April 14, 2002 – Delving further into the operations of the Ingeborg Nesbitt Clinic and the Frederiksted Health Center on Friday, the Committee on Health and Hospitals unearthed concerns including lack of staffing, salary disparity and the possible loss of a $145,000 grant to upgrade the complex.
After almost two years, the health center still has no lease on the property it occupies. Vivian Ebbessen-Fludd, its executive director, said the delay in securing a lease could jeopardize a $145,000 federal grant.
The properties include two buildings at 22 and 26A Strand St. and two parking lots at 51B Queen Cross St. and 46-49 Strand St.
In February, Gov. Charles Turnbull vetoed a bill that would have authorized the government to lease the Ingeborg Nesbitt Clinic and the Frederiksted Health Center to the Frederiksted Health Care Center Inc. for $1 a year as a good faith gesture. The nonprofit FHC needs the lease to qualify for federal monies.
In a Feb. 21 letter to Senate President Almando "Rocky" Liburd, the governor indicated that his reason for vetoing the bill was that "it will have a detrimental impact on the Department of Health and the government of the Virgin Islands."
He said it would be wrong for the government "to lease its buildings and land for a pittance of $1, only to have the agency that owns it becomes a tenant in its own property. The government cannot lease the entire premise to a non-profit organization and then turn around and become subservient to the same organization."
In testimony on Friday, Ebbessen-Fludd said the government would also benefit from the federal grant, which would fund capital improvements to the health complex.
"Leasehold improvements will be gained by the Department of Health," she said, for example in an improved "preventive maintenance plan." She said she had in the past used monies from the grant to repair the air-conditioning system and the telephone system, which, she said, are properly the duties of a landlord -– the V.I. government.
Dr. Lucien Moolenaar, deputy Commissioner of Health, said a task force was "indeed working on legislation." He said a draft of its recommendation would go to the governor for review and would be submitted to the Legislature, and urged senators not to rush an override of the governor's veto before they see the draft.
Sen. Lorraine Berry said the V.I. government has "given a $1 lease to profit-making entities."
"I would like to see a partnership here," she said.
Sen. Adlah "Foncie" Donastorg suggested that Innovative Communications contribute to the Frederiksted Helath Complex and other health care organizations, saying Innovative gives the governement only $1 back for each subscriber charged monthly for emergency 911 service though it collects as much as $4 per month from subscribers like him who have more than one phone line.
Problems with programs and physical plant
In an April 2 press release, Sen. Alicia "Chucky" Hansen said her office had received complaints from patients serviced by the clinic who were on the Medical Assistance Program (MAP). She noted complaints of internal confusion, relocation of MAP staff, lack of privacy for clients and a MAP card machine that was out of service.
Sen. Douglas Canton Jr., Health and Hospitals committee chair, toured the health center Wednesday afternoon with Ebbessen-Fludd and Marian Miranda, chairwoman of Frederiksted Health Care Center Inc., to investigate Hansen's concerns. Canton said he found the MAP program had been relocated to a larger room and that the card embosser, a printing device, had been disconnected in the moving process by a non-authorized employee, yet to be identified.
"The concerns that were thrown out to the public have a different finding," he said. "I like to go and find out what the facts are."
Systems technician Sherwin Rey said he flew from St. Thomas on Wednesday to check the equipment and found that a communications cable to the card printer was disconnected. In testimony Friday, he said he had found employees using an embosser "from the 1980's" as a manual backup unit to prepare the cards.
Canton, a computer expert, applauded Rey for his rapid response.
"It is always good to have plan B," he said.
Disparity in programs and wages
Priscilla Berry-Quetel, Director of the MAP, outlined alternate methods to ensure that clients are serviced. "The highest-costing expenditure in the program is prescription drugs," she said.
The program maintains a service contract with outside firms including Nisky and Sunrise Pharmacies on St. Thomas and Doctor's Choice Pharmacy and D & D Apothecary on St. Croix. Kmart serves both districts.
A January 2001 report on Medicaid in the Virgin Islands lists eligibility requirements for residents. Income criteria for a family of four cannot exceed $8,500.
Berry-Quetel said recipients must meet both income and "resource" criteria, and said eligibility was not determined on a medical diagnosis.
Senators were reminded of the MAP cap being addressed by Delegate Donna Christian-Christensen.
Berry-Quetel urged senators to develop a task force to rapidly and aggressively move the issue forward to Washington. She said, "The national average expenditure per Medicaid recipient in FY 1999 for the Virgin Islands was $436 per patient, while in the States the average expenditure per Medicaid patient was $3,862. This clearly shows the disparity of care for Virgin Islands Medicaid patients."
She also expressed concerns about disparity in the wages of supervisors over their employees. In the past two weeks, senators have heard the same cry from other government agencies, including the Law Enforcement Supervisors Union.
Berry-Quetel said her critical issues were Medicaid, available medical services, program vacancies and salaries. There are 22 vacancies in her department, she told the committee. In the certification unit on St. Thomas, four employees process some 1,500 client cases and contacts per month, she said, adding that one program director had not received "a salary increase in seven years."
Although that person, she said, manages a budget of $14 million annually, the director's assistant makes $13,000 more annually.
"This is an inappropriate and unjust situation that is not unique to this director," said Berry-Quetel. "The legislature should support our governor in his desire to change this injustice."
Under questioning by Sen. Vargrave Richards, she admitted to being the director portrayed.
In an interview with Ebbessen-Fludd, she referred to a copy of the agreement handed out at Friday's hearing. Section III, Item 3 addresses Berry-Quetel's concern about the continuance of the MAP program at the Frederiksted facility. It says the Health Department agrees to provide onsite services which include WIC, Mental Health and Substance Abuse services, Family Planning and Health Education Programs.
Impact of non-profit vs. government ownership on employees.
Another pending issue is the benefits compensation plan and the allocation of staff for the center. Currently the center engages 65 government employees, three grant-funded employees and nine FHC-hired employees.
"Employees should not be negatively impacted by the transfer," Ebbessen-Fludd said.
The affiliation agreement states that "the Department of Health will continue to staff with its employees pending further negotiations and agreement."
Six unions now represent employees of the Frederiksted Health complex and discussion continue between the Office of the Governor, Office of Management and Budget, Health Department Office of Collective Bargaining, Office of the Attorney General and both health centers: Ingeborg Nesbitt and the East End Medical Corporation.
"Cooperative efforts will ensure employee benefits are re
tained and a smooth transition takes place between the Department of Health and the Frederiksted Health Care Center," Ebbessen-Fludd said.
However, she expressed concern about subpoenas being served on employees.
On April 9 during a Finance Committee hearing, Pickard-Samuel moved to subpoena witnesses to ensure their appearance at an April 16 hearing. Ebbessen-Fludd said she was served Thursday, on King Street in Frederiksted.
Of her employees she said, "A subpoena in their mind is jail. They are walking around scared." She said it would have been more productive to request a meeting with the staff to hear their concerns, or just extend an invitation to them to attend the senate session.
At the end of Friday's hearing, Sen. Emmett Hansen II said he had agreed at first with the veto of the lease agreement, but that after the day's discussion he had changed his mind. He assured his colleagues that he would join them in the push to override a gubernatorial veto in favor of FHC.
Two more hearings are scheduled to hear operational concerns at the Ingeborg Nesbitt Clinic. On April 16 at 6 p.m. Sen. Hansen will chair the Finance Committee and Hansen II has called another Government Operations meeting for May 2.
All seven committee members were present including non-committee member Hansen II. Present were Sens. Berry, Canton, Roosevelt David, Donastorg, David Jones, Liburd, and Richards.
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