If it smells rotten, something’s isn’t right

Mr. Raho, respectfully submitted in response to your recently published article in the Saipan Tribune, my response is that if it smells rotten then probably something isn’t right. You have voted against resolutions 2014-02 and 2014-03 and you ask the board of trustees to now come together to work with the CEO, knowing that what she did falls under some definitions of corruption? Should the board just say okay, now we have to work with the CEO in her way when that way was the unjust and wrong way? I suggest to you that the board of Trustees have stood up and charted a new course, a heading that is unalterable. They have chosen openness and truth, transparency and moral leadership of the corporation as a whole.

Much has been debated about Public Law 16-51. Let’s discuss it for a second. Let’s let the public decide as P.L. 16-51 can be read online at www.cnmilaw.org/pdf/public_laws/16/pl16-51.pdf

House Bill 16-9 was signed into law as Public Law 16-51 on Jan. 15, 2009 by then-governor Fitial. Its purpose was stated on page 1: “The Legislature finds that the healthcare service under the Department of Public Health is not operating as effectively as demanded by the consumers of its healthcare. Several factors are responsible, including a changing environment for public healthcare financing, stagnant public funding, and difficulties in procurement, recruiting and staffing.”

For factors that still baffle me, the PL 16-51 authors created a mess when they placed the CEO in charge of CHCC and not the board as is in almost every mainland USA hospital. Mr. Raho, do most all of the U.S. mainland hospitals have it wrong? Respectfully submitted, how has the CHCC system been working?

Here is an example of the role of the board from the Children’s Hospital of Los Angeles but there are literally thousands just like it: “The Children’s Hospital Los Angeles is a non-profit, private pediatric hospital under the leadership of a volunteer board of trustees, consisting of community leaders and physicians.”

Here it is from the Cleveland Clinic: “Currently, there are 23 members of the board of directors. The board is comprised of dedicated community leaders who are selected on the basis of their expertise and experience in a variety of areas beneficial to the Cleveland Clinic Health System. Board members serve as volunteers and are not compensated for their services. The board also includes three physicians who are members of Cleveland Clinic’s Professional Staff.” “The board of directors is the primary governing body of Cleveland Clinic. The directors are responsible for Cleveland Clinic’s operations and affairs”

Respectfully, Mr. Raho, perhaps you know more than most all USA hospitals with regard to hospital organizational structure as you oppose a current bill to amend PL 16-51, which intends to place the board of trustees in control of CHCC. You were critical that it was raised by a private citizen and not one of the people in the CHCC administrative cartel. The last time I checked, Saipan was part of the American democratic system where any person can bring such things to a member of the house for review and ask for sponsorship. Isn’t the government “by the people and for the people”?

The principle reason cited as your opposition to the P.L. 16-51 revision was that the board of trustees knows less that the CEO and CHCC’s mostly non-physcian ad hoc committee known as “the governing body” (if I read your article correctly). I guess if that were true, then why is it that a judge can decide a malpractice case? Should all malpractice judges be physicians or part of the CHCC governing body, if the latter is the most knowledgeable in the land as related to health care matters? I submit to you that the physicians are not in charge at CHCC at present. In fact my “insubordination,” as one of the reasons for the termination of my contract, was not even applicable as I was not an employee or in other words “subordinate” to anyone. I was a contract physician. The incident came to light because I would not endanger an elderly patient by admitting them to an orthopedic service instead of the first 24 to 48 hours of a medical service for pre-operative clearance as is standard by my medical education, training and experience and backed up by many scholarly studies. I championed for the patient and against Sherleen Osman’s demands.

Let us look closer at P.L. 16-51as it directs the new CHCC:

Page 5 (line 14) “Adopt such rules and regulations as may be necessary for the exercise of the corporation’s powers, performance of its duties, and administration of its operations”

Page 5 (line 19) “Adopt and maintain financial controls and policies consistent with those of well managed nonprofit and public healthcare corporations doing business in the United States.

Page 6 (line 6) “Prescribe, adopt, amend and repeal bylaws;

Page 7 (line 19) “The board shall adopt rules and regulations governing the conduct of its affairs

Page 6 (line 25) “There shall be a board of trustees whose role shall be advisory to the CEO, except as provided in this section”

Page 8 (line 12) “The board shall evaluate annually the performance of the CEO. It may recommend the removal of a CEO pursuant to the terms of the CEO’s employment contract. The governor shall accept the board’s recommendations regarding removal of the CEO…”

Page 8 (line 1) “The focus of the board shall be upon strategic planning, the recruitment and retention of a qualified CEO, credentialing medical staff, and ensuring the highest possible quality of healthcare.

Page 7 (line 29) “The board shall act as a fiduciary in the execution of its duties.”

Page 10 (line 3,4) “In exercising the powers granted under 2806 of this chapter, the CEO shall: (1) Enforce the rules and regulations of the corporation

Respectfully, Mr. Raho, did the CEO adopt the rules, regulations, policies, bylaws and enforce the rules and regulations of the corporation? I submit to you that after the crap was made up in order to discredit me and keep me from being credentialed as a private doctor at CHCC, they were not followed. The bylaws state that the Chief of Staff, Dr. Kotheimer, shall convene a hearing automatically. The bylaws state that a physician’s privileges may be “suspended” following a mandatory review, only in my case the wording was changed to “dismissal” which was not in the bylaws. After a hearing then an appeals process is still another opportunity for the physician to be heard. Dr. Sherleen Osman stated that as a contract physician I was ineligible for due process as outlined in the bylaws, yet the bylaws state that every physician who delivers care is a member of the medical staff and subject to the bylaws. The bylaws state one year term limits for officers, e.g. Drs. Osman and Kotheimer. The operations policy states rules for credentialing that have not been followed.

Further for your review is an email to the board of trustees by Sherleen Osman where she attempts to discredit me by saying, “when he was not even involved in emergency medical services at CHC.” Any patient or patient’s family member that saw me deliver care in the emergency room knows this to be nothing more plain that a lie.

Mr. Raho, three patients were placed in harm’s way when the only orthopedic surgeon, and the one who performed their surgery, was terminated three days before the end of his contract. This is against any notion of consenting of a patient to their rights upon being admitted as mandated by Medicare, i.e. that their orthopedic surgeon may be dismissed for made up crap just after their surgery, leaving no orthopedic surgeon in charge of their post-operative care.

Mr. Raho, someone was recently hurt due to the lack of radiographic follow up after their orthopedic surgeon was no longer there.

Finally Mr. Raho, I respect you and that you have reservations and wish to openly support CEO Muña and your vision for the duties of the board of trustees as you interpret P.L. 16-51. Maybe the board’s resolutions 2014-02 and 2014-03 are or are not legally enforceable. If we all just take a second and step back then you can see the real weight of these resolutions. The board passed them essentially saying, wait a minute, you can’t just do it that way. You have to follow due process. The real weight is in the spirit of the resolutions.

When I first arrived at CHCC one of the emergency room physicians told me that things work differently on Saipan, inferring that any sense of normal or right and wrong is subject to Saipan interpretation. I also read that people who arrive go through three stages, the first a wondrous awakening of all of the good that they can do for Saipan, the second is frustration at the people who roadblock those efforts and finally the third, giving up and settling for apathy or moving on. I am staying. I will not abandon the people.

John Del Rosario Jr. wrote an article that I admire. It appeared in the Tribune on April 4, 2014, and was titled, “The Prelude to Corruption is Secrecy.” Professor Robert Klitgaard has an equation that sets corruption to a lack of transparency. Websters defines corruption as, “dishonest or illegal behavior especially by powerful people (such as government officials or police officers)”. In my case, all the board of trustees wanted to do was to bring everything out in the open and allow due process to work last fall. Instead, the impacts were potentially career devastating for me.

Mr. Raho, without due process and without Resolution 2014-02, did you consider the impact that that would have on my career. Every place that I apply for privileges asks if I ever had them terminated before. What would I say? What about all of the people not being helped because I failed to be able to work? Does my 84-year-old mother not deserve to have money sent to her every month as well?

The implications of that made up crap and the lack of due process goes far beyond P.L. 16-51. It ventures far into human decency with regard to right and wrong. It becomes a reflection of how our parents raised us and what would they say about our actions if they were all alive today. We can all debate the legal issues of those resolutions but how about just thanking the members of the board of trustees who are fighting for a better healthcare system, right and wrong, and to step up to the plate against the tide and say do it the morally correct way.

This whole thing stinks. I submit that every office that oversees a portion of this attack that I was put through had a choice. Do they join the board of trustees and stand up to corruption, secrecy, and the lack of transparency or do they stay in the shadows unspoken? Was this what the emergency room doctor suggested as “the Saipan way” the first day I arrived? With so many people championing me and this cause now, is the reader of this rebuttal part of the Saipan problem or part of the solution? What a great mirror this has been. I suggest that you couldn’t uncover these people even with an expensive consultant’s report. To the board of trustees, Mr. Raho and the people of Saipan, thank you for standing up and discussing this and to all of those who offer their support…I give my loyalty.

Grant Walker, MD
Board Certified and Spine Fellowship Trained Orthopedic Surgeon