Both Schneider Regional Medical Center on St. Thomas and Juan F. Luis Hospital on St. Croix need to replace existing kidney dialysis equipment soon and substantially increase their dialysis capacity to meet a steadily growing need in the V.I. community, according to testimony offered this week before the Senate Health Committee.
Sen. Patrick Sprauve, chairman of the Health Committee, held oversight hearings Wednesday to get feedback on the hospitals’ dialysis, air transportation and emergency services needs, and to find out what is happening with long-delayed renovations to the Frederiksted Health Clinic.
Elizabeth Harris, acting chief executive officer of Schneider, said in her prepared testimony that Schneider had 12 dialysis machines at the end of their useful life that must be replaced by the end of this year at a projected cost of $225,000.
The dialysis unit has a total of 16 chairs being used for two to three shifts a day, six days a week, she said. There are 73 patients using dialysis regularly now, along with occasional patients and visitors to the island. The unit is now operating near or at its capacity and must expand in order to meet the requirements of the Centers for Medicare and Medicaid Services (CMS).
Schneider wants to expand into the adjacent Physical Therapy Department at a projected cost of $340,000. Harris believes that in the long run a free-standing out-patient facility is the best route to meeting the growing dialysis needs of St. Thomas.
CMS surveyed the Schneider dialysis unit in August and the report, received Oct. 27, found several areas needing improvement, including water quality, infection prevention and quality assurance, Harris said. A corrective plan is due from the hospital Nov. 17.
At Juan Luis the situation is very similar, said Darice Plaskett, that hospital’s acting CEO. Chronic dialysis services are provided Monday through Saturday, the same as on St. Thomas. There are 16 stations as well. They have the capacity to treat 90 patients a day—a bit more than St. Thomas. But the number of dialysis patients is expected to double in five years, and the system is already running at capacity.
"The current statistic signifies a need for aggressive strategic planning to address this territory-wide healthcare issue," Plaskett said in her prepared testimony to the committee.
When CMS surveyed Juan Luis in April, it found some problems with water quality and with the unit’s procedures, she said. The hospital submitted a plan of correction, which CMS accepted and the problems are being corrected. In previous testimony to the Senate, Plaskett said no patient was harmed by the lapses in protocol identified by CMS.
She said there was an ongoing lawsuit concerning some of the issues referenced by CMS and that legal counsel had advised her not to discuss those matters.
"The most recent water-quality reports have all been satisfactory, however," she said. Meanwhile, the dialysis unit at Juan Luis remains certified, but there is a need for more support and expertise, so emphasis has been placed on training, education and quality assessment. To help with that, she said the hospital has submitted a $200,000 grant request to the U.S. Department of the Interior for technical support.
As with Schneider, Juan Luis needs to replace many of its units. Most of its dialysis machines are over seven years old and, while functional, the maker will stop making that model later this year, so parts will begin to become scarce, she said.
To address the growing demand for dialysis, Juan Luis wants to set up a larger, better unit with 32 stations at an estimated cost of $9.8 million. They’ve applied for $10 million in federal stimulus funding, which, if it comes through, will finance the expansion, Plaskett said.
Emergency Room Updates, Frederiksted Health Center
Both hospitals plan major renovations to their emergency departments. Harris said Schneider projects a cost of $4.8 million to replace much of the department’s air conditioning and environmental control system—and another $3 million for other upgrades to the emergency department. Juan Luis also needs renovation and upgrading, and Plaskett thanked Sen. Neville James for sponsoring a bill that would appropriate $3 million for the purpose.
In the afternoon, Public Works Commissioner Darryl Smalls testified about the ongoing request for proposal process for mold removal and renovations at the Frederiksted Health Center.
Closed since April 2008 for the work, then projected to take three or four months, the Frederiksted Health Center has been operating out of the Herbert Grigg Home for the Aged ever since.
Smalls said new RFPs for the mold remediation part of the work were advertised in the beginning of October and responses were due Nov. 9. RFPs for the renovation cannot be sent out until the design work is completed by the Atlanta engineering firm of Johnson Spellman and Associates (JSA). JSA officials sent the committee a letter and a statement of the general outlines of their plans but said in the letter the final design work could not be completed until the mold remediation is complete, because the outcome of that work affected the scope and details of their work. The clinic’s Frederiksted facility will remain closed until sometime next year.
