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Enhancing healthcare for American Samoa tops Admin’s agenda

Lbj hospital sign
rhonda@samoanews.com

Pago Pago, AMERICAN SAMOA — The 2024 State of the Territory Comprehensive Report re-states throughout that the foremost goal for the Lemanu-Talauega Administration is “enhancing the health” of its citizens. And despite considerable strides in doing just that “there is much work ahead to address the lingering impacts of persistent systemic challenges and navigate the recovery process from a global pandemic.”

 Department of Health leads the Administration’s list of accomplishments and significant projects involving various initiatives and grant funding — with a total of $44 million in American Rescue Plan Act (ARPA) funds for Community Health Center and Behavioral Health infrastructure and workforce capacity to further support COVID-19 mitigation efforts.

AREAS OF INTEREST IN HEALTHCARE

Last year, DOH was given leadership of the New Hospital Project, taking it away from the LBJ Hospital, by order of Gov. Lemanu P.S. Mauga during a meeting. The LBJ Hospital board and leadership had made known its opposition to building a new hospital, asking instead that the funding be used to renovate and improve the existing facility and its services. Lemanu has stood firm on building the new hospital in Tafuna despite even Fono support for the LBJ plans.

Proposed fee adjustments are in the works to various fee including health permits, closure penalties for businesses violating health conditions, and other charges. No date is provided as to when the fees would go into effect.

In July last year the DOH proposed to implement a new fee schedule for Facility Health Permits, creating a new regulation under the American Samoa Administrative Code — a flat fee rate of $100 for all food and non-food establishments, as well as a $100 per day for an organization and $50 per day for an individual.

Post Business inspection follow-ups: $50 first follow-up; and continuous follow-until inspection is corrected is $25 per day; Violation- risk factors: $50 per risk factors/ food safety violation identified during inspection, if business is not closed.

The highest proposed raise is for closure of business activity — $5,000 for first closure; $7,000 for second closure; and $10,000 for third closure. Other proposed fees are: Closure due to a food-borne illness outbreak: $5,000; Certificate of food condemnation: $100 per certificate; Export Health Certificates for Containers — $200 per export container; Burial transit permit—  $50 per permit; Exhumation permit — $50 per permit; Assessment with condemnation certificate — $50; and, Copy of Permit/Certificate — $10.

The LBJ Tropical Medical Center (LBJ) is highlighted for its extensive work on a number of Engineering and Facilities projects, upgrading and adding to existing facilities. This includes obtaining  a MRI machine and a second CT Scan machine  for the first floor of its ICU/ER project, which is planned as a 3-story building, replacing the current footprint of the ER.

Nursing services were also the focus of LBJ improvements and lists RN Recruitment from Thailand: Total 36, 15 arrived; Local RNs employed at LBJ and passed NCLEX-RN- 6; Local LPNs employed at LBJ and passed NCLEX- 7; 3 Fijian nurses passed NCLEX-RN; 18 remaining Fijian nurses are attending Chaminade University review; and, Per diem DOH nurses assisting LBJ with coverage (no number noted).

The Department of Search & Rescue is reviewed in its 15 months since inception, noting collaboration across the Emergency Medical Services (EMS) Division, Fire Protection (FP) Division, and Marine Patrol (MP) Division—integral components in DSAR's emergency first responder functions.

EMS was the busiest with an annual — Oct 22, 2022 to Sept 23, 2023 — dispatch of 7,969, with calls received of 5,531 of which 4788 were medical calls and trauma calls were 743. There were 989 medical transfers, while ‘apparent DOA’ was 110. It had 28 outgoing Medivac, with a total of incident responses at 6658.

A breakdown of Emergency Calls show that 3,696 patients were treated and released, 479 refused treatment and transport, while 31 absconded, leaving no identification or other. EMS transported 95 bodies to the Morgue.

For Fire Protection Division no data is available on fires it covered, except for work it did in collaboration with the Marine Patrol Division which notes it addressed 5 search-and-rescue missions in the western districts of the island; and on its own addressed four minor HazMat calls related to ammonia leaks at the canneries. It cites numerous inspections conducted throughout the year, primarily for private businesses and public educational institutions, ensuring compliance with National Fire Protection Agency (NFPA) recommendations, but no actual data is reported.

The Fire Department has long been a source of concern in the community with residents pointing to its response time, and that once on site of the fire, unable to put the fire out to save the structure, if possible.

The TCR lists most of the department’s activities in 2023 seem to be in its Fire Prevention Outreach Program, which included educational activities, career day events, private sector business affairs, and professional development workshops, aiming to educate diverse audiences on fire safety measures.

Two training events are also listed with various aspects of firefighting, HazMat, and emergency response covered.

Its Fire Chief retired in December 2023, and his replacement as of yet has not been announced.

For the Marine Patrol Division, the TCR reports that it provided 60 assists for emergencies, boater requests, and collaborations with various agencies and events. Fourteen (14) officers completed rigorous training sessions with the USCG Honolulu Maritime Safety Security Team, gaining certifications across essential skills, and it conducted boating education outreach efforts including the Annual Boating Raffle. The Angel Ring project also continued with rings installed in four additional areas.

Little known is the assistance from the SEATOW Foundation, which allowed MPD to launch 5 life jacket loaner stations at various locations; 2 in Ofu, Manu’a, 1 in Olosega, 1 in Utulei at the South Pacific Water Sports and 1 at the Marine Base.

For the American Samoa Medicaid State Agency, one of its main activities for FY 2023 focused on gathering data for ineligible services and ineligible individuals for Medicaid.

The project had Medicaid accepting on a temporary basis for one fiscal year, off-island referral for cancer patients and ineligible individuals.

“This included American Samoa permanent residents and other immigration categories.

“Obtaining the referral numbers and the costs for non-eligible individuals was necessary to acquire the documentation to propose potential solutions.

“The demonstration was made possible using 100% local match. Medicaid cannot use federal dollars for ineligible referrals or ineligible services.” The project depleted Medicaid’s total local match budget, and according to ASMSA, it needs more time to assess this service coverage.

The TCR further notes that “historically, cancer treatment due to its long-term duration and indeterminate costs, has not been covered by the American Samoa Government due to the local match constraints.”

It reiterates a well-known fact that in all 50 states and US territories including American Samoa, only US permanent residents (green card holders) are eligible for Medicaid.

Highlighted key accomplishments of FY 2023 for ASMSA include the facts that Medicaid reimbursed LBJ Medical Center a total of over $45.6 million; and reimbursed DOH a little over $8 million. It also made inroads into opening up Hawaii to accept American Samoa referral patients for the first time through the Medicaid program. Hawaii Eyesight has a contract with Medicaid for cataract surgeries, as well as a contract with Orthopedic Associates of Hawaii for surgeries, excluding spinal cases. COVID reimbursement for testing, treatment and vaccination at LBJ and DOH continue through Sept. 2024.

The TCR lists 3, 074 patients for all Medicaid services outside of LBJ, excluding the DOH community health centers that logged 45,205 patient encounters.

Of those 3, 074 patients, among them are the 229 referred to NZ/HI on the Off-Island Medical Referral Program,78 to the Hope House and 505 to dialysis services at the Hope Dialysis Center.

Medicaid Funding breakdown lists MAP payments (MAP), Children’s Health Insurance Program payments (CHIP), Prescription Drug Program Payments (EAP), Health Information Systems (HIT), Administration and Medicare Co-Pay for a total of $97,543, 909 million expended in Federal Match with Local Match at $3,577 million. $3 million was the highest amount expended for MAP in local match required.

There is also a note referencing the MAP allocation — that over $33 million is expected to be returned to CMS after the FY 2023 reconciliation due to the lack of local match for medical services.

The State of Critical Infrastructure, Education, Environment, Security, Key Demographics, and Culture will be reviewed in upcoming issues of Samoa News.