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The dialysis care system in the Virgin Islands is in crisis, according to medical providers, patients and advocates who testified before the Senate Committee on Hospitals and Human Services Wednesday.
The financial instability of these critical healthcare facilities, largely a result of funding delays and spiraling costs, has emerged as a major concern, and it threatens the lives of hundreds of residents requiring regular dialysis treatment, especially on the island of St. Croix.
Aminah Saleem, a patient advocate with the Virgin Islands Healthcare Foundation (VIHCF), described the situation as urgent, noting that funding delays might prevent the foundation's dialysis unit from opening in time for this year's hurricane season. The facility, 95% complete after an initial allocation of $1 million from the American Rescue Plan Act (ARPA) funds, now faces a shortfall of over $940,000 due to escalating costs of materials and labor.
The VIHCF has requested that senators intervene to expedite the approved additional funds from the Office of Management and Budget (OMB). Another $750,000 is needed for six months of operating costs until insurance and federal program reimbursements start to come in. The VIHCF has stressed that the facility will be self-reliant once these revenues begin to flow.
When operational, the new dialysis facility is set to relieve some of the current strain on healthcare by accommodating 78 patients across three shifts. This equates to a third of the 230 individuals requiring dialysis in the territory, among them those currently forced to receive treatment in a deteriorating trailer at the Juan F Louis hospital. These trailers, retrofitted as temporary dialysis facilities following the 2017 hurricanes, have been operating in less than optimal conditions, with only one of the two still functional.
Volunteer Angel Rivera, a dialysis patient himself, emphasized the poor conditions and expressed concerns over the fear of retribution that many patients feel if they voice their complaints. The trailer currently requires monthly certification to continue operating and is not built to withstand severe weather, posing a risk to the 40 dialysis patients it serves. The Caribbean Kidney Center (CKC), the only other facility on St. Croix, would not be able to accommodate these additional patients.
The CKC, despite its long-standing service in the territory, is also struggling to remain open due to rising labor costs. Dr. Walter Gardner, medical director of CKC's parent company Helpers LLC, revealed that without immediate intervention, closure of CKC is imminent, a situation described as "medically and economically devastating" for the community by CKC Executive Director Yvette Rodriguez . The Center's invoice for staffing services in a two-week period in May amounted to over $72,000, a cost deemed "prohibitive and unsustainable."
“Closure of CKC is imminent without your intervention,” Dr. Gardner told senators. “Patients would die.”
Committee chair Senator Ray Fonseca disclosed that a discussion had been convened between OMB Director Jenifer O’Neal and Senate President Novelle Francis, out of which a commitment emerged “to make certain that first of all Dr. Gardner’s center on St. Croix is not closed.” During his time for questioning, Francis said he does not believe “that the discussion of the closure of CKC is an option.” However, he pointed out that the allocation and disbursement of ARPA funds is not within the authority of the Senate. “The administration has made it clear that the legislature doesn’t control the ARPA money,” he noted.
Senator Capeheart, committee vice-chair, said that the territory needed to now have serious discussions with Medicare towards increasing reimbursement rates. “I think there needs to be some renegotiation conversations again,” she said, noting that medication, supplies, and labor have all increased significantly in cost while Medicare payouts remained flat. This was the first time in her six months in the 35th Legislature, Capeheart says, when hearing testimony from the public had brought her to the point of tears.
Senator Gittens lambasted the Bryan administration for its delay in releasing the needed funds to the VICHF, and contrasted it against the news that $45 million had been taken out of the territory’s general fund without legislative authorization to settle a debt owed by the Water and Power Authority. “I am sick to my stomach,” said Gittens. “If they could give them that $45 million outside of our authority, why can’t they help our people keep these doors open?”
The senator provided a short but sharp lesson on opportunity cost, noting, “If we had that $45 million sitting aside that we could move just like that, we could assist our people. It’s a crying shame”. Admitting that the WAPA deal continued to bother him, Gittens said it was because the money spent on the latest bailout of the beleaguered utility could have instead been used on more pressing concerns.
Testifiers pressed lawmakers to convene another hearing in July where all stakeholders in the sector can come together and work on finding a sustainable way forward for dialysis care in the territory.
