By Troy Torres
(Tumon, Guam) Guam Memorial Hospital is dilapidating quickly with a balance sheet that can't fit the cost of its payroll and medical services, let alone the physical and IT infrastructure it needs to survive. This is the information Senator Therese Terlaje was able to drill out of hospital officials during an oversight hearing she held last night at the Guam Congress Building regarding GMH operations. The facts answered by GMH officials are in stark contrast to the message portrayed by Gov. Lou Leon Guerrero, who has said that is being prioritized.
Ms. Terlaje is the chairwoman of the legislative health committee, and has been the only senator to raise GMH's problems since the legislature's term started in January. She also has been adamant about financial solutions for the hospital.
During budget discussions last month, Ms. Terlaje implored other senators to dedicate an anticipated surplus of Fiscal Year 2019 revenues to GMH, particularly for construction projects needed to fix its leaking roofs and electrical panel. The governor's fiscal team opposed Ms. Terlaje's amendments, which did not garner enough votes to change the budget in favor of GMH.
Her impassioned plea for GMH fell on mostly deaf ears, as senatorial allies of Ms. Leon Guerrero shot down her proposals to provide GMH even the minimum funding needed to begin repairing its facilities.
News of the anticipated surplus actualizing since the fiscal year ended has since resulted in senators racing to appropriate these funds, despite the excuses they gave during budget deliberations opposing Ms. Terlaje's attempt to send that money to GMH.
For greater detail on last night's oversight hearing, please read the news release from Ms. Terlaje's office below:
Senator Therese Terlaje, Chairwoman of the Committee on Health convened an Oversight Hearing on the Guam Memorial Hospital last night to address an array of critical issues plaguing the Guam Memorial Hospital Authority. According to Terlaje, the hearing was necessary to review quality of care to patients in the 41-year-old facility and for accountability for funding given to GMHA for patient care. “I wanted a very clear and public record of Management’s priorities as to quality patient care, including staffing and facilities, and a record of exactly which issues GMHA management will resolve this year, and which they have decided to put on hold and why.”
Administrator Lillian Posadas, Associate Administrator of Operations, William Cando, Assistant Administrator of Administrative Services, Don Rabanal and Rodalyn Gerardo, Chief Auditor and Acting CFO provided updates on the hospital’s elevators, boiler units, roof repairs, electrical panel, the sunsetting Electronic Health Records system, withholding tax debts and clarifications on public complaints of bloated staffing and physician salaries, amongst other issues.
GMH is continuing to prioritize improving quality of care and increase bed capacity through the recruitment of nurses. At the same time, it is dealing with long delayed facility repairs and management issues.
Elevators: According to Posadas, of the four Elevator units, two are currently functioning. Water leakage has damaged internal electronic components of. GMH has procured passenger carriages for two elevators. However, in order to install the carriages, contractors are assessing the elevator shaft for leakage and rooftop repairs. They estimate it will take 3 to 4 months for each carriage to be replaced but will make sure that two elevators remain functional. The repair of the two elevators will cost a total of $500,000.
Boiler Units: One of two Boilers went down as of September 24th. Per Posadas, the contractor was onsite to conduct an assessment on the working boiler to ensure that it keeps running. The 30 and 20-year-old boilers were listed by GMH in its FY20 request for Capital Improvement funding. Although the focus, for now, is to repair the existing boiler, Posadas noted that the cost of replacing one boiler is estimated at $500,000.
Roof repairs: On June 26th, GMHA filed a claim with Moylan’s Insurance. A site inspection was conducted on June 28 and the cost estimate of $5 million submitted by GMHA last month is pending a response from Moylan’s Insurance.
Electrical Distribution Panel (EDP): A thorough assessment was done by GPA with infrared devices, several hotspots were identified and repaired or replaced. A 600-amp breaker was replaced recently. According to Posadas, based on the expertise of GPA, the EDP is in good standing. GPA will continue to do frequent rounds to detect hot spots and make sure things are in working order. Senator Terlaje asked Posadas if repair of EDP will still cost $6 million and if she was confident that the state of the EDP did not pose an eminent danger. Posadas stated that the bigger concern was the location of the panel to the water tank and that the plan is to relocate one of those items. Posadas further stated that the Army Corps of Engineers will assess and determine what to do. According to Cando the panel is also next to the boilers which poses multiple risks with all of these systems next to each other. Cando further stated that if the Army COE says the facility is not structurally sound, investment in a new panel may be put on hold.
The Army Corps of Engineers Assessment: The assessment of different components of the hospital will take place between November 18- 22 to determine structural soundness. GMHA expects a response to be complete in January, which will help determine if the present facility should be retrofitted or if there will be a need to rebuild a new facility at a different site. During the hearing Posadas stated that her personal preference is to build a new hospital at a new site in Mangilao, next to the University of Guam. Posadas stated that cost of retrofitting and to do so without interrupting operations will be challenging. Posadas prefers Mangilao next to UOG as an opportunity to be affiliated with UOG as a teaching hospital, bring in interns to build up professional pool and for closer proximity for people of the south. Senator Terlaje asked Posadas if she was making or working on a formal recommendation to which she replied no, that she was just being “straight and honest.” Cando reiterated that they were waiting on the Army Corps of Engineers assessment. Terlaje stated that it sounded like a decision had already been made and pressed the need for a truly objective assessment.
Electronic Health Records system: According to Posadas, the current system Optimum, will sunset in December 2020 and there will be no option but to replace it. A Request for Information (RFI) went out and GMH received 5 vendor packets. The project team has reviewed packets to identify how to proceed with an RFP. However, GMH cannot proceed until funding is identified. GMH has previously provided an estimate of $21 million to replace the current EHR but now says the price range for a new records system will cost between$40 to $50 million. Assistant Administrator of Administrative Services, Don Rabanal stated that the $20 million estimate was basically a figure from a particular vendor but a solid figure will not be available until the details of the RFP are compiled and vendors are allowed to quote. Rabanal further stated that the increased estimate is based on several indications from RFI packets and that total cost will not have to be paid upfront, but more likely throughout a 5-year period which amounts to at least $10 million a year. Senator Terlaje stated that the increased estimate was shocking and requested GMH to provide more concrete information on how amounts are calculated. Terlaje further stated that the goal of a new EHR system was to ensure CMS compliance. Senator Joe San Agustin stated that RFP details should coincide with CMS requirements.
Withholding Tax Debts: GMHA owes 4.9 million in taxes alone for 2018 (excludes interest and penalties) and interest and penalty fees for certain quarters for 2014 ($43,000), 2015 ($300,000), 2017 ($350,000). GMH has submitted a request for a waiver of interest and penalties to DRT estimated at $2 million. Posadas assured the Committee that payments have been made in recent weeks, and they are working towards paying off this debt within 6 months. Senator Terlaje questioned the knowledge and approval of past non-payment of withholding taxes by the Administrator and Board of Trustees and impressed upon Administrator Posadas, the need for procedures to ensure proper communication of such issues and prevention of such violations. Terlaje requested accounting of funds received by GMH, including the GMHA Trust Fund, the Healthy Futures Fund, and Department of Interior funding, and how these funds are being used.
Employment of Physicians, and Salaries: Senator Terlaje requested clarification on how some doctors are employed and paid by GMH. GMH assured the Committee that the process and methods of hiring physicians is under review and GMH is making efforts to ensure fairness and consistency.
With an interest in long term solutions,
“The Hearing was informative, but there remain many issues requiring further follow up by the committee and by the Board. In many ways, we are only as good as our information. I hope the Board will demand full transparency and accountability moving forward and be an active part of ensuring quality care and the best use of limited resources at the hospital. We’re dealing with short term and long-term issues, and it’s necessary for our entire community to have a realistic view of which issues will be addressed by GMH in FY 2020 and the issues we must look for other avenues to resolve. I believe if the public and local businesses can follow along, they can help in this regard. With additional information that is being obtained, our community will also be able to build on prior studies and proposals towards a long-term plan.”
“We want to make sure that the goal remains quality patient care and value for the people’s investment. The Board of Trustees must be actively involved and hold management accountable to these priorities. That’s the only way this is going to work.”