Officials in the Billings office for Indian Health Services are working quickly to help patients find new health services after the Indian Health Board of Billings unexpectedly closed and left patients without care last week.
A sign went up on the door of the Indian Health Board of Billings' Alderson Avenue clinic late last month saying it was shuttered temporarily for repairs.
And then last week, IHS officials realized the clinic's closure was permanent when the Indian Health Board of Billings failed to seek an extension of its contract with IHS by the May 2 deadline.
With the deadline passed, the Indian Health Board of Billings' contract with IHS is expired, and the clinic can no longer operate. The Indian Health Board of Billings has been operating for more than two decades.
As such, the clinic's failure to renew its contract with IHS caught many people by surprise.
"We fully expected (the contract renewal) to occur," said Dorothy Dupree, Billings area director for IHS.
Once the deadline passed, the first thing IHS officials did was work to secure the thousands of medical records of the patients treated by the the Indian Health Board of Billings clinic.
And they've started working to find an organization that can offer replacement services.
IHS officials tried to answer questions left in the wake of the clinic's closure at a Tuesday afternoon community meeting, including where patients can go to seek health care service until a new clinic opens.
But one question remained unanswered.
"So what happened?" Dupree said.
She acknowledged that lots of rumors are circulating regarding the abrupt closure, but as of right now they have no answers.
"This is a very serious situation," Dupree said.
The Indian Health Board of Billings operated as part of the federal Urban Indian Program. Federal law allows for IHS to contract with health care providers to serve American Indian populations that live in urban centers rather than on reservations, where IHS clinics are set up.
For an urban clinic to be established, it must be overseen by a board of directors, whose trustees come from federally recognized Indian tribes.
The federal government has provided health care for American Indians for more than 200 years.
Indian nations have a unique relationship with the federal government. A treaty dating to 1787 requires the government to provide tribal members living on reservations with free health care.
For American Indians living in cities rather than on the reservation, the Urban Indian Program is the vehicle that allows them to still receive free health care.
For that reason, IHS officials are eager to find an organization that can get a new clinic set up.
In the meantime, officials are working with local care providers to offer options for Indian Health Board of Billings patients. Dupree and others from her office met with officials from RiverStone Health, the county's health office, Tuesday morning.
"The expectation is that it's likely a small portion will seek out RiverStone," said Director John Felton. "We don't anticipate it'll be a large number of patients. But we'll be well prepared."
Debbie Rawe, who lives and works in Billings, had been visiting the Indian Health Board of Billings for years to manage her diabetes. She doesn't receive health benefits from her employer and so relies on IHS for her health care.
With Indian Health Board of Billings' clinic now closed her options are to find a provider in Billings, which will cost her hundreds of dollars out of pocket for her diabetes medications and supplies, or to travel down to Hardin to visit the nearest IHS clinic.
"With my job, I can't go to Hardin all the time," she said.
Roughly 5,900 American Indians live in Billings. The Indian Health Board of Billings used to serve most of them. However, outpatient visits had declined rapidly in the past few years. In 2012, the clinic had 4,349 visits. Last year, the number had dropped to 3,026 visits.
Before the clinic closed it was treating only 857 patients.