Pago Pago, AMERICAN SAMOA — Concerns over the quality and reliability of dialysis services at the LBJ Hemodialysis Clinic dominated last week’s Senate Health Committee hearing, where senior LBJ officials were pressed on longstanding issues affecting some of the territory’s most vulnerable patients. Committee member Senator Tuana‘itau Malaki Togiola — himself a dialysis patient — led much of the questioning, raising operational, staffing, and infrastructure problems he said continue to compromise patient care.

Tuana‘itau directed nearly all of his inquiries to LBJ CEO Papali‘i Dr. Scott Anesi, Chief Medical Officer Dr. Aitofele James Sunia, and Acting Chief Financial Officer Tuiavatele Victor Tuiasosopo. He described repeated breakdowns in the clinic’s water filtration system, which he said can delay treatment for two to three hours while technicians work to restore service. To keep the day’s schedule on track, dialysis sessions are shortened — a practice he argued places patients at risk.

He also cited chronic understaffing, insufficient dialysis chairs and machines, and even basic logistical issues such as the lack of parking near the clinic. According to Tuana‘itau, the clinic previously operated with four or five nurses per shift, but now often has only two. He added that a dialysis chair recently broke while a patient was undergoing treatment, saying the incident underscored his belief that LBJ leadership is not giving the clinic the attention and resources it needs.

Papali‘i Dr. Anesi acknowledged the challenges and said LBJ is in the process of upgrading the filtration system. Two new reverse‑osmosis units have already been installed and are awaiting certification before being brought online. He said these upgrades will stabilize water supply and reduce treatment delays.

The CEO reported that the dialysis clinic is currently serving 274 patients, up from 225 at the beginning of the year, with two or three new patients added each week from the ER. To meet demand, the clinic now operates five shifts on Mondays, Wednesdays, and Fridays, and four shifts on Tuesdays, Thursdays, and Saturdays. Of the clinic’s 38 dialysis stations, 32 are in use, and five additional stations have been ordered. LBJ also plans to add another shift to the Tuesday–Thursday–Saturday schedule.

Despite the growing need, LBJ is not accepting off‑island dialysis patients, a policy that Senate President Tuaolo Manaia Fruean said he supports. He noted that several CCCAS members living off‑island had hoped to attend last week’s general conference at Kanana Fou but were unable to travel because LBJ could not accommodate visiting dialysis patients. Tuaolo told LBJ officials that “we need to do better,” and asked what resources — staff, machines, or otherwise — were required to improve services.

Papali‘i Dr. Anesi responded that while more machines would help, the clinic’s most pressing limitation is space. He said LBJ is exploring options to expand dialysis capacity into nearby areas, including space adjacent to the OBGYN clinic. He added that space constraints are not unique to dialysis, noting similar overcrowding in the Dental Clinic and Pharmacy.

Senate President Tuaolo also asked about preventive health outreach and staffing levels in the ER. Dr. Sunia testified that the ER requires 22 doctors to operate effectively but currently has only 10, following several departures. Five new physicians have been hired, but delays in credentialing have slowed their start dates. He said LBJ has appealed to the Health Regulatory Board to expedite the process. While the new ER facility will be “one of the best in the region,” Dr. Sunia cautioned that its value depends on having adequate staff: “What’s the use of having a new ER when we don’t have enough doctors?”

Lawmakers also questioned LBJ’s decision to relocate several administrative offices to the Alofa office building. Papali‘i Dr. Anesi said Billing and Coding, Human Resources, Grants, and Administration have moved temporarily while the new training center in Faga‘alu is completed. LBJ plans to open an urgent care clinic and medical clinic on the building’s first floor next month, while existing clinics in Faga‘alu undergo renovation. LBJ is paying $60,000 per month to rent the first floor and half of the third floor.

Senator Muagututi‘a Tauoa spoke at length, urging LBJ leadership to prioritize the health of elderly parents, youth, and all residents who depend on dialysis. He said Samoan cultural values demand that the government and its health institutions “do better” for those who rely on life‑sustaining treatment.