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Head of LBJ's Primary Care disputes CMO’s assertions

Dr Sean A. Stracensky, Chief of Primary Care Clinic, now known as Family Medicine Services is disputing assertions made by Chief Medical Officer, Dr. Iotamo Saleapaga, who has recommended due to low patient numbers, overstaffing, repetition of what the medical clinics are doing, and not being “cost effective”, the clinic should be closed.


Dr Stracensky sent a letter to Hospital Board Chairman Mase Akapo last week disagreeing with Dr Iotamo, and the letter was leaked to Samoa News.


“I strongly feel that there are several inaccurate or incorrect assertions in Dr Saleapaga’s memorandum,” Dr Stracensky wrote, and explains the clinic provides critical health care services to the people of the territory and should remain open and functioning as it is.


“The Family Medicine Clinic (formerly known as the Primary Care Clinic) provides a full range of primary care medicine services to the adults and adolescent patients of American Samoa.” He said they care for patients with chronic medical conditions such as diabetes, hypertension, gout, chronic cancer pain, and skin conditions such as fungal infections and psoriasis and also provides care for acutely ill patients, who do not require immediate urgent attention in the Emergency Room. 


Additionally, their staff members perform physical examinations for the military, federal and territorial government agencies, ASNAP, and students attending various schools both on- and off-island and they are involved in preventative health issues, including employee health screening and treatment, immunization review, and rheumatic heart disease prophylaxis.


“The primary care model of health care delivery is based on the idea that any given patient is assigned a health care provider who then becomes ‘their doctor’. The bottom line … this system is aimed at providing health care which helps our patients become healthier, more satisfied with their treatment, and more connected with the people providing their health care,” he asserts in the letter, dated Jan. 8, 2014.


The doctor continued, “Our clinic operates on a scheduled appointment basis precisely to achieve these goals and… regularly scheduled appointments help ensure that: 1) the patient will be seen on the day and time they expect to be seen, 2) the patient has dependable access to the health care provider that they have come to know and trust, and 3) health care providers can review and prepare for appointments ahead of time, optimizing medical testing and treatment, and minimizing wasteful use of hospital resources.”


Dr Stracensky said he disagrees with and disputes many of the assertions in Dr. Saleapaga’s letter regarding his department’s staffing and productivity. 


For reference he refers to an attached Annual Report 2012-2013, which details patients seen and staffing levels.


On staffing levels the doctor said the clinic has historically been understaffed and they would benefit from increased staffing to meet the large patient load that is requesting their services. He noted in an overview of clinic staffing from 2010 through to 2013 the difficulties the clinic faced, including in 2010 there was a period of several months where all other staff had completed their contracts and left LBJ, and he alone saw all patients “while we worked urgently to recruit and hire replacements.”  


“Our staffing issues were further strained by providers taking contractually obligated leave for continuing medical education, annual leave, and family/maternity leave,” the doctor said.


He wrote, a review of the data on patient census and staffing levels makes it “obvious that we are actually chronically understaffed for the patient load that we typically see” and using a baseline of four providers to calculate our productivity is “inaccurate and misleading”.  


Dr Stracensky said the CMO also noted a ”repetition of what the medical clinic is doing” yet the Family Medical clinic is operated on the outpatient primary care model.


“It is inevitable that there is some overlap in responsibilities between our department and Internal Medicine. Patients seem to prefer one clinic or the other, and I strongly feel that it is important to offer them alternatives that suit them best. Ultimately, it is a healthier, happier patient that benefits from having a choice of health care providers and clinics.”


Dr Stracensky further pointed out that CMO Dr. Saleapaga notes the low numbers of patients seen at the clinic; approximately 5 patients per day, yet the clinics see far more than five patients per provider per day and the clinic’s patients are at or above the expected standard when taking into account staffing levels.


Finally, Dr Saleapaga also claimed the clinic is not cost-effective, and Dr Stracensky stated he could not address this point, as there were no financial figures provided. However, he noted the clinic overhead is minimal, consisting only of office space, staff salaries, and supplies. 


Dr Stracensky concluded he has worked at LBJ as a physician since 2006, and has been involved as a provider and departmental supervisor for the Family Medicine Clinic since 2009. “I can state without reservation that this department and clinic are a credit to the hospital and its leadership,” he writes.


“This clinic delivers safe, effective, and efficient health care that directly has a positive impact on the lives of a large portion of the Territory’s population.”


The doctor asked the board chairman to review his letter with the hope the hospital board will allow the Family Medicine Clinic to remain open and continue to serve the population they all care so deeply about.


A copy of the letter was sent to the hospital CEO, Dr Saleapaga and other hospital officials.


Emails sent to board chairman Mase were not returned as of press time, asking about any decision, which the board has made regarding the clinic.




Samoa News should point out whether or not the clinic stays open may be a moot point under LBJ — it may be an issue for the DOH.


Governor Lolo M. Moliga in his State of the Territory Address at the Fono’s opening on Monday said the hospital in 2014 will dedicate its energies to chronic care services.


As such, the governor said, hospital services like Dental, Primary Clinics, EMS and others identified subsequently will be transferred to the health department.


The DOH Director and the hospital board will collectively identify functions, which should be placed under DOH, the governor noted in his address. See story in Tuesday, Jan. 14, 2014 issue of Samoa News for details.