Improve medical care, don’t just build a new hospital

David Lubofsky

By David Lubofsky

We are at the point now that people are so desensitized listening to the dire issues and death that surrounds Guam Memorial Hospital or the historical apathy of Guam’s leadership to resolve these issues that we seem to have learned to live with the impending doom. The message that has come from the legislature when they are not too busy focusing on taxing soft drinks, or fireworks or arresting beggars is that a new hospital is a must, which the governor also agrees with as I of course also do. It will though be about 5 years until we see one if we are lucky.

So, in the mean time do we continue to die from lack of patient basic appropriate care or the worst maternal health care in the country? Go build the hospital, but what about the people of Guam over the next 5 years or longer?

I, for one, do not think saving lives is totally correlated with the GMH building, leaky roof, electric etc. I have had the opportunity to visit or be a patient in some really deplorable medical facilities around the world.

When I worked in mainland China, I had the opportunity to visit hospitals. They were very run down to say it mildly, but doctors and nurses were in and out of patients’ wards. Actually, while in China a friend of ours had a heart attack and things were so bad that we had to push the ambulance to jump start it. Still, the care seemed to be right on target with a building that was terrible. She survived. Would she have survived at GMH?

I have also visited hospitals in Cambodia, Haiti and in the Philippines in rural areas among other places. In General Santos, Philippines I got sick and even though the building was in bad condition, the medical staff was superb. They showed up to see patients, unlike my GMH experience. Yes, this isn’t always the case, but my point is that even though we badly need a new hospital it shouldn’t be an excuse to compromise medical care or a pie-in-the-sky excuse to allow the people on Guam to continue to die at GMH due to apathetic leadership ignoring the most basic patient care issues as a major priority in the here and now.

I have read more than once the federal report from the Center for Medicaid and Medicare Services, or CMS, regarding GMH. It’s clear that basic steps need to be taken that are already based on existing, established GMH policies and protocols, which by the way that Nurse Flores referred in part to during her testimony at the oversight hearing when discussing another child that died.

It’s my opinion that the GMH leadership and our medical leaders on Guam for transparency should respond to the following questions to improve GMH patient care and save lives. These questions are based on basic already-established protocols to protect patients.

  1. Please outline the current accreditation progress and related issues negatively impacting said progress?
  2. On or about May of 2019, the CMS paid a surprise visit to GMH. They looked at 12 patients. The report at that time was hidden from the public until discovery in a legal case. CMS attributed at least two deaths to management issues at GMH. Please provide information as to how you have mitigated the serious issues that CMS reported.
  3. GMH regulations and CMS policies require a registered nurse to supervise and evaluate nursing care for each patient including a nurse supervisor on each floor 24/7. Please discuss your current status to meet this crucial requirement? CMS stated GMH failed in this area, leading to deaths.
  4. What is the current status of your rapid response team for pediatrics and the adult inpatients? A past criticism was that pediatric nurses did not know the rapid response team even existed. Imagine that.
  5. Please explain how the pediatric and adult ICU unit is accessed? If doctors are not available or home sleeping how do patients get the ICU care needed? This was also an issue brought up in the past with the CMS when a 5-year-old child was not moved into ICU and the staff did not follow established protocols leading to his death.
  6. Explain the purpose of your risk management team and root cause analysis when a patient succumbs within 24 hours of admission? When was the last time this team did such an analysis and reported out and acted on their findings? Nurse Flores testimony seemed to indicate it’s not done.
  7. Medical peer reviews are required, but are they done? Not done per Nurse Flores testimony it appears. Is this info reported to the GMH Board for action? When was the last time?
  8. CMS and others including patients or families have faulted GMH for not properly prioritizing – appropriately – patient needs. What has GMH done to alleviate this issue which can contribute to the demise of patients?
  9. Patients have showed up for and been prepped for procedures as was Mr. San Nicolas who was interviewed on Kandit News recently, but then discharged due to lack of equipment or needed items. This is a dangerous shame. Things are so bad that a nonprofit group raised money to buy equipment for the respiratory unit at GMH. Please explain how you are mitigating this dangerous situation to protect the people of Guam. Let me add that I have spoken to many unhappy patients at GMH personally in front of the hospital, including an upset husband whose wife couldn’t get emergency medical interventions due to a lack of equipment. I also spoke last week to a mother at GMH whose son could not get a respiratory mask that fit him.
  10. Guam has been noted to have the worst maternal health care leading to deaths in the country and perhaps even in the free world. It’s easy to blame the patient’s diet etc, or point the finger at others, but what have you done to protect patients at GMH? If doctors harm patients how do you hold them accountable? Medical negligence is repeated often by the same doctors as 1 percent of doctors commit 32 percent of malpractice. It’s my belief that issues of maternal health or death can be sometimes traced back to these repeat performers. What are you doing to protect our mothers and babies?

Great health care happens in free clinics and run down facilities all over the USA but it’s only on Guam that has legalized a lack of medical accountability that our legislature has sanctioned. Is this lack of accountability correlated to the worst maternal care in the country or the continued problems with patient care at GMH?

What is clear, we shouldn’t have to wait five years to save lives or find out that a new hospital didn’t improve the terrible patient care that we now suffer with at GMH. Our senators think the new hospital is the solution without exploring basic medical issues to save lives now, it appears.

Senator Lujan and the Guam 37th legislature with all of the good intentions and nice sound bites can throw as much money as they want at GMH now, after GMH has mismanaged our tax dollars, which only fixes how the public perceives their apathy recently, but does not improve the most basic medical care at GMH. This has been the problem for decades. GMH leadership mismanages the hospital including financially, senators throw money at GMH to make up for the mismanagement and to take the heat off of themselves, and then walk away thinking they accomplished something, and patients die.



David Lubofsky is a resident ofTamuning.

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