RAPID CITY – A lawsuit that has challenged the sovereign right of the Oglala Sioux Tribe and the Cheyenne River Sioux Tribe to assume control of tribal healthcare in Rapid City is nearing a conclusion.

In July of 2019, the Oyate Health Center opened its doors to patients. The grand opening of the tribally-run clinic signified the arrival of a new era of healthcare for tribal-citizens living in Pennington County. For the first time, the healthcare of tribal-citizens living in the Rapid City Service Unit would be under the control of tribal-nations and managed by a tribal organization.

In 2018, the Oglala Sioux Tribe, the Cheyenne River Sioux Tribe, and the Rosebud Sioux Tribe opted to assume control of the Rapid City Service Unit using federal law called the Indian Self-Determination Act (P.L. 93-638) first established in 1975.  This law was passed to allow tribes to govern their own institutions and services to tribal members, after nearly a century of control and domination by the federal government.  The law allowed both tribes and tribal organizations to contract services formerly provided by federal departments and agencies.

When the Rosebud Sioux Tribe chose to continue to receive their portion of the Sioux San Clinic services from the Indian Health Service instead of moving forward with the plan to “638”, the Oglala Sioux Tribe and the Cheyenne River Sioux Tribe then enacted new resolutions and moved ahead in unison with running the former Sioux San Clinic under a self-determination contract, renaming it the Oyate Health Center. 

Their goal was to assert their sovereign rights over health care services in the Pennington County area and to improve services for the tribal people of the Rapid City area, and show that tribal citizens could deliver better health care services than a federal agency. 

“This is what tribal sovereignty looks like in action. The tribes demanded that the federal government remove the Indian Health Service in the belief that our people and organizations could do a better job of managing resources intended for tribal healthcare,” said Brandon Ecoffey, Communications Director for the GPTLHB.  “We have done that successfully.  Although we have some glitches like any new organization, our people no longer see hours of wait time at the Clinic, they are seen right away by medical providers who care about them and help them understand what is happening to them.”

Several supporters of the Indian Health Service initially filed suit in federal court against the Indian Health Service, trying to stop the self-determination contract between the Great Plains Tribal Leaders Health Board and Indian Health Service. After they lost in federal court, they appealed to the Eighth Circuit Court of Appeals, but lost at that level as well. 

Those plaintiffs have now filed a writ of certiorari, asking the US Supreme Court permission to file an appeal.  Contrary to well-settled federal case law, the lawsuit alleged that the Health Board is not a tribal organization because it is also registered as a non-profit organization in South Dakota.  However, their position is contrary to well-settled federal and state law on the subject, and the plaintiffs are unlikely to get permission to file an appeal with the U.S. Supreme Court.

Both federal cases involving tribal organizations in South Dakota and elsewhere have clearly established that a federal court does not look at the nonprofit status of a tribal organization, but rather to its essential tribal character.  The Health Board is an organization of eighteen tribal governments, who have joined together to improve health care, its board of directors is made up of tribal leaders, and as a result, it is a tribal organization as that is defined under federal law.  It is allowed to enter into self-determination contracts with federal departments and agencies. 

“It is unfortunate that so much of the organization’s energy has been spent clearing up misinformation coming from people who still see the Indian Health Service as the only federal institution who can run healthcare at the Oyate Health Center,” said Ecoffey.  “We believe in tribal sovereignty and we are showing people every day that tribes and tribal organizations can provide health care services to our people better than the federal government.  It is really about faith in our own people.” 

“The anticipated denial of the writ to the Supreme Court will put to rest a lot of the disinformation that has been circulated about the rights of tribes to take control of their institutions and subsequently their ability to choose how resources meant for tribal citizens are managed,” added Ecoffey.

The Eighth Circuit Court of Appeals agreed with the federal court that “the Health Board is an entity organized under South Dakota law controlled by 17 separate federally recognized tribes.” The Health Board was, therefore, legally allowed to contract the services previously provided by the Indian Health Service to the Rapid City Service Unit at the Sioux San medical facility.

Twice, the Eighth Circuit has upheld the decision of the United States District Court in Rapid City, which found that the GPTLHB is a “tribal organization” under federal law, importantly because it is “an entity ‘controlled, sanctioned, or chartered’ by tribal governments.”

For the last two years, the staff at the Oyate Health Center have worked to improve the health of tribal citizens who use the facility. Navigating the difficulties presented by a global pandemic and the challenges of opening a new clinic, the organization has successfully shortened wait times, expanded behavioral health services, and improved the overall experience of its patients.

The organization has recently rolled out a patient texting service to help patients stay up to date with their care and hired a full-time driver to help patients with rides to and from appointments. Usage of the facility by patients has steadily increased to over 20,000, a happening that the Health Board says is a sign of patient satisfaction.

“The federal government had decades to get healthcare right, yet, under the Indian Health Service we have only seen a reduction in services across the Great Plains. It is time that tribal organizations and tribal citizens get a fair opportunity to prove that we can do it better,” said Ecoffey.

Established in 1986, the GPTLHB represents tribal communities in South Dakota, North Dakota, Nebraska, and Iowa. The organization is overseen by the elected tribal leaders of 17- tribal entities in the area. Through public health practices and the formation of tribal partnerships, it works to improve the health of the American Indian peoples through health support, health care advocacy, and direct-patient care at the Oyate Health Center.