A Pafford Medical Services ambulance on St. Croix on July 13, 2022. Photo Credit: V.I. CONSORTIUM
The V.I. Government owes Pafford Medical Services more than $34 million, a 7-month debt causing alarm among local medical professionals about the ability to sustain health services in a territory that has become heavily reliant on the emergency medical service provider.
After learning of the matter from people with knowledge of the issue, the Consortium contacted the V.I. Dept. of Health, which confirmed the debt to Pafford to be $34.1 million. Health Commissioner Justa Encarnacion said the local government had found a funding source through the Federal Emergency Management Agency, and that a process to make good on the covenant would soon be completed.
"FEMA has been great partners and the delay has nothing at all to do with FEMA," the commissioner stressed. "But we just have to work through the process and that's what we're doing now."
The local government's inability to pay Pafford for seven months — whose services are integrated into the territory's health care operations — raised concerns about the longevity of medical services in the U.S. Virgin Islands. From the V.I. Dept. of Health to the V.I. Dept. of Human Services, FIRE EMS and even the Bureau of Corrections, Pafford has become a critical need.
The Arkansas-based firm, which offers "all forms of pre and post hospital healthcare, ranging from basic life support response to critical care ground and air response," was contracted by the USVI government at the onset of the Covid-19 pandemic for emergency health services, including the provision of personnel, ambulances, equipment and supplies. The firm also provided assistance after Hurricanes Irma and Maria.
Ms. Encarnacion sought to remind the public that the strain on medical services was a nationwide problem. "We first need to have the public realize that it's a national shortage not just of nurses, but a national shortage of all clinical staff, and to a large degree the national shortage has been happening for the last, I would say 15 years for nursing as well as other clinical staff," she told the Consortium during an interview. "We saw a higher number attrition, especially nurses, during the pandemic because of what nurses had to go through. And of course a lot of the nurses left their [local] jobs and went to do travel because it is right now in a state of emergency and you are paid more. As a result of that nurses were leaving their stationary jobs to go into travel nursing to work with emergency services like Pafford, which pays a lot more."
The territory also lost a lot of nurses because of stringent Covid-19 rules adopted by local health officials. Nurses brought their plight to the fore during a widely viewed protest in August 2021, stating at all they sought was the option to be tested for Covid-19 instead of a mandatory vaccination policy, the latter of which was adopted by the territory's two hospitals.
"After this state of emergency I believe it's going to normalize a little in terms of the cost, and we'll be able to afford travel nurses a little bit more," Ms. Encarnacion said. "So the intent — which we've started already; we've been speaking to hospitals, Human Services, as well as Fire EMS — to ensure that they are securing funding, and they are seeking opportunities to recruit the needed positions in their entity for reliable staffing throughout the territory."
The commissioner said contracts with Pafford under Covid-related state of emergency terms will continue through May 11, the date when the federal Covid emergency declarations are set to end. Thereafter, Ms. Encarnacion is hoping that new contract terms with Pafford will be more financially sustainable. "We can only hope that that is how it's going to happen because [the costs] were down a lot prior to [Covid], so we can only hope that that is how it's going to happen. You talk about normalcy post-pandemic, this is part of the normalcy we're looking forward to," the commissioner said.
Combined, local health agencies must provide a 10 percent match of $1.2 million monthly before the remaining funds from federal sources can be accessed to pay Pafford Medical Services. "That's not just for the Dept. of Health, that is for everyone within the territory utilizing Pafford," Ms. Encarnacion said, adding that about five local departments and agencies in the USVI currently have agreements with the emergency health services provider.
The commissioner said each local agency currently receiving federal funding to service Pafford will have to negotiate their own contracts after May 11. She said the current structure that sees D.O.H. managing the entire contract was a necessity when the pandemic was raging, and that D.O.H. — which has oversight over the territory's public medical services, including hospitals — used its authority to assist in the provision of staffing to several government arms — the hospitals, Health and Human Services and Fire EMS, among others.
The federal government, aside from informing that the federal emergency declarations tied to Covid-19 will expire on May 11, hasn't been quite clear on what happens next in terms of funding, the commissioner said. She said work in the White House and in Congress continues regarding next steps. "We have an opportunity on a week-to-week basis to discuss areas like this under the Association of State and Territorial Health Officials, and we did meet with the person in the president's office who is responsible for the Covid task force. And so one of the things that he indicated is that they are still working on the options that will be available. So nothing is concluded right now; we have to wait and see what happens," Ms. Encarnacion said.
