Juan Luis Hospital CEO Kendall Griffith presented a $10.3 million plan of correction Monday to the Territorial Board, a plan to get the embattled hospital up to the standards of the Centers for Medicare and Medicaid Services.

Almost half of that amount — $5 million — would go to medications and prescriptions. Some $1.6 million would go toward paying third-party consultants and $1.5 million toward the hospital’s psychiatric unit. The rest would go to various vendors and service providers, including a $500,000 allocation toward cost containment services by the company Advisory Board.

Griffith said the funding would ensure “an approved Systems Improvement Agreement with CMS” and a successful resurvey by the agency in nine months.

CMS’ pending decertification of the hospital was announced Sept. 18, one day after Juan Luis received notice from CMS following a hospital-wide survey by the agency at the end of July. CMS decertification would mean the hospital would no longer be abel to bill Medicare and Medicaid for patient services, cutting a big revenue stream.

After conferring with the government, the Legislature, and the law firm Ropes and Gray, hospital executives headed to Baltimore to meet with CMS officials.

On Oct. 6, JFL received notice that CMS is granting the hospital an extension until Nov. 20, and the option to enter a systems improvement agreement that would correct deficiencies cited by the agency. Another resurvey nine months later would determine if JFL held up its end of the bargain.

Griffith, however, stressed it would take a lot of collaboration.

“It was very clear that they are expecting a coalescing of all levels of government to commit to improving JFL,” said Griffith of CMS.

In addition to a resolution supporting the hospital’s new systems improvement agreement, the Senate must define uncompensated care, Griffith said, “which would help the government determine the level of funding that would be given to the hospital every year.”

They would also need to fill the vacant positions in the St. Croix district hospital board, which would be a show of commitment from the executive and legislative branches, according to Griffith. The St. Croix board currently has five sitting members and had its first official meeting on Sept. 29 after not having quorum for a year.

According to Griffith, JFL officials are conferring with the administration and the Legislature on finding the funds for the cost of their plan of correction.

Staffing and Morale Issues

Griffith said the CMS report cited “adverse events” in 2013 and 2014 – incidents in which patient care was compromised, in some cases resulting in patient death. The hospital had not had any such events since then, Griffith said. The report also faulted Griffith for failing to report those incidents to the hospital board or the Territorial Board.

Griffith highlighted the hospital’s staffing issues.

“There is a direct correlation between staffing and quality,” he said.

The emergency room needs a lot of work, according to Griffith. It is understaffed, driving up the average waiting time for patients. Griffith said they are looking "aggressively" for health care providers to keep the emergency room and other critical intake areas fully staffed.

The recent CMS findings and near-decertification also affects staff morale, according to Griffith, causing concerns of nurses leaving the hospital.

“We’re actively speaking with the staff, reassuring them that we just have to do what we said in the plan of correction, and we’ll be OK,” said Griffith. “But so far we haven’t had any hint of a massive exodus of nurses or physicians.”

When asked by board member Wilbur Callender if the hospital has been able to eliminate problems with disruptive behavior, Griffith responded yes, adding “it comes with a cost.”

“Anytime you make significant change in an organization that is accustomed to doing things a certain way, people fight back, and they attack not just at the professional level, but they attack at the personal level,” said Griffith, refusing to publicly answer Dawson’s inquiries on the nature of the personal attacks.

Griffith said that for “significant, sustainable change” to occur at the hospital, hard decisions have to be made and followed.

“But they also have to be the right decisions,” said Dawson.

“I’m very confident about every decision that I’ve made … and the decisions that the medical executive committee at JFL has made regarding disciplinary action for accountability in disruptive behavior,” Griffith responded.

Griffith said there are vetting and accountability processes for healthcare providers, as well as clear guidelines on professional and ethical conduct. If staff failed to follow the rules, there is also a set of procedures for disciplinary action.

“We’ve seen a lot of improvements, we’ve also seen a lot of drama,” Griffith said. “I think that any change, any revolution is never easy, and it is fraught with a lot of controversy and difficulties. And JFL will see through all of these things.”

Present in the St. Thomas board room were Board Chairwoman Lynn Millin-Maduro, board members Dawson, Callender, Cornel Williams, Anthony Ricketts, Maria Tankenson-Hodge, Philip Arcidi, Greta Hart-Hyndman, and Debra Gottlieb.

In other action, the board voted unanimously to table the discussion of implementing Griffith’s one-year contract until the next meeting in the absence of an actual contract. Williams was absent during the voting. The board also voted unanimously to move the remainder of the agenda until December.