Saleapaga says his record speaks for itself
After many attempts to reach Chief Medical Officer Dr Iotamo Saleapaga to comment on recents encounters with former outspoken hospital board member, Velega Savali, the CMO did not answer. However, in a letter, leaked to Samoa News, dated Sept. 6, 2012, addressed to the former LBJ CEO, Mike Gersternberger and board members during his contract renewal time, the doctor pointed out that he’s served for “many, many years and not one malpractice lawsuit against him.”
Prior to leaving the hospital board last month, Velega told Samoa News that one of the reasons he resigned was due to the fact the hospital had rehired Saleapaga, as Medical Director and stated the previous Hospital Board and the former hospital CEO Gerstenberger had not renewed the doctor’s contract for specific reasons.
Samoa News received a copy of correspondence between Saleapaga and then CEO Gerstenberger regarding his request for a contract renewal, which cited issues under the headings of Clinical, Citizenship and Contact concerns. We also obtained a copy of a “Memo for the Record”, recorded by Gerstenberger, concerning the meeting he held to discuss the contract renewal and the hospital’s concerns, and to allow Saleapaga to respond to issues he had raised. The documents were leaked to Samoa News from a former hospital board member of the Togiola Administration. (See full story on front page Feb. 21, 2014.)
Recently, we received Salepaga’s written response to the issues raised by the former hospital CEO, Gerstenberger, but were waiting for a response from Salepaga to the letter he wrote Sept. 6, 2012 to the then CEO and LBJ Board members. In his letter, Salepaga answered certain allegations by the former CEO.
To the absence of a CPRS (Computerized Patient Record System) record of required daily visits and progress notes on many of Salepaga”s inpatients, including critically ill patents in the ICU, and questions about the his dosing and monitoring of certain antibiotics and certain xanthenes, the doctor said the following.
1. Prior to the computer system, notes were hand written, however when he received a letter on the matter he “immediately” tried his best and was getting better on the daily basis with the CPRS.
2. Regarding the allegations of antibiotic usage abuse of certain medication —vancomycin, steroids, xanthenes — Saleapaga explain that Theosophylline has been around for ages and only a first year medical student would perhaps not understand those medications. “Of course in-patients with renal disease, the pharmacy will call and dosage will be adjusted accordingly for vancomycin. Levaquin is very simple even the nurses would know.”
In response to the former CEO’s allegations that the CMO when on-call was “frequently argumentative, unhelpful and generally non-responsive to patient issues,” Saleapaga denied the allegation. Instead he stated that if anything he would help the doctors more or all of them working in the ER, including moonlight doctors. “You must remember these doctors are not certified emergency doctors, they are there to do the work because they are assigned to do so and I give lots of credits to these hard working physicians.”
Salepaga further noted that in his many years in medicine he has never taken advantage of a working colleague and that is “not in his heart rather the other way around” — he helps his colleagues.
The doctor’s routine of seeing patients in the Clinic prior to the clinic’s opening time and the high number of outpatients seen in the Clinic, was also questioned by the former CEO.
In his response, Saleapaga noted that a lot of patients prefer to be seen in the morning, as the patients are working and they prefer not to take leave or call in sick. “Remember the vision statement, we deliver the service to the patients and not vice versa.” The CMO further stated that without these patients there would be zero revenues generated from patients visiting the labs and X-rays.
Saleapaga basically said he was taken aback by then CEO’s comments stating that he (Saleapaga) was expecting a congratulations rather than complaints for the services provided to the people.
“I have been working in the hospital for many-many-many years and have not had one malpractice lawsuit [filed against me]. If you question the quality of care I provide for the people of American Samoa, the statement mentioned earlier should answer that.” Saleapaga also wrote that according to the log books he sees more patients in the clinic and this is not new as he has done this service — seeing a number of patients for years.
Under Citizenship concerns, the letter to Saleapaga notes in four points that he’s not a team worker. “That’s not my life and not my style,” was the doctor’s reply.
Under Contract concerns, Gerstenberger highlights that Saleapaga was “cautioned by the Hospital Counsel in October of 2011 regarding outside employment which is not allowed” under his current contract. However, Saleapaga pointed out that he was never advised by the hospital counsel and called Gerstenberger a liar. “You could be liable for this big lie,” he wrote.
In his September 2012 letter, Salepaga did not address the the former CEO’s allegations that the high number of outpatients the doctor did see in the Clinic, was also in question — due to it being twice the amount of patients seen by other practitioners.
According to the former LBJ CEO during “the second Quarter of this Fiscal Year” (which would be in 2012), Saleapaga managed the smallest number of inpatients — 13 — while other physicians saw patients ranging from 28- 69 in number, and during that same period “your mortality rate was the highest of any practitioner in the service at 23%. The Mean Mortality Rate was 12%. (Mortality rate is the number of your patients, who died, based on the average number of patients you treated.)
“Your average length of stay for this period was also the highest in the service at almost ten days. The Mean was slightly over 6 days,” wrote Gerstenberger.