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Saleapaga merges Primary Care with Internal Medicine

The Primary Care has officially been merged with the Internal Medicine Department, said Hospital Medical Director, Dr Iotamo Saleapaga, in a letter to all physicians, sent out on Monday this week. Saleapaga stated that the former Primary Care Clinic is now an extension of the existing Medical Clinic and will no longer be called Primary Care Clinic but rather a Medical Clinic.


Samoa News understands the merge was ordered by the CMO without consulting with the CEO.


The CMO further states that Dr. Jerome Amoa will remain to serve as the Chief of Services for the Internal Medicine Department, inclusive of the Primary Care Medical staff.


“All in-patient consultations from the wards will be directed to the Hospital list on call. All urgent consultations from the Emergency Room at any time will also be directed to the Hospital List on call,” he said.


According to the letter, it is the responsibility of the ER physician to provide patients, who require follow-up care with appointments for the medical clinic. The physician is to contact the medical clinic clerk for the next available time for a scheduled follow up appointment.


(Samoa News received many queries of whether or not patients had to go to ER to get a follow-up appointment to see ‘their’ doctor at the now re-named Primary Clinic. Yes, you do — according to Saleapaga’s letter)


“For ER physicians please schedule patients follow up appointments in a time frame that seems fit and sensible. Furthermore, please make certain that appropriate lab tests have been ordered and that lab test results are entered into the Computerized Patients Record System (CPRS) in addition to the complete and endorsed physicians notes,” said the CMO.


The CMO informed the hospital physicians that he’s “anticipating problems and dilemma from these new changes.” He said, however “let us continue to work together to make this system a success.”


Saleapaga pointed out they will continue to address predicaments either by him or within the Department staff “to find solutions for the smooth operation and or transition of patient care practices.”


In the meantime, while some physicians support this move, some do not.


Pediatrician, Dr. Mike Favazza, said he has no problem with the merging of outpatient services at LBJ,”…making things more efficient here.” He said, “My concern has not been whether the merge should or shouldn't take place. However, I have been informed that Family Medicine trained physicians and Physician Assistants that currently work in the Family Medicine (Primary Care) Clinic are being asked to take in-house calls for the internal medicine service.


“This is completely inappropriate,” said Favazza.


He further stated that while the hospital has a shortage of qualified Internal Medicine trained physicians who are willing to take in-house call, they have an obligation to keep the patients in this hospital safe.


“To ask physicians and mid-level care providers to practice medicine outside the scope of their training is reckless. It has nothing to do with work hours, and everything to do with the training, expertise and experience required to manage patients when they are so sick that they need to be admitted to the hospital,” he stated.


Favazza said inpatient and outpatient medicine are not the same, and inpatient medicine requires training and experience in practice, not just “letters after your name”.


He told Samoa News, “We do need more Internists who are willing to take in-house call, but we simply cannot ask unqualified providers to fill that role. It is neither safe for our patients, nor in line with our bylaws and employee contracts, and potentially could place us at risk of violations with CMS and jeopardize our hospital's funding.”


The doctor said as long as they are able to keep the roles of the physicians and providers within the scope of their training and qualifications, then a merger of outpatient services should be able to be planned and may be beneficial to the hospital in terms of streamlining outpatient care. 


One female physician told Samoa News the main purpose for the Primary Care Clinic was to help relieve the number of patients seen at the ER, however, after a while they started seeing patients by appointment only and patients who were seen by the medical staff of the primary care clinic were patients with follow-up appointments only.


The woman, who chose not to be named, said the average number of patients seen on  a daily basis was 20, compared to the number of patients the ER physicians see every day.


“It doesn’t take a wizard to figure out the unfairness in this, while we see close to a 100 patients at the ER on a daily basis, those with the Primary Care see roughly about 20. It’s not right or fair.”


“Some patients were being turned away by those at Primary Care because they did not have an appointment, so those people came back to the ER,” said the woman.


She further told Samoa News the current move by the CMO will benefit everyone, not just a few.


Samoa News spoke to two other physicians who both stated they don’t agree, but they only work at the hospital and did not want to comment further.


Another physician who did not wish to be named told Samoa News there are other internal problems with this merger that have to do with insubordination and circumventing the CEO, which he is not happy about.