Crisis looms at Yap hospital
Updated: Mar 7, 2021
Legislature nixes salary raises for doctors; hospital official says low pay rates hamper recruitment
Editor's note: Gov. Henry Falan issued a clarification on March 3 to his recent executive order revoking Yap State Memorial Hospital fees. The revocation is only for the $10 “after-hours encounter” fee which has been reverted to the normal $2 fee. All other fees established in 2018 remain the same.
Colonia-- Yap is one of a handful of places on the globe that remains free of Covid-19 due to its locked border. But healthcare leaders on the small island agree that it will only be a matter of time until the virus breaches its shores when the border is reopened.
The state’s Health Crisis Task Force has worked around the clock for the last year preparing for that eventuality.
One critical step toward that goal is the recruitment of more doctors.
With only four doctors working at the small hospital, Chief of Staff Dr. Mandela Bodunrin informed the state’s leadership in a public hearing on Nov. 12, 2020 that they will be unable to take care of patients if or when the pandemic arrives. They must recruit more doctors and that, he said adamantly, requires competitive compensation.
A sector grant for doctors’ salary increases was awarded to the Department of Health Services by JEMCO for fiscal 2021 in the amount of $102,767. With the agreement of the then Acting Attorney General’s office, the health agency gave the doctors temporary contracts in January 2020 that included the salary increase; those contracts expired on Sept. 30 at the close of fiscal 2020. The increase was to become official for fiscal 2021. In the meantime, new doctors could be recruited at the increased rate.
Or so they thought.
On Nov. 5, Yap Gov. Henry Falan wrote to Speaker Vincent Figir seeking legislative assistance in alleviating "a potential catastrophe."
“Our doctors today have stopped coming to work at our hospital concerning their compensation, which was approved by JEMCO and grant awarded by OIA, which I officially transmitted to your august body on Sept. 22, 2020 but was not approved until today," Falan told the speaker of the Yap State Legislature.
"Since they have not been paid in the last two weeks, there is now a real threat for their walking out, and some may even move on to other greener pastures.”
The doctors had refused to sign their new contracts when the legislature voted down the increased salary for the coming year. It wasn’t for their own benefit; new hires would be impossible, the doctors argued.
Their contracts are up for renewal on Feb. 28. It is not known if they will sign a new one.
The matter was referred to the legislature’s Finance and Health & Welfare Committees and the public hearing scheduled 10 days later.
In his impassioned opening statement at the hearing, Falan told the leadership that it “really worries me that people may go to the hospital without doctors. I’d like the leadership to assure its citizens that we do care for their welfare and that we’re looking after their interest.”
The governor told the lawmaking body that the doctors had “done their homework in making sure there was funding for such a request” and that key staff had completed the necessary protocols before he signed the grant application.
“We will stand by [the doctors] so they can stand by us," Falan said.
Sen. Nicolas Figirlaarwon, chairman of the Finance Committee, said "the hospital created the problem themselves.”
In the state's 2018 audit, Deloitte & Touche discovered an over-expenditure of $1.26 million in the general fund and $1.65 million in federal and sector grants, even though tax revenues had gone down.
JEMCO recommended that vacancies not be funded for fiscal 2020 and fiscal 2021.
But, according to Figirlaarwon, there was a “leftover” for the hospital. The health department sought JEMCO's permission to use the leftover for salary raises without obtaining a resolution confirming availability of the funds — in violation of state law.
The temporary contract was also in violation of the law, Figirlaarwon said.
The legislature decided that government salaries should remain at fiscal 2020 approved levels to help the state “get out of this mess,” Figirlaarwon said.
The responsibility for the approval of the temporary contract was with the Attorney General’s office which had a 100 percent turnover in succeeding months.
The decision was made prior to the hiring of the new Acting Attorney General Eliesa Tuiloma, but he accepted responsibility on behalf of that office and agreed that all appropriations must go through the legislature.
Bodunrin next addressed the matter of the doctor’s work slowdown, asserting that the doctors were not on strike.
They had been working for six weeks with no pay because they had not signed their new contracts, but they continued to see emergency cases.
Each doctor works an average of 80 hours extra including holidays and weekends; the doctors are overwhelmed, he said emphatically. “Only the salary is being looked at here, not the hours we put in," Bodunrin said.
The state hospital fights to bring in more doctors and improve Yap’s health care delivery, but salary cuts would hamper these goals, Bodunrin said.
“I’ve tried to bring doctors in,” he continued, “but when they hear about the salary that’s paid in Chuuk or Pohnpei and Kosrae, that’s it. When we had the temporary increase, we had two doctors ready to come in, but the border closed.”
If more doctors are hired, the increase will be shared among them, so it will not be that high for each one, he added. “If we have Covid right now, we cannot handle it. Please,” he pleaded, “this is why we are asking for the increase.”
When asked why a new contract has not been signed, Bodunrin explained that the hospital could not get more doctors to come in at the lower rate.
Tuiloma noted the Hippocratic Oath that all doctors take. “They’re thinking about Yap and the welfare of the people as to why they’re asking for that increase," he said.
"When we talk about the increase in the doctors’ salary, we should weigh their request against the welfare of the people. It is not for [the doctors’] personal welfare that they are asking for this increase," Tuiloma added.
In a final report submitted to Falan on Dec. 1, Figirlaarwon enumerated the reasons for the denial of proposed salary increases.
First, the temporary contracts signed the prior January were deemed illegal.
Second, all funds must be appropriated by the legislature. While JEMCO can approve “allowable uses,” only the legislature can give a seal of approval for availability of funds.
The report also noted that the doctors were in violation of the law when they stopped working since the law states that government employees “shall not strike against the government.”
The report acknowledged “the importance of ensuring that the people of the State of Yap continue to be provided with professional health care by the most qualified medical professionals that the state can afford. And, we also realize that the department and every government agency is aware of the state financial deficit as projected by the administration to be around $3 million.”