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Lack of local nurses and doctors continues to be challenging for LBJ

Photo of LBJ Hospital sign

Pago Pago, AMERICAN SAMOA — LBJ Medical Center chief executive officer Faumuina John Faumuina has informed lawmakers that one big challenge faced by the only hospital in the territory is the recruitment of local Samoan nurses and doctors.

Faumuina said this when he appeared last Wednesday before the Fono Joint Budget Committee hearing on LBJ’s FY 2020 proposed budget, totaling $50.78 million — a $68,500 decrease from the approved FY 2019 budget.

The CEO told the joint committee that a big challenge faced by LBJ is staffing of medical professional positions for nurses and doctors. He said it’s been made difficult because many local physicians are leaving and LBJ has to reach out to off-island medical professionals.

He said LBJ has also spoken with Gov. Lolo Matalasi Moliga about help with “recruitment” of local medical professionals by encouraging local students to focus on the medical professional - nurses and doctors.

He said recruiting from off-island is very expensive, not only in terms of salary but other benefits that come with the package offered to that person.

According to the CEO, the hospital is working closely with the American Samoa Community College nursing program, where students have a chance to work and observe at LBJ.

Under the Governor’s Special Program, the administration is allocating $100,000 in FY 2020 for the ASCC nursing program, which the governor says is “endangered due to the lack of funding to cover the cost of this critical program.”

At last month’s cabinet meeting, Lolo said he met recently with the LBJ  board and Faumuina, where it was “emphasized” that one of the problems faced by the hospital is the “lack of Samoan doctors and nurses.”

“We’re hoping everyone, including ASG agencies and the hospital, sit down and figure out a way to recruit Samoan doctors and nurses,” Lolo said, adding that this is a “big challenge for us.”

Another issue Faumuina touched on during the budget hearing, is that the US Army Corps of Engineers has completed its assessment of the hospital, as mandated under provision of a federal law.

The Army Corps has submitted its report to the US Interior Department, which then contacts the US Congress, which sought a report addressing the condition of LBJ, estimating the cost of renovating and modernizing the current facility, constructing a new facility, and whether a renovated facility will have sufficient capacity to meet American Samoa’s needs. (See Samoa News July 24th edition for details.)

While awaiting federal decision on the Army Corps report, Faumuina said LBJ continues to make improvements to the facility, as necessary, utilizing Capital Improvement Project funds. Additionally, LBJ remains in contact with Army Corps on additional information needed.

Another issue Taufete’e shared with the committee is the LBJ’s debt, which he says was close to $15 million when he returned as CEO in 2014. He said vendors refuse to provide medication and other supplies unless payment is received first.

At this point, the debt is about $5 million, which includes the ASG debt he said, noting that he has already began discussions with the ASG Treasurer for an “off-set” between the two parties, of what is owed. If this is agreed upon, the LBJ debt will be down to $1.5 million, he said.

LBJ’s largest revenue sources include $16 million from Medicaid; $8 million in US Department of Interior subsidy; and $10 million from Medicare, according to the FY 2020 budget document.

Faumuina reminded lawmakers that Medicare only pays 80% of the bill while the balance is paid by the patient. He said it’s difficult to collect from local residents and in the end, the LBJ absorbs the difference.

As for Medicaid, Faumuina said LBJ is required to first provide proof that the service was provided before Medicaid pays only 50% of the bill, while the balance is absorbed by the hospital, which depends on the ASG subsidy to cover the balance.

“I understand that many times it’s difficult for ASG to pay the subsidies, as it depends on their cash flow,” Faumuina said at least three times during the hearing. However, he added, it’s the hospital’s responsibility to control spending.

According to the Governor’s Special Programs budget proposal, $2 million is allocated for LBJ subsidy in FY 2020.