The actions of senators led by Sen. Alicia "Chucky" Hansen and temporary "interim" Chief Executive Officer Dr. Kendall Griffith led directly to the recent ugly findings by the Centers for Medicare and Medicaid Services and CMS’s decision to decertify the Gov. Juan F. Luis Memorial Hospital on St. Croix.
The structural financial problems at both V.I. hospitals are well documented. When attempts were made to reform the hospital, Hansen and Griffith led an attack on the reforms, forced out reformers and dismantled the normal governance of the hospital.
The JFL governing board knew well of the growing strains on the hospital and the need to become more efficient and solvent while also improving care.
In 2010, the hospital board searched for a new CEO, looking for someone able to come in and make tough, unpopular choices. When it hired Jeff Nelson, then-board chairman Valdemar Hill said they had chosen him because Nelson was a “turnaround expert” with extensive experience at financially troubled health care institutions.
“We don’t anticipate this person will be at the helm forever,” Hill said at the time. (See "Luis Hospital Hoping to Fill CEO Position in January") After Nelson took office, the board declared a financial emergency and sounded the alarm consistently to all who would listen.
In testimony before the Senate, Nelson and other hospital officials said that without an infusion of cash as many as 100 jobs would be affected. The senators took no action.
In February 2012, Nelson laid off 85 certified nursing assistants and licensed practical nurses, saying it was a difficult decision but an inescapable one given the hospital’s financial condition.
Moving to a system in which the staff of registered nurses would be expanded, making them responsible for more patient care, was part of an attempt to become a "magnet hospital," which typically attracts and retains more patient, Nelson said. He said more than $56 million goes off-island each year as residents of the U.S. Virgin Islands seek medical care on the mainland. Moving to an RN-dominant model would help the hospital provide more of those services on St. Croix, Nelson said.
The nurses who were laid off protested, understandably, (See "Nurses Protest Layoffs at Luis Hospital") and Hansen went on the warpath.
The V.I. Legislature immediately moved to interfere with the normal governance of the hospital, threatening to overturn the hospital bylaws, its board and its CEO by legislative fiat to stop Nelson from doing anything else that might be unpopular with the employees. (See "Limit Sought on Hospital CEO’s Authority)
Hansen injected herself into management decisions at the hospital, publicly and loudly pretending the hospital was doing fine financially when everyone knew it was not.
"JFL is making more money than ever," she said in a July 12, 2012, press release. "Although Nelson is spreading doomsday predictions about the hospital’s finances, JFL’s financial statements show otherwise."
Those "doomsday predictions" have all come true, of course, as the hospital ceased paying electric bills, employee taxes, employee pension contributions, tens of millions in vendors bills and has needed repeated infusions of cash just to meet payroll over the last year.
In a June 22, 2012, release, Hansen had this to say about CMS:
"I also have concerns that Mr. Nelson has maneuvered the governing board of JFL Hospital to rush into an agreement with the Centers for Medicare and Medicaid Services. … I think bringing the hospital to the brink of closure is exactly what Mr. Nelson needs to force his plans upon the JFL Hospital Board and our community."
In late 2012, the board stripped Nelson of some of his responsibilities and began searching for a person to fill the newly created position of chief operating officer. Ultimately, Nelson was asked to resign.
The board appointed Griffith to temporarily fill in as "interim CEO" in January 2013. It was a decision not without controversy.
Then-board chair Kye Walker said at the meeting when the board appointed Griffith: "I just want to make clear, I’ve received some calls from people who have questioned the decision to appoint Dr. Griffith as interim CEO, and that’s not something the board is entertaining.”
“The issues facing JFL are larger than the board, larger than everyone in this room, and it’s a community issue. It’s a territorial issue. We’re not entertaining any nonsense about who can work with whom and who can’t work with whom. Everyone has to get together and work as a team," Walker said.
Six months later, Griffith and Hansen forced Walker and member Imelda Dizon off the board, threatening a legislative dismantling of the hospital’s board to make it more amenable to the interim CEO. A few months after that, Griffith terminated the chief financial officer, with both assistants also leaving. A former CFO, Nellon Bowry came in temporarily a month later, but in the chaos, the hospital stopped sending out bills until Griffith hired an interim CFO the following year and billing resumed. Here is a letter JFL sent patients, apologizing for not billing and offering 40 percent off the bill if they would just please pay something. [Hospital’s letter]
In July 2013 Griffith resigned as interim CEO. In public, he claimed he resigned because of the difficulty of maintaining his medical practice while managing the hospital.
“I knew that accepting the position of interim chief executive officer while also practicing as a physician would be a challenge," Griffith said.
His action caused lawmakers to propose a complete revision of the JFL administrative setup.
"Senators Sanes, Capehart, Hansen and I worked feverishly today to draft legislation to dismantle the St. Croix Hospital Board," said Sen. Kenneth Gittens in a July 11, 2013, press release.
Before that happened, Griffith agreed to return, but only if Walker and Dizon left the board. Senate President Shawn Michael Malone said at the time Griffith’s "only condition for returning" was not related to his family or practice, but "that new members of the board be appointed." (See "Senate Session on JFL Hospital Scheduled, Then Canceled")
The board had been created to oversee and govern the hospital. Giving the temporary, emergency interim CEO veto power over the board’s membership turned the system on its head.
There were five members, a bare quorum of the nine-member board at the time Griffith forced Walker and Dizon out, leaving three. Board member Wallace Phaire resigned in December 2013, less than a week after Griffith fired Chief Financial Officer Deepak Bansal, leaving the board with two members.
Gov. John deJongh Jr. nominated two new members, Phillip Arcidi and Dexter Skepple, who flew through the nomination process. But Skepple ultimately withdrew without serving. Recently the Legislature confirmed Kimberly Jones and Troy DeChabert Schuster to the board, bringing it back to the bare quorum of five it had before Griffith forced out members of the board ostensibly overseeing him.
The September report from CMS mentions the lack of a quorum on the board five separate times. It speaks of a "lack of oversight" and "the Governing Body’s ineffectiveness." It lists terrifying patient-harm incidents that should have been reviewed by the St. Croix board or, if not, by the territorial board so preventative measures could be put in place. Just the other day a headline trumpeted that the board finally had a quorum again. (One of that board’s first acts was to remove the word "interim" from Griffith’s title.)
Griffith mentioned CMS 11 times during his July budget testimony and discussed plans of correction. But he made no mention of quorums, oversight or review, seemingly unaware CMS was extremely concerned at the lack of review of patient harm incidents. [Griffith budget testimony]
He did not soft-pedal the financial situation, saying it "will lead to adverse patient outcomes" and "will create a downward spiral of quality care and may result in our CMS decertification," which would "lead to a loss of 59 percent of our revenue stream and, hence, our inability to maintain even the most basic of operations.”
Money is clearly an issue. But Griffith proposed no cuts or efforts at austerity or structural reforms at the hospital; nor is there any indication he is willing to do anything that will make him unpopular with the staff.
Nine months earlier, on Nov. 22, 2013, Griffith and Bansal appeared before the Senate to warn the hospital would soon be unable to make payroll. Bansal urged moving to the physician-pay model used in every other hospital in the country, saying if the hospital paid regular, competitive salaries, it could see a financial turnaround "within a few months." Griffith opposed the change. (See "JFL Hospital Struggling to Make Payroll")
Seven days later, on Nov. 29, 2013, Griffith fired Bansal. Patients ceased being billed for months. But physician compensation remains unchanged – and unmentioned in Griffith’s budget testimony this year.
Fortunately most of the problems cited by CMS cost nothing to fix. They require effective management.
Pre- and post-surgery checklists that make sure a doctor hasn’t sewn a sponge or needle inside a patient do not cost money, but they require effective management, which was lacking.
Having nurses follow a new policy and not secretly put psychoactive "chemical restraints" in patient IV bags to make them stop bothering them does not cost money; it requires management and oversight, which were lacking.
Labeling pharmaceuticals correctly does not cost any more money than labeling them incorrectly. It requires management.
Bringing credentials, new employment contracts and patient incidents to at least the Territorial Board if not the district board does not require money; it only requires effective management.
Griffith is a good man and a fine cardiologist. But that does not erase the monumental mismanagement of the hospital under his watch or justify the deeply destructive political games played out by Hansen and other senators.
Public life is hard. Sometimes you believe you are fighting for the right thing only to find you are wrong. Well-meaning people can make mistakes. But forgiveness requires repentance and repentance requires owning up to the mistake.
Have any senators repented of "working feverishly … to dismantle the St. Croix Hospital Board" yet?
Hansen certainly was not contrite at the time; nor does she seem to be now. The other senators can, and should, speak for themselves.
There are some who argue that vandalizing the board and forcing members out are not the problems. They blame deJongh for not fixing the board fast enough after Hansen and Griffith worked so hard to break it.
The difficulty the governor faced in filling vacant positions is not unique. It’s hard to find qualified people who are willing to put themselves through the process, especially when Hansen may at any moment vilify a candidate loudly and at great length on television until the candidate is rejected.
There are structural problems affecting the finances of both hospitals. But the actions of Hansen and those senators who followed her lead, and the actions of Griffith are why one hospital is facing catastrophe and the other is struggling. But while we should pull out all stops to find resources for the hospital, there will not be good governance at JFL while the CEO has veto power over the board.
And that apparently will not change while Hansen is still in office.