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Complaints About Medical Care on St. John Aired

Oct. 26, 2005—Medical facilities on St. John are not up to par by residents' standards, according to Yvonne Wells, spokesperson for the island's Lions Club, the local AARP and the Business and Professional Women's Organization.
At a public hearing held on St. John Wednesday night, Wells told senators the Myrah Keating Smith Community Health Center and the Morris F. DeCastro Clinic on St. John do not deliver adequate services, do not have properly staffed offices and are not diligent in returning lab results to patients.
In addition, Wells, former advisory board member for the Health Center, said billing and filing systems within the two facilities are not efficient and more services are needed for the elderly. Testimony provided by Ivy Moses, executive director of Helping Others in a Positive Environment (HOPE) Inc., also revealed HIV/AIDS prevention and treatment services on the island are poor. Moses said in general, the number of HIV cases in the territory are escalating, and the Health Department is not employing enough individuals to help with prevention efforts or community outreach/education programs.
Moses said her organization is federally funded through the Centers for Disease Control and Prevention, which requires that a Memorandum of Understanding be established between HOPE, Inc. and the Health Department to provide HIV/AIDS services to the community. Moses said the Health Department agreed to deliver an MOU on several occasions, but has not yet honored that promise.
Wells further expressed concern that rates for ambulatory services on St. John are high, while transport services on St. Thomas and St. Croix are significantly lower. Wells said inter-island transport for patients is also costly and inefficient, due to the absence of a helicopter to ferry individuals between islands, as well a lack of emergency medical technicians. EMTs are stationed in Cruz Bay but not in Coral Bay
Rodney Miller, the Roy L. Schneider Regional Medical Complex's CEO, said Wednesday that 90 percent of Wells' concerns were never brought to the attention of hospital management—despite statements made by Wells that Miller had been told about problems earlier this year.
Miller added the many shortcomings of these departments have been a result of budget cuts imposed upon the hospital since 2003. These cuts, Miller said, have resulted in the loss of about 50 positions at the Center over the last two years, as well as a lack of resources.
"But despite these things, the facilities have continued to do an outstanding job," Miller said. "I have not received any correspondence from citizens who believe otherwise."
Miller added Wells' statements seem more like complaints from a set of disgruntled employees, since the Myrah Keating Smith Community Health Center has been maintained as best as possible since it came under the auspices of the Schneider Hospital in 1999.
"There is little money given to us to maintain the Center, which costs $3.1 million a year. There was little money in the budget for it this year, and no money at all appropriated to the Center in the recent Omnibus Bill." Miller said. "And, since we [Schneider Hospital] have to subsidize Myrah Keating, we take issues seriously, very seriously, on a daily basis."
Giving some truth to Wells' concerns, however, Miller said there is inadequate staff in the labs on St. John, and medical records at the Center are in need of organization. Once again, Miller said lack of funding is what's hindering the Center's improvement in these areas.
Addressing other issues brought to light by Wells, Health Commissioner Darlene Carty said there are a number of programs which are fully functioning at Myrah Keating and Morris F. DeCastro, including Women's Health and Immunization. While Carty added some programs such as dental services, environmental health, and mental health are sporadic; she would nonetheless give the clinic a "high performance grade."
Carty also told Moses she would arrange a meeting to discuss the MOU.
On the topic of emergency medical technicians, Carty said a number of new positions are provided for in the 2006 budget. Certification training for these positions is presently ongoing, she said and once complete, the positions will be filled.
Since one of Wells' concerns was that there were no EMT's stationed at the Center itself, Carty said she has also had discussions with Fire Services to see if that situation could be remedied. Dr. Joseph De James, a family care physician at Myrah Keating, added he has talked with EMTs on St. John who said they are able to respond quickly to cases when stationed in Cruz Bay.
Sen. Usie R. Richards said the EMTs were supposed to be at the Center, and have a 20-minute response time for 90 percent of the island's calls.
Carty said services for the elderly would also be improved through an additional clinic at Morris F. DeCastro in Cruz Bay. Once a physician has been hired, she said, the new clinic will be up and running.
Regarding the disposal of hazardous waste materials, which Wells said is being done improperly, Carty said the incinerator at Myrah Keating has been shut down, but waste continues to be shipped off island to be disposed.
Wells also mentioned that administrators working at the clinic are usually off-island, leaving little staff in control of the island's medical facilities in the evening hours. Harold Wallace, who started working as the Center's administrator in September, took exception to those statements. He stated he is always on call 24 hours a day, seven days a week.
While Wallace does currently live on St. Thomas, he said he hopes to move to St. John in the near future. In the meantime, Wallace said he is at Myrah Keating for a good portion of the day, remains on call when he is back on St. Thomas, and leaves a medical doctor and a nursing staff at the Center when he can't be there. Wells said this is not true.
Carty said she does not personally get over to St. John much to check on the facilities—only about twice a month but added that will be changing shortly.
Wallace also took the opportunity to tell Wells about the work he has done at the Center so far. Currently, Wallace said he is taking an assessment of what needs to be done, asking people in the community for their input. Once the assessment is complete, he will hold a town meeting to discuss any further plans for the facility.
Incorrect lab results and ambulatory fares were the last discussed topics at Wednesday's meeting, and of great concern to Sen. Liston Davis. To assuage Davis, De James said he has only known of three cases in which lab results have been "mixed up" or incorrect, and that is usually due to patients having the same last name.
Wells added the situation at the lab is made worse by the fact that there is only one technician. Wallace said this statement is correct, and the hospital is looking into the situation.
Rates for ambulatory services are higher on St. John, De James said, because Myrah Keating is an "outgoing" patient care center while Schneider Hospital treats patients in-house. While aware of this, Wells said St. John residents requiring ambulatory assistance are charged four times when being taken over to St. Thomas—when picked up and taken to Myrah Keating, when transported from the Center to an ambulatory boat, on the ambulatory boat ride, and when picked up from Red Hook and transported to Schneider Hospital.
Carty said she would look into better regulating the fares for St. John. Sen. Lorraine L. Berry said the legislature would also look into procuring helicopter services for medical transport, since it is both timely and inexpensive. During Wednesday's hearing, it was revealed that Myrah Keating has a helipad to accommodate such transport, but no helicopter.
Present at Wednesday's hearing were Sens. Berry, Craig Barshinger, Davis, and Richards. Sens. Pedro "Pete" Encarna
cion, Neville James, and Norman Jn Baptiste were absent.

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