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WEDNESDAY, NOVEMBER 6, 2013, NO. 257
Medicaid dollars threatened Senate to hold emergency hearing Friday to address ongoing JFL issues TOM EADER Bureau Chief ST. CROIX — The Legislature will hold an emergency hearing at 9 a.m. Friday on St. Croix to address ongoing issues in the Gov. Juan F.
Luis Hospital and Medical Center, according to Sen. Clarence Payne III, chair of Committee on Health, Hospitals, Human Services and Veteran’s Affairs. Senators will have an opportunity during the hearing to not only
question hospital administrators about the state of JFL, but also hear from government health officials about the state of the territory’s entire health system, Payne said. He said he has invited hospital administrators and officials from
the Virgin Islands Department of Health and VI Department of Human Services. Payne said DOH is supposed to be integral in monitoring and certifying the hospital, while DHS oversees the Medicaid program.
Payne said the Legislature is concerned about the issues at JFL because the hospital is the gatekeeper of the territory’s health care system. He said proper care starts
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WEDNESDAY, NOVEMBER 6, 2013
JFL: FROM PAGE 1 at the hospital, so the senators must ensure the players involved are working together so there isn’t any room for mistakes. “It is where the health of the community has to be treated,” Payne said. “It’s where the health of the community has to be evaluated, properly screened.” Payne invited a consultant with the Centers for Medicare and Medicaid Services who is assessing the hospital to testify at the hearing as well, but he said the consultant will probably decline. He did, however, get an opportunity to speak with a CMS representative during a teleconference last week with other senators, including Sens. Nereida Rivera-O’Reilly, Terrence Nelson and Alicia Hansen, as well as staff members from the offices of many other senators.
CMS compliance: CMS said on Jan. 25 that JFL failed to achieve compliance. CMS approved a plan on March 4 to correct the compliance issues. CMS released a full report of non-compliance in February that found inadequate infection control procedures, a lack of communication that may have led to a drug overdose, lack of peer review practices in the operating room and many other deficiencies at JFL, according to a 79-page evaluation based on a visit in September 2012. Payne said CMS now is at its wit’s end. “They speak of the hospital is at risk of losing its accreditation because of its inability to provide competent, safe, quality care and services to the residents on the island of St. Croix,” Payne said. Payne said CMS officials spoke with Gov. John de Jongh Jr. and his team and Delegate to Congress Donna Christensen before talking with the senators. Jean Greaux, Government House spokesperson, said the governor is concerned about the state of the territory’s health care system, particularly JFL. “The territorial hospital board will continue a meeting later this week to review recent findings of CMS and to chart a plan of corrective action,” Greaux said. “The governor will await the final outcome of that meeting and a Senate committee hearing on Friday before making public his administration's next steps.” Greaux said the governor likely will be meeting with the leadership of both of the territory's hospitals to discuss their challenges and develop solutions. He said de Jongh will be making a nomination to the governing board of the St. Croix hospital. Christensen said CMS is concerned with the hospital’s financial situation, but more concerned with patient care. She said as bad as things are now at the hospital, it will be 10 times worse if the hospital loses its CMS certification because Medicare and Medicaid dollars (totaling 40 percent of the hospital’s revenue) would stop coming into the hospital. She said the
territory’s entire health care system needs an overhaul. “We really need to look at the entire system,” Christensen said. “There have been some attempts to fix it here and there, but if we don’t do the entire system we won’t achieve what we need to.” Jeff Nelson, former JFL chief executive officer, told the Senate Committee on Government Operations, Energy and Veteran's Affairs in August 2012 that if JFL does not meet the conditions of CMS, "JFL will close from the lack of Medicare and Medicaid payments starting in February." Nelson warned of closure again in September 2012. He said the hospital would be forced to close if it didn’t get a cash infusion to address the CMS concerns. “To serve any level of care, JFL is required to meet all of Medicare’s 23 Conditions for Participation by February and to have cash to pay the hospital’s bills now,” Nelson told the Senate Finance Committee in September 2012. “Otherwise, JFL will close. We truly mean close.” By failing to exceed Medicare’s conditions, Nelson told senators that the hospital will not be paid for services rendered to Medicare and Medicaid patients after February 2013. “Without these revenues, JFL will not be able to pay employees and suppliers,” he said. “In turn, there will be no surgeries, no laboratory, no ER, no cafeteria, no jobs.” Payne said the Legislature was the last entity CMS needed to speak with regarding the condition of the hospital’s standing with CMS. He said CMS stated that it’s the Legislature’s fiduciary responsibility to do what needs to be done to get JFL in the condition it’s supposed to be. CMS reported that patients were given wrong medicine, the hospital has a shortage of medicine for dialysis patients and the hospital has poor accountability for its financial standing, Payne said. “CMS has made some very strong allegations of gross misconduct by doctors getting into almost fisticuffs in operating rooms,” Payne said. “CMS has stated that the staff and the executive administration team are constantly at odds. CMS reported that the staffing at the hospital is woefully inadequate and that too much money is being spent on overhead — on salaries of the CEO, the COO, the CFO.” Payne said he learned there was a time last year when JFL had 10 vice presidents on the job, adding he now believes the number has been reduced to six or seven. A JFL employee, who declined to provide their name out of fear of termination, said it’s common for hospital employees to be given additional responsibilities to complete during their work day. The source said part of the reason is because the hospital is loaded up with managers and directors.
“We need the people on the frontline to be employed, not everyone upstairs in their office,” the source said. Focusing on how the hospital is loaded up with managers and directors, the source said the Human Resources department is top heavy with at least five directors. Payne said CMS reported that they pay JFL twice the national average per discharge. “They pay Luis $10,000 per discharge and the national average is $5,000 per discharge,” he said, adding JFL is still in dire need of financial assistance.
Financial constraints: While the hospital is adequately staffed with administrators, CMS reported that JFL has a lack of financial resources and lacks the ability to keep the necessary supplies and medicine available in addition to having problems with not paying vendors and contractors, according to Payne. An audit conducted at JFL from May 9, 2011, to Dec. 31, 2011, by the U.S. Department of the Interior, Office of the Inspector General revealed that the St. Croix hospital has a long-standing financial deficit and has reported annual operating losses averaging $35 million from fiscal year 2005 to fiscal year 2010. The hospital is $42 million in debt. The amount of money the hospital receives from the Legislature each year has declined by nearly $13 million over the past six years. The hospital received $31,988,278 in fiscal year 2008, $26,412,682 in fiscal year 2009, $26,979,851 in fiscal year 2010, $23,766,266 in fiscal year 2011, $19,800,000 in fiscal year 2012, $18,200,000 in fiscal year 2013 and $19,253,114 in fiscal year 2014. Christensen said the hospital owes CMS about $700,000, adding that half must be paid by the end of the year. “Everybody wants this hospital to work for the people that it needs to serve, but I just don’t see any way to do it without an infusion of money,” she said. Even though the hospital has a lack of financial resources, doctors and nurses are still treating patients and other hospital employees are getting their jobs done. Dr. Anne Treasure, an OB/GYN with privileges at the hospital, said there still is decent care at the hospital, but they don’t have enough money to fulfill their mandate of serving those who cannot pay, or to meet requirements imposed by regulatory agencies. She said reports of the problems are demoralizing staff because most are working harder with fewer resources. The bottom line, she said, is that the government is not providing the hospital with the money it needs to function and grow. Treasure said there are many unique problems impacting the territory, including a Medicaid cap and a relatively small insured population. “We have fewer insured people, but people on this island have to get
care and I’m not going to stop until it’s as good as it can be,” she said. Treasure isn’t the only employee to talk about how the hospital’s employees are providing decent care despite the financial constraints, either. “The hospital’s running good,” Crystal George, a pharmacy technician, said. “We’re short of money, but the hospital’s running good.” In order to perform her daily duties, George, who has worked in the hospital as a pharmacy technician for two years, said the pharmacy orders priority medications it really needs to treat patients rather than stocking up medications that aren’t commonly prescribed. She said she likes helping people while working in her role at the hospital. “I love my job, and the environment,” she said about working at the hospital. While George said she has been able to do her job despite the hospital’s fiscal constraints, the employee who spoke on the condition of anonymity said the fact that the hospital is strapped for cash is having a negative impact on daily work. “I lack the necessary resources to do my job effectively, and they know this,” the source said, adding the hospital lacks an efficient computer system and there are times when the fax and copy machines don’t work. “It makes it hard to do your job.” The source, who has worked at the hospital for several years and is a long-time resident of St. Croix, said there are days when the hospital doesn’t have paper to print on or garbage bags for the trash cans. The source said the hospital is divided and an unpleasant place to work. “You’re scared to say what your true feelings are,” the source said. “You’re scared to have an opinion; you’re scared to take a stance on anything because you just don’t know how it’s gonna go across.” In one instance, the source said just last week hospital officials held a meeting to urge employees to call up senators and the media to tell them the things printed about the hospital in The Avis on Oct. 29 were not true, including allegations of vehicular vandalism. The source said it was an inappropriate thing to ask of the employees. “I can’t in good conscience tell anyone it’s not true because it is true, because I saw the letter that was written to (Dr.) Chris Seaver,” the source said. “He showed me pictures of his Jeep spray painted in orange. The CMS consultant’s car; that’s not a lie. Why should we lie?” The source said hospital employees have to watch what they say every day because it could result in them being terminated. “We need our jobs and we’re scared to death, but at the same time we’re not willing to go out there and lie to people and say The Avis printed all that stuff and they’re just pure lies — no they’re not,” the source said.
Hospital report findings A Special Report on the troubled Gov. Juan F. Luis Hospital and Medical Center published in The Avis on Oct. 29 revealed the following: • No vascular surgeon at the hospital since Oct. 18. This means patients with ailments impacting the circulatory system, like gunshot wounds, dialysis emergencies or aneurisms, may be treated by a trauma surgeon without specialized training in vascular surgeries, have to wait for a vascular surgeon to fly over from St. Thomas or have to be airlifted off island for care. • Vascular surgeon Dr. Christopher Seaver resigned after allegedly finding spray painted on his car “You’re a piece of s---,” finding dead chickens on his car with a note that read “We’re watching you,” and had his salary cut. • General surgeon Dr. Albert Titus was suspended last weekend although hospital officials are not confirming the cause. • The operating room is overrun with tension and disputes among physicians and staff. • A Centers for Medicare and Medicaid consultant found spray painted on her car "You Are Next" after a dispute in the operating room. • The hospital is dangerously close to losing CMS compliance, which could force the closure of the hospital. • Physicians are alleging that local senators are influencing decisions at the hospital to benefit their friends. • Physicians are alleging that the Association of Hospital Employed Physicians union is trying to block reform that is necessary to make the hospital financially viable. The trend nationally is for hospitals, particularly in small areas, to convert to a hospital system that directly employs physicians with productivity clauses, rather than the system at JFL where hospital physicians are on contract and have private practices. The lack of a functioning St. Croix hospital board is making a difficult situation worse. The territorial hospital board did not re-certify Titus during a meeting last Thursday. JFL is in the process of hiring five operating room nurses, two surgical technicians and three certified nurse anesthesiologists.