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Committee Members Shed Light on Ambulatory Surgery Center Decision

Dec. 2, 2004 – Lifting the veil of secrecy that has surrounded the workings of the ad hoc committee formed to evaluate a Certificate of Need for a proposed ambulatory surgical center, three of its members spoke Thursday, two of them offering differing views.
Moleto A. Smith Jr., one of two committee co-chairmen, spoke briefly and carefully Thursday, "The committee signed a confidentiality requirement," he said, "so I wouldn't violate that."
He said, "Generally speaking, the committee reviewed the application based on the information we were given. It was a rigorous procedure of due diligence which allowed for each proponent and each opponent to give voice. Based on the committee's review of the application, the report was forwarded."
Carole E. Thompson, a medical professional, is the lone member who opposed the committee's recommendation to approve the CON. Stephanie Scott-Williams, community activist and former senator, supports the committee's decision.
After the committee's report was made public in late October, Thompson declined to elaborate on her decision, saying, "It wouldn't be appropriate until the commissioner makes a statement." She said in a phone interview Thursday, "She [Carty] is my commissioner and she has already spoken. I want to speak my view. The way it was reported, it appeared as though everybody sanctioned it," Thompson said.
"I feel very strongly that the hospital would be seriously undermined. I don't think it would be financially viable for the hospital," she said. "Frankly, just from the attitude of the others, I felt the bottom line is that it is not a community thing for people to have choices. It's because there's money in it."
Scott-Williams said her role in the committee was to "deal with the facts that were presented, and find out what the impact would be to the hospital and to the community, and, of course, to ensure that the ASC would be a viable institution and be able to stay afloat, not another white elephant."
She said, "The long and the short of it is we dealt with the facts, not how we personally feel. We dealt with the information that was presented and we had the opportunity to speak to both sides to be sure that when we came to a consensus, we were doing it in the best interest of the community."
Health Commissioner Darlene Carty announced the decision to approve the CON Friday evening. She has not spoken publically since.
Carty has refused to provide minutes of the committees' meetings. She told Roy L. Schneider Hospital chief legal counsel Amos Carty she had been advised by her legal counsel not to release the minutes. Carty wrote to the commissioner citing the V.I. Sunshine law which provides these documents should be open to public scrutiny. However, the documents were not released. She also told the Source she could not release the minutes. (See "Carty Approves Ambulatory Surgical Center").
The Virgin Islands Code, Section 254(a) clearly provides that "all meetings of a Governmental agency or any subdivision thereof authorized to take action on behalf of the agency shall be open to the public." Both the meetings and the minutes of this committee are open meetings and public information.
The committee is a public body by definition, but the members' names were not released until the committee's letter of recommendation to Carty was leaked to the media in October. RLS officials say they have yet to receive a copy of that document; therefore, they have declined comment on it.
In U.S. states with CON laws, there are strict criteria for reviewing applications and public forums for the community to express their views.
The Source had reported that five of the committee members – Smith, Lewis Stern, Scott-Williams, Brian Dooley and Ray J. Barry – had signed the committee's report, and that members Albert F. Richardson and Joseph R. Papa did not. Thompson said Thursday that Richardson and Papa are in favor of the ambulatory surgery center, but were not present at the meeting where the report was signed.
Thompson said she is particularly concerned about the fate of those who don't have medical insurance. She works with elderly medicaid and medicare patients, and those who have no coverage. "I have looked at every aspect of the whole thing, and I can read between the lines. What would happen to those [patients] who couldn't fit in because they didn't have insurance coverage? I am not impressed."
Thompson said, "The [ambulatory surgery center] group said they would take some indigents. The hospital has to take all indigents. Besides, if your source of revenue is heavily depleted [because of that revenue loss], then the hospital can't hire the kind of specialists it seems to have been moving toward. There's been an improvement at the hospital, from my perspective."
She hit on another point. "I feel equally strongly that, though these doctors may be the best in their field, they have actually grown in this community. I wonder if they asked the hospital about trying a working arrangement. This is where all of them got their public starts.
"They talk about people going off-island for treatment. Most people do not go off-island. They go to a doctor here first. Invariably, they go off-island because a doctor here recommended it. The hospital sends people off-island when they don't have the ability to provide treatment because of some speciality they don't have."
Thompson said, "Since I have worked at medical assistance, I have worked in practically every capacity, and I have seen the kind of people who come for service. Without medical assistance, we would have a very sick community." Though Carty's recommendations for the ambulatory surgery center include medicare and medicaid acceptance, there is no percentage of patients included that the facility must take.
Thompson continued, "We are not helping the hospital by being divided amongst ourselves. When others see this, they can easily slip in and take the business."
The Pavia Hospital of Puerto Rico has recently set up shop in Charlotte Amalie to tap into the V.I. market. (See "Schneider Hospital Faces More New Competition").
Scott-Williams said the group had signed confidentiality statements "which cover things like figures." But, she said, "It's all over now, the decision is out. Carole [Thompson], who had the dissenting vote, met with us and asked questions based on her concerns.
"I was proud of the group – Moleto [Smith] and [Raymond] Barry, co-chairmen. Moleto made sure what we used to guide us was clarified. We knew it would meet with some controversy, so we wanted to make sure we did the best possible job based on what was given to us. Some of the stuff we had to ask for further clarification. We kept pushing until we felt we could make a decision."
Scott-Williams said, "The more you look at it, people are looking for choices. People were going off-island, and some [procedures] still can't be done because we don't have the ability." Something that bothers her, she said, is "people referring to the center as a hospital. It is not a hospital."
Scott-Williams said she applied for a place on the committee months before she was selected. "I was afraid they were turning me down,"she said.
There is no public information on how the committee members were selected. The purpose of the committee, Carty has stated, was to "seek public input" on the center's proposal. However, she has made nothing public about the committee's deliberations.
There have been reports that the Health Department's CON manual is outdated. "It'
s not a manual," Smith said, "there are rules and regulations that govern the processes that were developed through the Department of Health."
Carty was in a meeting on St. Croix Thursday, and did not return calls.
The hospital will hold a press conference at 10 a.m. on Dec. 9 to respond to Carty's approval of the CON for the center.

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