Search & Rescue still unable to receive Medicaid funding directly
Pago Pago, AMERICAN SAMOA — The director of the Department of Search and Rescue (DSR), Save Liuato Tuitele told lawmakers in Monday’s budget hearings that funding from federal sources for functions now carried out by DSR remain with the entities that performed the functions before DSR was created two years ago.
The issue was raised by Senate President Tuaolo Manaia Fruean who pointed out that EMS, which is under DSR, is included in the LBJ proposed budget.
Tuaolo asked the DSR director to confirm if EMS was under his jurisdiction because the LBJ's proposed budget includes one EMS position with a salary of $50,000 and a proposed amount of $240,000 for materials and supplies.
Director Save confirmed that EMS was a part of his department however, the LBJ Hospital receives federal grants for EMS and the DSR has to request use of that funding because it cannot receive the funding directly.
Tuitele explained that DSR cannot bill Medicaid and Medicare for use of ambulances for example, because it is not registered as a Medicaid provider.
He said that he has held discussion with the Director of Medicaid and the LBJ CEO about this and he has been told that their department has to be registered as a Medicaid Provider first before they can receive funds directly from Medicaid.
He said that Medicaid Director Sandra King-Young has given assurance that she will look at a way to incorporate DSR as a Medicaid provider in the Medicaid State Plan.
The director said the ambulance service is busy non-stop as families unable to transport family members to the hospital call on the ambulances for everything from changing bandages to doctor appointments, and the ambulance is on standby to transport the patients back to their homes.
Faipule Larry Sanitoa pointed out that it has been two years since DSR was established, and more effort should be done to rectify these problems so that federal funds earmarked for these specific functions now under DSR jurisdiction will be channeled straight to the department.
Sanitoa stated that the DSR's proposed is kind of misleading with the absence of these funds needed to operate their mandated functions, as they are still part of the government entities that controlled these government agencies like EMS.
The department’s proposed budget for Fiscal Year 2025 is $4.3 million, of which $3.9 million (90%) is for personnel services. Equipment is budgeted for $45,000 and materials and supplies at $61,000.
Sanitoa also pointed out that there are not enough funds earmarked for materials and training for the fire service which is also under DSR jurisdiction. He said he heard that DSR received two federal grants, $280,000 from DOI and $100,000 from USDA and asked how these funds will be utilized.
DSR Director Save confirmed that they received these funds two weeks ago and he revealed that he plans to use part the DOI grant to fund an academy for the fire department because it has been more than 10 years since the last one was held.
The rest of the fund will be used to purchase needed fire-fighting equipment. He stated that he wants to purchase a fire engine with a bigger water tank like the one used by the airport fire and emergency service, which can carry 1,000 gallons of water.
He reasoned that the smaller fire engines can be used to respond to fires in congested residential areas like Fagatogo, Atu'u and Mesepa, as the bigger fire engine would not fit.
Save clarified that only one employee can be paid using the DOI grant funds.
Sanitoa commended the DSR director for prioritizing an academy for fire service employees and pointed out that the last academy coordinated by off-island instructors was in 2002 and 2012, which was the last training by local instructors.
The faipule also reminded Save of the multi-million lawsuit against the government for the Laufou fire ten years ago where the government had to pay $5.7 million for negligence, and expressed his hope that this scenario will not happen again.
Lawmakers recognized that as first responders with life saving responsibilities, EMS, Fire and Marine Patrol, the divisions under the department, need adequate funding to be able to carry out their functions.
Senator Magalei Logovii asked Director Save if he had any plans to reopen the fire substations in Faga'itua, Leone and Tafuna.
Save replied that because of the shortage of employees and equipment, he intends to begin by reopening the Tafuna fire substation, then Faga'itua and Leone substations. After the planned academy, staff will be assigned to work at all the three substations.
The DSR director said that this long term plan has been supported by the governor. However, he admitted that he did not have a specific timeline of when this plan will in fact eventuate when Senator Magalei asked when this would happen.
Magalei stated that the reason he wants to know when this is likely to happen, was because it is clear that fire engines and services are in dire need at the moment.
He argued that if a fire happens in Faga'itua, the family that owns the house that is on fire may as well try to put out the fire themselves because if they call the fire service, their house would burn to the ground by the time the fire service arrives at the scene.
He also commented on the recent fire in Nu'uuli where there were no fire hydrants in the immediate vicinity and other cases where existing fire hydrants were not working. Magalei said that he noticed that off-island fire employees are always checking that hydrants are working and maintaining them so that it is ensured they will work when a fire does happen.
Senator Magalei also queried the amount of $10,000 in the DSR proposed budget which listed that it was for the purchase of firearms and ammunition, and asked who the firearms were for, how were they going to be used and if they were certified to use them.
Director Save Tuitele explained that the firearms were to be used by the Marine Patrol who are mandated to use them in the execution of their duties.
However, he said that none of them are currently certified to use them but he is working closely with the DPS commissioner on finalizing an academy for the use of firearms to be coordinated by FBI or DEA personnel to certify Marine Patrol and DPS personnel.
Senator Malaepule pointed out that before, the maintaining of the various substations was the sole responsibility of DPS because the Marine Patrol and Fire Service were under DPS, but now the Marine Patrol and Fire Service were under DSR.
Malaepule pointed out that DSR was eligible for many federal grants to fund these services.
Faipule Luaitaua Gene Pan raised the issue again by pointing out that the DSR proposed budget does not have any funds earmarked for a grant writer.
Save confirmed this saying that they do not have one but that they have a staff member who is performing this important need with the help of other senior members of his staff.
Senator Tuiasina Laumoli related a recent incident at Leala where a man drowned while saving his daughter. He said police and EMS arrived at the scene but no one could get into the water as it was very rough. He said the Marine Patrol Unit arrived several hours later and by then the man had succumbed.
Senator Satele Aliitai Lili'o commented on three recent fires, two in Nu'uuli and one in Alao, and asked if any investigations into the cause of the fires were and who had the authority to close these investigations.
He said by the time the fire service arrived at the scene of the fire in Alao, the building had burned to the ground. The same thing happened in the fire that destroyed the LDS church in Nu'uuli. With the fire that destroyed the former shopping center in Nu'uuli, the scene was cleared the very next day.
According to the DSR director, the dispatcher who received the call about the fire in Alao told the fire department to standby while she waits for confirmation, because the person who had reported the fire sounded drunk.
Subsequently, by the time the fire service arrived at the scene of the fire in Alao, the building had burned to the ground.
With regard to the fire that destroyed the LDS chapel in Nu'uuli, Save said that the call reporting the fire had been too late and that by the time the fire service arrived, they could do little to save the building.
The DSR director however stated that the fire service arrived at the scene of the Nu'uuli Shopping Center fire while it had not developed into a fiery blaze. He said he can confirm this because he was present that morning.
Save said that the main factors that contributed to the fire getting out of control was the absence of a fire hydrant in the immediate vicinity and his staff had to use nearby fire hydrants and secondly, the wind played a major part in spreading the fire to all parts of the building.
After they managed to put out the fire, he instructed the personnel responsible for investigating the cause of the fire to carry out their investigations as quickly as possible because the scene of the fire had to be cleared for the safety of residents who lived next to the scene.
He pointed out that the residential housing was less than 50 meters away from the scene of the fire with a gas station directly opposite on the other side of the road.
He said, the danger of fire re-igniting and debris like roofing iron etc. blown by the wind to the neighboring houses was a real threat, which was why he instructed the scene of the fire to be cleared after the necessary investigations.
Faipule Shaun Va'a revealed that it was he who had called 911 to report the fire in his district at 12:20am. The Vaifanua faipule said that he called about 20 times and the dispatcher finally answered at 1:45am. The fire service arrived at about 3:30am and by that time, the building had burned to the ground.
He said everyone even children know that the number to call for emergencies is 911 but In the recent incident, the 911 dispatcher said to call the Fire Division.
According to Directior Save, 911 is under DPS and when a call is made to 911, they will call EMS, Fire or Marine Patrol.
However, the DSR director revealed that under directions of the Governor, a new 911 Center will be opened which will coordinate calls to Fire, EMS, Marine Patrol and DPS.
Other government departments and agencies whose proposed budgets were reviewed on Monday included Administrative Law Justice, Territorial Audit, Criminal Justice Planning Agency, ODAPM Petroleum Co-Op/ASDRO and the Department of Human & Social Services.
The budget hearings continue today.