Heal with steel
Cancer sucks. Cancer is a disease caused by uncontrolled growth of usually innocuous parts of the body that invade and destroy vital organs causing pain, suffering, and death.
A government shutdown sucks. A government shutdown occurs when political leaders fail to fund an operational budget and a lot of “nonessential” government activities suddenly cease.
During shutdowns, government employees are split into “essential” and “nonessential” groups. Nonessential employees receive furloughs: They stop getting paid and are off work until the shutdown is resolved. Essential workers also stop getting paid, but they still have to work.
A shutdown usually suspends a lot of government functions. In 2013, the US federal government shutdown forced the Centers for Disease Control to almost completely cease operations leaving the nation vulnerable to disease outbreaks such as influenza and tuberculosis. Vital medical research activities at the National Institutes of Health and the National Science Foundation were likewise nearly completely shut down.
Our island people were shocked last month when they woke up to find that the Guam Memorial Hospital had lost national safety accreditation. GMH leaders acknowledged that widespread problems involving the hospital’s "environment of care," physical infrastructure, medical staff leadership, national patient-safety protections, and administrative quality controls have existed for the past six months. GMH officials recognized ongoing systemic failures to protect patient safety. Basically, GMH has failed its most recent health inspection and its violations have been ongoing for the past year.
This past week, GMH officials have consistently pinpointed the root cause of GMH’s patient safety failures as a lack of money.
In spite of repeated taxpayer subsidies, a $144 million budget, and $110 million in collections, we are told that GMH is broke. Despite a veritable hiring freeze of more than 50 key clinical personnel and the shutdown of more than 33 acute care patient beds including more than 5 intensive care beds, GMH is supposedly broke. The fact is that GMH does not have enough nurses and doctors to take care of Guam’s poor people, yet GMH still routinely makes payroll payments for more than 900 full-time employees who allegedly do something at the hospital.
According to GMH officials, only essential personnel now work at our island’s only public hospital. There is no fat to cut. GMH is lean to the bone. Apparently, any attempt to laterally transfer more than 200 bureaucrats from Personnel, Billing, Collections, Public Information, Legal, and upper management offices would be useless. I disagree.
Like a cancer, GMH leadership greedily clutches to this notion of absolution from fiscal pain. Meanwhile, the Department of Education acknowledges the presence of “nonessential” personnel in their budget and is preparing to cut $20 million in expenditures in order to meet fiscal realities. Simultaneously, politicians plan to raise taxes, borrow money, and raid the $30 million Tourist Attraction Fund to pay for GMH shortfalls.
When cancer is eating at your lung or at your brain, if you want any chance to live, you must be prepared to cut the cancer out.
The mandate of the Guam Memorial Hospital is to provide quality patient care in a safe environment. The mandate of GMH is to provide care regardless of a person’s ability to pay. This is why GMH exists.
GMH has no mandate to fund nonessential government jobs. GMH has no mandate to make payroll. If the US federal government will require “essential” employees to work without pay during a government shutdown, then GMH can too.
GMH administrators, Governor Calvo, and each and every one of our senators must ask what is their Why? Why do you burden your people with taxes on food and medicine? Why do you tax small businesses on gross receipts and yet absolve banks, hotels, and insurance companies from paying any taxes at all? Why does GMH payroll matter more than making vendor payments for medicine and hospital supplies?
The false primacy of government payroll payment over the payment of clinical expenses is the reason why GMH cannot fix its current patient safety violations. While hospital leaders claim that there is no money to pay for medicine or the Retirement Fund, they always find money to make payroll for the 1,385 warm bodies on the GMH budget.
A government that is for itself and not for the people will fail. In the case of GMH, too much pain and suffering has already occurred due to this cancer of payroll politics. As we as a community resolve to cut this cancer out, I hope that there is a special place in Hell for government leaders who knowingly sacrifice patient care in order to fund a bloated hospital payroll.
Dr. Vince Akimoto practices Family Medicine at the American Medical Clinic.