Why more doctors don’t come to the NMI

It is the middle of the night here in Idaho and I can’t sleep. I look at the Milky Way and I see the same stars that you will see tonight, tucked away in a Pacific island paradise. The islands are thousands of miles away and without healthcare reform passing both houses and surviving the inevitable veto by the governor, my thoughts are still with you via the hundreds of emails I keep receiving about your dire healthcare situation. I don’t know what more to do? It’s like that itchy spot on my dog’s back. He can feel it but he just can’t seem to get his paw into the right place. Lessons in life seem to find that same itchy way of repeating themselves, centuries erase memories and finally we call it history.

Did you know that most personality traits are ingrained by the age of 15? My dad was the VP of an insurance group and he left me with some Catholic lessons, maybe not his own but nonetheless lessons he wanted me to learn growing up as a kid. The first is, “When in doubt, follow the money trail.” The second is, “Outside of family, there are few altruistic acts and people generally act first in their own self best interests.” The third is, “History often repeats itself,” the focal topic tonight that percolates in my thoughts.

The Office of the Public Auditor and the Legislature’s CPA have both found areas of CCHC where money appears gone and can’t be traced. Could this just be poor accounting? My father taught me that “if I didn’t have the talents needed then I should surround myself with people who do and learn from them.” I am left wondering why CCHC hasn’t come up to speed with the simple and basic accounting principles after so many years now? Where is the money trail?

Shifting gears for a second, I would like to say that the CNMI’s judicial system appears swift, just, and impressive once things get to the courts, but actions of ambivalence to the law before matters get to the legal system is disconcerting, run amuck by adults well beyond the maturation age of 15, many in key government posts.

We see history repeating itself within some areas of the government or government-owned entities. There is a medieval feudal system vibe within the CNMI, and an underlying current of fealty, serfs, and a fiefdom. Within this presumed loyalty is also a sense of fear for one’s job and good paying jobs are scarce. To find history repeating itself, look no further than the actions of Osman, Muña, and the cyber bully named Ralphi Nadir.

My dad taught me that standing up to bullies was the only way to deal with them. I respectfully bring attention then to Ralphi Nadir in the context of the new anti-cyber bullying laws. For other doctors, if the rule of law doesn’t protect them before the court processes, i.e., the hospital bylaws, then what protection is there as they try to use their skills to care for your loved ones? Do we, as a measure of society, just remain silent and let the bullies take over?

CNMI lawyers will line up to sue a private doctor because there is no cap and no malpractice insurance in the NMI, but few will take on CCHC because of the $100,000 government limit and because it is represented by the Office of the Attorney General, someone they really don’t want to piss off. Setting up private practice is like putting a target on the private doctor›s back, akin to a one-legged man in an arse kicking contest. Doctors can be sued in federal court so their homes and kid’s college savings are up for grabs. Still the Ralphi Nadirs of the CNMI think that living there is such an honor that despite a lack of specialists such as an orthopedic surgeon, Valhalla exists on Saipan and he will put your lives at risk to get what he wants. Is this not a lesson of history repeating itself? The players and the stage change; however, the script remains the same, pulsed by a current of hubris intent.

For quite a while now you have been reading my articles touting healthcare reform and I respect the efforts of Sen. Santos, the Senate president, and other members of the House and Senate who have championed this undertaking and gone off in their direction. The sad thing is that with little happening elsewhere the result is history repeating itself. CCHC is predictably insolvent and bankrupt, and you still don’t have private doctors wanting to come set up private practice to fill in the voids. In fact, Medicaid is being taken away from the few private doctors who do remain. Having Medicaid, the Department of Public Health, and the clinics of Tinian and Rota all under the same overall budget and within the whims of the CHCC CEO is like throwing more cargo onto a sinking ship. Where is the oversight and where are the people to remove weight from this water filling 35-year-old steam vessel? You can argue for or against the board of trustees being entrusted with CHCC oversight but let’s have some oversight somewhere!

As it stands now the only true oversight to the CHCC CEO is the governor himself, a good man but conflictingly receiving healthcare at CHCC because there is only one hospital in the NMI. If the health committees of both the House and Senate oversee the board of trustees, then in turn oversee the CHCC CEO, then at least we have the “people” in charge and not a fiefdom. Otherwise, history is going to repeat itself “for it is the doom of men that we forget.” I wish that I was wrong but the pieces are predictably falling apart and it didn’t have to happen. It doesn’t have to go down further if the few stop acting in their own self-interest.

We have much in common, you and I. We can both look at the same Milky Way tonight. We are both human beings sharing a common bond of helping each other get through this thing called life, as short as it is. We are both Catholics, for the majority. On that note may I tell you that I was perplexed as a child attending Mass with my parents. People stood tall facing the altar and beholden to INRI, Jesus of Nazareth, King of the Jews. Two hours after Mass and these same people couldn’t even tell you what was said during the Readings and what relevance it had to their lives. The next day and these same brothers and sisters are back to being indignant and selfish. I wish I had my dad back because I would ask him why? Why bother taking the time to go to church if one hasn’t opened his heart to Christ’s message? Wouldn’t it be more fun to just go to the beach on Sunday mornings instead? It’s a lesson that my dad didn’t get the time to answer and now I too am old. Some people go to church, my faith, and they are just plain mean.

I’ve spent 28 years in healthcare. Besides being an orthopedic and spine surgeon, this is what I do, medical staff and healthcare governance, and there is one last lesson that comes to mind before I try to salvage the few remaining hours of sleep this night. Again it is from my mentor, my friend, my father. He said, “Son, there are three kinds of people in the world: those that make things happen, those that watch things happen, and those that sit back and wonder what happened?” Perhaps, if you are sitting in a bar reading this right now, could you please just say nothing and step aside? For those that feel the need for change, please contact your representative or senator and be a voice, be counted, be somebody. For those government leaders, please act altruistically and don’t make this boring too. People have given up on you and expect that nothing will change but they will still smile at you in church. Please let them see you working for “them.”

Dr. Grant Walker
via email