Mar. 2, 2005 – In a Senate meeting Tuesday where testifiers outnumbered committee members, officers of the Roy L. Schneider Hospital outlined the institution's goals and accomplishments and made a plea for autonomy and a more realistic budget from the government. The hospital projects a $23 million operating loss this year.
The government cut the hospital's fiscal year 2005 budget more than 17 percent, from $23.7 in FY2004 to $19.6 million in FY2005. Peter Najawicz, RLS chief financial officer told the Health, Hospitals and Human Services committee that the hospital has a $ 77.3 operating budget for FY2005, and the $23 million projected operating loss.
Rodney Miller, RLS chief executive officer, said, "We're running a $60 million operation with our hands tied behind our back." Without increased autonomy, Miller said, "We can't make any decisions."
The hospital is a semi-autonomous agency now. Under that status, it has received accreditation, enlarged its staff, added new medical programs, and almost completed the Charlotte Kimelman Cancer Institute. But Miller said it needs increased autonomy to function efficiently.
He cited the RLS graduate nursing program as a case point. The program has been successful he said, except that they can't retain the nurses. "After they graduate, they say they are sorry, but they have to go to the states where they can get employee retirement benefits." Under autonomy the hospital could offer those benefits. "We get the best and the brightest," Miller said, "and we're failing them
He said 30 nurses are now going to the mainland. The program has cut back on the traveling nurses program, saving the hospital $1.5 million a year, however the graduating nurses cannot get hired by the government, so they don't get the benefits.
Sen. Louis Hill was adamant in his support of RLS autonomy. "I support full autonomy," he said. "We gave UVI autonomy – we allocate money to them, and they make their own decisions. I don't see how a decision like this could hurt the government. I hope we see it this year, and I will be an activist for this issue."
Hill's statement got a round of applause from a group of American Association of Retired Persons members in the chambers, and a sharp reprimand from Committee Chair Usie Richards, who pointed out "this isn't a ball game."
Another thorny problem is the government owes $6 million to the hospital and the hospital owes $9 million to the government. Since last September the hospital and the Department of Finance have been at odds over the issue. Finance Commissioner Bernice Turnbull has said the hospital cannot offset its debt by what the government owes. (See "Finance Commissioner: Hospitals Had Been Warned").
The hospital is supposed to put money in the Hospital Revolving Fund to pay for its employees. The hospital has been catching up with $400,000 monthly payments, Miller said, but the government isn't paying its debt to the hospital. He said 90 percent of the $6 million debt comes from the Departments of Health and Justice. The hospital provides medical care for prisoners and foots the bill for the Health Department's utility bills, and patients referred by the DOH.
Miller said the government's priorities should be health and education The massive budget cuts the government has made to the hospital don't reflect that. "Either we're going to have to stop investing in the hospital, or they are going to have to give us some support," Miller said. "We've increased revenues, but we put it all back into the hospital."
Miller said he has met with the government's fiscal officers as recently as last week.
Senate President Lorraine Berry said it looks as though the time for full autonomy has come. Considering the hospital's current budget, Berry said, "There are financial problems; we need to spend more on health care. We have to have a reality check."
Right now, Miller said, the hospital is looking at having to lay off 43 employees. The hospital has, through attrition, 113 vacancies, Miller said, 90 clinical positions and 23 administrative posts.
Miller noted that the hospital is current on its Water and Power bill and gross receipts taxes. The government is WAPA's largest customer and has the most outstanding balance.
Collections are a chronic problem for the hospital. "Schneider is the safety net for the island's health care," Miller said.
Uncompensated care is another problem. By law, the hospital cannot turn anyone away. The cost of providing care to the indigent and uninsured cost the hospital $24 million.
Najawicz told the senators, "If we should be lucky enough to collect all bills we would get $54 million. He said the hospital has two collection agencies to try and collect the outstanding bills.
The Charlotte Kimelman Cancer Institute is scheduled to be completed in July, Miller said. After that, it will need about $7 million for equipment and staffing, and it will still need government support. It won't be self-sustaining for more than three years, Miller said.
Without that amount, Miller said, the facility cannot open. The hospital has been very successful in garnering private-sector support. Last week it received $100,000 from the Rotary Club of St. Thomas. "However," Miller said, "we have yet to receive monies appropriated by the 24th Legislature to operate and staff the center."
Berry noted that when the tobacco funds that paid for the institute were disbursed, it was established that the hospital would have to come back to the Senate for additional funding.
Meantime, Miller listed some of the hospital's accomplishments and goals. RLS has added new specialists in podiatry, neurosurgery, plastic surgery and interventional cardiology. It also has assisted veterans by providing blood-drawing services in conjunction with the Veterans' Medical Center in Puerto Rico.
Goals for this year include seeking increased autonomy, positioning the hospital as the clinical market leader, and focusing on operating highly competitive inpatient and outpatient ambulatory surgical services. Such services would be highly efficient for surgeons and customer-focused for patients and families, according to Miller.
Through the almost five hour hearing, Richards kept prodding the hospital officers about whether RLS had obtained a Certificate of Need for a piece of cardiac equipment it purchased. Richards has indicated that he thinks the purchase would put RLS in competition with the Cardiac Care Center of Excellence at the Juan Luis Hospital on St. Croix.
Last month, Richards sent a letter to Gov. Charles W. Turnbull and Health Commissioner Darlene Carty wondering if the hospital should have obtained a Certificate of Need for the equipment.
Under questioning by Richards Tuesday, Najawicz said the RLS board had given the hospital permission to purchase the equipment, which cost $950,000. The law states that any purchase of more than $100,000, requires a Certificate of Need.
Miller reiterated what he has said publically several times in several different venues. " I want to make it clear that the Roy L. Schneider Hospital has no plans to build a cardiac center on St. Thomas. We fully support the efforts of the Juan Luis Hospital to start a cardiac care facility on St. Croix."
Miller explained the hospital is purchasing equipment to treat heart patients in emergency situations where time is of the essence. " If you have a heart attack, every minute counts," he said.
Guidelines from the American Heart Association and the American and European Colleges of Cardiology state that 90 minutes is the time a surgeon has to open up a blocked artery. It takes about two hours to transport a patient to St. Croix.
Dr. Roy D. Flood, Schneider Hospital'
;s leading cardiologist, emphasized Miller's point last week. "One would prefer not to transfer a patient with a heart problem. We would be losing valuable time, and time is muscle. We would have a higher mortality rate." (See "Hospital Officials Say No Cardiac Center on St. Thomas").
Miller, Amos Carty, RLS chief operating officer and general counsel, and June Adams, RLS board chairman told Richards repeatedly that they could not comment on Certificate of Need issues because the hospital filed a petition for a writ of review in Superior Court in January asking for a judicial review of the Certificate of Need process.
Richards strongly objected to the hospital's stance. "I don't take lightly the posture taken in this particular issue regarding the V. I. Code. It is the responsibility of this body to make sure laws are complied with," he said. " Sometimes we, as elected officials, have the impression that administrators don't give a damn and don't need any follow up."
Miller attempted to explain further the hospital's position, but Richards wouldn't allow him to finish his statement.
Richards alluded to a meeting he had arranged between official of both hospitals to discuss the issue of the equipment, what is called a cath lab. He said neither hospital had gotten back to him on the discussion.
Miller said, "We met on a Monday…..," after which Richards interrupted him. " I am familiar with people dancing around issues," Richards said, "and you're saying you don't choose…"
"I'm saying let me answer so people will understand," Miller said. Richards retorted, "I am saying to you my records show that neither you nor Calliste [Gregory Calliste, Juan Luis Hospital CEO] got back to us. I am going to complete the meeting at this time."
Richards did allow committee members Sens. Craig Barshinger and Neville James, who arrived late, a few minutes for questions before formally adjourning the meeting.
Committee members Sens. Barshinger, Berry, Liston Davis, Pedro Encarnacion, James and Richards attended the meeting. Sen. Norman Jn Baptiste was excused. Non-committee member Hill also attended.
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