In the face of repeatedly reduced government appropriations, Schneider Regional Medical Center is struggling to provide the full range of services that residents and visitors expect, Interim Chief Executive Officer Angela Rennalls-Atkinson said Tuesday.

Rennalls-Atkinson told V.I. Senate Health and Hospital Committee members that SRMC’s leaders were dissatisfied when the Senate reduced the fiscal year 2012 allotment from Gov. John deJongh Jr.’s recommendation of $25,097,135 to $22,527,776.

Then, Rennalls-Atkinson said, SRMC received notice from the executive branch that its allotment would be reduced again, by $641,430, and so 11 positions were eliminated in January. And just last Friday, Rennalls-Atkinson continued, she learned the allotment sum was being cut one more time by $732,153.

“As respectfully noted, the initial recommended appropriation was insufficient to meet the mandate of operating a cancer center, acute care hospital, and an urgent care clinic on a 24-hour basis,” Rennalls-Atkinson said.

While the number of senators gathered Tuesday was small – they included Committee Chairman Sen. Patrick Sprauve, Sen. Usie Richards, Sen. Nereida Rivera-O’Reilly, and, briefly, Sen. Craig Barshinger – several took the opportunity to extensively grill Rennalls-Atkinson and her staff about the wording employed in SRMC’s recent dismissal letters to staff.

Senators were particularly interested in a line that attributed the dismissals to a lack of action on the 29th Legislature’s part, and they directed SRMC’s acting Human Resources Director, Marlene Adams, to read the offending letter aloud.

“Given the failure of the 29th Legislature to act on those proposals, which might have made this action unnecessary at this time, and with considerable regret, I write to inform you that you will be dismissed from your position,” Adams read.

Sen. Usie Richards demanded to know where the wording originated. Rennalls-Atkinson, who signed the letters, said it was a “standard letter” that had been handed down to SRMC’s human resources department by the executive branch.

“Why would you have to utilize this standard letter?” Richards asked.

“In retrospect, we maybe did not have to,” Rennalls-Atkinson said.

Rennalls-Atkinson’s prepared testimony suggested that SRMC is facing problems potentially larger than the senators’ anger over the dismissal letters’ finger-pointing message.

For example, years of delaying capital-improvement projects has resulted in emergency spending, such as when SRMC had to put $305,000 toward air conditioning system repairs last year, Rennalls-Atkinson said. Putting off inevitable capital improvements means that their projected costs have grown, and now SRMC needs to make $10.5 million in improvements during FY 2012, she said.

Beyond this, SRMC needs nearly $1.26 million to bring the hospital’s IT infrastructure and software up to federal meaningful use standards, and the hospital’s dialysis unit, which can serve up to 94 patients battling end-stage renal disease, is at its maximum capacity, Rennalls-Atkinson said.

Rennalls-Atkinson added that because Medicare and other government agencies reimburse SRMC at an insufficient rate for dialysis care, it does not make sense to undertake major unit expansion at this time. Instead, Rennalls-Atkinson said, SRMC is requesting certification for two additional stations in an “overflow unit.” If the stations are used at their full capacity, SRMC will be able to treat 12 additional patients, Rennalls-Atkinson said. This will allow SRMC to accommodate more traveling patients, who want to visit St. Thomas and St. John, but need to undergo dialysis treatments while away from home.

Rennalls-Atkinson said that unlike other General Fund recipients that can more easily redistribute terminated staff members’ duties to other employees, SRMC must maintain a certain number of doctors, nurses, and technicians in order to ensure the provision of quality health care.

“Unlike many government agencies, the reduction in the workforce must be replaced by agency staffing in order to maintain our current service delivery,” Rennalls-Atkinson said. “This and any further reductions in services will definitely impair SRMC’s ability to maintain its current level and full scope of services.”