Being from Sioux Falls and having worked in health care policy in South Dakota and other states, I am not surprised by this judgement. Funded by the deep pockets of credit card millionaire T. Denny Sanford, the Sanford health conglomerate has aggressively expanded its reach to three states. In 2013 Sanford was poised to merge with Twin Cities based Fairview Healthcare System, but pulled back when regulators raised questions. The goal is to establish a Sanford healthcare empire in the Dakotas and Minnesota dwarfing even the famed Mayo Clinic. Competition with Sioux Falls rival health care system, Avera, has resulted in Sioux Falls having the greatest concentration of orthopedic specialists in the country. Again I’m not surprised their aggressive empire building has resulted in this scheme.