While lawmakers – spurred by Tuesday’s termination of 85 employees by Juan F. Luis Hospital – considered how to replace the board of the hospital, get rid of its chief executive officer or even merge the management of the territory’s two hospitals, the hospital’s board gave CEO Jeff Nelson a glowing one-year performance review and reminded senators they had warned them exactly what was likely to happen.
Senate President Ronald Russell attended Wednesday night’s monthly meeting of the hospital board, and he asked how ending the jobs of the 85 licensed practicing nurses and certified nurses assistants could improve the quality of care.
Russell also challenged Nelson’s assertion that the move came in part because of concerns from the Centers for Medicare and Medicaid, known as CMS, the agency that certifies U.S. medical facilities for meeting required standards of care.
"Does CMS set policy for this hospital?" Russell asked.
Chairwoman Kye Walker said no, the board does, but because CMS certification is necessary for the hospital to be able to bill Medicare and Medicaid, the hospital has to bear in mind what the agency says.
Nelson added that if Luis Hospital is not able to participate in those federal health care programs, Medicare and Medicaid patients wouldn’t be able to receive treatment at the hospital without having to pay for it.
As to patient care, Nelson said, the termination of the LPNs and CNAs are part of a larger effort to use registered nurses for direct patient care, a target in seeking to become a magnet hospital by 2016.
Russell said the Senate is not satisfied and, in the light of the layoffs, will take action.
"Everything’s on the table," he said. "We will act."
In the hall after the meeting, Russell said healthcare, along with education and public safety, should be a top priority that should never be cut. In the case of budget shortfalls, other programs should be sacrificed to pay for those three, he said.
When asked how the hospital board should have proceeded, since it can only control its own spending and can’t raid other departments for funds, Russell said in such a case the board should "go to the Senate and say ‘Listen, we need a transfer of funds.’"
"We’ve been doing that for over a year," Walker said after a two-hour executive session concluded the meeting. Walker credited the lawmakers with forgiving the hospital’s debt to the government, "but they didn’t and maybe they haven’t been able to provide us the capital we need."
"We told the Senators that due to the reduction in our appropriation, due to the closing of Hovensa … there is no way we continue to operate the hospital the way we had been," Walker said. "We told them 100 jobs would be affected. At no time was there any outcry from any of the senators."
Nelson said times of change are stressful, but that the path the hospital is on, with registered nurses dominant in patient treatment, is the hallmark of the most successful hospitals.
"People are understandably afraid of change," he said. "Anytime you have change you have some concern. But the people of St. Croix deserve quality health care."
Dr. Robert Centeno, the hospital’s chief medical officer, said Russell’s concern was "disingenuous," citing "letter after letter" he has written to lawmakers over the years without response.
Meanwhile Sen. Alicia "Chuckie" Hansen announced Thursday she and Sen. Carlton "Ital" Dowe were drafting legislation to eliminate the Luis Hospital board and CEO and replace them with an interim board. The legislation would also provide for the immediate rehiring of all the terminated LPNs and CNAs.
During the meeting, an LPN who lost her job Tuesday asked why there couldn’t have been more warning, or why employees weren’t given the chance to go back to school while continuing to work in order to become RNs. Vanda Alezy also wanted to know when the promised assistance for going back to school would become available.
Nelson told the applications would be taken as of Thursday, and said that the hospital’s financial crisis made it impossible to wait or give warning.
Nursing instructor Kathy Shears told the board she applauds the direction the hospital is going, but is concerned that the abrupt transition is compromising patient safety. She talked of seeing patients trying to climb out of bed or walking the halls, their robes open, not sure where they were going.
Terry Lynch, interim chief nursing officer, said the process is in a state of transition but that patient safety is the top concern.
Meanwhile, after the meeting and a two-hour executive session, the board announced that it had given Nelson a glowing review after his first year on the job. The review process included a survey in which it said the 109 responses echoed that enthusiasm.
"We are very satisfied with Mr. Nelson’s performance," Walker said. Noting that he was hired because of his experience in turning around troubled hospitals, she said, "He has accomplished many of the goals we set for him when we hired him."
She pointed to the resuscitation of the troubled hemodialysis unit and the resolution of chronic medication shortages as two examples of Nelson’s tackling difficult issues.
But though the board heartily endorsed the CEO, they said that at this time the hospital’s financial situation precludes giving him a raise, so the issue of his compensation has been deferred until the economic picture looks stronger.
