by Ken Quintanilla

Guam - Several issues and concerns continue to plague the Guam Memorial Hospital as discussed at this morning's information briefing before senators and GMH. Guam's only public hospital is hoping to address these concerns as the island looks to the future.

Before the Committee on Health and Human Services, senators grilled GMH management and board members regarding several issues noted by the Centers for Medicaid and Medicare Services and the Joint Commission on Accreditation. Several life safety code violations discussed before the Legislature and noted by CMS included restoration and improvement of small compartment penetrations, fire sprinkler system upgrade, replacement of 199 doors, access control systems, and fire sprinklers in elevator shafts.

Although there were some conflicting issues brought up by both groups, GMH board vice chair Albert Gurusamy says there is still value in JACHO as it has raised awareness for the hospital's provision in care. "CMS really maintains federal regulations but they don't really dig down that deep of the elemental details of patient care, and that's where joint commission is valuable. So we're not accustomed to doing all of those details and I think that maybe we've gone a little complacent" he said.

GMH had an unannounced survey visit on August 31 and again on September 1. The Joint Commission cited GMH for recurring trends and patterns as far as the practice in medication management, provision and care treatment and services. As for cost-cutting measures, GMH chief financial officer Siva Karrupan says no other programs have been cut since the outpatient hemodialsysis services ceased late September. However, GMH sought the Legislature's help in paying dues to a private vendor and washing away with $700,000 worth of chemotherapy drugs in stock.

However Vice Speaker B.J. Cruz questioned GMH's decision to cease its distribution of drugs and its services so quickly before the inventory was fully used up. "What are you going to do with $700,000 worth of drugs," he asked Karrupan, to which he replied, "Senator, the decision was simply made was because we couldn't afford to buy these drugs anymore, and we felt that the responsibility of taking care of the outpatient MIP and Medicaid patients reset solely with Public Health."

GMH acting administrator Rey Vega noted that the ceasing of services was an administrative decision and will look into possibly rescinding that decision after hearing concerns. Regarding staffing, the hospital noted 293 vacant positions, 129 of which have been identified that immediately need to be filled, totaling around $8 million. Other staffing concerns were possible poaching of GMH's workforce from the new hospital especially in experienced nurses.

Acting assistant administrator for nursing services Jemmabeth Simbillo said, "Our staffing in the hospital now is we have brand new junior nurses but the acuity and increasing criticalness of patient conditions requires that you have a certain mix of your senior experienced nurses versus your new fresh nurses so that's the challenge that we continue to have."

She adds many mainland hospitals don't accept fresh graduates or nurses without experience, so GMH has an influx of new nurses creating a competitive environment. GMH does train other nurses but once they get experienced, tend to find other attractive offers in the mainland. Suggestions were made to train nurses at the University of Guam at the master's level and make changes to the nursing scholarship requirements.

Despite various concerns, JACHO is still expected to provide a survey visit to GMH next month to follow-up on GMH's corrective action plan.