75¢169th YEARUSVI WEDNESDAY, NOVEMBER 6, 2013, NO. 257

Puerto Rico: Urban estuary — Page 6

Mall shooterWanted to harm self — Page 14

U.S. elections: Coast to coast — Page 10

TOM EADERBureau Chief

ST. CROIX — The Legislature willhold an emergency hearing at 9a.m. Friday on St. Croix to addressongoing issues in the Gov. Juan F.

Luis Hospital and Medical Center,according to Sen. Clarence Payne III,chair of Committee on Health, Hos-pitals, Human Services and Veter-an’s Affairs.

Senators will have an opportuni-ty during the hearing to not only

question hospital administratorsabout the state of JFL, but alsohear from government health offi-cials about the state of the territo-ry’s entire health system, Paynesaid. He said he has invited hospi-tal administrators and officials from

the Virgin Islands Department ofHealth and VI Department ofHuman Services. Payne said DOHis supposed to be integral in mon-itoring and certifying the hospital,while DHS oversees the Medicaidprogram.

Payne said the Legislature is con-cerned about the issues at JFLbecause the hospital is the gate-keeper of the territory’s health caresystem. He said proper care starts

JFL, PAGE 4

Medicaid dollars threatenedSenate to hold emergency hearing Friday to address ongoing JFL issues

PAGE 4 The Avis WEDNESDAY, NOVEMBER 6, 2013

JFL:FROM PAGE 1at the hospital, so the senatorsmust ensure the players involvedare working together so there isn’tany room for mistakes.

“It is where the health of thecommunity has to be treated,”Payne said. “It’s where the healthof the community has to be evalu-ated, properly screened.”

Payne invited a consultant withthe Centers for Medicare and Med-icaid Services who is assessing thehospital to testify at the hearingas well, but he said the consultantwill probably decline. He did, how-ever, get an opportunity to speakwith a CMS representative duringa teleconference last week withother senators, including Sens.Nereida Rivera-O’Reilly, TerrenceNelson and Alicia Hansen, as wellas staff members from the offices ofmany other senators.CMS compliance:

CMS said on Jan. 25 that JFLfailed to achieve compliance. CMSapproved a plan on March 4 tocorrect the compliance issues. CMSreleased a full report of non-com-pliance in February that foundinadequate infection control pro-cedures, a lack of communicationthat may have led to a drug over-dose, lack of peer review practicesin the operating room and manyother deficiencies at JFL, accordingto a 79-page evaluation based on avisit in September 2012.

Payne said CMS now is at itswit’s end.

“They speak of the hospital is atrisk of losing its accreditationbecause of its inability to providecompetent, safe, quality care andservices to the residents on theisland of St. Croix,” Payne said.

Payne said CMS officials spokewith Gov. John de Jongh Jr. andhis team and Delegate to CongressDonna Christensen before talkingwith the senators.

Jean Greaux, GovernmentHouse spokesperson, said the gov-ernor is concerned about the stateof the territory’s health care system,particularly JFL.

“The territorial hospital boardwill continue a meeting later thisweek to review recent findings ofCMS and to chart a plan of cor-rective action,” Greaux said. “Thegovernor will await the final out-come of that meeting and a Senatecommittee hearing on Friday beforemaking public his administration'snext steps.”

Greaux said the governor likelywill be meeting with the leadershipof both of the territory's hospitalsto discuss their challengesand develop solutions. He said deJongh will be making a nominationto the governing board of the St.Croix hospital.

Christensen said CMS is con-cerned with the hospital’s finan-cial situation, but more concernedwith patient care. She said as badas things are now at the hospital,it will be 10 times worse if the hos-pital loses its CMS certificationbecause Medicare and Medicaiddollars (totaling 40 percent of thehospital’s revenue) would stop com-ing into the hospital. She said the

territory’s entire health care systemneeds an overhaul.

“We really need to look at theentire system,” Christensen said.“There have been some attempts tofix it here and there, but if we don’tdo the entire system we won’tachieve what we need to.”

Jeff Nelson, former JFL chiefexecutive officer, told the SenateCommittee on Government Oper-ations, Energy and Veteran's Affairsin August 2012 that if JFL does notmeet the conditions of CMS, "JFLwill close from the lack of Medicareand Medicaid payments starting inFebruary."

Nelson warned of closure againin September 2012. He said thehospital would be forced to close ifit didn’t get a cash infusion toaddress the CMS concerns.

“To serve any level of care, JFL isrequired to meet all of Medicare’s23 Conditions for Participation byFebruary and to have cash to paythe hospital’s bills now,” Nelsontold the Senate Finance Committeein September 2012. “Otherwise,JFL will close. We truly meanclose.”

By failing to exceed Medicare’sconditions, Nelson told senatorsthat the hospital will not be paid forservices rendered to Medicare andMedicaid patients after February2013.

“Without these revenues, JFLwill not be able to pay employeesand suppliers,” he said. “In turn,there will be no surgeries, no lab-oratory, no ER, no cafeteria, nojobs.”

Payne said the Legislature wasthe last entity CMS needed to speakwith regarding the condition of thehospital’s standing with CMS. Hesaid CMS stated that it’s the Leg-islature’s fiduciary responsibilityto do what needs to be done to getJFL in the condition it’s supposedto be.

CMS reported that patients weregiven wrong medicine, the hospitalhas a shortage of medicine for dial-ysis patients and the hospital haspoor accountability for its finan-cial standing, Payne said.

“CMS has made some verystrong allegations of gross mis-conduct by doctors getting intoalmost fisticuffs in operatingrooms,” Payne said. “CMS has stat-ed that the staff and the executiveadministration team are constant-ly at odds. CMS reported that thestaffing at the hospital is woefullyinadequate and that too muchmoney is being spent on overhead— on salaries of the CEO, the COO,the CFO.”

Payne said he learned there wasa time last year when JFL had 10vice presidents on the job, addinghe now believes the number hasbeen reduced to six or seven.

A JFL employee, who declined toprovide their name out of fear of ter-mination, said it’s common for hos-pital employees to be given addi-tional responsibilities to completeduring their work day. The sourcesaid part of the reason is becausethe hospital is loaded up with man-agers and directors.

“We need the people on the front-line to be employed, not everyoneupstairs in their office,” the sourcesaid.

Focusing on how the hospital isloaded up with managers anddirectors, the source said theHuman Resources department istop heavy with at least five direc-tors.

Payne said CMS reported thatthey pay JFL twice the nationalaverage per discharge.

“They pay Luis $10,000 per dis-charge and the national average is$5,000 per discharge,” he said,adding JFL is still in dire need offinancial assistance.Financial constraints:

While the hospital is adequatelystaffed with administrators, CMSreported that JFL has a lack offinancial resources and lacks theability to keep the necessary sup-plies and medicine available inaddition to having problems withnot paying vendors and contrac-tors, according to Payne.

An audit conducted at JFL fromMay 9, 2011, to Dec. 31, 2011, bythe U.S. Department of the Interi-or, Office of the Inspector Generalrevealed that the St. Croix hospitalhas a long-standing financial deficitand has reported annual operatinglosses averaging $35 million fromfiscal year 2005 to fiscal year 2010.The hospital is $42 million in debt.

The amount of money the hos-pital receives from the Legislatureeach year has declined by nearly$13 million over the past six years.The hospital received $31,988,278in fiscal year 2008, $26,412,682 infiscal year 2009, $26,979,851 in fis-cal year 2010, $23,766,266 in fis-cal year 2011, $19,800,000 in fis-cal year 2012, $18,200,000 in fiscalyear 2013 and $19,253,114 in fis-cal year 2014.

Christensen said the hospitalowes CMS about $700,000, addingthat half must be paid by the endof the year.

“Everybody wants this hospital towork for the people that it needs toserve, but I just don’t see any wayto do it without an infusion ofmoney,” she said.

Even though the hospital has alack of financial resources, doctorsand nurses are still treatingpatients and other hospital employ-ees are getting their jobs done.

Dr. Anne Treasure, an OB/GYNwith privileges at the hospital, saidthere still is decent care at the hos-pital, but they don’t have enoughmoney to fulfill their mandate ofserving those who cannot pay, or tomeet requirements imposed by reg-ulatory agencies. She said reportsof the problems are demoralizingstaff because most are workingharder with fewer resources. Thebottom line, she said, is that thegovernment is not providing thehospital with the money it needs tofunction and grow. Treasure saidthere are many unique problemsimpacting the territory, including aMedicaid cap and a relatively smallinsured population.

“We have fewer insured people,but people on this island have to get

care and I’m not going to stop untilit’s as good as it can be,” she said.

Treasure isn’t the only employeeto talk about how the hospital’semployees are providing decentcare despite the financial con-straints, either.

“The hospital’s running good,”Crystal George, a pharmacy tech-nician, said. “We’re short of money,but the hospital’s running good.”

In order to perform her dailyduties, George, who has workedin the hospital as a pharmacy tech-nician for two years, said the phar-macy orders priority medications itreally needs to treat patients ratherthan stocking up medications thataren’t commonly prescribed. Shesaid she likes helping people whileworking in her role at the hospital.

“I love my job, and the environ-ment,” she said about working atthe hospital.

While George said she has beenable to do her job despite the hos-pital’s fiscal constraints, theemployee who spoke on the condi-tion of anonymity said the fact thatthe hospital is strapped for cash ishaving a negative impact on dailywork.

“I lack the necessary resources todo my job effectively, and they knowthis,” the source said, adding thehospital lacks an efficient com-puter system and there are timeswhen the fax and copy machinesdon’t work. “It makes it hard to doyour job.”

The source, who has worked atthe hospital for several years andis a long-time resident of St. Croix,said there are days when the hos-pital doesn’t have paper to printon or garbage bags for the trashcans. The source said the hospitalis divided and an unpleasant placeto work.

“You’re scared to say what yourtrue feelings are,” the source said.“You’re scared to have an opinion;you’re scared to take a stance onanything because you just don’tknow how it’s gonna go across.”

In one instance, the source saidjust last week hospital officials helda meeting to urge employees to callup senators and the media to tellthem the things printed about thehospital in The Avis on Oct. 29were not true, including allegationsof vehicular vandalism. The sourcesaid it was an inappropriate thingto ask of the employees.

“I can’t in good conscience tellanyone it’s not true because it istrue, because I saw the letter thatwas written to (Dr.) Chris Seaver,”the source said. “He showed mepictures of his Jeep spray paintedin orange. The CMS consultant’scar; that’s not a lie. Why should welie?”

The source said hospital employ-ees have to watch what they sayevery day because it could result inthem being terminated.

“We need our jobs and we’rescared to death, but at the sametime we’re not willing to go outthere and lie to people and say TheAvis printed all that stuff andthey’re just pure lies — no they’renot,” the source said.

A Special Report on the trou-bled Gov. Juan F. Luis Hospi-tal and Medical Center pub-lished in The Avis on Oct. 29revealed the following:

• No vascular surgeon at thehospital since Oct. 18. Thismeans patients with ailmentsimpacting the circulatory sys-tem, like gunshot wounds,dialysis emergencies oraneurisms, may be treated bya trauma surgeon without spe-cialized training in vascularsurgeries, have to wait for avascular surgeon to fly overfrom St. Thomas or have to beairlifted off island for care.

• Vascular surgeon Dr.Christopher Seaver resignedafter allegedly finding spraypainted on his car “You’re apiece of s---,” finding deadchickens on his car with a notethat read “We’re watching you,”and had his salary cut.

• General surgeon Dr. AlbertTitus was suspended lastweekend although hospital offi-cials are not confirming thecause.

• The operating room is over-run with tension and disputesamong physicians and staff.

• A Centers for Medicare andMedicaid consultant foundspray painted on her car "YouAre Next" after a dispute in theoperating room.

• The hospital is dangerouslyclose to losing CMS compli-ance, which could force theclosure of the hospital.

• Physicians are alleging thatlocal senators are influencingdecisions at the hospital tobenefit their friends.

• Physicians are alleging thatthe Association of HospitalEmployed Physicians union istrying to block reform that isnecessary to make the hospi-tal financially viable. The trendnationally is for hospitals, par-ticularly in small areas, to con-vert to a hospital system thatdirectly employs physicianswith productivity clauses,rather than the system at JFLwhere hospital physicians areon contract and have privatepractices.

The lack of a functioning St.Croix hospital board is makinga difficult situation worse.

The territorial hospital boarddid not re-certify Titus duringa meeting last Thursday.

JFL is in the process of hir-ing five operating room nurses,two surgical technicians andthree certified nurse anesthe-siologists.

Hospitalreport

findings