Governor Albert Bryan on Tuesday said that the nearly $2 million being provided to the Virgin Islands Diabetes Center of Excellence for a dialysis center has been allocated but not yet released, as Mr. Bryan responds to criticism from Senator Kurt Vialet who also on Tuesday called for more information about the contract to be made public.
Mr. Bryan on Monday announced a public-private partnership with the V.I. Diabetes Center of Excellence that would see hundreds of diabetes patients and thousands more who are indirectly affected by the disease being able to access information and other specialized services about living and caring for others with the medical condition.
The V.I. Diabetes Center of Excellence is a nonprofit led by Ganesh Prasad who serves as its executive director. Also involved in organizing the effort is Plessen Healthcare, Mr. Bryan told the Consortium Tuesday.
"It's an allocation, not an obligation. We are making our plans for the American Rescue Plan (ARPA) Act monies and this is one of the things that we're going to do. It's a nonprofit that we're dealing with who are constructing this," the governor said.
The territory was provided with $584 million in ARPA funds tied to the Covid-19 pandemic which can be used to "respond to the public health emergency and address the negative economic impacts of this pandemic," said Delegate to Congress Stacey Plaskett in February when announcing the funding.
Mr. Vialet via release Tuesday asked a number of questions about the contract, among them whether an RFP was issued to solicit an entity that would build an independent dialysis center using these funds; what is the status of the private dialysis center that presently exists; and can the government provide funds to a private entity to offer a service that competes with the private market.
The funding was awarded to the V.I. Diabetes Center of Excellence without an RFP, which the administration believes it does not need in this instance, according to the governor, because the organization receiving the funding is a nonprofit.
Relative to the current private dialysis center, the Caribbean Kidney Center owned by Dr. Walter H. Gardiner, dialysis patients who were receiving care at the Juan F. Luis Hospital said in September during a town hall that they were opposed to a hospital board decision to transfer all JFL dialysis patients to CKC.
The patients were accompanied by their caretakers who also expressed displeasure with the decision. The main reason for the sharp rejection of the board's action was a universal rebuke of Dr. Gardiner's dialysis service by both patients and caretakers alike. They said they were wary of CKC, alleging that Dr. Gardiner had not treated patients with respect in the past, among other allegations. Forty-seven of the 49 patients signed a petition registering their opposition to being transferred to Dr. Gardiner's facility. The other two members were away receiving medical care but have expressed verbally their opposition to being transferred to CKC.
Dr. Gardiner refuted the claims in a response to the Consortium. "Quite frankly, no one person could be guilty of all the things I was accused of yesterday," he said.
Territorial Board Chairman Christoper Finch told the Consortium during the September town hall that the board was aware of some of the complaints, however, Dr. Gardiner had assured the board patients would receive warm treatment.
"We knew there were some concerns and we discussed this with Dr. Gardiner, and Dr. Gardiner assured us that he was welcoming to all the patients," Mr. Finch said. "One of the big concerns that I understood that people wanted to keep their own nephrologist and not use Dr. Gardiner as their nephrologist. So a lot of the discussions were about granting privileges to other doctors so that people could come in with their own doctors, which he has been very willing to do."
JFL Abandons Dialysis Services
The angst surrounding the Caribbean Kidney Center was a result of JFL's decision to stop providing dialysis treatment at the hospital. Mr. Finch said the decision was made based on a Centers for Medicare and Medicaid Services (CMS) ultimatum that the hospital come up with a plan to provide care in a suitable facility. In September, JFL dialysis patients were receiving treatment in temporary trailers at the hospital built after Hurricane Maria battered the medical facility. Though those trailers have served the patients and the hospital well, the concern is that a natural disaster such as a hurricane could destroy the trailers, leading to a potential disaster for patients.
Mr. Finch said CMS was pressuring the hospital to find a suitable facility. "We were under some pressure from CMS that people were supposed to be out by this hurricane season, " he said. "The patient advocacy groups have been very, very concern at that point that they would go through another hurricane season and something could happen to the trailers and they could end up going back to the states. That's not off the table; that's still a concern and that's why I mentioned earlier if Hurricane Sam had gone a little bit to the west, that's what we would be thinking of today instead of this conversation."
The options included building out a new facility, renting a space and making it suitable for dialysis services, or contracting out the service. JFL chose the latter.
The dialysis advocacy group told the Consortium following the September meeting that the federal government had provided enough funding for a more secure space along with all the necessities needed for a certified dialysis operation. The funding would be available until a new facility could be built, group members said. However, a space was never chosen, said group members, even after the advocacy group had located multiple options.
Angel Rivera, a member of the Dialysis Support Group at JFL, stated, "There was a plan from all the way 2019 that the federal government had given funds [to the hospital] to find a hardened structure whether it be to rent or lease a facility. They would have provided financing to build it out, staff it and equip it. [JFL] never moved on it."
"We went all around St. Croix looking for hardened structures," stated another member. The group members said the information was emailed to Dyma Williams, at the time acting JFL CEO. "We never got responses back. Many of these structures that we found, all they needed was proper plumbing and electrical for the dialysis machines and the air conditioning units," said a support group member.
Mr. Finch told the Consortium that finding a suitable space for dialysis service was difficult, describing certain levels of quality that must be met. And he said building a new structure, though considered by the hospital, was ruled out because of the pressure from CMS to be out of the trailers by the 2021 hurricane season — a timeline that was not enough for the requirements of a new dialysis unit.
Relative to Dr. Gardiner's Caribbean Kidney Center being the chosen firm, Mr. Finch said the hospital received only two bids, and the other company was asking for too much money.
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