STATE-TRIBAL RELATIONS COMMITTEE MINUTES

The second meeting of the 2001 interim of the Legislature's State-Tribal Relations Committee was called to order by Chair Senator J.E. "Jim" Putnam at 9:00 a.m. on Monday, July 9, 2001, in Room 412 of the State Capitol in Pierre, South Dakota.

A quorum was determined with the following members answering the roll call: Senators Arnold Brown, Patricia de Hueck, Richard Hagen, J.E. "Jim" Putnam, and Ronald Volesky; and Representatives Stan Adelstein, Jean Hunhoff, Barry Jensen, Thomas Van Norman, and Paul Valandra.

Staff members present included Tom Magedanz, Principal Research Analyst, and Phyllis Petersen, Senior Legislative Secretary.

A list of guests present during all or part of the meeting is on file with the master minutes.

(NOTE: For the sake of continuity, the following minutes are not necessarily in chronological order. Also, all referenced documents are on file with the master minutes.)

Chair Putnam noted that racial profiling is an important issue and that the committee will receive a report at a later meeting on the executive branch study of racial bias in law enforcement in South Dakota, which is being conducted by the Government Research Bureau at the University of South Dakota. He also said one meeting will be devoted to information on economic development on South Dakota Indian reservations.

Mr. Reuben Bezpaletz, LRC, Chief Analyst/Research and Legal Services, presented the committee with information on the Native American population in the state based on the results of the 2000 Census (Document 4). South Dakota ranks third in the nation with Native American accounting for 8.25 percent of the population. He predicted that by the time the 2010 census is taken, South Dakota will move up to second place. Almost every reservation county experienced a large increase in the Indian population and a decrease in the non-Indian population. The Lakota population also grew in South Dakota's urban counties. The Indian population is 20 percent younger than the white population, and between 52 and 56 percent of the American Indians in South Dakota are eligible to vote. Poverty, lack of transportation, and fewer polling places in the state discourage tribal members from voting. Representative Valandra also observed that Indian people do not vote in general elections because they are involved in their own tribal government. Representative Van Norman stated that the issue is equal access to polling places. Counties across the state have closed a number of polling places because of cost.

Representative Adelstein asked LRC staff to prepare a report for the next meeting on the percentage of Indians in South Dakota who vote in general elections.

Senator Volesky stated that nine of the poorest counties in America are in South Dakota and that the Legislature needs to prioritize Indian issues. He suggested that coordinating polling places in general and tribal elections would help more Indian people vote. Senator Hagen said that Shannon County does this but that another possible problem is that some elderly Lakota people do not vote because they do not speak English. Another consideration that may affect voter turnout by Native Americans is tribal sovereignty and the reluctance of some tribal members to participate in state or local elections.

The committee briefly addressed the problem of elderly care for Native Americans, a topic that the committee studied extensively during the 2000 Interim.

Chair Putnam introduced Ms. Aubrie C. James, Staff Assistant/Tribal Liaison in Senator Tim Johnson's office. Ms. James spoke to the committee about nursing homes on reservations and said that some federal construction funds may become available. She also said that reauthorization of the federal Indian Health Care Improvement Act (Senate Bill 212) is pending in Congress and would allow tribes to bill Medicare and Medicaid for certain elderly care purposes, among other things. She will provide a detailed report on SB 212 to the committee at the next meeting. Representative Van Norman said that the lack of nursing homes on reservations is a critical issue.

Ms. Sara DeCoteau, Health Coordinator, and Ms. Audrey German, Physician Recruitment and Retention Coordinator, Sisseton-Wahpeton Sioux Tribe; and Mr. Richard Huff, Service Unit Director, Sisseton Indian Health Service, addressed the committee on the issue of state medical license reciprocity for Indian Health Service (IHS) physicians. The Sisseton-Wahpeton Sioux Tribe will receive federal appropriations for a replacement health care facility in the next four to seven years. The new facility will have much more space, several new services, and the number of employees will increase from the current 71 FTEs to 161 positions. However, the new facility will not have inpatient capability and will not have an emergency room. IHS physicians need to be able to treat their patients in the Coteau des Prairies Hospital, a private hospital in Sisseton. Caring for Indian patients who are in nursing homes is also an issue. Since 1999, due to concerns about the legality of IHS providers treating IHS patients outside a federal facility, the patients are brought across the street to the IHS clinic to see the doctor. Ms. Coteau said a remedy might lie in a different interpretation of current state law or in changing the law. Meetings have been held since early 1999 with the South Dakota Board of Medical and Osteopathic Examiners, and according to their interpretation of SDCL 36-4, they will not allow IHS physicians who are not licensed in South Dakota to practice or see patients outside IHS institutions. Sisseton Indian Health Service established South Dakota licensure as a requirement for employment and did recruit two doctors who obtained South Dakota licenses and were granted privileges at the Coteau des Prairies Hospital. However, both doctors are leaving this month, leaving the Sisseton IHS with one permanent physician who does not hold a South Dakota license. Recruitment and retention of medical providers is very difficult and South Dakota licensure requirements can be a barrier to recruitment of physicians to work in rural IHS locations. There are mutual advantages and benefits to exempting IHS physicians from South Dakota licensure requirements or to granting reciprocity to IHS physicians. With the IHS replacement health facility in Sisseton, an opportunity is created for Indian and non-Indian communities to work together to improve health care in northeastern South Dakota (Document 5).

Mr. Dave Hewett, President of the South Dakota Association of Health Care Organizations, stated that maintaining access to health care in rural areas is a struggle. He raised a number of issues that complicate the situation, including malpractice and liability, reimbursement from Medicaid, federal and state license requirements, and state rules and regulations. Ultimately the Board of Medical and Osteopathic Examiners determines who may practice in the state.

In response to a question from Senator Volesky about IHS funding, Senator Brown said that the Division of Indian Health is under the US Department of Public Health. Mr. Huff indicated that the funding comes from the Department of Interior, although the agency is located within the Public Health Service.

Mr. Bill Nelson, Administrator/CEO of Coteau des Prairies Hospital in Sisseton, spoke in support of the proposal to allow IHS physicians to treat patients in private hospitals and nursing homes. He said this is a statewide issue but it has significant consequences regarding health care services in the Sisseton area. He felt the proposal would eliminate duplication and would allow the community to make the most efficient use of available facilities. IHS uses a large number of temporary physicians, so temporary licensure needs to be addressed also (Document 6).

Mr. Dean Krogman, representing the South Dakota Board of Medical and Osteopathic Examiners, discussed issues and concerns raised by the proposal to exempt IHS doctors from state licensing. He noted potential liability and billing problems that may arise. He also explained that the board sets the licensing criteria (Document 7). He pointed out that ARSD 20:47:03:03 subdivision (11) explains the residency requirement. He said that IHS should meet the requirements set by the board and that the residency requirement improves patient care.

Ms. Iyonne Garreau, Ms. Alta Le Claire, and Bryce In The Woods, Cheyenne River Sioux Tribe, told the committee of the need for a nursing home in their community. Presently there are fifteen elderly people in Eagle Butte in need of nursing home care.

Representative Van Norman read letters from Mr. Steven Sandven, Attorney for Sisseton-Wahpeton Sioux Tribe, and Mr. Gregg Bourland, Chair of the Cheyenne River Sioux Tribe, in support of lifting the moratorium on nursing homes (Documents 8 and 9).

Chair Putnam said that the next meeting will probably be held in late August or early September and will address economic development on reservations.

The committee adjourned at 3:20 p.m.