The Island’s only civilian hospital seriously jeapordizes patient care

Posted By: GuamBlog

Updated: 09/01/2013

In a 78-page report prepared by the U.S. Centers for Medicare and Medicaid (CMS), a litany of problems with Guam Memorial Hospital detailed why the federal agency has decided to begin the process to kick Guam’s only civilian hospital out of the Medicare program - which would mean a loss of more than $50 million each year for GMH.

That report, completed at the end of May this year, is accompanied by another 30-page Statement of Deficiencies, which together conclude that GMH poses an "immediate jeopardy to the health and safety of the agency’s patients," a charge Dr. Samuel Friedman tried unsuccessfully to bring to lawmakers attention earlier this year.

U.S. Centers for Medicare and Medicaid began the process to terminate Guam Memorial Hospital Authority’s Medicare provider agreement following a recertification and complaint survey completed May 27, 2011, which concluded the island’s only civilian hospital seriously jeapardizes patient care. The loss of the Medicare provider agreement could cost the hospital up to as much as 33% of its annual revenues.

Friedman, an oncologist with the Guam Cancer Center, was nominated by Gov. Eddie Calvo at the beginning of the year to serve on the Board of the Guam Medial Examiners. He has been a tireless critic of the draconian system of patronage that has hampered quality care at GMH for years. Legislators unceremoniously dismissed his nomination sending it back to Calvo insisting on another candidate instead.

At a public hearing on his nomination in March, the president of the Guam Medical Association Dr. Thomas Shieh testified against the oncologist calling Friedman’s charges of dangerous patient care, "irresponsible." Shieh told lawmakers, "He (Friedman) said GMH is killing people. Shieh proceeded to incorrectly deduce, “Killing involves criminal intent…he should be reporting that.”

Dr. Samuel Friedman, left, said in March 2011, “If no one is going to learn from mistakes, how do you expect to improve patient care?” During the confirmation hearing before lawmakers, Friedman spoke about his concern with patient care. He specifically spoke of an incident that occurred when a 41-year-old woman was improperly treated during her pregnancy and died while in labor at the hospital as a result. Dr. Thomas Shieh, right, took issue with Friedman’s comments and clamored to have the governor withdraw the oncologist’s nomination to the Guam Board of Medical Examiners. Shieh said, “I would certainly encourage Dr. Friedman to focus on the happier side of life rather than focusing on such negativity; that’s not going to help.”

Well a word to Dr. Shieh from Guam Blog - you should watch more Law & Order or just stick to telling your patients to “spread ‘em.” If the prevailing attitude at GMH is to wait until someone dies and “write a report,” then it just proves how on point Dr. Friedman was all along. The scathing Medicare report reaffirmed in graphic detail the accuracy of many of the charges Friedman attempted in vain to bring to light.

Direction Uncertain

Contrary to statements made yesterday by GMH Administrator Ray Vega, the report does not focus "mostly" on physical plant safety code issues. Rather, the report cites a wide range of problems that include, but are not limited to: failure to verify medical staff credentials; failure to meet standards in the administration of drugs; lack of patient privacy; expired medical devices and medications; and failure to ensure confidentiality of medical records among an exhaustive list of other issues. Only after reading through nearly 5 dozen pages does the report begin to note the concerns with the physical environment at GMH.

Stateside, when hospitals face the prospect of Medicare sending its patients elsewhere, the hospitals are often left too poor to operate or open critically needed new units. There is no other hospital on Guam for Medicare patients to go if GMH is kicked out of the program and GMH already suffers from weak financial management that has resulted in ongoing supply shortages and a backlog of vendor payments.

Yesterday, Vega appeared unclear as to how to interpret the report - or unwilling to admit to the public or himself how bad the situation is at GMH - but it is clear that an effective action plan must be developed and implemented in time to bring GMH into compliance with CMS standards.

A message on the subject of progress sent to Guam Blog last night from an anonymous person claiming to be a hospital employee reads, "There was so much not done under the last administration. I can see that there is work being done, maybe not very fast or very steady but its work just the same and that counts. There is still plenty problems with the Ins and the Outs who are so use to doing things wrong that they didn’t hide that from the CMS investigators. But I don’ think its as bad as it sounds."

Not Often Prescribed

Medicare does not often level the ultimate punishment on hospitals for lapses in care. Not often at all, it turns out. Upon receiving a copy of the report yesterday afternoon, Guam Blog spent the evening looking at how often this happens.

American Hospital Association

The American Hospital Association counts almost 17,000 registered and Community hospitals, along with federal government, nonfederal psychiatric, nonfederal long-term care hospitals and institutions and infirmaries run by prisons, colleges and universities.

Last year in California, which counts with 450 hospitals, federal Medicare officials listed 5 that were involuntarily “decertified” - in other words had lost their funding - since 2000. Nationwide, that figure amounted to just 31 hospitals. Guam may now soon have this dubious national recognition, too.

Dr. Friedman sounded the alarm to a roomful of tone-deaf lawmakers way back in March. He told lawmakers, “There’s a lot of bad medicine going on there that’s years out of date and that would be very easy to bring up to standards.” But the legislature refused to listen or to take a serious look into the deeply-rooted rot at GMH.

Many believe the Guam Legislature were more than happy to hide their own racial prejudices behind the protests of the doctors, nurses and administrators at GMH who are the most likely culprits noted in the CMS report. At worst, the Guam Legislature succumbed to their own close-minded bigotry;or, at the least, to their own form of “medical malpractice.”

It’s time to effect a real cure and find real leadership from professionals more willing to be open and honest about what is wrong at GMH like Friedman, and less eager to showboat a head firmly planted in the sand like Shieh.

Gov. Calvo swept out the host of failed hospital leadership at the start of the year and put in place a new GMH management team he said would make sure not to continue with "business as usual." However, after this dismal report and Vegas’ initial attempt to deflect the seriousness of the situation, it appears (unsurprisingly) that shuffling faces in management was not enough.

If the hospital is to save the tens of millions of dollars that come from Medicare billings each year, sweeping reform in patient care and management at GMH is the correct prescription for what ails Aturidåt Espetåt Mimuriåt Guåhan (GMH). There is no other way for the island’s only civilian hospital - and its management team - to survive.