CHCC bill goes to committee

Vice Speaker Janet Maratita’s (R-Saipan) bill to abolish the Commonwealth Healthcare Corp. and put its agencies under a resurrected Department of Public Health that will be a line department under the governor was referred to a committee last Friday during the House session on Capital Hill.

After being met with about 10 public comments against the bill and only one in support, Maratita’s House Bill 20-149, which seeks to abolish CHCC and reinstate DPH, was referred to a special committee composed of six members: Reps. Alice Igitol (R-Saipan), Blas Jonathan Attao (Ind-Saipan), John Paul Sablan (R-Saipan), Jose Itibus (R-Saipan), Gregorio M. Sablan Jr. (R-Saipan), and Maratita herself as chairperson.

In the special committee, only Attao did not co-sign H.B. 20-149.

Other House members who co-sponsored the bill included Igitol, Itibus, Gregorio M. Sablan, John Paul Sablan, Rep. Donald Barcinas (R-Saipan), Rep. Edwin Aldan (R-Tinian), Rep. Ivan A. Blanco (R-Saipan), and Rep. Lorenzo Deleon Guerrero (Ind-Saipan).

Several private citizens, CHCC officials and physicians testified against the abolition of CHCC.

One physician pointed out that Section 1 of H.B. 20-149, which states the findings and the intent of the bill, is false.

Section 1 of the bill states, “The Commonwealth Healthcare Corp. is not meeting the needs of the people of the Commonwealth and should be abolished and its functions returned to the Department of Public Health.”

The physician pointed out that libel and slander are crimes.

“The [Centers for Medicaid/Medicare Services, or CMS] inspection citation in 2012 was 40 pages. We had another inspection in 2017 [that was] four pages. Anyway you measure it, the hospital right now is doing hugely better than the hospital of 2011,” he said.

In a statement, CHCC chief executive officer Esther Muña thanked those who have testified in support of the current structure of CHCC.

“I want to thank the individuals that came out to support the current governance of CHCC and spoke against H.B. 20-149. Thankful to all the representatives that ensured this bill goes to a committee that should be objective,” said Muña, referring to rumors that the House would act on H.B. 20-149 without it being assigned to a committee.

“We have an independent board of trustees that is very qualified and strong and they should be given the chance to do their job,” she added.

In a lengthy introductory procedure, Maratita introduced H.B. 20-149, explaining why she chose to author the bill in the first place.

Citing Public Law 16-51, which established the corporation, Maratita said that CHCC has failed to establish an accounting system; produce monthly financial statements; establish required cash funds; establish a fee structure; develop a strategic plan; collect accounts receivables; and develop annual budgets.

“As of today, and [for] over six years since the enactment of P.L. 16-51, CHCC has yet to achieve any of these requirements as reflected in audit reports directly from the Office of the Public Auditor,” she said, citing CHCC audit reports for fiscal year 2012 through 2015.

“CHCC continues to place blame on its inability to provide quality healthcare services to CNMI citizens and residents on the CNMI governments’ underfunding of the corporation,” added Maratita.

One of several provisions in P.L. 16-51 requires CHCC to be a self-sustaining entity.

“Regrettably, because CHCC is a semi-autonomous agency, [the Legislature has] little to no control over how [CHCC] funding is spent,” said Maratita.

Also to be repealed by H.B. 20-149 is P.L. 19-78, the law that transformed CHCC’s advisory board into a governing board. Having been enacted in January 2017 and fully completed in early June 2017, the board also had to undergo training in order to understand the management of the hospital.

According to CHCC board chair Lauri Ogumoro, since its creation, the CHCC board has been governing for “just over a month.”

“Trying to undermine the [CHCC] board during its infancy is counter-productive to our mission and to the health of the corporation, which has recently shown significant progress in terms of finances and delivery of healthcare,” wrote Ogumoro, who was not able to attend the session.

Ogumoro explained that CMS dictates the governance structure of hospitals that participate in their program. Citing 42 CFR 482.12, CMS-qualified hospitals are required to have a governing body legally responsible for the hospital.

“H.B. 20-149 is designed to revert all of the CHCC back to the original structure as the DPH, back when DPH was not compliant with the CMS regulations regarding governance and a complaint was filed against DPH with CMS,” said Ogumoro.

“Despite changing political landscapes and administrations, the priorities of the CHCC remain the same, and must remain the same—advance the quality of healthcare, ensure access to care, and generate and preserve adequate resources for our health system,” she continued.

“We must protect our health care system from the vagaries of political whim; members of its governance must be free from fear of reprisal. Our healthcare system needs to be funded adequately so we can provide the healthcare we all deserve,” added Ogumoro.

Senate reactions

When sought for comments, Senate Committee on Health and Welfare chair Sen. Teresita Santos (R-Rota) opted to reserve her comments until the bill is transmitted to the Senate and referred to the “appropriate committee” for review.

Committee vice chair Sen. Sixto Igisomar (R-Saipan), however, said the current CHCC structure should be supported.

“To convert the CHCC back to a department under our Commonwealth government, absent any benchmarks or task-list to check off on what the current CHCC problems [are], we should continue to support the current CHCC organizational make up,” he said.

In a statement from Igisomar’s office, the senator said the current setup of CHCC has allowed the corporation to “innovate ways toward long-term solutions.”

“If we are now contemplating a 360-degree reverse…and revert to the status of nine years ago, then I hope we are now able to dispel the initial findings under P.L. 16-51 as to why our hospital should not be a department under the Commonwealth government,” he said.

He added that pre-CHCC, the government lacked the ability to manage the healthcare facility and was hindered by procurement limitations. Inflexibilities surrounded by being under the government have also hindered the hospital’s ability to meet “acute and long-term healthcare needs.”

“More importantly, the hospital must be a public-private or quasi-government corporation, professionally managed and independent from ‘politics’—among others,” he said.

On the repeal of P.L. 19-78, Igisomar warns that if a reorganization or termination occurs “…we must know what it is that we want or what performances are lacking so we can know how to better organize or which person can better manage or run our hospital.”

Mentioning his bill, Senate Bill 20-29, which seeks to amend P.L. 16-51, he said he understands that the CHCC board mandate is vital.

“…The board must hold the CEO accountable through a formal annual performance evaluation process, to be determined by the CHCC board. In short, let us allow the new governing board to provide us with necessary recommendations as the work with the CHCC CEO,” he said. “We must be more methodical for any sudden change.”