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Medical Subcommittee for the New Hospital Project offers 3 options

DoH director Motusa Tuileama Nua
reporters@samoanews.com

Pago Pago, AMERICAN SAMOA — Doctors, nurses and medical officials who are part of the subcommittee overseeing the plans for a new hospital are voicing their opposition to the project as it stands, laying out three options, the first and second of which include a long-term acute care facility either within the current hospital or as a free-standing facility.

The third option is the building of a new hospital as championed by the administration, which the subcommittee likens to building a “mini-LBJ”  which is “hazardous and risky”.

This is outlined in the executive summary from the Medical Subcommittee of the New Hospital Project, dated April 3, 2023, The report obtained by Samoa News, was endorsed by the medical subcommittee comprising four senior nurses and nine medical doctors from LBJ and the DoH.

They are Dr Elizabeth Lauvao; Dr Aiga Sesega; Dr Saipale Fuimaono; Dr. Ronald Yip; Naomi Walinski-King; Aiga Mareko RN; Josephine Fuga RN; Dr Akapusi Ledua MD; Dr Joseph Shumway MD MPH ; Dr Abraham Leiato MBBS; Dr Robert Gayapa MD; Dr Olita Koria-Laititi MBBS; Dr Fiatele Porotesano-Avegalio MBBS; Simamao Tuatoo RN DON and Rosamma Finney RN.

The new hospital project, which is now overseen by the Department of Health Director is of vital importance to American Samoa, the report says.

“The ARPA grant provided 300 million dollars to LBJ for service improvements and facility upgrades.

 “After further discussions, the ARPA Grant was split by the current Governor and $100 million was reserved to LBJ for repairs and service expansion; $200 million dollars was moved and allocated to build a new specialized acute care 40 bed specialty hospital to capture new medical services. 

 “The agreement splitting the grant was not done in consultation with a team of medical planning experts.”

According to the report the LBJ Board was excluded.

 “Critical stakeholders, including LBJ physicians and nursing staff were not consulted until very late in the process. 

“This grant was improperly left in the hands of well-meaning but inexperienced advisors. Seasoned stakeholders were specifically excluded from critical discussions.

“Most of the medical planning input was provided by two LBJ doctors with no experience or training in healthcare planning. Significant unintentional errors resulted.” 

Thus the report concludes the original proposal is flawed and unworkable. 

“It does not meet the health care needs of American Samoa — correct decisions in this matter are desperately required for the future.”

In its report, the Health subcommittee recommends not only an acute rehabilitative and chronic care medical facility with new services to the people of American Samoa but also expand the acute care services now being offered at the hospital.

RECOMMENDED SYSTEM IMPROVEMENTS

LBJ Medical Center would add the following Medical services:

Acute Care Services Expansion; Laparoscopic Services; Orthopedics including Joint replacement and Spine; Lithotripsy Service; Urology (Male and Female) Recruitment in this area has begun; Medical Missions short term and intermittent services; Neurosurgery; Surgical Dermatology services (Mohs Surgery); General Surgery, Cardiology, Radiology; GI Endoscopy Services (every day of the week); Cataract treatment (these services will start at LBJ in June 2023); Inpatient Dialysis at LBJ (Outpatient to New Hospital) and Acute Care Substance Abuse Unit.

The DoH would add the following medical and preventive services:

Primary Care Services Expansion in the Local Clinics; Improvement of Preventive Health Services; Increased focus on detection of early cancers with improved cancer screening; Development of comprehensive health registries for Cancer, Rheumatic Heart Disease, and other chronic diseases; Strengthen of the Public Health Clinic System with “Continuity of Care” providers; Support a unified electronic medical record with LBJ, DOH, and this new facility. 

“A single health record will promote communication and reduce medical errors,” the report says.

Furthermore LBJ and the DoH have committed to these improvements. 

As reviewed in Monday’s news article, an acute rehabilitative & chronic care medical facility that would provide new and critically needed services to the people of American Samoa is recommended by the Medical subcommittee.

The subcommittee offers the following final recommendations in its report:

OPTION A: Return the $200 million to the LBJ Hospital and do not divert funds to build a second hospital. 

“This is the best recommendation, if we follow the recommendations by the US Corp of Engineers, this is the best financial investment for the future of American Samoa. 

 “This would require the return of $200 Million ARPA money to LBJ. This would allow LBJ to make the necessary improvements as recommended by the US [Army] Corp[s] of Engineers. 

“This option provides the maximum healthcare benefit for the ARPA funds. Any other proposal will dilute the maximal benefit possible given the significant public investment in LBJ already. 

“LBJ can build and manage a chronic care/ rehabilitative care facility at the present LBJ site for less money and provide better management of its patients if it was located close to the current hospital.”

OPTION B: This option is sustainable, economically viable and is medically needed. 

 “This option fills a critical gap in the Health Care system of American Samoa building of a Long term, chronic care / rehabilitation specialty hospital is a good use of the ARPA funds.   Option A is Best. 

“Option B is strongly recommended as the only possible option if Option A is not chosen.

“This new chronic care facility will provide the maximal benefit for the limited health care dollars that are available. 

“This is the best medical use of the ARPA grant funds for the betterment of American Samoa. 

“It is a solution that does not risk the loss of this ‘once in a generation’ healthcare investment of $200 million dollars.

“As this facility is being built, LBJ and the DOH will likewise be making significant upgrades and improvements to their services with the additional funds allotted to them. 

“LBJ will also significantly upgrade surgical services and invest in strengthening its tele-health capabilities.

“This comprehensive plan (option A or B) completes the ‘missing services’ and will greatly diminish the need for off island referrals.”

OPTION C: Building a “mini-LBJ”, which is “hazardous and risky”.

 “It cannot be built within the allotted budget.

“It will not promote the health of all.

“It duplicates medical services. 

“After completion, there is a high risk of failure for this facility as it lacks the population base and funding to have sustained profitable operations. 

“There is no economically viable way to build “a Mini-LBJ”. 

“It will fail. 

“It is unrealistic. 

“The original plan is flawed and was presented without any reference to the US Corp of Engineering report.

“It was promoted with significant influence by off-island financial interests. 

“The initial medical LBJ physicians who promoted it locally had no training and experience in health planning, they were ill-used. 

“The briefing materials provided to the Governor to support the original plan were misleading and deceptive.  

“Such a facility would only serve a small segment of the population of American Samoa. 

“It is inequitable and unfair. 

“In a Samoan society built on family and community, this plan divides and fractures Samoan society.”

According to the report, building a “Mini-LBJ” does not improve the healthcare system of American Samoa; it weakens it for the next 50 years. 

 “It is important to understand that operational costs to run a ‘Mini-LBJ’ are prohibitively expensive.

According to the report, the operational costs are in excess of $70 million per year when built to the original grant proposal specifications. 

“What you build you will have to maintain, without a stable funding source, this facility would eventually become a very expensive cost to drain the financial reserves of the [American] Samoa Government. 

“Duplication of precious resources is wasteful. 

“A failing hospital would eventually channel governmental money from other vital services in transportation, education and other public infrastructural works — those projects should not be robbed in the future by a bad choice now.

“Without proper funding and proper planning there is a significant risk that this critical investment of $200 million dollars would be wasted and lost if a second acute care hospital was built. 

“Please note that no town in America with 50,000 people has two thriving acute care hospitals.

“Such a choice is economically burdensome.

“America Samoa should not go down this path,” says the report.

“Many towns in America have an acute care hospital and a long term/chronic care rehabilitation hospital.

“That is the correct model for American Samoa,” the report reads.

Further, the medical professionals point out that if the Governor cannot choose option A, they respectfully request that he choose option B. 

 “The wrong decision in this matter will be paid [for] by the children and grandchildren of American Samoa.

If option C is chosen by the Governor and his Chief of Staff, we request that this entire proposal be reviewed by the Department of Health and Human Services in Washington DC. 

ADDITIONAL NOTES

 “Who will a long-term chronic care facility serve, patient characteristics of a LTACH facility: multiple co-morbidities, respiratory failure which requires weaning of a mechanical ventilator, recent surgeries, presence of gastrostomy tubes, diabetes with recent amputations, patients in need of total parenteral nutrition, presence of bladder catheters or central vascular catheters, decubital ulcers, complex wound care, administration of intravenous antibiotics, multiple organ failure, and malnutrition. 

 “Patients who are admitted for these facilities are expected to recover under close observation.

“The typical average length of stay in these patients is, 25 days.

 “Funding for these services was authorized in 1982 with the Tax Equity and Fiscal Responsibility Act which allowed Medicare to reimburse long term care facilities on the basis of expenses incurred during each hospitalization, regardless of the initial diagnosis.

“This was reaffirmed in 1997 and again in 2002.  

“As previously stated, this is not a nursing home, it is not an assisted-care living facility. 

“It is a place to mange chronic medical issues and to also provide outpatient Cancer Care and more advanced rehabilitative care services. 

 “The Medical committee will only advise what is medically appropriate and wise for the benefit of ALL the people of American Samoa. 

“We stand together against corruption.

“This public funding should not be used to only benefit the few and the privileged in a privately run governmental hospital.”