As doctors close clinics
SAIPAN – Storm clouds yesterday literally and figuratively hovered over the Commonwealth Healthcare Corp. as physicians decided to close the outpatient clinics effective 1:35 p.m.
“This recent delay in payroll has not been the only hardship we have faced, but it appears to have been the hardship that has brought us to the breaking point,” stated a letter addressed and delivered yesterday afternoon to CHC CEO Juan N. Babauta, on behalf of the medical staff by Dr. Jeremy Richards, director of medical affairs.
The two-page explanation cited the ongoing challenges faced by staff that included: the inability of CHC to maintain needed essential medical supplies; make sufficient facility repairs; recruit and retain personnel; and meet contractual obligations to employees.
CHC’s rapid decline since it became a corporation last October has been widely reported in the media and has been a hot topic among elected officials. But a lack of consensus over solutions and a negative cash flow finally prompted the medical staff to draw a line in the sand.
“Staffing levels are at a critically low point, and several providers, who have significant obligations and cannot tolerate further delays in remuneration, are being forced to leave,” Richards explained.
One scary example yesterday morning was coverage in the emergency room.
During the early morning hours, non-critical cases were turned away from the ER due to the physical exhaustion of the two attending physicians.
The two doctors have been working non-stop to cover a very busy ER last week in the absence of one CHC ER doctor currently on vacation.
“We came close to losing coverage of the ER this morning; however, due to several providers stepping in to cover the exposed shift, we were able to maintain emergency coverage. The current staffing situation in the ER is unsustainable,” Richards emphasized in the letter.
The medical staff also advised Babauta that already-scheduled operations will continue through Friday, but non-emergency and elective surgeries are on hold until adequate staff, supplies and medicines are available.
Even if CHC is able to locate employees and funds to meet the minimum standards by Friday, Richards outlined a dire warning.
“We are rapidly losing our ability to maintain critical services of the hospital. ... [As of Friday,] we fear CHC will not be able to maintain the emergency room or the operating room, and we may need to shut down these services.”
In this worst-case scenario, CHC would face the difficult task of discharging plans for all acute and critically-ill patients.
“At that point we would recommend closure of the hospital.”
The letter’s catastrophic warning to the powers-that-be was echoed by medical staff after their noon meeting.
“Coupling the facts that Medicaid patients cannot get their medications or clinic treatment, and the CHC crises, it’s only a matter of time before the ER is flooded with patients who will die,” predicted one exhausted and frustrated doctor on condition of anonymity.
Another physician commented that last Friday’s missed payroll was a “breaking point” for the already-demoralized and overworked medical staff.
A third doctor turned his attention to CHC’s nurses.
“How much more can they endure? Once we lose our nurses, we’re dead in the water no matter what the medical staff decide.”
According to Leticia Reyes, director of nursing, the staff was continuing to report for work even while payroll and six months of housing allowances were past due.
“They are a great group of professionals doing their best in the face of adversity,” Reyes described.
After the CHC outpatient clinics closed yesterday, Reyes kept the nursing staff busy by temporarily re-assigning them to various hospital areas to enhance coverage.
As word spread of the clinics’ closures, CHC staff and patients were numb with the realization that the end may be near.
One dazed nurse gazed at her shoes while whispering, “How could the government let this happen in America?”
CHC’s in-house counsel, Allen Hazlip, arrived at CHC yesterday afternoon to provide legal expertise on the various problems facing the healthcare system.
Asked if the medical staff’s work stoppage was legal under NMI law and the employment contracts, Hazlip declined to provide a definitive answer.
“That question is one of many that remain to be answered,” he stated before leaving the hospital for an emergency meeting called by Lt. Gov. Eloy S. Inos yesterday afternoon to address the corporation’s immediate and short-term cash flow challenges.
CHC’s chief financial and administrative officer, Alvaro Santos, also on his way to the meeting, cited a needed minimum of a $650,000 cash infusion in order to meet last Friday’s payroll.
“This is also a vendor invoice payment week, so we’ll need much more than that,” he added.
The inability to meet payroll and vendor payments stems from the fact that CHC is collecting only between $600,000 to $750,000 a month in billings. This is a full 75 percent below its monthly operating expenses of approximately $3 million.
In an effort to bridge the difference between CHC’s collections and expenses, the Marianas Public Land Trust committed to providing a $7 million line of credit, which the governor signed off on in June.
However, the administration was wary of providing additional government agency funds to CHC until a repayment plan was provided.
Senior government officials told Variety the financial plan had not yet been submitted by CHC as of yesterday and thus the credit line was on hold.
As the events of the last 24 hours proved, CHC is already on life-support and time is running out quickly.
As one medical staffer observed, “CHC is ‘Humpty-Dumpty’ and once it breaks, there’s no putting it back together.”
As doctors close clinics