July 7, 2004 – Rodney Miller asked the Senate Finance Committee for help on Wednesday. The chief executive officer of Roy L. Schneider Hospital said the institution's nursing crisis "worsens each day," and he sees no light on the horizon to resolve the situation.
However, after Miller's testimony, some hope did appear.
Miller told the senators: "If this urgent situation is not addressed immediately, the hospital, through the governor, may have to declare a state of emergency. The seriousness of this problem cannot be overstated. We need help now."
The hospital administration's recommendation to hire registered nurses from Puerto Rico has not been heeded, Miller said. "Despite everyone who criticized our proposal," he said, "to this day not one person or group has presented a realistic solution to this critical problem."
He said the hospital has been trying to recruit Puerto Rican nurses. The problem, he said, is that those nurses are licensed based on having passed a Spanish-language examination which isn't deemed equivalent to the National Council Licensure Examination, or NCLEX. The hospital asked the V.I. Board of Nurse Licensure to implement a V.I. Code provision that would "enable licensed and experienced nurses from Puerto Rico to work here," he said, but the board denied the request.
After Miller left the Senate chambers, Winifred L. Garfield, Board of Licensure executive director, said the board had worked out a plan whereby nurses from Puerto Rico could be hired for a year on an emergency basis. She said professional nurse certificates thus approved could not be extended beyond the 12 months.
Garfield said each nurse thus certified would have to take a NCLEX review course at the hospital's expense and sit for the examination four weeks after beginning work.
Miller said Wednesday evening in a telephone interview that he had not seen the board's proposal until that day at the Legislature. "We have not had a chance to completely evaluate the entire proposal," he said. "On the surface, I commend them for responding to our proposal as a way to work with us. However, the proposal doesn't seem to go far enough."
For one thing, he said, "it will cost the hospital a tremendous amount of money to train and recruit [the Puerto Rican nurses]. And then to have them take the exam in four weeks, when they're not even used to their surroundings yet, I don't see how you can do that. It will put a heavy burden on the hospital. We will have to finish the evaluation. We are encouraged they want to help, but it will be very difficult to do that within one year."
Miller's proposal to the nursing board did not make passing the NCLEX a requirement for employment. He told the senators Wednesday that the hospital is "willing to discuss a reasonable time frame whereby the nurses would be required to take the exam after they had been employed by the hospital for a time certain." His proposal called for the nurses to be hired for two years and to take the exam within one year.
Miller noted the hospital's long-standing reliance on the costly services of contract traveling nurses. Each contract nurse costs the hospital on average $110,000 annually, he said, while each permanent nurse saves the hospital an average of $60,000.
NOPAs Have Hiring of 26 Nurses on Hold
The hospital currently has 26 would-be permanent nurses waiting for notices of personnel action to be processed for their employment, Miller said.
This prompted Sen. Louis Hill to exclaim: "You have 26 hospital-contracted nurses, and it takes three months to get a NOPA? What is wrong?"
Hill said the executive branch "is totally responsible for this problem in bureaucracy. It's their problem, and if they have a will, they can resolve it."
He asked Miller several times if the Legislature could do anything to help the hospital with its fiscal crisis. Miller replied that the section of the V.I. Code which leaves discretion in hiring to the licensure board "isn't totally clear. It could be changed to allow hiring of Puerto Rico nurses."
Adding to the hospital's financial problems, the governor's proposed fiscal year 2005 budget calls for a $2 million cut in its government appropriation. The hospital and the administration have recently been at odds over money the Finance Department is demanding. Miller recounted the situation Wednesday: The hospital owes the government, and the government owes the hospital. (See "Schneider Board Backs CEO in Clash with Government".)
Miller said an increase in the number of hospital personnel who are paid out of the Hospitals Revolving Fund is mainly due to the Office of Management and Budget having shifted positions that previously had been funded out of the General Fund. "It's a pervasive problem that has been conveniently ignored," he said. "In 1996, the payroll expense charged to the HRF was $82,730. That amount t grew to $2.5 million by 1999, and today it exceeds $4 million."
He said the clearest example of this policy of shifting personnel costs away from the General Fund is the $2 million reduction proposed for the hospital's FY 2005 budget. "It represents positions such as the director of pharmacy, radiology supervisor and nurses. The HRF is overburdened," he said.
Miller said the hospital has not overspent its FY 2004 General Fund personnel allotment.. "In fact, we are projected to underspend our current allotment by about $1 million," he said. On that basis, he urged the senators to reject the administration's recommended $2 million cut. He said if the hospital doesn't have the operating staff it requires, safety will be compromised, and "we would almost certainly lose accreditation."
Hospital-Administration Talks Continuing
Miller said hospital officials have met with Finance Commissioner Bernice Turnbull; Ira Mills, OMB director; and Juel Molloy, the governor's chief of staff. The hospital agreed to pay the government $200,000 of what it owes each payroll period. "We have paid $400,000 so far," Miller said.
Sen. Almando "Rocky" Liburd asked if the talks — with another scheduled for Friday, Miller said — would lead to a "permanent solution." Or "are we headed up the road again with just having a little Band-Aid to cool off the heat now, and then we go again?"
Miller said there's no permanent solution yet. "It's a work in progress until we make health care a priority," he said. "We are still a ways apart, and I'm not going to say we have a final plan until it's a go and everything has been solved. And I'm not sure when we are going to get there. It will take extensive discussion."
Sen. Luther Renee, the Finance Committee vice chair, conducted Wednesday's hearing in the absence of Sen. Adlah "Foncie" Donastorg, the chair, who left the chambers at the start of the hearing, citing an urgent personal matter.
Renee said he sensed "a resistance" on the part of the administration to helping the hospital. "When people ask me about coming to the V.I., the first things they want to know are the status of our health and our education," he said. "I am firmly in support of the hospitals' semi-autonomy."
Miller said the semi-autonomy of Schneider Hospital on St. Thomas and Juan F. Luis Hospital on St. Croix has been questioned by "certain high-ranking but misinformed policymakers who have declared the hospitals to be in the worst financial condition in the history of the territory." These critics, he said, "claim semi-autonomy resulted in the tripling of costs. They would have us go back in time … when the hospital lacked basic supplies including toilet paper, soap and bed l
Liburd said anyone maintaining that position "doesn't know what going without is. They weren't around then. It's as different as night and day." All senators on the floor said they support the hospitals' semi-autonomous status.
Miller did have some good news — that Schneider admissions are up by 8 percent. "This is great news for any hospital," he said. And the number of patients unable to pay has decreased, he said.
He also said that when the hospital received accreditation last year — a first, and a major accomplishment — one of the inspectors asked him if the two-decade-old facility was a "brand-new hospital."
June Adams, RLS board chair, told the senators: "We have been faced in the past couple months with the possibility of services being curtailed. We are paying them [the government] $400,000 a month now every month for the nurses that we have on our revolving fund. I realize money is important, but I cannot see how anyone knowing the situation — the improvements, the specialities, how we have improved so people don't have to leave the island — how anyone in good conscience can say we don't need the $2 million."
"I'm not a money person," Adams added. "I'm a nurse. I speak from the heart as a nurse."
Also present representing Schneider Hospital at the hearing was Amos Carty, chief operating officer.
Committee members present for the hearing were Sens. Hill, Shawn-Michael Malone and Renee. Sen. Roosevelt David was excused. Sens. Norman Jn Baptiste and Ronald Russell were absent. Also attending were Sens. Liburd and Douglas Canton Jr., who are not members of the committee.
Scheduled for later in the day in the ongoing budget hearings was testimony from the Nurse Licensure Board, the Health Department and the East End Clinic on St. Thomas.
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