Contrary to rational or sound governance

Regarding your report in the Friday, Dec. 26, edition of the Saipan Tribune pertaining to Senate Bill 18-52 which proposes to amend certain sections of Public Law 16-51 “the Commonwealth Healthcare Corporation Act of 2008,” I would like to state that I am adamantly opposed to this legislation as currently drafted as I believe it to be faulty, poorly thought out, and detrimental to the sound and proper governance and management of the Commonwealth Healthcare Corporation.

I would sincerely hope that members of the House of Representatives perform an intensive review and consideration of this proposed legislation to include convening public hearings and solicit testimony from various content matter experts in the field of Healthcare Governance and Management. I would also ask the members of the House to strongly consider what impact the proposed legislation may or may not have on CHCC’s Medicare Conditions of Participation and this significant and vital source of federal reimbursement.

In essence Senate Bill 18-52 seeks to amend the original P.L. 16-51 that created the Healthcare Corporation to change its advisory board to a governing board. Additionally it proposes to amend the board’s composition /membership from its current seven voting members, (four governor-appointed members, the corporation’s CEO, the corporation’s director of Medical Affairs, and the elected representative selected by the corporation’s non-physician healthcare professionals) to only five voting members all of which would be appointees of the governor.

SB 18-52’s negligent and unthinkable removal of any voting representation of CHCC’s medical staff would be contrary to rational or sound governance of any healthcare organization. Additionally this would cause negative impact on the ultimate credentialing process of the Medical Staff as now the new “governing board” would be ultimately responsible for the credentialing and Privileging of medical staff without any voting Physician Board member or medical staff representation. This would contravene current standards of practice for medical staff credentialing in healthcare organizations as this is a medical staff guided process.

Senate Bill in 18-52 in Section 1 of its opening paragraph accurately states: “Healthcare is a very complicated and technical industry. In order to develop high quality and efficient healthcare system in the CNMI, it is imperative that a qualified group of individuals rather than one individual make decisions of the Corporation.”

Then S.B. 18-52 in section 2825 which establishes the governing board of trustees and their necessary requisites for consideration of appointment states the only educational and experiential background: “Each member shall have at least a bachelor’s degree from an accredited United States post secondary Institution and three years of management and supervisory experience in the private sector including nonprofit corporations.”

I would hope that the members of the House of Representatives or anybody else reviewing this proposed legislation would see the deeply troubling contradiction of the above two paragraphs and return this faulty legislation back to the Senate for revision or reject it outright.

Unbelievably this legislation proposes to set up a governing board of a “very complicated and technical” CHCC comprised of strictly five politically appointees with nothing more that bachelor’s degree and three years management and supervisory experience in some non health care or medical related field making the ultimate decisions of the corporation. I really have to question this legislation’s concept of “qualified group of individuals” for such a complicated and technical industry.

S.B. 18-52 further goes on in section 2827 to establish stringent education and experiential requirements for all CHCC’s Corporate officers, CEO, CFO, director of Medical Affairs, hospital administrator, director of nursing, and director of Community Guidance Center all of which require at a minimum of a master degree and five years experience in upper level health care management and for the DMA a licensed physician with five years clinical practice and three years healthcare management experience.

Under S.B. 18-52 none of these highly trained and experienced healthcare corporate officers would be voting board members and be relegated to taking ultimate direction and governance from a politically oriented board with little or no knowledge of the intricacies of Healthcare organization governance and management.

In the very opening sentence of the findings and purpose section of P.L. 16-51 that created the healthcare corporation to begin with therein is stated the ultimate purpose for seeking to transition the Department of Public Health and CHC out of the executive branch: “The Legislature finds that the healthcare services under the Department of Public Health is not operating as effectively as demanded by the consumers of health care.” One can reasonably infer from that statement that DPH/CHC was not able to be adequately managed, governed under the CNMI Government and a bit of dissociation and freedom from excessive political intrusion may allow the new corporation the independence to strive to be more self reliant, efficient, progressive and advance the provision of health care in the CNMI.

S.B. 18-52’s attempt to reintroduce political intrusion to the governance and management of CHCC be the way of five member politically appointed governing board especially one in which its membership’s education and experiential training would be so ill equipped for the challenges of governance of an evolving healthcare organization would in effect be sending CHCC back into the proverbial dark age.

I for one would say that there was a bit of wisdom on behalf of the 16th Legislature in the drafting of P.L. 16-51 and the establishment of an “Advisory Board” as opposed to a Governing Board at the outset of the creation of the Healthcare Corporation. To me it must be demonstrated that an advisory board may be capable of succeeding at CHCC prior to the transition into any such concept or consideration of a governing board. Any advisory Board should be first demonstrating that it has the experience, expertise, leadership capabilities, to provide for the strategic guidance and oversight of the provision of quality healthcare at CHCC. The Advisory Board needs to first demonstrate that it understands the fine line between organizational governance and micro management and restrain itself from crossing the line from one to the other. Most importantly it must be demonstrated that an Advisory Board be capable of working in cooperation and in conjunction with Management and not denigrate to daily “Brawls” or a battle of egos. I am sorry to say we just are not there yet.

Again, I would ask any/all members of the House and even the Senate to review and consider the oversights and faults of the proposed legislation in S.B. 18-52.

If perhaps any member of the staff of CHCC or any member of the community has concerns with this proposed legislation outlined above I would encourage voicing either support or opposition to your elected officials.

Anthony Raho
CHCC board member