A sure-fire way to wreck NMI’s healthcare system

I read with dread on Friday morning the articles in the local newspapers regarding CHC and the Senate’s action on House Bill 17-278. Several things became crystal clear while reading these articles that morning.

First and foremost is that the Senate does not even understand the legislation they are discussing and voting on. From the article it is clear the Senate sees HB 17-278 as a “loan” from the Marianas Public Land Trust to the Senate to use in whatever way they see fit. This is wrong. The bill establishes a revolving line of credit from MPLT to the Commonwealth Healthcare Corp. For those who still do not understand, think of it as a credit card with a $10 million credit limit. Part or all the money can be taken out by CHC to meet its financial obligations; interest is paid only on the portion taken out until that money is repaid.

The CEO and COO of the healthcare corporation put in a great many hours and worked very hard with MPLT to secure this line of credit to help the corporation survive the next few months while we improve the operations of CHC to become financially self-sufficient. Now the Senate wants to gut the agreement and appropriate the money as a “loan” to pay the government’s financial obligations to the Public School System and Commonwealth Utilities Corp. Furthermore, there is no mention of how or who will be responsible for repaying the money that goes to PSS and CUC. It appears that CHC will be the ones solely responsible for repaying the funds to MPLT. That is like me taking out a loan from the bank and being told I have to give the money to my neighbor to use but I am responsible for repaying the money to the bank. That is foolish. Again, the management team at CHC worked diligently with MPLT, providing financial information, information regarding the plans to improve the financial health of the corporation, and making assurances regarding repayment terms and the corporation’s ability to repay the line of credit to MPLT. The Senate then goes and says, “Thank you very much, we will now step in and pirate the credit you worked so hard to secure and pay our debts with it.”

Another thing that has become very clear is that, contrary to all the statements in the newspaper and on the television news, the government of the CNMI does not care about the healthcare system or the health of the people of the CNMI. Making the CHC a “public corporation” was not an effort by the government to improve the healthcare system in the CNMI. It was a way the government could eliminate $43 million from its own budget. And Thursday’s further hijacking of the line of credit is the Senate’s way of trying to score political points with the public. If the government continues to interfere and undermine the efforts of the CHC management team to improve the healthcare system in the CNMI it will result in disaster. The CNMI will have a healthcare system and hospital that will be on par with the worst healthcare systems in the world.

It is sad that acting governor Eloy S. Inos feels this is a “very workable piece of legislation” that “addresses many of the urgent issues.” If you ask anyone with knowledge of the situation at CHC they will tell you this bill does almost nothing to help CHC nor does it even remotely address what the original intent of the MPLT line of credit was. The healthcare corporation did not approach MPLT with the idea that we needed a loan to be used to correct the problems at CHC. The intent was to establish, again, a line of credit that we would be able to use as a financial bridge to enable us to continue operating as a healthcare facility while we implement numerous changes that will improve the financial health of the corporation, hospital, Tinian and Rota health centers.

The medical staff at CHC has become extremely disillusioned with the work environment here on Saipan. We have until now continued to do our best at treating the patients at CHC as well as the Tinian and Rota health centers. We believed that if we just do our jobs, the administration at CHC would be able to produce the positive changes we have been told about and encouraged by. Things like expanding our laboratory capabilities, improving our diagnostic radiology services, updating our charges, updating and streamlining our coding, billing and collection system so we can collect the appropriate amounts from the insurance payers. However, we cannot sit back any longer and wait. We need to speak our minds. Without serious improvements in our system we are doomed.

Sen. Ralph DLG Torres’ amendment to spend $583,000 on a CT-scanner for the hospital shows how little even the chairman of the Senate Committee on Health is aware of the problems at the health center. Yes, our scanner is old and outdated and needs improvement but this is something that can be done at a later date once we are more financially stable. Currently, we do not have a radiologist on staff in the CNMI. We need to send our images to a radiologist in Guam who reads them and sends back a report in a few days. Further, we are currently unable to perform many laboratory tests due to lack of payment to vendors who provide reagents and supplies, clinics are closed or open only sporadically due to understaffing, equipment is in need of repair which is not being done because vendors are unpaid, we are unable to send patients for off-island medical referrals because airlines, hotels, and worst of all hospitals and providers who care for these people are not paid for their services. Currently we are struggling to make payroll each pay period, all our employees are about to lose their own health insurance due to lack of payment by the corporation, our employees have not received housing allowance in almost four months now, and the contributions to our retirement accounts have not been made by the corporation since the start of the year. Due to these struggles many of the staff have begun to look for alternate employment, including myself. So I ask you, Senator Torres, what good does having a new CT scanner do when you have no staff to see the patients, no staff to order the test, no one to read the images and no one to treat the patients once a diagnosis is made?

This is not about “greedy” doctors. This is about the healthcare providers’ legitimate concerns regarding the future of the healthcare system here in the CNMI. Two months ago when people asked me about the hospital and what was going to happen, my reply was, “We are going through some tough times but we are going to be okay if we can implement the changes needed to improve the healthcare system.” When I was asked that question more recently I shook my head and said, “I don’t know.” After reading the actions of the Senate regarding HB 17-278 my answer is, “I am the director of Medical Affairs, the highest position held by a healthcare provider within the Commonwealth Healthcare Corp., and I am looking for a new job.”

With this type of interference by individuals and government bodies that are unaware of the problems with CHC and ignorant of the solutions needed to correct these problems, healthcare in the CNMI will not survive. This is not a joke, nor is this some sensationalized propaganda to garner headlines. This is a sincere warning from a doctor who truly enjoys living on Saipan and providing critically needed healthcare to the people of the CNMI. At this point I do not see the healthcare system here being able to overcome its difficulties with this interference.

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