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LBJ CEO says hospital needs more money — one way: eliminate “free service”

LBJ hospital
Faumuina to Fono: Revisit current law requiring LBJ to provide "free" service

Pago Pago, AMERICAN SAMOA — LBJ Medical Center chief executive officer Faumuina John Faumuina has called on lawmakers to revisit the current law that requires the only medical center in the territory to provide “free medical attention” to the public.

Faumuina made the request last week during the hospital’s fiscal year 2019 budget hearing before the Fono Joint Budget Committee, where he also pointed out that LBJ is proposing in the new fiscal year budget allocation, a Behavior Health Center.

At the outset of the hearing there were discussions and questions regarding the difference in LBJ’s budget document provided by the hospital, which shows a total of about $50 million, while ASG’s FY 2019 budget summary under the Enterprise Fund shows a total of $46.84 million for the hospital.

Faumuina stressed that LBJ’s proposal is $50 million but the ASG Budget Office had requested to reduce it by $4 million. His response was for the Budget Office to reduce it themselves since they made the request.

According to ASG budget documents, the government’s FY 2019 subsidy for LBJ is $4 million. The ASG Budget Office representative who was at the hearing pointed out that the $4 million subsidy and the $46.84 million in the budget summary gives LBJ a total proposal of over $50 million.

However, there were still some concerns from lawmakers who wanted to make sure the final numbers for the budget are correct and firmed up before budget hearings are completed early next week.

Faumuina explained that whatever subsidy received from ASG,  it is used for matching funds for Medicaid and Medicare — which are the major funding sources for LBJ. He said under Medicaid, the feds share is 55% and local matching is 45%; and for Medicare, the feds pay 80% and 20% is local, which is what the patient pays if they qualify for Medicare. However, it's LBJ that comes up with the 20%.

The CEO informed lawmakers that LBJ needs all the financial help it can get, to which Sen. Magalei Logovi’i responded that he wished there was a money tree at the Fono to help fulfill everyone’s request for more financial assistance.

Faumuina said LBJ has been told by the ASG Budget Office that the hospital’s ASG subsidy will come under the Governor’s Discretionary Fund, meaning the governor will disburse the money once funds are available.

However, he noted — at least three times during the hearing — that if there’s no money coming from the ASG subsidy, there’s not much LBJ can do.

With lawmakers from both chambers present, Faumuina said he wanted to address a provision of the law — under Title 13, ASCA 13.0602 — which requires LBJ to “provide free medical attention” to the public.

He said the question is, who pays for the “free” medical attention and where does LBJ come up with the money to cover this free service?

Faumuina suggested that the Fono revisit this provision of the law and remove the word “free” and have the public pay for medical service, so there’s no worry about the government providing subsidy.

He said the government needs to provide financial assistance in order to address Title 13 of the law, which has been in place for many years, even though there isn't enough resources to go around for all ASG expenditures.

Among other issues that came up during the hearing, was a question from Rep. Vailoata Eteuati Amituana’i regarding the Behavior Health Center, whose operations were to be funded by the Health Department but it's now part of LBJ’s budget.

Faumuina explained that since the facility opened in mid 2016, the hospital and DoH had reached an agreement for LBJ to provide funding for that first year; however, come fiscal year 2017 and thereafter, DoH will provide funding while LBJ operates the facility.

Faumuina claims that DoH only provided funding once, for one quarter, and nothing else up to now.

That's why, according to the LBJ CEO, the hospital board moved to include the facility's budget into their 2019 package, because the hospital is pouring financial resources into the facility but there’s no set budget for it.

Vailoata then asked why LBJ is still using Bluesky internet service — as shown in the budget document — instead of the American Samoa TeleCommunications Authority (ASTCA). Faumuina responded that ASTCA’s service wasn’t up to par at the time and LBJ is now monitoring the new upgrade to see if the hospital can switch to ASTCA, which he says has improved, but is still slow.

There were several questions pertaining to personnel, and one of them, dealt with foreigners being hired by the hospital. Faumuina explained there’s a shortage of local Samoan medical personnel, especially in nursing, and therefore a need to hire foreigners.

Sen. Fai’ivae Iuli Godinet noted that the budget included increments and he asked if they were paid out, to which Faumuina answered, not “across the board”, due to the lack of sufficient funds, but are paying increments on the anniversary date of a person's employment.

He said his heart goes out to the employees who have been there for many years, as contract employees get paid adjustments when their contracts are renewed.

He said LBJ wants to pay increments to its employees, the career service employees. 


The $600,000 allocated for the “blood bank” was questioned and the CEO explained that  LBJ’s supply is provided by the American Red Cross, which is paid for this service.

However, if there’s a shortage on island and there’s delays in flights bringing in the blood supply, the LBJ then issues a call to the public for blood donations when there is an urgent need.