What needs to be done for true healthcare reform

Well, here I am at 2am finishing up my suggested revisions to Public Law 16-51. My initial version of this was changed a bit as it now appears on the pre-bill form, House Bill 19-04, so I have worked hard to restore key elemental changes. Some of these are:

(1) The separation of the administrative and medical professional arms of the corporation;
(2) Protection of the doctor-patient relationship, self-policed by the medical professional arm only through two peer review committees;
(3) The board of trustees oversees both arms of the corporation;
(4) Eliminates the practice of medicine by the untrained CEO;
(5) Encourages partnering between the public sector CCHC and private doctors so that additional services can spread to Tinian, Rota and Saipan itself;
(6) It really puts Tinian and Rota on the map and pathway for healthcare reform;
(7) Term limits where appropriate;
(8) accountability of the CEO and the board all the way up to the Senate, who are the people’s elected representatives;
(9) Creation of a much-needed Surgeon General since we really don’t have a functioning public health department that is tracking the crucial current needs and future needs of all of the islands. This position may interface with the Peace Corps or military medical personnel. We need redundancy of facilities and providers and expansion into current non-served areas;
(10) To remove unnecessary master’s degree boundaries that legislation would put on candidates because a bachelor’s degree plus many years of education can be equally effective.
Perhaps the most important reason for healthcare reform is to create the oversight and remove the small power-based pockets of control that lie in the hands of non-elected people in our healthcare system.

There are things that both opponents and critics can debate but what we can agree on is that changes need to be made in order to grow healthcare access and services for the CNMI. For self-serving reasons, Mr. Raho, CEO Muna and Sherleen Osman don’t seem to think we need any healthcare reform at all.

The government belongs to the people and in keeping with that basic premise, my proposed changes set a clear chain of command from the people to their elected officials to the board of trustees and then a division to two separate functioning arms of the CHC corporation: the administrative arm and the medical professional arm. This ensures that doctors and patients make their relationship and decisions free from outside and unnecessary influences.
I have spent 28 years in healthcare and, as a surgeon, have never had so much as a malpractice case filed. I currently sit on a board certification examination board of orthopedic surgery in the United States. At the risk of sounding less humble, I have earned a place to propose these healthcare changes.

There are patients whom I operated on that I have never seen again. One was from Tinian. Many patients had so much difficulty getting to the CHCC hospital from the other islands. Orthopedic care is currently reduced to a contract with a doctor from Guam who was run out by the administration and malpractice suits.

Former House representative Ana Teregeyo was mismanaged and sent home with an infection by an orthopedic physician assistant who was not necessarily supervised by an orthopedic surgeon. What has she had to finally correct this? Four subsequent surgeries. It was my honor to snatch her from Saipan and bring her to the mainland where she allowed me to participate in her reconstruction. It would be my humble wish that this is a testament to my character and thus my entrance to correcting the much needed small power bases through healthcare reform. I would like to see a future where what happened to Ms. Teregeyo and what is currently still happening can never happen again to the people of the NMI. Somewhere along the way, if the new oversight means that what happened to me, Dr. Gary Ramsey, and others, then all the better.

We need to expand medical providers not only on Saipan but Tinian and Rota alike. It is no longer safe to put all of our hospital and operating room needs in the hands of one place, the CHC. The government simply does not have the money to go about building surgical centers and mini-hospitals the size of grocery mini-markets on Tinian and Rota and on the other side of Saipan. These energy efficient and low administrative centers are a must for the future of the people of the CNMI. So how do we do it? We build future partnerships between the public and private sectors. We make it easier to attract more private physicians instead of chasing them away.

One thing that I did not put in the bill, mostly because I did not know how to do it legally is to fix the rates on electricity (12 cents per kilowatt hour on the mainland) and water (0.005 cents per gallon on the mainland), from the CUC. This could be subject to increases only by an index fixed to inflation. Everyone needs to do their part to save healthcare and the CUC maybe needs to be mandated to do their part.

As you know, I feel passionately about this and I have put about 100 hours into the thought processes of this. I will readily make myself available to the senators and to the Senate Healthcare Committee via FaceTime in order to give my testimony.

Thank you for believing in this project. The CNMI needs this healthcare reform!

Dr. Grant Walker
via email