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Hearings Show Deep Problems in Health Department

August 9, 2005 – While Health Department representatives seemed optimistic about progress made in the past year – and optimistic about their $56.7 million budget request — testimony given by Health Commissioner Darlene Carty at finance hearings Tuesday gave the impression that there are still many areas which need to be corrected.
The lack of an official office space in the St. Thomas-St. John district, for example, has led to "organizational ineffectiveness, little or no accountability and ownership, low morale, lack of an adequate decision-making process, inadequate centralization of facilities, insufficient staffing and the absence of cross training and appropriate supervision" within the department, Carty said.
While Carty did state that a four-phase plan is being implemented to address this issue, an evaluation process for the proposed plan will take another year, keeping anything from being fully enforced.
Carty added that officials are designing a plan to merge the Health Department for the St. Thomas-St. John district with the Department of Human Resources — a move which many senators disapproved. However, since a split has occurred between the department and the hospitals around the territory, Carty emphasized that the proposed merger is critical in the creation of a "viable public health agency."
"It is necessary for us to implement several cost-saving measures, increase our revenue collection and reduce our accounts receivable," Carty said. "Thus, in accordance with the law, we support the merger of the Department of Health with the Department of Human Services and ask that the legislature identify funds to conduct a feasibility study on the benefits of the merger."
Sen. Terrence "Positive" Nelson stated that such a merger would be a "mistake."
"It would be more efficient if the department were to merge back with the hospitals," he said. "It just seems like hospitals should be at the core of a health department."
Carty explained why that would be difficult: "It's harder for the department to regulate itself when the hospitals are involved," she said.
On the topic of STD/HIV and AIDS Drug Assistance programs, Carty acknowledged that the department is directly responsible for the delay in using federal funds to purchase HIV medications. While Carty added that no local money has been budgeted for this purpose, she also said that the department has no problem with receiving grant funds from the federal government.
The rising number of dengue fever cases was also on the tip of everyone's tongue on Tuesday — especially from St. Croix Sens. Juan Figueroa-Serville and Norman Jn Baptiste.
"The area of William's Delight on St. Croix was identified as one of the dengue fever hotspots according to your department… Setting aside the issue of stagnant water collecting in tires, I believe that there is another factor contributing to the rise of dengue in the area," Jn Baptiste said. "There is a road that leads from Estate Diamond to the back of William's Delight. Because it is used so infrequently, residents have taken to dumping a whole lot of garbage along there. These things, like old refrigerators, are also collecting water and forming breeding grounds for mosquitoes."
Jn Baptiste added that due to recent construction in William's Delight, the roadway is also home to a number of open cisterns and a gut, into which water runs, collects and stagnates.
While Carty did not comment much on that particular problem, she did say the department has been working on plans to begin combating the illness and to bring the number of dengue cases down.
"The department is tracking the significant increase in suspected cases. We are alarmed because most of the cases that have been laboratory confirmed show that the affected persons had dengue before, and that a second infection is more serious," Carty said. "So, the department has actively re-implemented fogging and larvaciding throughout St. Croix, St. Thomas, St. John and Water Island, to include schools and other high-risk areas."
Additional testimony by Carty revealed that fogging is not the most effective way to eliminate the mosquitoes that carry dengue fever. "We are also increasing our staff training, and introducing year-round dengue fever education activities in schools…as well as increasing our communication to the public."
There are presently 48 confirmed dengue cases within the territory, and there is no cure for the illness. Health representatives acknowledged that several patients have either voluntarily left the V.I. for outside care or were referred to facilities on the mainland or Puerto Rico.
"I'm sorely disappointed in what's going on within this department," said Sen. Usie R. Richards, the Health Committee chair. "You guys don't seem to be getting anything done. Your priorities aren't straight. When you came before the Legislature for confirmation [as commissioner] Ms. Carty, I voted for you because I thought that you could do the best job in rectifying the affairs of a staggering department. But I have not as yet seen the fruits of my decision."
An overall budget of $13.1 million — including $7.4 million in federal funds —was also submitted to senators from Department of Labor representatives.
Present at Tuesday's hearings were Sens. Jn Baptiste, Nelson, Richards, Figueroa-Serville, Roosevelt C. David, Liston Davis and Adlah "Foncie" Donastorg. Sen. Neville James was absent.

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