The following is information prepared by the Office of Sen. Therese Terlaje. Ms. Terlaje is the chairwoman of the legislative health committee, and conducted an oversight hearing including public health agency officers regarding the COVID-19 crisis:
Senator Therese Terlaje, Chair for the Committee on Health, and Senator Joe San Agustin, Chair for the Committee on Appropriations, held a critical oversight hearing today with the Department of Public Health and Social Services. Attending the hearing along with senators from the committee were key staff of the DPHSS including its Director, Linda DeNorcey.
The main purpose of the oversight was to hear whether the Department had sufficient resources, including funds, staff and supplies, to be able to handle its continuing role in COVID response, risk mitigation, and recovery efforts as businesses and government services re-open. This would gain a better understanding of the department’s available resources through the fiscal year and how federal funds may impact programs.
The hearing particularly focused on whether personnel, equipment, supplies and allocations to DPHSS in the recent CARES budget prepared by BBMR are sufficient to respond to increased demand for public assistance, ensure testing capacity to support safe reopening of the community, and prompt contact tracing capacity to swiftly quell any spread.
Tess Arcangel, Chief Human Services Administrator, clarified the eligibility and processing status of Supplemental Nutrition Assistance Program (SNAP) applications, stating that only income levels, citizenship and residency are considered. An applicant must meet the income threshold of 165% of the federal poverty level and must be a US Citizen or legal alien.
If an applicant has lost hours or is unemployed, Public Health can cross check with the unemployment list provided by the Department of Labor or the applicant may attest to it under penalty of federal law. Most applications are being processed within 24 hours. Benefits may be uploaded and available within the same day.
According to DPHSS, SNAP recipients already qualify for the recently launched Prugåman Salåppe’ Ayudon I Taotao. The list of eligible recipients has been provided to the Department of Administration for assistance checks to be cut. New applications for the program are available for those who may not currently be on the SNAP program and residents are encouraged to apply if they meet the requirements.
Medicaid and MIP are also available to cover those who may have lost health insurance coverage due to unemployment. Senator Telo Taitague noted special concerns over the current appropriation for the MIP program as the $ 4.4 million dollars has already been spent. Although $3 million was put back into the program with the expansion of Medicaid funding, there may still not be enough funding to carry through to the end of the fiscal year.
Specific attention was paid to the role of the Department and its Director with respect to her authority under the Islan Guahan Emergency Health Powers Act under 10 GCA Chapter 19. Although Section 19502 of the statute gives the director clear authority over procurement of facilities, she clarified her role has been procurement within DPHSS for supplies and contractual services with all requisitions routed through General Services Agency (GSA) and that she did not procure any of the services for isolation and quarantine facilities.
CARES Act and Funding
Director DeNorcey and Tommy Taitague, Administrative Services Officer, advised that there is a total of $16 million in awards from multiple federal grants that will cover various programs including senior citizens, crisis response and emergency preparedness.
There were concerns raised by the committee with regard to how the nominal $397,000 proposed in the government CARES Act budget would be expended. Tommy Taitague shared that it is a partial reimbursement of $1.2 million already expended. The request provided to BBMR only included expenses already incurred, but did not include projected expenses because they will be availing of federal grants. When asked by the Chair if the money was enough to fulfill the agencies requirements to keep us safe, he admitted he was uncertain and that personnel costs were coming from the DOA allotment of $22 million to cover hazard pay but overtime could possibly come from the agency’s existing budget.
Enforcement of PCOR2
DPHSS created guidelines for which businesses could open under Pandemic Condition of Readiness 2 (PCOR2) as outlined in DPHSS Memo 2020-07. Guidance has also been assembled which would provide those businesses with criteria on how to safely operate by implementing social distancing policies, required training, signage and the proper sanitizing of high traffic and high touch areas.
Senator Terlaje inquired about the role and available resources of the Division of Environmental Health (DEH) with regard to enforcement of these new reopening guidelines. Tom Nadeau, Director of the Division of Environmental Health advised they don’t have enforcement authority for pandemic operational guidelines with the exception of businesses that fall under the Guam Food Code, and that they remain at the same staffing levels as before the pandemic.
There are no current plans by DPHSS to increase enforcement personnel and the division has traditionally been understaffed to meet their inspection mandates and public expectation. Director DeNorcey advised that the federal funding is very specific to the grants that have been awarded, with none going to DEH.
Residents may call the department to report violations or concerns about these operational guidelines and the calls will be dispatched to the proper division.
Division of Senior Citizens
Most of the programs for Senior Citizens are in operation, according to Arthur San Agustin, Administrator of the Division of Senior Citizens, including meal deliveries, transportation and caregiver support. There is a significant spike in services such as the nutrition program and food delivery program. Though the division is understaffed, funding has been received from both the Families First Coronavirus Response Act and the CARES Act to enhance support services which includes the need to modify operations to comply with new health and safety guidelines.
Funding has been identified for hiring to expand investigations, contact tracing and surveillance, according to Annette Aguon, Contagious Disease Coordinator. Cross training of existing employees and cooperation with the University of Guam was also being added for scalability of the program, as needed.
Aguon also advised that with the increase in staffing, it currently takes 1-2 days to complete an investigation which includes the home, workplace or community settings of a positive patient.
COVID-19 Testing Capacity
GeneXpert and ABI 7500 testing modules are currently being utilized by the public health lab. The test kits are being ordered from the CDC with a weekly allowance being disbursed, although there have been shipping delays. The department advised that even if there is a low supply of test kits, it shouldn’t prohibit testing because Diagnostic Laboratory Services continues to operate. In addition, GRMC and GMH have also expanded testing capacity for the island.
Validation testing for samples tested with the Abbott ID module proved that the 1 ml transport medium did not affect the testing. The machine was moved to the northern facility as recent guidance issued by the manufacturer requires swabbing to be done on the spot with samples tested immediately.
5000 more test kits will be arriving and DPHSS is coordinating activities with another company that would assist with expanding testing capacity to 1000 units per day.
In response to an inquiry from Speaker Barnes, Director DeNorcey confirmed that she disallowed the use of non-FDA approved tests. Dr. Janna Manglona of DPHSS confirmed that EUA tests can be used according to the Physician’s Advisory Group.
“I recognize the huge burden that has been placed upon DPHSS to keep us all safe through this pandemic. I’m thankful for the director, division heads and all the hard-working staff for the proactive team approach they have taken to address this public health crisis on top of existing critical health and public welfare mandates. The attendance and concern expressed by my colleagues at the hearing echo the public’s concern that DPHSS be able to attain the supplies, personnel, and other help it needs to adequately address the continuing health risk and expanded safety precautions going forward,” stated the Oversight Chair.