Dec. 9, 2004 – The Roy L. Schneider hospital will appeal Health Commissioner Darlene Carty's decision to issue a Certificate of Need to a proposed ambulatory surgical center.
Speaking at a Thursday morning press conference, Rodney Miller, RLS chief executive officer, said that the hospital opposes the surgical center "because it is wrong."
"The center will devastate the hospital's ability to provide critical health care services to the people of St. Thomas," he said.
The hospital has been vehement in its opposition to the center since it first brought to light the possibility of its existence about a year ago. "Had we not brought the plan before the public, it may have just skated through unnoticed," Miller said.
"We oppose Commissioner Carty's decision because it is not based on documented need. The surgeries that are performed by this hospital are ambulatory surgical procedures, the same ones that will be performed at the proposed center," Miller said. "The hospital today is using about 60 percent of its capacity with all these procedures performed at the hospital."
Miller asked how Carty could justify a need when the hospital's "existing facilities have significant excess capacity? The commissioner's decision cannot be justified."
Miller estimates, if the proposal goes through, that the hospital, which he said is already under financial stress, stands to lose $2.3 million in annual revenues.
The hospital by law must accept all patients. "Let me be perfectly clear," Miller said, "the hospital will be unable to financially support itself if the only, or larger, population that it serves [are] the uninsured, under-insured and poor patients. The end result will be the collapse of the health care system in St. Thomas, which will have a devastating effect on the territory as a whole."
The hospital officials are almost as incensed about the secrecy surrounding the ad hoc committee and its processes as they are about the center itself. Hospital spokesman Michael Burton, in opening the press conference, said, "When the commissioner named an ad hoc committee to review the proposed ambulatory surgical center, the committee was bound by the Sunshine Act to have public meetings. This committee has never announced its meetings, posted any agendas or released any minutes. Our health commissioner even refused to name the committee members. This committee may be the most secretive government committee in the V.I. government's history, even requiring a confidentiality agreement among its members that prevented them from talking to others."
Moleto Smith, committee chair, told the Source last week that he could not speak freely about the meetings since he had signed such an agreement. The committee's members were made public when the committee's letter of recommendation to Carty was leaked to the media. (See "Ambulatory Surgical Center Passes First Hurdle").
Amos Carty, RLS chief legal counsel, said the hospital will appeal the decision. To do so, he said, he would need documentation from Darlene Carty on the committee's processes. Amos Carty said he needs, among other things, to know the dates for the appeal process.
He said, "We will take all legal steps necessary to give us the information. We are working with a nationally recognized firm to help us in terms of putting everything together." He said the hospital has hired Epstein, Becker and Greene, a worldwide legal firm, specializing in health care law, to "explore all options necessary and required for the appeal."
"We need to see documentation – the findings of need, the statistics, the demographic data, the rules and regulations governing the process the committee used," he said. "It would show us how the committee determined their decision. The commissioner has said she would provide us with the information, but she hasn't done so yet."
What the hospital board did receive, one week after Darlene Carty's decision was released to the media, was a four-page document from the Government House public relations office. The document was not signed, nor did it have an official letterhead. It reports her decision to grant the certificate to the center and gives the criteria by which the center's application was reviewed.
The document doesn't include any information on how the committee reached its decision. The committee's meetings and deliberations remain undisclosed, though Amos Carty, the press, and at least one private citizen have requested these minutes and been denied.
It states that "anyone can appeal the commissioners's decision based on the grounds for reconsideration specified in the Rules and Regulations." These "rules and regulations" are among the documents Amos Carty said he has not yet received from the commissioner.
June Adams, RLS board chair, said she was "appalled that any committee at this time could grant a CON. The hospital will have to lay off personnel, without doubt. Our budget has already been cut by $2 million," she said. "The central government can't help. The community has to know about this. Where will these workers go?
"I want the community to know we are not a monopoly," Adams said. We provide care to anyone who comes to our doors. This new center would have no beds, then it will put in just five, then 10, and soon it will be a private hospital. Nothing was brought to us first. If we'd denied them a hearing, we would understand. These physicians have not paid their dues to the V.I."
"I may be emotional, and if I am, I have a right to be," Adams said. "The center would be a step backwards for us. We will not allow anyone to push us back."
Fielding questions later, Miller wondered how five doctors could afford the $2 million to $3 million the doctors' group has said it would need to get the facility in operation. "I don't think this could be done without a silent partner," he said. "They are not investing that amount of money for something to fail."
The original group of nine doctors – Drs. Byron W. Biscoe, Jeffrey Chase, Catherine Kean, Sonia Taylor-Griffith, Horace Griffith, Derrick Jones, Francesco Isolani, Michael Savage and Adam Shapiro – has been diminished by almost half. Drs. Chase, Isolani, Savage and Shapiro have dropped out.
Another thing that rankles the hospital officials is the committee's claim in its report to Darlene Carty that the hospital "did not submit information to substantiate its claim that the proposed facility would have a substantial adverse impact on the hospital."
Amos Carty said the hospital had, indeed, submitted material. Many of the committee's requests came with only a day for the hospital to comply, he said, and they required "more research than we could possibly do in that time."
He produced an envelope file folder about seven inches thick stuffed with material that was given to the committee. For example, the doctors' group has claimed the hospital needs more operating-room time. Dr. Frank Odlum, RLS chief of surgery, showed to the press copies of documents which he personally took to the committee refuting this claim.
The doctors' group and the hospital officials were never afforded the opportunity to face one another in a dialogue which could have informed the committee, the hospital officials emphasized.
They said that is the way CON reviews are normally conducted in other jurisdictions.
Helen Gjessing is one of the three respondents of the committee's early request for public input. The committee said it had one in favor, one against, and one undecided, though it didn't announce the names.
Gjessing has an extensive health and science background. She taught biology and genetics a
t the College of the Virgin Islands, and, subsequently, the University of the Virgin Islands, for 34 years.
She said she had trouble finding anything in the CON documents the Health Department provided to be of any use. There was very little relevant information, she said. She asked Dr. Keith Callwood who was assisting Commissioner Carty in the evaluation process, what criteria they were using.
"Dr. Callwood told me a need for a surgical center had already been established. I asked him where, and he said in the 1989 health plan. I asked him how those 15-year-old rules could be adequate for this particular organization now to justify a need. He asserted they were. And I asked him to extend the deadline for comment another 30 days so more complete information could be available."
Miller noted that the center is not a popular idea with local physicians. He looked around the crowded conference room. "Do you see these doctors – Dr. Alfred Heath, Dr. Sidney Comissiong – rushing to join the center?" he asked. He noted that a recent V.I. Medical Society poll of 33 physicians in St. Thomas and St. Croix showed they all opposed the surgery center.
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