Quality Health Care and the Indian Health Service: Rosebud Sioux Tribe v. United States

The ongoing relationship between the United States Government and Native American tribes is one fraught with tension. This tension is readily apparent within the Indian Health Service (IHS), a Government provided health services operation within the Department of Health and Human Services.[i] Access and quality issues plague the IHS and IHS patients. For example, patients can only get free IHS medications at IHS facilities, which are often few and far between on massive reservations.[ii] Moreover, IHS facilities frequently do not have the capacity to provide what many Americans would consider standard, run-of-the-mill hospital services, “such as emergency departments or MRI machines.”[iii] Tribes are rightfully frustrated, and some have filed lawsuits against the Government.

The Rosebud Sioux Tribe (Tribe), in Rosebud Sioux Tribe v. United States,[iv] sued the Government based on the closure of the emergency department in the Rosebud IHS Hospital, alleging in Count III that the Government violated “treaty rights, other statutory obligations, and the trust responsibility obliging the Government to provide health care services to the Tribe’s members.”[v] The Government filed a motion to dismiss all counts in the suit.[vi] The court denied the motion with regard to Count III following “the “established Indian law canons of construction [which] ‘require the court to construe the statutes . . . liberally in favor of the Tribe and to resolve any ambiguous provisions to the Tribe’s benefit.’”[vii]

The Rosebud court considered language in the foundational 1868 Treaty of Fort Laramie, which states the Government “hereby agrees to furnish annually to the Indians [a] physician, . . .  and that such appropriations shall be made . . . as will be sufficient to employ such persons.”[viii] The court also pointed to specific language in statutes, such as the Snyder Act and the Indian Health Care Improvement Act, which recognize the special trust obligations the Government that the Government must provide health care to tribes[ix] and ensure the “highest possible health status for Indians.”[x] Moreover, the Rosebud court relied on Eighth Circuit precedent in finding an unambiguous declaration that the federal government must provide health care to tribes.[xi]

Given these recognized obligations, the Rosebud court correctly concluded the Tribe has a cognizable claim under Count III. While the outcome of this case remains to be seen, a basic recognition of the Government’s health care trust responsibility to tribes at least leaves the door open to future equitable relief.

Hopefully, the denial of the Government’s motion to dismiss in the Rosebud case is a good sign for not only the Tribe, but also for other tribes around the country. As the battle for healthcare wages on in Washington D.C., it is imperative that the right for the “highest possible health status for Indians”[xii] not be neglected as it so often has been.



[i] About IHS, Indian Health Service,

[ii] Misha Friedman, For Native Americans, Health Care is a Long, Hard Road Away, National Public Radio (April 13, 2016),

[iii] Id.

[iv] Rosebud Sioux Tribe v. United States, No. 3:16-CV-03038-RAL, 2017 WL 1214418, at *1 (D. S.D. March 31, 2017).

[v] Id. at 2.

[vi] Id.

[vii] Id. at 9 (quoting Cheyenne River Sioux Tribe v. Jewell, 205 F.Supp.3d 1052, 1062 (D. S.D. 2016)).

[viii] Id. at 7 (quoting The 1868 Treaty of Fort Laramie).

[ix] Id. at 7.

[x] 2.5. U.S.C.A. § 1602(1).

[xi] Rosebud Sioux Tribe v. United States, No. 3:16-CV-03038-RAL, 2017 WL 1214418, at *1, 8 (D. S.D. March 31, 2017).

[xii] See supra note 9.