It is with regret that I must announce my leave of absence from Guam Memorial Hospital emergency room duties. I have served the people of Guam for nearly 24 years working in the ER. It has been a trying and challenging position but quite rewarding as to patient outcomes under my care. Now, however, for the last three or four months conditions in the ER have become intolerable.
The ER has become overcrowded with up to 15–24 patients who have been admitted to the hospital, but are kept waiting for days for beds upstairs on the floors. This not only is poor medicine but dangerous to patients' health and safety. They lie throughout the hallways coughing and choking with black mold emanating from the vents overhead. They have to attend to their personal needs with visitors walking up and down the hallways and are exposed to all the noise and trauma without even so much as safety curtains.
Trauma unit beds are already occupied, so cardiac and trauma victims are sometimes kept in the hallways because of lack of appropriate beds. This means they don’t have monitors to follow their progress and are at risk of shock or, worse still, cardiac arrest.
The responsibility for these conditions lies squarely at the feet of Drs. Bordallo (OB/Gyn) and Aguon (Pulmonologist). They were appointed by the governor to be medical directors without regard to experience, knowledge or ability to run the various hospital departments. Prior to their inauguration, each department was run by a medical doctor who is board-certified in that department’s specialty, and the department board was responsible for the care and running of their departments. That's not the case anymore. Now all departments are run by the downstairs administration.
The nurses in the ER are now overwhelmed by their tasks. In addition to the normal complement of ER patients, they now have to care for up to 24 additional patients with no extra nursing help. They not only have to give hands-on care to these patients, but they are responsible for the enormous amount of paperwork that goes with this care. No wonder morale is down and tempers flare.
Dr. Annie Bordallo and Dr. Joleen Aguon have been appointed illegally by the governor.
The medical staff rules and regulations state specifically that the medical director shall be appointed by the hospital administrator with the approval of the Board of Trustees with recommendations from the Medical Executive Committee. I was the MEC president when they arrived, and I can assure you that none of these rules were followed. Also the MEC is the body responsible for coordinating the activities and general policies of the various departments, not the medical director.
Corruption overwhelms the chaos
Having laid bare some of the chaos permeating the hospital, I would like to pen a few words regarding the corruption that I have seen – corruption that in some way overwhelms the chaos.
What I find most pertinent about the appointments of the double medical directors by the governor is the fact that they were given complete command of the hospital regardless of their inexperience and lack of knowledge.
I, therefore, assume it was a political plum.
Each of the doctors receives $225,000 annually for a part-time job. In addition, besides running her lucrative birthing center, Dr. Bordallo has signed up for the government retirement benefits – and Dr. Aguon as well – which will mean they will be paid for the rest of their lives by GMH. In addition, Dr. Aguon receives a hefty compensation package for running the CCU/ICU, and at one time she was also billing for procedures she did in the hospital – even when ER doctors do many procedures that we don’t bill for because it is part of the job. Finally, Dr. Aguon works every day at an outside clinic for which she receives another salary. This is hefty compensation for part-time work. And Bordallo and Aguon don't work holidays or weekends, unlike ER doctors who work every single day in the ER.
So what led to this state of affairs? I believe it all started with Dr. Larry Lizama, who was appointed by the Calvo administration.
It is kind of convoluted, but he helped to keep Medicare payments low, so that the insurance companies who based their billing payments on how Medicare paid the hospital were able to pay less than half what GRMC – which has a higher Medicare reimbursement – demanded.
My understanding was that he received $450,000 per annum as the medical director and took over most of the functions of the hospital administrator. To his credit, he kept his hands off of most of the departments – most of all the ER. For that, I was thankful, because we could do a decent job without interference.
Dr. Lizama then started a hospitalist program and Urgent Care and glommed onto a further $200,000 payment. He was then given charge of the EMS – after Public Health backed out – and further funds were paid ... worth at least $25,000 a year. I ran the EMS for six years at no charge, I did not ask for one penny because as ER director, I thought it was part of my duties. Somehow, Dr. Lizama then talked the Legislature into transferring medical care at the Department of Corrections to GMH. So GMH pays close to $500,000 per annum to Dr. Lizama to run the clinic, and the really sick patients are still sent to GMH. DOC ran to hundreds of thousands a year, but they paid little to GMH and now GMH has another heavy debt and Larry has a little more pocket money.
Problems can be rectified
Enough is enough.
I actually thought that women, being more honest than men, would be less corrupt. I find now that there is no difference. Naïve me, but I still love and trust my nurses.
Are the problems in the ER at GMH insurmountable? No, they can be rectified. It will take some belt-tightening and change in direction.
First, you need to get rid of the current medical directorship with its secretive meetings behind a succession of closed doors. You need open meetings with input from all the hospital departments as already enumerated in the policies and procedures. One director only needs to be appointed at $200,000 per annum – saving $250,000.
Second, you need to get rid of the enormous administrative tail with a large amount of cash flow it entails. For the nursing administrators, give them some hand-on nursing work in addition to paperwork. As far as the other paper bashers are concerned, most are running around creating more paper and hindering the real workers at the hospital.
Out with them.
The savings have got to be enormous.
Third, the CEO is the administrator of the hospital, not the medical director. The medical directors are under the direction of the CEO. As per medical policies. Let that be.
Fourth, the medical director is supposed to meet with the president of the medical staff as equals. He represents administration; the president represents all of the doctors on the staff. The current medical directors did not meet with me once when I was president, though I was always available. You cannot run a hospital this way.
Finally, nurses must be better paid. I’m not writing about the administrative ones, but about the lowly, hard-working, poorly paid hands-on nurses who take care of the patients. I have always been impressed with them. In fact, two or three months ago a patient who was ambulating in the hallway defecated a very large diarrheal stool. It ran down his legs onto the floor. The nurses didn’t hesitate. Three of them ran over to the patient with towels and immediately wiped him down and the mess on the floor.
Nurses, I think you are great.
I also believe you should be paid better for your endeavors. In fact, in the U.S., beginning nurses get paid approximately $40 an hour. Here it is just over $17. And the cost of living in the U.S. is cheaper than on Guam. In addition, the GMH doctors are compensated at a rate just below their U.S. counterparts. The pay raise would go only to the Florence Nightingales that do the dirty work – not to administrative nurses that are well up in the pay scale and delegate onerous duties to the floor nurses.
So, in regard to the corruption and mismanagement present at GMH, it behooves the Legislature to look into my complaints. Not by having a hearing where discontented, ax-to-grind doctors elaborate their fancied wrongs ad nauseum.
A fact-finding team should investigate the complaints of poor management and – most of all – to go over the books.
Also, with most of the hospital funding coming from Medicaid and Medicare, I think it is only right and proper that the FBI investigate GMH for improper dispersal of U.S. taxpayers' funds.
Dr. James Last has been a surgeon at the Guam Memorial Hospital for more than two decades. He is a past president and ER director at GMH and is board-certified in emergency medicine and internal medicine