The Finance Committee budget hearing Tuesday was almost harmonious, with the Health Department coming within its budget mandate and senators praising other presenters.
Health Commissioner Wilbur Callender was the only agency head to come to the Finance Committee this week with a budget reduction of 15 percent for his department.
But he said Tuesday, "We do not know exactly how our programs will be affected under this new reduced budget."
A major concern for senators was the absence of adequate ambulance service on St. Thomas and St. Croix. On two occasions ambulances were not available on St. Thomas and once on St. Croix, according to Dr. Herb Sanders, director of Emergency Medical Services.
Another area of concern: indigents with mental health problems.
Callender said the mental health complex planned for the East End — to be built on government property — will help mitigate the homelessness of the mentally ill.
The Michele Motel, which now houses some of the mentally ill patients, will be sold when the new complex is built, he said.
Facing a decrease of $8.2 million in its budget, the Health Department intends to increase its collections by 20 percent.
The total budget for Health as approved by the governor is $50,153,501: $27,254,405 from the general fund, $2,734,567 from the Health Revolving Fund and $20,164,529 from federal funds.
More than 60 percent of Health's budget will go to personnel, including fringe benefits.
Callender said he didn't know what the 15 percent cut would do to planned re-establishment of a public health lab and public health pharmacy. Expansion of clinic hours and services and an employee health program —- which is mandated by certain contractual agreements — may also be in jeopardy.
A totally unrealistic Medicaid cap placed on the Virgin Islands was another problem identified by Callender, and later by the CEO of the Roy L. Schneider Hospital, Eugene Woods.
Woods said 40 percent of all patients entering his hospital are uninsured. The national average is 6 percent.
Calling Medicaid "woefully" inadequate, Woods said the federal program provided only $670 per eligible person in the territory. The national average is $3,311.
"We need $57 million, not $5 million (from Medicaid)," he said
The $5.4 million cap on Medicaid payments for the territory can be changed only by an act of Congress.
In the afternoon session, Woods said he plans to improve the hospital's services and physical structure and then market it to make it "the hospital of choice for the Caribbean."
Eugene Welch, the chief financial officer, said the hospital had outstanding receivables going back to 1990 of $126 million; $40 million of that is owed by government agencies. Uninsured patients account for $64 million.
With improvements in the computer system, he said, some of the money owed will be collected through improved billing.
Judith Grybowski, Nurse Licensure Board chairperson, who testified at midday Tuesday, told the senators nurses trained at the University of the Virgin Islands are able to meet the standards needed to take the licensure exam, but nurses from other areas of the Caribbean do not meet the pre-requisite level. Grybowski said UVI assists nurses from other areas to meet the standard.
Grybowski was questioned about licensing for lay midwives. She said the board had not reached a conclusion on the issue, but since lay midwives were not nurses, perhaps her board was not the entity best suited for licensing them.
Grybowski told senators the Licensure Board has a revolving fund but the board has problems accessing it because the account has never been reconciled with the Finance Department records. Though her board should be able to get into Finance's records, "we've never been able to," she said. And she doesn't know where the money is.
Committee Chairwoman Lorraine Berry joked that maybe it was part of the "missing $120 million," referring to federal money that had been used for unauthorized purposes during the Schneider administration.
With the restructuring of government, Sen. Gregory Bennerson suggested, the Nurse Licensure Board might be one of the boards that would be combined with another agency.
Grybowski said she would deal with it if it happened.
