Reforming the CNMI healthcare system

Editor’s Note: The following is the testimony offered by orthopedic surgeon Dr. Grant E. Walker in reference to Senate Bill 19-04, which proposes to transform the Commonwealth Healthcare Corp. advisory board into a governing body. This testimony has been submitted to the Senate and House Health Care Committees.

Second part of a series

I saw nurses overworked when there could be a nurse student program so easily established. I have nothing but respect for these gifted and compassionate clinical and in-patient nurses. These Florence Nightingales (and some men) are top notch because they are nice and because most of them have four-year nursing degrees versus many that have two-year degrees in the mainland. The facilities personnel do so much to keep running this energy sucking hospital machine with its dated equipment

I so loved your patients and as an Idahoan we seem to have more in common than our cultural differences. One particular patient was 17 years old and she wanted to study nursing. She wanted to see the x-rays of her broken ankle but there was no wheelchair around, nor were there x-ray monitors in the cast room. With her mother’s permission, I carried her to the nursing desk to show her the ankle fracture. Her mother thought I could have a good educational impact on her young one and invited me to their family’s house for dinner. It was meager, with a carpet on dirt floor. It had exterior walls made from various pieces of construction tin layered together. They were humble and I was honored that they invited me in to share.

I also saw a young local woman with an orthopedic complaint who also commented that she had a growing breast mass and no insurance. Can any man truly understand the stress on a woman who has a growing breast mass and cannot afford to get a biopsy? Every single day of her life she lived with the fear that it could be breast cancer and that she could lose her breast or worse, even die.

I approached one of the two caring general surgeons, and an anesthesiologist. The two of us came in when the clinic was closed and, with the help of the clinic nurse manager, the mass was removed in its entirety. The anesthesiologist was not allowed to administer anesthesia in the clinic but stayed for the whole duration, holding the scared patient’s hand. We sent to the pathology lab. I paid for the processing charges myself. In fact, I bought shoes for patients and as a sidebar, drove around with dog food in my car for all of those skinny canines you have running the streets!

The orthopedic physician assistant was a heck of a nice enough young man but he was not supervised by an orthopedic surgeon as would be necessary for his CNMI license while he ran the CHC orthopedic clinic. Mistakes in judgment were made, not because of malice but because he lacked the education and experience of an orthopedic trained doctor.

Returning to the 70-year-old Japanese patient from Tinian, he had not seen a physician for some years so there is no telling what hypertension, lung problems or diabetes he may or may not have. I am the first to admit that I am OCD when it comes to patient care and I will not recklessly endanger a surgical patient by not having a thorough pre-operative clearance. A subsequent blood pressure of 180, blood sugars of 220 or a urinary tract infection may not be life threatening when walking on the street but these and other risk factors significantly increase the complications and mortality in the first few days of the post-operative patient. I know because I am an American trained surgeon, and I have seen all this in training.

For this 70-year-old Japanese man with a hip fracture, I performed a history and physical examination to the best of my orthopedic abilities and requested that the patient be admitted for 24 to 48 hours to medicine service for preoperative clearance. There are plenty of orthopedic journal articles that show that without this in-depth clearance in order to discover potentially unknown co-morbid conditions, the mortality of the patient is substantially increased.

I received a telephone call from the director of Medical Affairs, “Dr. Walker, you will admit this patient to your orthopedic service.” Now, in 28 years of healthcare I have never ever heard of anyone getting in the way of the direct doctor-to-patient relationship. Under no circumstances, whether it be in a courtroom, licensing board or one’s own moral judgment, can anyone ever tell a surgeon to operate when he does not feel that there has been a proper pre-operative clearance. It is unethical and downright dangerous. CHC did not have an ethics committee. I was polite and tried to educate the DMA but it was no listening, no reasoning with the one on the other end of the telephone.

Now, this telephone conversation happened about the same time that I applied for privileges as a private doctor. I wanted to stay on in your beautiful CNMI; however, I knew that the administrative power bases that existed were unworkable for the quality of care that my OCD needs.

To be continued tomorrow.

Grant E. Walker, M.D.
Special to the Saipan Tribune