Op-ed — St. Thomas
An Open Letter to the CEO and Board of the Gov. Juan F. Luis Medical Center
As a healthcare provider, former Acting Commissioner of Health and Medical Director of the then St. Croix Hospital, the fiscal plight of this facility and the recent dismissals of LPNs and CNAs are deeply troubling to me as it has been to a broad spectrum of the St. Croix community. That is not to say that I am not concerned about the dismissals of teachers, other government workers and those who would be laid off by HOVENSA's closing. I am, but I want to specifically address the healthcare issue in this letter.
I think that the firing of the aforesaid nursing staff is not only shortsighted, but threatens patient care as well as the health of the remaining nurses. We all know that the hospital's financial status is precarious, but the details are unclear. I ask then, what savings will be realized since RN's will be hired to replace them at what appears to be additional costs?
I agree with replacing costly travelers with direct hires, but not with dismissing LPNs who are months, or even a year, away from an RN degree, and I also disagree with displacing local residents who will now be unemployed with individuals brought in from outside of the Virgin Islands. There must be a better way.
Further what is so important about the Magnet Program when we barely meet the critical Medicare certification and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards and they determine whether or not we get reimbursed for services! There is no concern or standard in these official bodies that would require the firing of LPNs and CNAs. While the RN ratio is most important, the LPNs and CNAs are seen as an integral part of the nursing team.
And in the system the hospital now is planning to operate under, is the RN supposed to be responsible for critical decision making, skilled care, coordination and documentation as well as feeding, bathing, and transporting patients? This is a scenario begging a costly mistake – in terms of patient safety as well as money.
I also wonder, and ask, if all other cost cutting measures were considered before taking this drastic step? Are there services that can be privatized under an (Employee Stock Ownership) ESOP-like process so that the employees would form a business to supply the service? It has been suggested by some on the hospital staff that savings could also be realized from discharging those individuals, who are simply being housed, do not need acute hospital care and for which the hospital receives no reimbursement.
Which begs another question: what kind of coordination is taking place between the hospitals, Department of Health, the Department's Medical Assistance Program (Medicaid), the Community Health Centers and Human Services?
The Virgin Islands under the Patient Protection and Affordable Care Act is eligible for close to $49 million in federal funds in this fiscal year - 2012. The match is 55 federal: 45 local. My staff and I worked hard to assure this kind of increase in Medicaid and are continuing to work to achieve a more favorable match.
I am sure the Governor Juan F. Luis Hospital as well as the Roy Lester Schneider Hospital and Medical Center have provided care to a significant number of Medicaid eligible individuals and I suggest they calculate what they are owed and work with the Medical Assistance Program (MAP) to bill and be paid for the services they rendered. It may be the only short term source of an infusion of badly needed revenue for our hospitals and the Department of Health should cooperate. The Department should also speed up their raising of the income limits to include more people which is the purpose for which we increased the dollars and which would increase the number of Medicaid patients the hospitals could bill for.
In terms of the boarders, wouldn't the additional Medicaid dollars make it possible to house those among them who require skilled nursing at Seaview? And since the same Government is paying for these individuals to occupy expensive hospital beds, why not transfer those needing only "custodial" care to Herbert Grigg and use some of that same money to hire additional staff for that facility- even some of the CNAs and LPNs that were just let go.
There are also initiatives that we are working on in Washington. In addition to changing the Medicaid match we are working to make our hospitals eligible to be Critical Access Hospitals which would enable them to get increased reimbursement, access to more rural health dollars as well as programs where they can purchase medication at reduced costs. It is also possible under this designation to set up and be paid for long term care. The limitation here is that it is possible that the Republican leadership in the Congress may not allow any meaningful or relevant legislation to be passed this year.
Because the Department of the Interior is also concerned and has been approached by the U.S. Department of Health and Human Services, I will ask Interior Department Virgin Islands Field Officer and former Senator Basil Ottley to join me in calling a meeting with the leadership of JFL Hospital, the Department of Health, Frederiksted Health Care, Inc., and the Department of Human Services as well as the Governor's task force on healthcare reform so that we can get a better understanding of how these departments, agencies and task forces are working together to ensure quality healthcare is provided for our residents in the most efficient way possible and to explore how better collaboration might help the hospital to continue to fulfill its mission as well as how my office and the Department of Interior could further support them and assist in improving our healthcare system.
I have to believe that there are other solutions within our reach. And I know that where there is a will, there will be a way!
Donna M. Christensen is the Virgin Islands Delegate to Congress.