A regular Source feature, Undercurrents explores issues, ideas and events developing beneath the surface in the Virgin Islands community. This is the second in a set of stories examining health care services.
It’s virtually impossible to get a professional opinion of the territory’s health care system that is not qualified. It seems there’s always a "but."
One of the most positive assessments comes from Dr. George Rosenberg, best known for his radiology services but also the president and CEO of V.I. Equicare, a professional organization representing most of the physicians in the territory. He is also on the credentials committee for Roy L. Schneider regional Medical Center on St. Thomas.
He sees vast improvements in both the quality and quantity of services offered in the territory over what was available 20 or 30 years ago. At one time there was no orthopedic surgeon, only one ear, nose and throat specialist, no cardiologist.
“It’s a different world,” Rosenberg said. “We have nothing to be ashamed of in the quality of our medical community … I would challenge anyone to find, for a community our size, (a health care system) that provides such a wide, competent range of services. The services we provide are state of the art.”
One reason things have improved is because through Equicare doctors have been able to negotiate standardized rates with insurance companies; that stability has drawn more physicians to the territory, especially in specialized services that were not available in the past. But Rosenberg admits there are still some holes.
Health Commissioner Michelle Davis also is aware of gaps.
“We do lack a proportion of certain specialties,” she said.
There are few cardiologists and psychologists, no full-time pulmonologist, no neurosurgeon.
Additionally, Davis said, like many jurisdictions across the country, the territory could use more practitioners of internal medicine and more nurses.
Critics charge that the territory is losing potential revenue because residents are forced to go off island for specialized treatments – or because they choose to go stateside for other reasons.
At a recent legislative hearing, Sen. Nellie O’Reilly asserted, “More than $30 million is leaving this territory for health care.”
The assessment of the Virgin Island’s health care delivery system is a favorite topic for Dr. Cora Christian, a former assistant commission of Health and the first woman from the Virgin Islands to earn a medical degree. In fact, she’s writing a book on the history of medical care in the territory since it has been under the U.S. flag, starting with the time of the transition from Navy to civilian governors.
“At one time we were considered one of the best health care systems in the nation – documented,” Christian said. “Part of the decline really sits on the doorstep of the federal government.”
In particular, she cites the federal cap on Medicare funding for the territories.
“Already we’re handicapped, and we have public hospitals,” she said.
The local government can’t turn patients away, but it can’t afford to treat them for free either. It’s a long-standing and common complaint.
“CMS (Center for Medicare and Medicaid Services) fees assigned to the USVI are unrealistically low,” Dynel Soto, V.I. Equicare director, said at a May hearing sponsored by the Legislature’s Committee on Health, Hospitals and Human Services.
The point was made by several health professionals at the hearing. Meanwhile, representatives of the St. Thomas and St. Croix public hospitals testified that CMS patients make up approximately 70 percent and 60 percent, respectively, of patients at the hospitals.
The Affordable Care Act could have put the Virgin Islands back on equal footing, Christian said, but in what she labels “geographic discrimination,” it was left out of the ACA.
Funding challenges are just one of the issues plaguing the V.I. health care system.
More immediate concerns
Davis, who is new to the system, has enough to concern her without such distractions. When she took over as commissioner in March, the Zika virus was just getting a foot hold in the islands.
Trained as an epidemiologist and with a background with the federal government – she is actually on loan to the territory from the U.S. Health and Human Services Department – Davis has tapped into resources at the Center for Disease Control to mount a massive public awareness campaign and to address vector control.
At the beginning of this month, with the count of confirmed cases in the territory at 79 and growing, the department had conducted 235 presentations about the dangers of the virus and how best to avoid getting it or transmitting it. Health is offering free testing at various locations. And, in an effort to protect against the birth defects associated with the virus, is offering give-aways to pregnant women, including mosquito netting and repellant to deter the most common form of transmission, as well as condoms, to address the possibility of infection via sexual contact.
The response from the V.I. population appears to be vastly different from that in nearby Puerto Rico where, according to national reports, there is considerable skepticism about the seriousness of Zika and resistance to federal attempts to control its spread. There have been accusations that the federal government planned aerial spraying of a heavy-duty insecticide, Naled, despite local opposition.
In contrast, Nykole Tyson, director of public relations for Health, responded to an email inquiry that “We have found that people are not only very open, responsive and willing to learn about Zika so that they can make informed decisions about how to protect themselves and their families, but they are also enthusiastic to implement Zika prevention methods and change behaviors if need be.”
As for Naled, Tyson said because 80 percent of V.I. households rely on cisterns for drinking water, the Health Department never considered its use. Instead, the department “decided to conduct all our vector control and larvicide treatment by hand so that we can prevent any potable water contamination. This is the same reason we have not advocated the use of aerial spraying or truck fogging.”
Other pressing problems
While Zika is currently center stage, Davis said long term, the most serious health problem facing the Virgin Islands is obesity. The causes are obvious: poor nutrition, lack of physical activity, diets heavy with salt and fried foods and skimpy on fruits and vegetables.
Hypertension and heart disease are also at high levels.
The entire population is not unhealthy, she said, “but we have a portion that is very unhealthy.”
Davis said she believes prevention needs to be more of a priority, and health care providers and government officials need to build more of a collaborative relationship.
“If we were all working together on the same page, we would have a better system,” she said.
As with any service, “there’s always room for improvement,” she said. But “overall, we have a good health care system.”
(Next: Regulating health care.)