Pago Pago, AMERICAN SAMOA — After being the spokesperson of the LBJ Hospital during Senate hearings since his appointment as CEO, and with more than 20 years of service in American Samoa under his belt, Dr. Akapusi Ledua’s contract was unceremoniously terminated by the LBJ Board recently, along with that of Chief Operations Officer (COO) Dr. Jean Anderson.

Samoa News reached out to Dr. Ledua for a comment about his termination, but he said that his lawyer has advised him not to comment on the issue.

However, he consented to an interview with Samoa News, saying that it was time for him to move on and join his family in Alaska.

According to his impressive resume, Dr. Akapusi Ledua, graduated from the Fiji School of Medicine with an MBBS degree in 1991. He joined the Fiji Military Force in 1990 as an Officer Cadet and was commissioned to Captain in 1991.

He did his Medical Internship in 1992 at the Lautoka Hospital then worked as a medical officer at the Fiji Military Hospital in 1993-1994.

From 1994-1995, he deployed on a Peacekeeping tour of duty in the Middle East under the United Nations Interim Forces as Senior Medical Officer and Humanitarian Officer. During his deployment, he was promoted to the rank of Major. He returned to Fiji in 1996 and became the Chief Medical Officer at the Fiji Military Hospital.

In September of that same year, Ledua resigned from the military to join an orthopedic surgery training program under the Australian Orthopedic Association Outreach, where he graduated with a diploma in Orthopedic Surgery from Australia in October 2000. He then returned to Fiji and worked at the Colonial War Memorial from Hospital in Suva from 2000-2002.

An orthopedic surgeon (orthopedist) is a medical specialist who focuses on injuries and diseases affecting the musculoskeletal system. They diagnose and treat conditions of the muscles, bones, and joints, including sports injuries, degenerative diseases, tumors, infections, and birth defects. Orthopedic surgeons also perform joint repair and replacement surgeries.

It was in September 2002 that he first came to work at LBJ Hospital on a 2-month short-term contract, and he saw that there was no orthopedic surgeon here to provide orthopedic services.

While working his short term contract, he was approached by the LBJ Director of Human Resources to sign a long-term contract with LBJ. He couldn’t decide because he wanted to talk with his family and pray about it.

So he returned to Fiji after that brief stint at LBJ with the understanding that he would inform the HR Director of his decision.

However, Dr. Ledua recalled that while he was in Fiji, the LBJ HR Director contacted him and sent him his two-year contract.

After discussing it with his family and praying about it, he felt that God was calling him to honor the contract and provide the service to a community that needed orthopedic care.

Hence in January 2003, he left his elderly parents and extended family and relocated with his wife and their three children then, aged 9, 4 years and 2 months old, to American Samoa in what he believed was their call of duty. Their youngest child was born in LBJ Hospital.

Thus began what was to become more than 20 years of service to the people of American Samoa.

Since there was no orthopedic surgeon on island, Dr. Ledua hit the ground running as he immersed himself in his work 24 hours, seven days a week for two years. He said he was always on call, with only a few hours of the week he managed to spend with his family.

At the end of two years of this rigorous schedule, he took three weeks off to travel with his wife and children to visit friends and families in Fiji.

They did this every two years, four times in the course of eight years from 2001 to 2008!

Fortunately, in 2009, he recruited another Fijian orthopedic surgeon to LBJ, which helped lessen his workload.

The inception of the LBJ Orthopedic Department and the many developments it has gone through despite the many challenges he faced with no other orthopedic doctor to turn to for assistance, is a testament to his courage, resilience and commitment to his calling.

This did not go unnoticed by the LBJ management and Board then, who recognized his exceptional contributions and facilitated his remarkable ascent up the corporate ladder by promoting him from Chief of Orthopedic Surgery to Vice Chief of Staff in 2010, and subsequently to Chief of Staff in 2012.

That same year, he was appointed as Chief Medical Officer in 2012 so he relinquished the Chief of Staff role. He was replaced as the Chief Medical Officer in 2013 with two years of his contract still left to serve. That is another story. So, he returned to Chief of Orthopedic Surgery in 2013 until 2020.

By 2015, Dr. Ledua who knew that one day he would be leaving, began searching for a local doctor to continue the service of the Orthopedic Department for the people of American Samoa.

Coincidently, it was at that time that a young local doctor named Dr. Naseri Aitaoto returned after graduating from the Fiji School of Medicine, and was employed at the Department of Health.

Dr. Ledua then approached DOH Director Motusa Nua requesting that Dr. Aitaoto be transferred to LBJ so he could train him to become an orthopedic surgeon.

His request was granted and Dr. Aitaoto joined him at LBJ where he was trained in orthopedics surgery under the Pacific Island Orthopedic Association. Dr. Aitaoto spent the last 2 years of his training in New Zealand under the same program.

"Dr. Aitaoto successfully completed his Orthopedic training and returned just two weeks ago with a Fellowship from the International College of Surgeons in Orthopedic Surgery," he said proudly.

"We hired two more orthopedic surgeons during the last two years which makes it five orthopedic surgeons altogether working at the LBJ hospital at this time. So from 2003 when I first arrived where there was no orthopedic doctor, we now have a full-staffed Orthopedic Department.

"We are now performing surgeries never done before on-island like Total Knee and Hip Replacement Surgery, ACL Reconstruction, Arthroscopic surgeries of the shoulder and knee, and complex Orthopedic Trauma surgery. These are surgeries that are not done anywhere else in the Pacific except Australia and New Zealand and only some in Fiji mainly by the visiting orthopedic surgeons.

When the COVID-19 pandemic hit American Samoa in 2021, Dr. Ledua had been appointed Acting Chief of Staff and was also the LBJ Hospital Lead Physician for the Covid operation. In 2022, he was again appointed Chief Medical Officer.

He acquired the United States Medical Licensing Examination (USMLE) and the Educational Commission for Foreign Medical Graduates (ECFMG) certifying his knowledge equals a medical graduate from the United States medical institutions.

Dr. Ledua is also a member of a few prestigious professional Associations in the United States. He is a member of the American College of Healthcare Executives, the American Association for Physician Leadership, and the American Academy of Orthopedic Surgeons. He is also a Fellow of the International College of Surgeons in Orthopedic Surgery.

He advanced further still in February 2023 with his appointment as Acting CEO.

As if in anticipation of his inevitable ascension to healthcare executive leadership role, Dr. Ledua pursued tertiary certification online in 2021 from the Grand Canyon University, Phoenix, Arizona where he graduated with a Master of Business Administration with Emphasis in Health System Management.

He graduated in May 2023 just before he was confirmed as CEO a month later in July.

On August 21, 2024, the LBJ Board terminated his contract.

Despite the termination, Dr. Ledua expressed a sense of solace and peace, knowing that he performed his role and any task with integrity, while maintaining moral and ethical standards without any compromise.

Reflecting on his journey in American Samoa, he acknowledged that everything he had achieved at LBJ had manifested because of God's grace and guidance.

Asked about the highlights of his tenure at LBJ over the past 22 years, he shared that the first was the development of his medical career translating into service.

He elaborated on how far he had progressed in his chosen profession through the years he had worked at LBJ not only in medical skills but also in his ascension to the top post of the hospital.

“Acquiring all this knowledge and skills not only as a physician but as a healthcare executive, I was excited and passionate to transform the institution that has been part of me for over two decades to another level — a level of excellence with high standards of quality and safety for the people in this Territory.

"My vision was to develop a new model of care where valuable outcomes or results of quality care is more important than the volume or quantity of care. This model aligns with the CMS requirement and standard that is expected to be enforced and implemented by 2030.”

Secondly, was mentoring a local doctor and guiding him on the path to becoming a certified orthopedic specialist, ensuring the continuation of his work after his departure.

But the most rewarding highlight of his career in the Territory was the profound satisfaction he felt when his patients, after receiving his treatment, were able to return home with a clean bill of health.

“The feeling you experience when you see a patient return to a functional state with quality life is awesome and humbling at the same time," he shared. "Nothing beats that feeling, and I give all glory and honor to God for using me as a vessel to convey His healing power to the afflicted."

The former CEO mentioned that before his tenure, LBJ would hire orthopedic surgeons from European countries such as Sweden and Norway. These surgeons would work for one to one and a half months before returning home, leaving LBJ to face the same recurring issues.

He thanked and praised the orthopedic doctors who are members of the Church of Jesus Christ of Latter-day Saints from the mainland. These mostly semi-retired health professionals generously offer their services free of charge through a special LDS Church medical service program each year, providing invaluable support to his department and the entire organization, and our community.

Dr. Ledua addressed the issue of the shortage of orthopedic surgeons in the Territory, noting the trend of students who attend medical schools on the mainland not returning to American Samoa, in contrast to those who attend the Fiji School of Medicine, who consistently come back to work here.

He believed there should have been more focus on sending students to Fiji and, upon their return, providing them with opportunities for specialized training in Australia or New Zealand in their chosen medical fields or areas that lack local representation.

He revealed that the practice has been, when students return after graduating from the Fiji School of Medicine, they work at either LBJ or the Department of Health without the opportunity of sending them back for specialized training in demanding medical expertise here at home. They continue working until they near retirement, at which point another batch of medical students are sent to Fiji.

He highlighted that out of approximately 90 doctors working in the Territory, only about 20 are local.

Referring to the LBJ Orthopedic Department he had set up from scratch, he expressed his pride at our far it has progressed and the many patients they have helped.

"I'm so thankful I was able to assist and mentor a local doctor and get him into a training program to become a certified Orthopedic Surgeon," he shared. "My vision was for sustainability and a permanent solution to the lack of Orthopedic Service just like when I first arrived.

"I knew that one day I would leave, but I wanted to help a local physician in his professional career development so he could take the helm and continue the orthopedic service in American Samoa. This was my vision when I took up this leadership role at LBJ Hospital.

"The first three medical graduates doing their internship now know my vision as I have shared my plan with them.

“That is the legacy I want to leave behind. A sustainable and better healthcare for all the people of this Territory.

“I wish all the best for those who will continue the work.

“As for me, I need to move on to a higher calling that God has prepared for me."

He added that he is leaving with a sense of fulfillment because he has accomplished the mission God had sent him to carry out in American Samoa.

The former LBJ CEO said he has already applied to several hospitals and healthcare institutions in the United States and Alaska where he will be joining his family.

"I owe my family a lot of quality time because I spent more time at LBJ than with them when they were all here and even more in the last 3 years where I have been separated from them because of this calling”, Dr. Ledua said.

"My children were young then but now they have families of their own, except a daughter. Now, I'm a grandfather of four! and very much looking forward to spending quality time with them."

Wrapping up the interview, Dr. Ledua reiterated his profound sadness and disappointment to be leaving LBJ after 22 years of service without fulfilling his vision for LBJ.

The former LBJ CEO stated that his main concern is the missed opportunity to improve this Territory’s healthcare.

“Now, I have to wait for the next door that God is going to open for me," he declared. "In the meantime, I am looking forward to enjoy my family time.”

TERMINATIONS

To date, there has been no official word from LBJ about the terminations.

There was a Senate hearing to be held today, Wednesday, September 4, 2024, with Dr. Ledua and the LBJ COO subpoenaed to appear before the Fono, but the hearing has been postponed, until next Monday, Sept. 9, 2024. 

Senate Hospital/ Public Health Committee Chairman Tuiasina Dr. Salamo Laumoli and Senate President Tuaolo Fruean told senators yesterday that the Senate Legal Counsel had advised an indefinite postponement because certain issues with the termination “could implicate some witnesses of violating the law”.

However, after further deliberations by the senators, where media and observers were asked to vacate the Senate chamber during discussions, and then allowed back into the hearing, it was announced that the hearing would happen this coming Monday.

(See story in today’s issue of Samoa News for details of the Senate decision.)