Dialysis patient. By. GETT IMAGES
In what can be described as an emergency meeting of the Committee of the Whole, lawmakers met on Friday afternoon to forge a way forward in filling the mammoth gap left following Pafford's announcement of their withdrawal from the territory.
It’s a decision that the medical service provider says it was forced to make after the mounting debt owed to them by the Government of the Virgin Islands became too onerous. “It's unfortunate that they find themselves at a quagmire where they have to actually fight to be able to get the payments,” Senator Novelle Francis stated. He joined several colleagues in thanking Pafford for their “contribution to the community” during Friday’s session.
According to Pafford, the GVI through various entities including the Department of Health and the Bureau of Corrections, has outstanding bills in the region of $10 million. The company's departure is already impacting several healthcare facilities – including the territory’s hospitals, which will have to accommodate patients which the Caribbean Kidney Center is no longer able to treat, absent its major support from Pafford. The Center owes Pafford over $1.6 million, which could rise to almost $2.5 million by January 2025.
The fate of CKC was discussed in great detail on Friday, with health officials painting a grim picture of the current reality. Though Pafford still supports CKC, it won’t for much longer, and the approximately 110 individuals who access dialysis at the facility will have to seek service elsewhere after January. This circumstance, according to Christopher Finch, chairperson of the V.I Government Health and Hospitals Corporation, creates an urgent “need for funding for the hospitals to expand outpatient dialysis care.”
In the St. Thomas/St. John district, the Schneider Regional Medical Center cares for 74 dialysis patients, while CKC supports 55. “Once we realized that CKC was likely to cease dialysis care, SRMC CEO Tina Commissiong started the internal expansion of the SRMC dialysis capacity,” said Mr. Finch. The expansion process has included “building out a space adjacent to the present hospital dialysis clinic with 12 additional patient stations to accommodate the CKC patients.” The build-out is reportedly 90% completed.
SRMC has also “[diverted] funds” to facilitate the purchase of a water treatment system. The remaining construction and equipment installation could last 30 more days, and extra funding will be needed for medication and supplies. But even after jumping that hurdle, SRMC will face challenges in collecting Medicare payments to restock supplies and pay salaries until the facility is certified. It’s a process that could take a few months. “With only two days of cash on hand, SRMC does not have the money to pre-order these items,” admitted Mr. Finch.
The potential closure of CKC, with nearly all dialysis staff hired through Pafford, will also create a staffing problem for SRMC. “The hospital will need time to find and hire professional staff,” Mr. Finch said, a process that could span 4 months.
“This hospital so far has spent $978,009.21 on construction and equipment purchases using Public Finance Authority funding and ARPA funds that were designated for other purposes. SRMC desires to be reimbursed for these funds,” Mr. Finch declared. SRMC anticipates that caring for 55 additional dialysis patients until January when the facility can be certified could cost an additional $1,047,200.
Over on St. Croix, the Juan F. Louis Hospital cares for 42 patients in a trailer located in the parking lot of the old facility, while CKC serves 60 patients. The current trailer clinic at JFL “poses a risk for hurricane damage” and faces water supply and fire suppression challenges, Mr. Finch noted. The hospital’s management does, however, have a long-term plan to build a FEMA-funded outpatient dialysis clinic off-site, with a building shell on the north side of St. Croix already leased for that purpose. However, unanswered requests for architectural proposals to build out the space are causing delays, and JFL does not anticipate that the facility will be built out by January.
Like SRMC, JFL has also spent funds intended for other purposes to purchase dialysis equipment and other related expenses totaling $230,000. The hospital’s total funding request is just over $1.75 million, which would cover medication, supplies and staff for the next four months. “I must emphasize that neither hospital has sufficient funds to take on this initial cost on its own,” warned Mr. Finch.
If CKC closes and hospitals are unable to absorb the increased number of dialysis patients, the GVI will have no choice but to fly them to the mainland for treatment, adding to the millions of dollars already spent by DOH on stateside healthcare.
When the conversation boiled down to money matters, Senator Franklin Johnson wondered why JFL was spending funds to lease a building off-site, instead of buying or leasing CKC’s property on St. Croix. “We offered that to the owner, and at that time the owner was not interested,” explained Mr. Finch. “This is a problem I have with the government as a whole. We continue leasing, and if we pay attention to what the cost would be to buy a building or buy the CKC, we will save so much money,” Mr. Johnson countered.
With the burden of dealing with Pafford’s departure now resting squarely on the shoulders of the territory’s lawmaking arm, Senator Dwayne DeGraff stated that “we need to make it clear that the Legislature isn't the one that got us in this pickle.” Notwithstanding, it is indeed the Legislature who is responsible for identifying a solution. Senator Ray Fonseca, who chairs the Committee on Health, Hospitals and Human Services, therefore introduced a series of bills intended to cushion the blow.
The first, Bill 35-0274, appropriates $1,000,000 from the General Fund to the Schneider Regional Medical Center. Bill 35-0275 appropriates $2,111,507.10 in FY2024 from the General Fund to the Department of Health for the arrearage owed and projected cost to Pafford Medical Services for services rendered to the Caribbean Kidney Center for the period of October 1, 2023, through September 30, 2024. These funds are expected to be available until expended. The final bill, 35-0276, appropriates $1,000,000 from the General Fund to the Juan F Louis Hospital and Medical Center to assist in purchasing dialysis machines and chairs, a reverse osmosis water system, medication, supplies, construction, and staff salaries. With the bills all passed by lawmakers, they now head to Governor Albert Bryan Jr.’s desk for approval.
