May 28, 2002 – Three days after taking on his new job as chief executive at Roy L. Schneider Hospital, Rodney E. Miller was getting a lesson from the heart about his new roots.
It was Myrah Keating Smith Community Health Center Day on St. John. And some of the speakers who once worked alongside the public health pioneer for whom the center is named were taking their listeners back to the day when Miss Myrah rode across the island by donkey, delivering babies.
It wasn't so long ago, they said, when injections were delivered by steel syringes and gauze bandages had to be separated and rolled, then sterilized in an old-fashioned, free-standing brick oven. For many years there was no doctor on St. John; only a dedicated nurse and midwife who worked 12-hours a day, drawing little pay but lots of thanks from a grateful community. If Miss Myrah fell asleep on her donkey, they said, it was no problem, because the donkey knew its way home.
Now the island's up-to-date health center — which most local folks still refer to as the Myrah Keating Smith Clinic — sits high on a hill just outside of Cruz Bay, filled with doctors and nurses, computerized records and modern diagnostic techno-tools. A team of drivers shuttles patients and workers to and from town. Front desk staff keep the atmosphere cheerful, and a maintenance crew keeps the clinic clean. It is — Miss Myrah's daughter said on that day– the kind of place her mother would have been proud of.
Moments after Coral Bay artist Karen Samuel's new portrait of Miss Myrah was unveiled in the clinic lobby that day — May 15, the telephone rang. As those assembled dispersed for a celebratory luncheon, Rodney Miller picked up the phone and got back to work. Like Keating Smith the pioneer, the new hospital chief executive said he was expecting a heavy workload.
"It's nice to reflect on the trail blazers in this territory," Miller said in an interview later. "We have to be mindful that, not too long ago, the nice amenities and research technology we have were very limited. So it says a lot about this world and how far we have come."
His job as the top administrator for Schneider Hospital and the St. John health center, he said, is to take the hospital system "to the next level."
Miller is the successor to Eugene Woods, the administrator who ushered in the age of semi-autonomy for the hospitals system. The territory's hospitals now have greater decision-making powers, a smoother purchasing system, streamlined billing and a fast track for new equipment. Revenues have risen under the new system, but the demands of a mostly working-class population with little or no health insurance has kept them from rising as fast as they could.
Despite the limitations, Miller says, he wants to bring "world-class quality health care" to the territory. The new CEO said he will spend 90 days figuring out what he has to work with before setting his course.
Other needs and priorities may present themselves on the way to meeting those goals, Miller said, and he's banking on his previous experience as head of Georgia's Savannah Memorial Health University Medical Center to anticipate and juggle those needs as well.
The preliminary sketch he carries in his head for the future of the hospital system contains four goals — raising revenues, achieving compliance with the Joint Commission on Hospital Accreditation, capturing a greater share of federal Medicaid reimbursements, and advancing the creation of a cancer center.
"We are currently underfunded as relates to Medicaid, compared to hospitals in the States," he said. "We provide a great deal of indigent care that we are not reimbursed for." He said it's his intention quantify the number of indigent patients the system serves "so we may utilize it to make the case" for higher Medicaid reimbursements.
Gaining accreditation from the joint commission, he said, is one way to qualify for a bigger Medicaid share. Meeting the standards for accreditation will mean making improvements. Gaining cooperation from the private sector in order to make those improvements without straining government resources is one of the essential steps, he said.
It worked in Savannah, where the client base was similar to the one he has found here in the Virgin Islands, Miller said. In the few weeks since he hung out his shingle as hospital CEO, none of the community's not-for-profit groups or businesses have come knocking on his door, he said, but he's hopeful.
He's also hoping for good relations with the hospital and health center staffs. At the St. John ceremony, he took the opportunity to tell those present: "Don't hesitate to call on me, because, first of all, I'm a servant and I will always be about my Father's business."
At the same gathering, Miller heard words of wisdom from a voice of experience, that of Keating administrator Erica McDonald. The two knew each other in the States through their membership in the American College of Health Care Executives, although they have not worked together before.
McDonald, who took over as administrator of the St. John center a little over two years ago, warned Miller that skepticism from the lower ranks generates peer pressure that works against the cooperation needed to get things done. "It's a risk for employees to get involved in the things that management wants," she said.
Miller says he expects to draw on his experience in the military as a resource to help him meet those kinds of challenges. "I have worked in a very, very diverse environment … I am a people person, and I believe my relationship style and my management style will be a complement to the employees here," he said.
His one admonition — to himself and those who work with him: "Always realize the patient is first."

Publisher's note : Like the St. John Source now? Find out how you can love us twice as much — and show your support for the islands' free and independent news voice … click here.