June 4, 2001 – A bill to fine-tune the V.I. hospitals' semi-autonomy met with sharply divided receptions at a Senate Health and Hospitals Committee hearing Monday on St. Thomas.
Hospital officials heartily endorsed the proposed Healthcare Quality Improvement Act of 2001, but Dr. Lucien Moolenaar, deputy health commissioner, took issue with several of its provisions.
One of those provisions would increase the composition of the Government Employees Service Commission Health Insurance Board by adding the chief executive officers of the two hospitals. Moolenaar called this "dangerously approaching the slope of conflict of interest."
Board chair Paulette Rabsatt, however, voiced strong approval for inclusion of the CEO's. "Issues impacting our only hospitals should more readily come to the boards' attention," she said, and this "can only serve to improve the quality of health care in the territory."
Rabsatt also said the board should include the territory's director of personnel as an ex-officio member, since her position is "integral to the proper administration of employee benefit matters."
Eugene A. Woods, CEO of Roy L. Schneider Hospital, and Thomas Robinson, his Juan F. Luis Hospital counterpart, supported the measure. Woods said "the board needs as wide a representation as possible, so we don't hear what's going on after the fact." Three years ago, he said, "the hospital had no impact on the negotiations with Blue Cross. For example, Blue Cross doesn't cover self-inflicted wounds that come into the emergency room. That is an issue that a hospital CEO would have raised."
Moolenaar argued that the inclusion of health-care providers on boards which regulate agreements between providers and financiers "can significantly sway the outcome away from the best interest of the consumer." He said his department would favor non-voting seats for the hospital CEO's.
Robinson countered, "A voice without a vote is a very small voice, indeed. The problems we've had with Blue Cross could have been avoided if the hospitals had had a voting member."
Committee members expressed concern about "overloading" the board and taking hospital officials away from other tasks. Sen. Douglas Canton, committee chair, said the CEO's should be included on the board, but not necessarily as voting members.
Woods offered his "compromise," should opposition to voting membership build, to being an ex-officio member.
Another point of dissension was a proposal to exempt government-owned health care facilities from the requirement for a Certificate of Need. Moolenaar said the proposal would allow the semi-autonomous agencies to duplicate services, expand unnecessarily and establish fees without oversight from his department — and, in general, "circumvent the regulatory authority of this agency."
Woods said there was no attempt to take away oversight responsibility, but a desire "to streamline the CON (Certificate of Need) process." He said the provision is consistent with the Legislature's original intent "that the CON apply to privately owned health-care facilities, instead of government-owned."
Sens. Roosevelt David and David Jones agreed with Woods. Jones said the hospitals should be fully autonomous and should not be required to present a CON to the Health Department every time they need a piece of equipment.
The bill also exempts critical positions, such as pharmacists, radiology and laboratory technicians, and physical therapists, from the employee attrition program which initially exempted only doctors and nurses. Woods said the measure is needed to "protect these desperately needed positions."
Among other provisions in the expansive bill are a section restricting treatment of illegal immigrants to emergency medical care, and a measure creating a less-cumbersome hiring process which Woods said would "eliminate much of the bureaucracy that we experience."
Woods said the bill "represents another step in the long journey toward making our health-care facilities the providers of choice for Virgin Islanders and the Caribbean." While semi-autonomy is not a panacea to health-care problems, he said, in the almost two years since the legislation was passed, it "has resulted in many positive changes with people receiving health care here at home without having to leave the territory." And he commended the governor and the Legislature for "taking this bold step."
The committee held the bill, sponsored by Sens. Canton, Jones, David, Lorraine Berry and Almando "Rocky" Liburd, until its next meeting, set for Thursday, so amendments can be drafted addressing the concerns voiced by those testifying Monday.
Committee members at the hearing were Canton, Jones, David and Richards. Sens. Berry, Liburd and Adlah "Foncie" Donastorg were excused.
