The Omaha-Winnebago Hospital is an Indian Health Service facility on the Winnebago Reservation in Nebraska. Photo by Kevin Abourezk

Winnebago Tribe set to assume control of troubled hospital on reservation

'We can’t keep begging them to fix it'
The Winnebago 12 Clans Unity Hospital debuts under tribal control on July 1
By Kevin Abourezk

The Winnebago Tribe is not planning to charge patients from the Omaha Tribe for services at the 12 Clans Unity Hospital. Negotiations continue with the Indian Health Service to address the matter.

WINNEBAGO, Nebraska – The 59-year-old Winnebago man suffered a seizure late that night in May, forcing his family to call 911.

An ambulance took nearly 25 minutes to get to his home in Winnebago.

Medical staff at the Omaha-Winnebago Hospital couldn’t find his medical history, though he had been there for all of his previous seizures, and initially didn’t give him enough sedative to stop the seizure. Staff couldn’t find scissors to cut his shirt off and failed to find a vein suitable for an IV, leading them to drill a main line into his neck.

The chaotic hospital scene that nearly cost the life of Victoria Kitcheyan’s father is just one more reason she is happy her people will now get to chart their own course for health care.

“I really thought that we were going to lose my dad that night,” she said. “We should have a place that they can get safe care.”

Victoria Kitcheyan, a council member for the Winnebago Tribe, testifies about the crisis in the Indian Health Service before a Senate Committee on Indian Affairs hearing in Washington, D.C., on February 3, 2016. Photo: SCIA

On Sunday, the Winnebago Tribe will officially take control of the Indian Health Service hospital in its community and finally have direct control of its health care. The transition is a major stepping stone toward sovereignty and self-determination for the tribe, but also represents the start of a hard fight to repair long-lingering problems at the hospital.

The IHS hospital in Winnebago has struggled following the July 2015 decision by the Centers for Medicare and Medicaid Services to terminate the facility's certification due to serious lapses in patient care. The hospital, already suffering from inadequate funding, can no longer bill Medicare and Medicaid for services.

Almost three years later, the IHS had yet to even submit an application to regain certification.

“This is the worst kind of chicken and egg problem,” Rep. Jack Bergman (R-Minnesota) said at a March 20 hearing that focused on the IHS. He argued that the agency faces an uphill battle in correcting problems at Winnebago and other troubled facilities in the Great Plains.

The Winnebago tribal council felt much the same and voted last November to pursue self-governance after failing to see improvements at the hospital.

The move to self-governance – as set forth by Title V of the Indian Self-Determination and Education Assistance Act of 1975 – allows tribes to assume control over health care funding and programs that the IHS would otherwise provide. A tribe must enter into a compact, as well as a funding agreement, with the federal government that sets forth the terms of their nation-to-nation relationship.

The effort, though, has seen resistance. The Winnebago Tribe shares the hospital with the neighboring Omaha Tribe, whose leaders have raised questions about the initiative.

The Omaha Tribe, whose Chairman Michael Wolfe is seen here speaking at the Nebraska State Capitol in Lincoln on June 26, 2018, does not support the Winnebago Tribe's self-governance initiative. The two tribes have shared the Indian Health Service hospital. Photo by Kevin Abourezk

“I feel that IHS has failed us, has killed our people, has not fulfilled their obligations to the people,” Omaha Chairman Michael Wolfe told Indianz.Com in February. “Now they’re bailing out, and they’re just happy and tickled pink that Winnebago wants to take this hospital over. They broke it. Why should the Winnebago want to come and fix it?”

The Winnebago and Omaha tribes would need to agree to move forward with self-governance if they wanted to offer all of the same programs with the same level of funding. For now, the Winnebagos plans to move forward without the Omahas, though they plan to keep the door open, said Kitcheyan, a tribal council member.

“I hope that the tribes are going to come together in the near future to finalize those conversations,” she said.

The failure of the tribes to negotiate a hospital agreement could affect Omaha citizens who seek health care at the hospital starting Sunday, she said. The Winnebago Tribe will have to start billing those patients as it won’t have funding to provide them health care.

“The Winnebago Tribe is not wanting to do that,” Kitcheyan said. “The Winnebago Tribe has done everything to be a good neighbor and to try to facilitate these conversations over the past three years, but we’re just kind of getting backed into a corner ourselves.”

The hospital will have a new name, new branding and new management starting Sunday.

The tribe’s longtime legal counsel, Danelle Smith, will serve as executive director of the Winnebago Comprehensive Healthcare System (WCHS). The tribe also has named Gary Wabaunsee, a citizen of the Seneca-Cayuga Tribe of Oklahoma who has 40 years of experience in health care management, as hospital administrator.

Dannelle Smith is serving as the executive director of the Winnebago Comprehensive Healthcare System, the Winnebago Tribe's new health care entity. Gary Wabaunsee will be serving as administrator for the hospital on the reservation, to be known as the Winnebago 12 Clans Unity Hospital on July 1, 2018. Photos: Winnebago Tribe

Dr. Lynelle Noisy Hawk, who is Oglala and Hunkpapa Lakota and the former clinical director for the Crow/Northern Cheyenne Hospital in Montana, will serve as the hospital’s clinical director.

Smith, a citizen of the Winnebago Tribe, has served for 14 years as the tribe’s general legal counsel and spent the past 2 ½ years on the tribe’s self-governance steering committee, which has carried out planning and implementation of the tribe’s assumption of the Indian Health Service hospital on its reservation.

“Our people don’t even know what good health care looks like,” Smith said. “We made the big decision that we can’t wait for IHS, for the federal government, to do this for us anymore. We can’t keep begging them to fix it.”

She said the tribe’s decision to take control of the hospital is also a great burden and it will be up to the management team put in place to ensure improvements are made. She said she hopes to regain certification from the Centers for Medicare and Medicaid Services (CMS) within 18 months to two years.

“We’re going to push for sooner than that,” she said.

Smith said the Winnebago Tribe also will seek to gain a portion of federal funding recently appropriated for hospitals, such as the Winnebago hospital, that are seeking to regain CMS certification.

Kitcheyan said the tribe has worked hard to educate its members about how self-governance works. Some tribal members were concerned the tribe would lose health funding by taking over the hospital.

She said the tribe won’t lose health funding but will get to decide how best to use the funding it receives. Also, the tribe will be able to decide who to hire and who to fire at the hospital, unlike when the hospital was under IHS management, she said.

That means health care providers who don’t serve the tribe’s members competently likely won’t keep their jobs, Kitcheyan said. However, hospital employees who perform well also won’t have to suffer under incompetent leaders who typically stay in their posts for only a few months, she said. Indeed, the hospital has had 13 chief executive officers over the past 7 years.

“I think immediately people will see a turnaround with customer service,” she said.

The tribe doesn’t plan to continue an agreement with the hospital’s current emergency department contractor. She said the tribe prefers to hire permanent providers instead.

“We’re not going to leave that in the hands of a contractor,” she said.

Starting Sunday, patients also will see a new sign announcing the hospital’s new name: Winnebago 12 Clans Unity Hospital.

Dancers are seen at the Winnebago Tribe's homecoming powwow in 2016. This year's event takes place July 26-29, with a grand opening celebration for the Winnebago 12 Clans Unity Hospital taking place a day prior. Photo: Winnebago Powwow

The tribe plans to host a grand opening celebration for the hospital on July 25, a day before the start of its annual powwow. The event will feature speeches, dedications and presentations by Winnebago powwow royalty.

“We want to make a big deal out of it,” Kitcheyan said.

The move to self-governance is a personal one for Kitcheyan, who not only nearly lost her father in May at the hospital but also lost her aunt in 2011 and her boyfriend last year at the hospital. Her aunt was considered one of five unnecessary deaths at the hospital since 2011.

She said her boyfriend suffered cardiac arrest in August near Homer and was taken to the hospital. He was left in a screening room for nearly 2 hours before dying.

“He should have been life-flighted,” Kitcheyan said. “I just firmly believe that he could have been saved.”

Quality health care isn’t just a catch-phrase for the Winnebago people, she said. It really means something, especially to those who’ve lost loved ones at the hospital.

“It’s really hard sometimes to carry on, but nobody else can die under those same circumstances,” she said. “It’s going to get better. I hope that our future generations won’t know the third-world health care that this tribe had, that we were at the mercy of that quality of care.”

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