Doctors wrestle over management practices at GMH

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Guam – As the proverbial walls of the Guam Memorial Hospital slowly chip away, citation after citation, threat after threat, emotions are ever increasing while administrators, lawmakers and doctors scramble to find a solution and save the hospital before it falls into receivership or worse, complete disintegration.

At an oversight hearing last night at the Guam Congress Building, emotions ran high and progress seemed slow as the hearing went on for nearly four hours, starting with doctors offering opposing views of how things are being run.

“I also heard some physicians are upset because I apparently threw them under the bus by saying the medical records was not getting done. Just to let you know, in a healthcare system and every institution, it is a known fact, we physicians don’t do documents on time,” noted Dr. Kozue Shimabukuro, the physician-turned-whistleblower who was stripped of her administrative duties and responsibilities in April. “So that’s why as an administrator and the leaders of the organization, we make sure we follow the rules. GMH had a wonderful accountability policy but we were just not following it.”

“I think GMHA is dysfunctional on almost all levels. There’s a small group of doctors who control running of GMHA in a regressive way that’s out of date, without any self appraisal and who control and who push an impotent and ignorant administration,” added local Oncologist Dr. Samuel Friedman.

Obstetrician/Gynecologist Dr. Tom Shieh, an outspoken critic of health care matters on island, addressed numerous issues outlined by some physicians in their complaints against the hospital. One concern he raised and directly responded to was regarding physician medical charts.

“I just wanna give you an example to offer some clarity that medical records are being done and that it’s not all physicians, OK. If you’re gonna pick on this medical records issue, identify those doctors who’s not doing their records,” said Dr. Shieh.

“About five witnesses had said there are some good doctors at GMH. I don’t wanna leave this building with the impression that it’s a flip of a coin whether you’re gonna get a good doctor at GMH. The vast majority of doctors at GMH are good so I resent that statement,” added Obstetrician/Gynecologist Dr. Jonathan Sidell.

It seemed to be a war of doctors’ perspectives, all stemming from years of underfunding at GMH. The focus now is–are hospital administrators so inept and incompetent that their actions rise to the level of misconduct or even corruption?

While that remains a point of contention, Vice Speaker Therese Terlaje drove home this point regarding at least one report that’s indisputable, the 78-page report from the Centers for Medicare and Medicaid which is now threatening to pull GMH’s provider agreement–a critically-needed funding source for the hospital.

“It’s true, isn’t it, that there are several complaints in the CMS that really have nothing to do with needing extra money?” said Sen. Terlaje. “It’s a reporting of adverse events and then having them reviewed, right, which–we’ve even heard testimony regarding that and then we’ve heard testimony by another doctor saying that’s not true, all of these incidences are reviewed, but CMS is saying they’re not.”

In fact, much to the dismay of Speaker BJ Cruz, the GMH Board of Trustees still has not seen the CMS report.

“Did you not feel that between the sixth and the eighteenth of June, you could have asked the chairman [of the GMHA Board of Trustees] to have an emergency board meeting to meet on Thursday or on Friday to one, review the report that had come from CMS, but more importantly, to see what you were going to be responding back to CMS since it’s under their governance?” Cruz lambasted GMH CEO PeterJohn Camacho, referring to the June 6 date Camacho received a notice from CMS to the June 15 deadline to respond and to the June 18 date of the GMH oversight hearing.

“We didn’t, I didn’t, we–I didn’t think of that one, sir, I’m sorry,” answered Camacho.

The potentially deadly blow by a CMS finding only adds to the fire already brought on by the Joint Commission five months earlier when it, too, threatened to revoke accreditation, citing 41 areas of failures.

“I was able to count 32 out of 41 of those points of emphasis that in many ways have no relation to funding,” argued Sen. Fernando Esteves. “At the very least, soiled instruments being transported to the decontamination room without even a biohazard label. I mean if that’s a funding issue, please let me know I could go pick one up for you.”

While PNC has obtained a copy of the CMS letter and 78-page report, Camacho has refused to release the report to the public, noting a procedure he typically follows in responding to these matters. He could not, however, cite a policy, law or regulation that would prohibit hi from releasing the documents.