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Primary Care Clinic on the block in LBJ power struggle

Hospital CEO Joseph Davis Fleming has threatened to tender his resignation following a move by the newly reinstated Chief Medical Officer Dr. Iotamo Saleapaga asking the hospital board — directly — by-passing the authority of the CEO, to discontinue the services provided at the Primary Care Clinic.


In his letter last week Thursday that was leaked to Samoa News over the weekend, Fleming voiced his disappointment over the issue.


Fleming’s letter to the hospital board was to counter a letter sent to the board by Dr. Saleapaga noting a low number of patients at the clinic, overstaffing, a repetition of what the medical clinic is doing and not being cost effective as the reasons why the Primary Care Clinic should be closed down.


According to Fleming’s letter, he thought the hospital board was to discuss the issue of the Primary Care Clinic at the board’s meeting this past Friday, however, a board member told Samoa News the issue was not discussed.


Fleming in his letter stated he was never consulted about the Primary Care Clinic, and “the fact that the request has been submitted directly to the board without my involvement is not only inappropriate, but also disrespectful, insulting and a blatant act of insubordination, if the CMO is supposed to report to the CEO per his contract and job description approved by the board last month.”


He continued, “Additionally in just two short days, I have already received numerous complaints from medical and nursing staff about decisions that are being made by the new medical leadership without consulting with any of the affected parties currently responsible for supervising the impacted patient care service and staff.”


Fleming went on to admonish the board, “This is totally an unacceptable way to run a hospital and I will not sit back and watch this newly introduced form of chaos take place in such manner to the detriment of the entire hospital and the people of this territory who we faithfully serve.”


The hospital CEO wrote he has bent over backwards to be “nice and cooperative and truly believed” this all could work out in the long run.


“However, I am extremely disappointed to learn that this is not the case and that your (Board’s) new CMO and Assistant CMO (both who I like very much) have decided to make drastic changes on their own without even involving the hospital CEO, which is unheard of in my industry,” he stated.


"There apparently must be a major misunderstanding about the role of a CEO and the question of who is actually running the hospital," Fleming wrote adding, "Please let me know if you wish to review the hospital CEO's job description for this or any other hospital in the US or globally, and I will be happy to provide to you if you are unclear about the scope of a hospital CEO's responsibilities, which is indicated in my employment agreement, and expected by US HHS/CMS hospital compliance requirements."


The CEO concluded, "With all due respect, I humbly request you to resolve this matter ASAP.


“If my authority, as LBJ’s CEO, is compromised any further, and if my authority to be consulted and make final decisions about all aspects of the hospital’s operations is no longer supported by the Board as reflected by permitting the new CMO to go over my head in this manner, I will be forced to tender my resignation on the grounds of breach of contract and will exercise my legal rights accordingly as well as go elsewhere as soon as possible to help other countries that sincerely want my help in building up their healthcare infrastructure.”




Dr. Saleapaga in his letter — also leaked to Samoa News — which the LBJ CEO refers to in his Dec. 08, 2013 letter to the board, said the purpose of the Primary Care Clinic is to help relieve the number of patients seen at the ER, however, it sees patients by appointment only and patients that are seen by the medical staff of the primary care clinic are patients with follow up appointments only.


The clinic is staffed with three physicians and an assistant physician.


The letter sent to the board on Thursday has a statistical graph of the total outpatient visits by all services yearly and the number of patients seen at all the Outpatients Clinic, which has decreased tremendously from 116,000 to 95,000 (difference of 20,000 patients) from 2009 to 2013.


“Financially, the hospital is not generating that much revenue due to less people seen at the clinics. Based on the statistics, I believe that the number of physicians that are currently working at LBJ is adequate, perhaps, reshuffling of staff members from clinics with low volume of patients to be relocated at the clinics with high volume of patients for example the Primary clinic to ER and medical clinic,” said Dr. Saleapaga.


He pointed out the average number of patients seen yearly for the last five years is 4,946.8. For 2013 the primary clinic is staffed with three physicians and an assistant physician and so far 4,780 patients was seen at the primary clinic. “Evaluating these numbers it indicates that approximately 435 patients are seen in a month, each staff member sees five patients per day and these numbers are very low compared to all the other outpatient clinics.”


He said there’s an immense need for the medical staff; physicians and physician assistant in the ER and Internal Medicine. “I strongly recommend, closing the Primary Care Clinic for the reasons as follows; low number of patients approximately five patient per day, overstaff of medical staff, repetition of what the medical clinic is doing and not cost effective.”


(Samoa News has not independently verified the clinic’s staffing or the statistics.)


Dr. Saleapaga recommended relocating two medical staff members to the ER, relocating two other medical staff to Internal Medicine and giving medical staff members a choice of where they want to work whether in the ER or internal medicine.


He pointed out two physicians in the Internal Medicine Department are leaving this month and this Department is in need of medical staff.


“The LBJ is spending a vast amount of money paying overtime for physicians working in the ER due to shortage of staff. Adding to more staff members would lessen this unnecessary spending would help alleviate some of its financial burdens,” said Dr. Saleapaga.


Primary Care Clinic’s Chief of Family Medicine Service, Dr. Sean Strancensky also raised concerns about this matter.


In an email Dr. Stracensky sent to board members and the CEO, he said, as Chief he should have been involved in any discussion that affects the Primary Care Clinic.


“… I have not directly heard from anyone regarding this matter, rather I come to work and the first thing I read is a forwarded email stating that there is a request to close our clinic!”


He said they are proud of the work they do at Primary Care and the clinic is an integral part of the health care delivery system.


About the closing he said, “This is surprising to me and if true, very disappointing and disheartening,” said Dr. Stracensky, who has been working at the hospital for seven years with the Primary Care Clinic.


Last month, LBJ board member Velega Savali took issue with the move to rehire Dr. Saleapaga noting there were “concrete” reasons why the former hospital board opted not to renew his contract in October of last year.


As reported last year in Samoa News, rumors were circulating that former hospital CEO Mike Gerstenberger had fired Saleapaga — after an argument occurred between the pair during a meeting.


However, at the time Dr. Saleapaga told Samoa News the hospital didn’t want to renew his contract. Saleapaga had been a physician with the hospital for some 30 years before his termination and was rehired and appointed Chief Medical Officer by the current board last month.