April 11, 2007 — Deep personal and political divisions among doctors doing kidney dialysis at Juan F. Luis Hospital and the V.I. Kidney Center, along with a growing diabetes epidemic in the Virgin Islands, is causing stress and hindering planning and cooperation, the Senate Health, Hospitals and Human Services Committee discovered Wednesday.
Whatever their personal differences, the doctors all spoke from the same script regarding kidney treatment: Like the rest of the nation, the territory has a growing obesity problem, which in turn has fed a growing diabetes problem. Diabetes and high blood pressure have both led to more kidney failure.
As the population of people needing dialysis to clean their blood of the poisons their failing kidneys cannot, the island’s dialysis doctors, staff and facilities are being stretched ever thinner, creating stress, burnout and eventual failure of the system. All favor a third kidney dialysis center based in Frederiksted as an integral part of the solution.
“Another obstacle is the great number of residents needing dialysis treatment,” said Juan F. Luis Chief Executive Officer Gregory Calliste. “If the trend continues, Juan F. Luis will not be able to meet the need.”
“We are at our maximum capacity,” said Juan F. Luis Medical Director Kendall Griffith. “In essence, we are bursting at the seams, which has created undue stress on dedicated, hard-working staff at the hemodialysis unit. In my opinion the most feasible option is a satellite facility that can expand. That should be in Frederiksted.”
“The average number of dialysis patients in the U.S. is 60 to 80 per 100,000 people,” said Dr. Ramesh Lakhram, director of dialysis at Juan F. Luis. “Right now we have 130 who need dialysis on this island alone. That is four times the prevalence of dialysis than elsewhere in North America.”
Lakhram said the solution was a new dialysis facility, as did Dr. Walter Gardiner, chair of the V.I. Kidney Center.
“Given that the hospital is at capacity, and we have the capacity for only eight more patients, it seems we are headed for disaster,” said Gardiner. “We have a project to expand and are working with several Frederiksted agencies to get things going.”
Although everyone recommended the same solutions, everyone also agreed there was a serious problem among the doctors that was impeding cooperation. In particular, Gardiner and Dr. C.J. Perez, director of hemodialysis at Juan F. Luis, do not care for one another, though there appear to be other problems.
“There is greed involved, insecurity and paranoia,” said Calliste. “I have been director for three years now, but I am told the dialysis unit has been the biggest problem for the last 15 years. Not because of resources, but because of the politics, antagonism and pettiness in that unit. Everything we plan for that unit is met with resistance, and patients are caught up in this fiasco,” said Calliste.
“We seem to have ongoing problems, especially with leadership in the dialysis unit,” said Lakhram.
Lakhram said one critical way to improve efficiency and ease the strain on the island’s dialysis treatment facilities would be to ensure all three of the island’s current kidney doctors have privileges in every clinic that does dialysis. However, Gardiner, who was initially openly hostile to Perez on Wednesday, said he was essentially driven out of Juan F. Luis to form his own clinic and does not have privileges at the hospital.
“I would have to see a big change before I could see granting Perez privileges at my clinic,” said Gardiner.
Perez and Gardiner both later said they would work professionally together and would meet with hospital officials in the next week to begin working on cooperating to best address the looming crisis in kidney care in the territory.
“I look forward to meeting with Dr. Perez and everyone else in the upcoming weeks,” said Gardiner. “I regret 'the politics,' as we call it. It was not my doing, but I have to deal with it, and I do not always deal with it well.” For his part, Perez said he will always work and interact with his fellow doctors with professionalism.
Calliste, Griffith and Lakhram all said another major obstacle in dialysis care, as well as the rest of the hospital, was an ongoing nurse shortage. Calliste and Griffith both asked the Legislature to act to raise nurses' salaries to help alleviate the shortage.
“The most difficult issue to recruitment is the salaries the Virgin Islands pays are not comparable to the rest of the country,” said Griffith. “When they can make three or four times more elsewhere, we cannot entice them to come here.
Near the end of the hearing Calliste took pains to note that divisions in the nephrology (kidney care) department were a very small part of the overall picture at the hospital.
“The bottom line is that Juan Luis hospital is making progress, we have made progress and we will continue to make progress,” said Calliste.
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