The United States Court of Appeals for the Eighth Circuit addressed an appeal concerning the Rosebud Sioux Tribe and its members against various federal entities and officials. The central issue was whether the district court correctly determined that the United States has an obligation to provide "competent physician-led healthcare" to the Tribe, based on historical treaties and legislation. The court affirmed the district court's ruling, emphasizing a duty established by the Treaty of Fort Laramie of 1868, which included commitments by the United States to provide healthcare professionals and support for the Tribe. Key provisions of the Treaty included the annual provision of physicians and other professionals, along with the requirement for a residence for the physician. The appeal also referenced the Snyder Act of 1921, which allowed for federal appropriations to support the care and assistance of Native Americans. Historical reports indicated ongoing efforts by the United States to improve health conditions for the Tribe, demonstrating the government's evolving responsibility over time.
In 1976, Congress enacted the Indian Health Care Improvement Act (IHCIA), which created the Indian Health Service (IHS) and aimed to elevate the health status of Native Americans to the highest possible level. The IHCIA establishes a national policy to fulfill the government's trust responsibilities to Indian tribes and provide necessary health resources. The Snyder Act initiated federal funding for healthcare across recognized tribes, and the IHCIA organized the delivery of these services.
The Rosebud Hospital in South Dakota serves roughly 28,000 Native Americans and is managed by the IHS. Following significant deficiencies in emergency care identified by the Centers for Medicare and Medicaid Services (CMS) in November 2015, the hospital's Emergency Department was placed on "divert" status, redirecting patients to distant hospitals. Subsequent reductions in operating hours and diversion of surgical and obstetric services occurred due to staffing shortages, although the Emergency Department reopened in July 2016.
In response to ongoing issues, the Tribe filed a complaint against the U.S. government and IHS, seeking declaratory and injunctive relief. The district court dismissed several claims but permitted the Tribe's assertion that the government has a trust duty to provide adequate healthcare services. After cross-motions for summary judgment, the court partially upheld the Tribe's position, affirming a duty for the government to deliver competent healthcare, but found the Tribe exaggerated the government's obligations regarding health status improvement. The government has appealed this decision, arguing that Indian trust law dictates no healthcare duty exists without a trust corpus, misinterpreting the district court's ruling and the relevant legal principles.
The Tucker Act and the Indian Tucker Act do not grant a substantive right for individuals to recover monetary damages from the United States; such rights must derive from other legal sources like the Constitution or federal statutes. The Supreme Court's rulings in Mitchell I and II established that while the Indian General Allotment Act of 1887 only created a limited trust relationship regarding timber resources, subsequent analysis revealed a fiduciary relationship due to the government's extensive control over tribal assets. This relationship consists of a trustee (the United States), beneficiaries (Indian allottees), and trust corpus (Indian timber and lands).
Further clarification came from the Navajo I and II cases, where the Navajo Nation's claims of breach of fiduciary duty related to coal lease amendments were acknowledged, but the Court ruled that monetary damages could not be recovered under relevant statutes. The existence of a general trust relationship does not suffice for jurisdiction under the Indian Tucker Act for claims of monetary damages.
In the present case, the Tribe seeks only declaratory and injunctive relief based on the Treaty, the Snyder Act, the Indian Health Care Improvement Act (IHCIA), and federal common law, explicitly not claiming monetary damages. The Tribe's argument hinges on whether the Treaty and related statutes impose a duty on the government to provide adequate healthcare. The interpretation of the Treaty must favor the Tribe, consistent with the canons of construction in Indian law. The Treaty explicitly mandates the government to provide a physician annually and to make necessary appropriations, reinforcing this commitment through continued healthcare delivery to tribal members, even encouraging them to forgo traditional medicine.
The Government, under the Treaty, established clinics and provided healthcare, with an expectation from the Tribe that such services would be delivered. The Treaty is interpreted liberally in favor of the Tribe, particularly given that tribal signatories had limited English proficiency and signed with an "X," highlighting potential misunderstandings of the agreement. Historically, the Government has provided healthcare in exchange for the Tribe's trust, further supported by the Snyder Act, which authorized funds for the welfare and health of Indians, and the Indian Health Care Improvement Act (IHCIA), which aimed to improve Indian health status. The Supreme Court recognized the Indian Health Service's (IHS) obligation to provide healthcare to Indian people. The district court found a legal duty to provide healthcare based on Congress's clear declaration of responsibility arising from the unique relationship between the federal government and Indians. Distinctions are made from the Quechen Tribe case, where no enforceable duty was found, as that case did not involve an operative treaty. In contrast, the current situation involves a Treaty that established a duty, with the Snyder Act and IHCIA reinforcing an already existing obligation. The Government's argument regarding the vagueness of the declaratory judgment is rejected; the Declaratory Judgment Act allows for defining legal rights amidst a substantial controversy. The Tribe has specifically alleged that the Treaty, Snyder Act, and IHCIA create a duty, and there is a documented history of healthcare deficiencies at Rosebud Hospital. The district court's order aims to clarify the Government's accountability regarding these deficiencies, affirming the treaty-based duty owed to the Tribe in light of IHS's purpose.
The Government's duty to provide "physician-led" healthcare to the Rosebud Sioux Tribe stems from a promise in the Treaty and is reinforced by the Snyder Act and the Indian Health Care Improvement Act (IHCIA). This duty encompasses the need for competent healthcare, recognizing that historical adjustments are necessary when interpreting treaties decades later. The declaratory judgment emphasizes the Government's accountability for ongoing deficiencies at Rosebud Hospital and asserts that the Government must improve its healthcare services.
In dissent, Circuit Judge Kobes acknowledges the serious healthcare deficiencies but argues that neither the 1868 Treaty nor subsequent statutes impose a judicially enforceable duty for competent healthcare. He contends that the role of the physician was intended to be temporary and educational rather than as a permanent healthcare provider for the Tribe. Kobes references the Ninth Circuit's ruling in Quechan Tribe, which indicated that the Snyder Act and IHCIA lack the necessary language to establish a trust-based duty. He stresses that any duty must originate from the Treaty, which should be interpreted based on the historical intentions of the parties involved, favoring the interpretation that benefits the Tribe due to the Government's superior negotiating power.
The Tribe asserts that the Government's promise to provide a physician and cover related costs establishes a duty for competent healthcare, citing Article XIII of the Treaty. However, the dissent questions the Tribe's historical justifications for this interpretation and challenges the notion that the Sioux exchanged land for healthcare services to the extent claimed.
The 1868 Treaty significantly reduced Sioux territory established in the 1851 Treaty of Fort Laramie, decreasing it by more than half from approximately 60 million acres. However, the treaty did not fully cede control of the remaining land, designated as "unceded Indian territory," to the U.S. Government. Article XVI mandated that the Government withdraw its military presence from this area and prohibited white settlers from entering without Sioux consent. The Sioux agreed to settle within a designated agricultural region, which was intended to transition them away from traditional lifestyles and facilitate education and land distribution.
The treaty's design aimed to reduce conflict among the Sioux, the U.S., and allied tribes by encouraging permanent settlement while maintaining Sioux rights to hunt in the unceded territory. Although the treaty promised various forms of assistance, including education and property rights, it lacked detailed provisions for the roles of professionals like physicians, leading to ambiguities about their responsibilities. The treaty explicitly required only teachers to provide services, implying that other professionals, aside from a second blacksmith, were not obligated to deliver their services due to a lack of provided supplies.
Understanding the Sioux's actual consent to the treaty terms is crucial, as historical records reveal limited Sioux-authored documentation. The most relevant sources are reports from government Indian Agents, which, despite their biases, serve as the best available evidence of Sioux interpretation at the time. Notably, an 1868 report referenced Dr. Livingston, the agency physician, as successful in his efforts among the Sioux, marking the earliest mention of a physician's role in this context.
A report indicated that a physician, Dr. Livingston, faced significant challenges in his practice due to a lack of essential medicines and had not received compensation for over a year while serving prior to the Treaty’s ratification in February 1869. This suggests that his medical services were not provided under any Treaty obligation, as he was already in position before the Treaty was signed. The Treaty’s purpose was not to guarantee ongoing medical services for the Sioux but rather to instruct them in self-sufficiency regarding healthcare. Reports from 1869 and subsequent years noted that the Sioux expressed satisfaction with government administration and were inclined to adopt agricultural and civilized practices, learning from white examples. While healthcare was not explicitly mentioned in the Treaty, the focus was on educating the Sioux to live like white Americans. Later reports emphasized the need for skilled agricultural assistance to help the Sioux become self-sustaining, indicating a strong governmental commitment to education and training rather than direct provision of healthcare services.
The 1873 Upper Missouri Agency report by Dr. Livingston highlighted the impending expiration of Treaty provisions that had provided rations to the Sioux, indicating that they would soon be left to fend for themselves, which necessitated special Congressional legislation for their survival. The Flandreau Sioux, despite lacking external support, aspired for self-sufficiency and sought to establish family farms, recognizing Treaty professionals primarily as educators. The Indian Agent noted their desire for rapid advancement in civilization and reliance on personal responsibility. However, despite the pressing healthcare needs due to high mortality rates from whooping cough, the focus was on teaching sanitation rather than providing direct medical care. Reports from the Flandreau Special Agency indicated that no trades had yet been learned by 1876, but the Sioux expressed a strong desire for independence. Similarly, reports from the Standing Rock Agency in 1875 and 1876 demonstrated that the Sioux understood their situation and were eager to adopt white settlers’ lifestyles for future welfare. They acknowledged their obligations under the Treaty and expressed a willingness to engage in measures for their improvement and progress.
The Treaty, as understood by both the Government and the Sioux, aimed to encourage the Sioux to adopt the lifestyle of white Americans, emphasizing education over service provision by Treaty professionals. The primary responsibility of these professionals, including physicians, was to instruct the Sioux to independently manage their needs. Historical reports indicate that physicians were to educate rather than provide ongoing healthcare services. Although the Treaty does not establish a right to healthcare, members of the Tribe can pursue claims under the Federal Tort Claims Act for negligent medical care by government-employed physicians. The conclusion drawn is that neither party intended for a single physician to address the health needs of all Tribe members indefinitely. The court's interpretation, which implies a broader obligation for ongoing healthcare and the provision of various professionals, distorts the original agreement of the Treaty. Judicial alterations to the Treaty are cautioned against, as they exceed the proper scope of judicial authority. The dissent underscores the obligation to adhere to the Treaty’s text and original context, rejecting the imposition of unagreed-upon commitments.
