By Mar-Vic Cagurangan
Guam’s health care system has always been a political battleground for the island’s elected leaders. The perennial debate over how to provide proper medical care for the island's residents and how to cure the ills of the aging Guam Memorial Hospital becomes even more ferocious during election years.
The opening question at the Guam Medical Association’s debate at the Hilton Resort and Spa on July 27 made it clear that even Democrats have clashing ideas.
The current government has plans to replace the 50-year-old GMH, which, according to the U.S. Army Corps of Engineers, is too costly to repair.
Where should the new hospital be located? On the west side of the island, Gov. Lou Leon Guerrero replied, saying there is already a hospital in the north. She cited patient accessibility, topography and space as the factors in choosing the right location.
The governor has identified a spot next to the Eagles Field in Mangilao as a potential site for the new hospital, which she said should also be accessible to residents in the south. “The location must be able to house not just the hospital but also public health, Guam Behavioral Health, the veterans’ clinic and public health lab,” said the governor, who is seeking four more years.
Her challenger, Congressman Michael San Nicolas, said north is the best spot. He argued that the new hospital should be built at the old hospital site in Oka Point in Tamuning, close to GMH and medical clinics. “The doctors want to be able to get to a hospital faster because their existing operations for the most part are more along the Tamuning central part of the island,” he said. “We can be more flexible by adding the geographical factor.”
This was the first public face-off between Leon Guerrero and San Nicolas, who are vying for the Democratic Party’s gubernatorial nomination in the Aug. 27 primary. Guam voters got a better look at the Democrats’ health care priorities.
GMH, which lost its accreditation in 2018, was severely tested by Covid-19 which pushed Guam's health care system into abysmal exhaustion at the height of the pandemic in the summer of 2020. A large stream of federal Covid relief aid allowed the government hospital to survive the brunt of the pandemic. But that financial support won’t be around much longer—and neither will the hospital
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“The Army Corps of Engineers has said the life of our current hospital is only five years, so it’s very urgent that we build a new hospital,” Leon Guerrero said.
Amid criticism from the legislature, the governor has set aside $300 million in federal Coronavirus Relief Fund for the hospital project, which is still in the nascent stage of planning.
But San Nicolas said it will take seven years to build a new hospital. “We need to invest more in GMH. We can maximize the useful life of GMH. Renovating the maternity ward is a commonsense investment,” he said. “We must also identify future use of the GMH by repurposing it for an additional health care center.”
Leon Guerrero argued that GMH is currently being taken care of with a $30 million infusion. “GMH has been a recipient of emergency funds. GMH does have a dedicated source of funding—the pharmaceuticals,” the governor said. “The government is not going to abandon GMH. If we have to course more funding sources so it can operate, then we would.”
Leon Guerrero said Medicaid enrollment has been expanded to include hundreds of migrants from the freely associated states, allowing GMH to ease its financial burden. In December, the federal government awarded immediate Medicaid coverage for citizens from the Federated States of Micronesia, Palau and the Marshall Islands living on Guam and other parts of the U.S. in a Covid-19 pandemic relief bill. Previously, citizens were required to have a five-year residency.
But San Nicolas rebutted that Guam will be able to take more advantage of Medicaid dollars if the government has an updated Medicaid State Plan. Guam’s state plan, he said, “is still in the typewriter.”
Throughout the years, Guam has been beset by never-resolved issues such as the shortage of specialist doctors and nurses. “We have plans to alleviate the shortage of nurses. We have increased nurses' salaries because nurses are leaving for better compensation,” Leon Guerrero said, adding that additional resources have been extended to the University of Guam’s nursing program.
San Nicolas said he will push for more scholarships to build a local pool of nurses.
To address the shortage of specialty physicians, Leon Guerrero said recruitment efforts have been ramped up through partnerships with private medical providers.
But San Nicolas said he heard a different account from the medical community.
“The medical professionals I’ve spoken with have shared with me that the investments that we’ve made thus far are not adequate,” he said. “This administration is the most funded administration. It has had emergency powers to be able to do those things and for us to be having a conversation now that that isn’t resolved is very, very disheartening.”
The question related to expanding access to immunizations was posed to the candidates for lieutenant governor during their turn at the debate podium.
Sabrina Salas Matanane, San Nicolas’ running mate and former broadcast journalist, said the one-hour-a-day immunization service “is completely unacceptable.” The daily immunization hours “should be expanded to 8-5 when they are open and offered 8-5 at three immunization locations or all public health community centers.”
Lt. Gov. Josh Tenorio, Leon Guerrero’s running mate, said he favors expanded access to immunizations but the community health centers are functioning autonomously. “They are able to operate really fast,” he said.
With regard to the GMH reaccreditation, Tenorio expressed confidence that the public hospital will regain its lost status after the visit of an accreditation team this spring. “We are looking at all deficiencies,” he said.
But Matanane wondered what has been taking the administration so long to achieve its goal. “Here we are, four years later, the hospital is still not reaccredited.”
Abortion is a topic that always finds itself at the center of the election debate on Guam. With the U.S. Supreme Court’s decision to overturn Roe v. Wade and leave policy decisions to individual states and territories, abortion is a particularly weighty topic in this year’s elections.
The reversal of Roe v. Wade was a “dark day for women,” Leon Guerrero said. While suggesting that any policy proposal should be presented in a referendum, the governor urged Guam voters to reject any initiative that would restrict women’s right to privacy and safe options.
San Nicolas avowed his “pro-life” position, which he admittedly doesn’t share with his “pro-choice” running mate. At any rate, he agreed with Leon Guerrero that any abortion-related proposal must be presented to Guam voters.
The question related to a proposed bill that would allow the publication of complaints against physicians turned out to be the most vicious part of the debate.
“I don’t support this bill. I think it’s very dangerous,” Leon Guerrero said. “I think it’s still not very responsible because this bill to publish accusations, even if it's not being justified, is, I think, totally reckless performance. I don't support this. Yes, there are claims that occur; there are errors that are made, but without giving due process to our doctors and even our nurses I don’t think that’s right.”
San Nicolas said he doesn’t support the bill either. “I have some experience with unsubstantiated claims,” he said, clearly referring to the U.S. House Committee on Ethics’ report questioning his 2018 campaign finances. “I know how they can hurt families,” he said. “Unsubstantiated claims have no business being put out there in ways that are going to be harmful to you or to your families.”
Leon Guerrero did not forego the chance to take a potshot at her challenger. “What the congressman is talking about is the ethics report,” Leon Guerrero said. “And if you read the ethics report, the report says that they have found substantive evidence. We are in this race without a cloud over our heads. We are in this race without having to answer questions about our integrity.”
While health care may always be a dinner table issue for politicians, deliberations on this industry require more than soundbites. There will be more discussions in the future, said Dr. Thomas Shieh, GMA president. “Health care issue cannot be discussed all in an hour and a half session. So, our plan will have GMA forums, and it will not be a debate, but will be a heart-to-heart discussion on health care issues directly affecting the patients on Guam.”
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