The Gov. Juan F. Luis Hospital governing board discussed at its monthly meeting Wednesday the status of improvements to avoid decertification of St. Croix’s only hospital by the U.S. Centers for Medicare and Medicaid Services.
CMS notified JFL in September of its intention to decertify the hospital – jeopardizing an important funding source. The federal agency cited a number of deficiencies including harm caused to patients, possibly one death, and a lack of governance.
After meeting with CMS in October, JFL was able to squeak out an extension with Nov. 20 as the deadline for having an approved Systems Improvement Agreement. The hospital then has nine months to implement the plan and pass CMS inspection.
Dr. Kendall Griffith, JFL chief executive officer, told the board a systems agreement draft has been sent to the 30th Legislature and Gov. John deJongh Jr. Hospital administrators asked for a meeting that was attended by three senators and were assured legislative support and a reference letter to CMS.
Griffith said the governor made a few suggestions that were added.
Taetia Dorsett, assistant to the governor, said at the meeting that deJongh would want a corrected agreement before signing a final letter of support.
The board also discussed troubled areas such as the emergency room, the mental health unit and finances.
In the ER, there is a personnel shortage and three physicians are needed “immediately,” according to Dr. Mavis Matthew, chief medical officer. She said she has advertised for physicians and nurse practitioners.
Without proper staffing, it is difficult to provide timely and thorough care. “Fast tracking” varies daily, depending on patients and staffing. Dr. Anthony Ricketts, board president, asked about the waiting time in the ER and was told that in August and September 200 patients left JFL without treatment.
“Hopefully by December most of these experiences will have been reduced significantly,” Ricketts asked, adding that the level of care needed should help streamline the department.
Board member Kimberly Jones suggested patients be told to go home or wait in a comfortable area until they can be seen by a doctor. Those who go home can be called an hour before a physician can treat them.
In response to a question from Philip Arcidi, JFL board treasurer, Matthew said the longest waiting time is between 9 and 11 p.m.
He said the “situation should be remedied” because the ER is “revenue producing.
Possibly due to the CMS threat, the hospital has been treating fewer patients and raising less cash, according to Michael Younger, interim chief financial officer. For the last few months, around $4 million had been collected per month, but in October there was only $3.8 million in revenue.
Annual revenue is down more than 5 percent to $73 million and operating expenses are below 31 percent – due in part to fewer traveling nurses. Younger did not give the dollar figure for operating expenses.
The lack of psychiatric health care on the island was demonstrated by several observers who attended the meeting to point out the care in the ER is not sufficient and can be disruptive and even harmful to other patients.
Aminah Saleem spoke from experience about trying to control someone with mental illness in an emergency room. She said the hospital is responsible for seeing mental health patients in two hours, according to the law.
Without a mental health unit there is nowhere for them to wait other than the common area. “The psych ward is the first line of help,” Saleem said. “When we can’t handle them, we call the police to take them to the ER.”
Saleem said that last weekend, the mother of an uncontrollable war veteran tried to get him admitted to JFL. That mother was told by hospital staff that the V.I. Police Department would have to issue a 722 or 733 order to force him into the hospital, Saleem said. When the Police Department was contacted, VIPD told the mother it was up to the hospital, Saleem reported.
In the meantime, the veteran committed a crime and the judge gave him until Thursday to get a written order of admittance or he would be put in jail, Saleem continued, adding that the hospital administrators stepped in and were able to get the required paperwork for the mother and her son before the meeting ended.
Another major problem at the hospital is the millions of dollars in uncompensated care. The board discussed that the Medicaid funding from the Affordable Care Act might cover some of those losses in the future.
Griffith said he has met with Human Services Commissioner Christopher Finch to learn about eligibility and said the program might be in place around the end of the year.
Griffith said the “key issues” to achieve CMS compliance are governance, medical records and quality improvement. He said new software being installed this week would help with incorrect and incomplete medical records and that quality care would improve over the next two to three months.
To reach a higher level of hospital oversight, Griffith said he is interviewing for legal counsel, a chief financial officer and a chief operating officer. He is also searching for a third-party consultant to propel JFL to CMS compliance, a consultant who would be approved by the board.
Arcidi said the company would need to make concrete assurances and demonstrate progress is being made within six months.
“So now we need to be patient. We’re definitely on the right track,” Griffith said. He warned the board not to pay attention to “distractions.”
Board members attending the meeting Wednesday were Ricketts, Arcidi, Jones, Joyce Heyliger and Troy Schuster.
