Taking Control of Our Healthcare
The Oyate Health Center is a tribally-owned and operated walk-in primary care clinic located in Rapid City, South Dakota. The facility is under the management of the Great Plains Tribal Leaders’ Health Board.
When the Great Plains Tribal Leaders’ Health Board took over management responsibilities of the Rapid City Service Unit on behalf of the Oglala Sioux and Cheyenne River Sioux Tribe in July, it was both an expression of sovereignty, and the deployment of a proven strategy.
How Did We Get Here?
In 2010, tribal-citizens in Rapid City approached their representatives in tribal-government to take action on their behalf to improve the quality of care that offered at the Sioux San Hospital by the Indian Health Service. This request came after the release of the Dorgan Report in 2010 that detailed the shortcomings of healthcare in Indian Country. That same year, the emergency room services at Sioux San were suspended after multiple standards of care violations were found by the Centers for Medicare and Medicaid Services. The events leading up to these sanctions were detailed by the New York Times.
In 2014, the Oglala Sioux Tribe, Cheyenne River Sioux Tribe, Rosebud Sioux Tribe begin negotiations to take control of the Rapid City Unit. The three tribes believed that they had the capacity and know-how to provide healthcare for their citizens.
In July of 2019, the Oyate Health Center opened its doors to patients.
What is 638 contracting and self-determination?
In 1975, the United States Congress passed the Indian Self-Determination Act, also known as Public Law 93-638. The act was initially intended to pave the way for “maximum Indian participation in the government and (for) education of the Indian people” -and to allow for more local control of resources meant for tribal-citizens.
The passage of this game-changing law marked a shift in how the federal government had long dealt with its “Indian problem.” Policies of eradication, assimilation, and eventually, political and cultural termination gave way to a new era of tribal self-governance. In this new scenario, tribal-nations now had the opportunity to manage and improve service delivery systems that the federal government had responsibility for overseeing.
Since 1975, the Harvard Project for Native American Development notes that communities that have taken full advantage of this program have seen improvements in nearly every socioeconomic marker.
“Federal promotion of tribal self-government under formal policies known as self-determination is turning out to be, after a century or more of failed efforts to improve the lives of US indigenous people, the only strategy that has worked, In doing so, the strategy is improving the well-being of its poorest and arguably historically most oppressed and disempowered people,” wrote one expert.
Tribes who have not taken of taking programs and policies over from the federal government are uniformly marked with little to no signs of development progress. While other parts of Indian Country have jumped at the chance to remodel, remake, and improve federal programs to their liking, the people of the Great Plains have yet to fully deploy this strategy.
The proof is in the results.
In a study conducted by the National Indian Health Board of 83 tribal health facilities, 86% saw a decrease in waiting times. The length of wait-times is one of the main criteria for measuring patient satisfaction in healthcare. Other improvements have been shown in the tribally owned saw-mills, tribally held construction companies, as well as in firms like Ho-Chunk Inc. Tribal governments and the organizations they partner with are simply better at delivering services than the federal government.
Why does 638 work?
Before the advent of self-determination, tribal communities were forced to deal with one-size-fits-all policies that were designed and managed by federal agencies. Any significant decision making power resided with bureaucrats in far off places who had little to none experience working in Native American communities. When tribal citizens wanted to express dissatisfaction with a particular service, there was almost never a local official with the authority to address their concerns. When tribal governments and tribal organizations take control of these services, they have the ability to respond to concerns expressed by constituents quickly. Local decision-making ability carries over to all parts of how an organization operates. Individuals with direct knowledge of a situation can create policies that best serve customers and patients. Additionally, federally managed facilities restricted by red tape that makes it hard to change the way funding is utilized often leads to misuse and often waste.
Self-determination has also proven that a large part of funding intended to improve the lives of tribal citizens was spent on government operating costs. When contracting federal programs, tribal governments have the opportunity to cut out the “middle-man” and receive these funds upfront. This results in more dollars for addressing issues in Indian Country.
Oyate Health Center Timeline
- 1970: President Nixon calls on Congress to create a new era of Indian self-determination.
- 1972: “Trail of Broken Treaties” march on Washington DC.
- 1975: Longest Walk from Alcatraz to Washington DC.
- 1975: Native American Self-Determination Act
- 1981: President Reagan’s administration severely rolls back funding for social programs for Indians.
- 1986: GPTCHB the Aberdeen Area Tribal Chairmen’s Health Board (AATCHB). Established by the chairpersons and presidents of the 18 member tribes and tribal communities, GPTCHB sought to serve as a liaison between the Great Plains Area Indian Health Service (GPAIHS), formerly known as the Aberdeen Area Indian Health Service (AAIHS), and the Great Plains tribes.
- 1991: Northern Plains Healthy Start (NPHS) Program enabled GPTCHB to achieve non-for-profit status and come into existence.
- 1994: Indian Self Determination Act Amendments are passed by Congress.
- 1996: Cobell case filed.
- 2003: Through the determined efforts and accomplishments of former Executive Director Carole Anne Heart, Rosebud Sioux, the health board expanded by securing funding for the Northern Plains Tribal Epidemiology Center (
- 2010: Dorgan Report issued, details
shortcomingsof healthcare in Indian Country.
- 2010: Sioux San loses Emergency Room after multiple CMS standards of Care violations.
- 2014: Oglala Sioux Tribe, Cheyenne River Sioux Tribe, Rosebud Sioux Tribe begin negotiations to take control of the Rapid City Unit as an expression of tribal sovereignty through the self-determination process.
- 2015: Unified Health Board,
tribaladvisory board for the Rapid City Service Unit, engaged GPTCHB to provide technical assistance to tribal leaders to address ongoing problems.
- 2016: GPTCHB begins
seriesof tribal education opportunities related to Title I and Title V P.L. 638.
- 2016: GPTCHB’s Board of Directors and the Great Plains Tribal Chairmen’s Association pass joint Resolution 2016-01, calling for supporting “the closure and removal of all funding and personnel from Great Plains [Area] Office of the Indian Health Service”, decentralizing Area activities in favor of local oversight.
- 2017: CRST, OST, and RST passed resolutions authorizing GPTCHB and Dr. Don Warne to explore the feasibility of developing a tribally managed health system consisting of RCSU serving as a specialty care referral site for CRST, OST
- 2018: Unified Health Board passes a motion for GPTCHB assistance in drafting resolutions requesting GPTCHB
assumemanagement of RCSU on behalf CRST, OST, RST.
- 2018: The joint meeting of the three tribes to seek consensus on moving forward, resulting in the verbal request to GPTCHB to pursue management and construction contracts on their behalf.
- April 4, 2018: OST passes GPTCHB requesting and authorizing resolutions.
- April 5, 2018: CRST passes GPTCHB requesting and authorizing resolutions.
- April 19, 2018: RST passes GPTCHB requesting and authorizing resolutions.
- March 23, 2018: The joint meeting of the three tribes to seek consensus on moving forward, resulting in the verbal request to GPTCHB to pursue management and construction contracts on their behalf.
- December 2018: RST Rescinds Resolution to manage & construct.
- April 19, 2019: Negotiations resume with Indian Health Service resume.
- May 31, 2019: GPTCHB & IHS enter into a contractual agreement.
- July 21, 2019: GPTCHB assumes control of the Sioux San IHS Facility.
- July 27, 2019: First round of Core Connections training held for Oyate Health Center employees.
- October 30, 2019: Second Round of Core Connections Training
- Dec 1, 2019: Dr. Mark Harlow accepts an offer from Oyate Health Center to serve as Chief Medical Officer.
- January 5, 2020: Oyate Health Center unveils plan to install an Integrative Health care model.
- January 20, 2020: Oyate Health Center implements Integrative Health care model
- January 28, 2020: Third round of Core Connection training
- Today: Today, the Great Plains Tribal Chairmen’s Health Board continues to work toward reducing public health disparities and improving the health and wellness of tribal-citizens across the region