeal this asinine decision by a faceless Captain Francis Frazier in Aberdeen or from our local ACEO Bernie Long. If my healthcare provider says I need an ultra sound test I will get one because I trust and depend upon her medical advice. If she is overruled by a bureaucrat in Aberdeen so be it; I know she tried. I am glad I was able to save the I.H.S. a whopping $100.00.

Tim Giago was born, raised and educated on the Pine Ridge Indian Reservation. He was a Nieman Fellow at Harvard with the Class of 1991 and the founder of the Native American Journalists Association and he can be contacted at

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