By Frank Whitman
As Guam continues to face the desperate need for a new Guam Memorial hospital, an apparent split is forming in the community over the best location and whether the government should build a medical “complex.”
The most recent legislative public hearing on the matter was Nov. 20, during which testimony was heard on Bill 185-37, introduced by Sen. Chris Barnett. If enacted, the bill would mandate that the hospital be built in Tamuning.
That hearing was followed a week later by an information hearing for health care providers hosted by Gov. Lou Leon Guerrero on Nov. 27 at the Hilton Guam Resort and Spa.
While there is overwhelming agreement on the need for a new hospital, Leon Guerrero proposes a complex that will include a new GMH, a Department of Public Health and Social Services center, a Centers for Disease Control and Prevention laboratory, a Guam Behavioral Health and Wellness Center facility, a Department of Veterans Affairs center, a pharmacy, and an assisted living facility.
Under the governor’s plan, the complex would be built on a 102-acre area in Barrigada off Route 15 in an area known as Eda Agaga (also called Adacao).
Others say the complex is too extravagant and the government should focus on building a hospital. They say a medical complex of sorts has grown up on its own in Tamuning near GMH in the form of more than 50 specialty care clinics, pharmacies, physicians’ offices and other health care facilities. They also say plans have changed for some agencies.
“Public Health has already stated on the legislative record the CDC lab will be located next to (the University of Guam),” Barnett said.
In addition, Behavioral Health and Wellness has said it plans to expand its current facility in Tamuning and the VA plans to open a Community-Based Outpatient Clinic adjacent to the Guam Regional Medical City hospital in Dededo, he said.
The administration contends the Ypao site is too small to accommodate all the facilities it has planned for the complex and would not provide space for growth.
Barnett opened the Nov. 20 hearing by acknowledging the concerns of residents of southern Guam who testified in opposition to Bill 185, saying Eda Agaga is more accessible to them and that they sorely need better access to health care.
“That is why I want to push for improvements to existing facilities in the south and push for new facilities that are actually located in the south for the people in the south,” he said.
During the legislative hearing, Dr. Thomas Shieh, president of the Guam Medical Association, presented slides with information from a study of potential sites for the new hospital prepared by the Matrix Design Group Inc. for the Office of the Governor at a reported cost of $6 million.
He showed several slides from the study with tables which indicated that Ypao Point should be the preferred site over Eda Agaga. “Ypao comes out to be No. 1 based on the critical factors which are … location, population density, travel distance, emergency response time and the distance from the clinic.”
In particular, using drive-time analysis, Ypao provides the best access to the sites studied, Shieh said.
According to the Matrix chart, 35,686 residents – patients and providers - could reach the Ypao site within 10 minutes, while only 13,731 could reach Eda Agaga in that amount of time.
The Matrix information also indicated more people – 27,358 - would not be able to reach the Eda Agaga site within 30 minutes while 24,598 people would not be able to reach Ypao within that amount of time.
More than 60 health care providers attended the Nov. 27 hearing, which was conducted by Krystal Paco-San Agustin, the governor’s director of communications.
Paco-San Agustin acknowledged that there is no significant disagreement about the need for a new hospital. “The debate now has evolved to ‘Do we need a hospital or do we need a medical complex?’” she said.
She noted some gaps in health care coverage on the island. There is no Public Health facility in central Guam following a fire at the Mangilao Public Health center. And, she said. the Behavioral Health and Wellness Center, adjacent to GMH, has no facilities for inpatient care.
Veterans complain regularly about the quality and limited care available at the CBOC, which is adjacent to Naval Hospital Guam in Agana Heights. “Part of that is that the CBOC can’t expand,” Paco-San Agustin said.
Guam veteran care problems include high physician turnover, care available only off-island necessitating an expensive eight-hour flight and wait time for prescriptions. As envisioned, the health care complex would address those problems.
The complex would include insurance provider offices, more than ample parking and a power substation to cut down on power outages in emergencies.
The Ypao Point site with 17 usable acres is too small for the complex, she said.
Paco-San Agustin questioned the accessibility to Ypao Point in light of Tamuning traffic congestion and ongoing road repairs.
“The central location increases access, especially for our southern residents,” she said. “The Department of Defense has already made plans to increase access along Route 15.”
The governor told attendees that in addition to southern residents being able to travel up Routes 4 and 10 to Route 15 – also known as the Back Road to Andersen - residents of Yigo would be able to access Route 15 from Marine Corps Drive via Gayinero Road and those in Dededo would have a similar shortcut using Macheche Avenue.
“People that live in Yigo and Dededo now, if they have an emergency and they have to go to GMH, they have to go through that traffic of Marine Drive,” the governor said. “Whereas (with a hospital at Eda Agaga) they just cut across from Gayinero Road or the Macheche road that takes you straight to Eda Agaga.”
In response to a question about the timeline following a decision on the location of the new hospital, the administration would start immediately with such preconstruction activities as environmental assessments and permitting.
“The design of the building is expected to take a year to a year and a half,” said
Melanie Mendiola, administrator of the Guam Economic Development Authority.
“But even before a site is selected we could do assessments on multiple sites just to keep the ball rolling," Mendiola said.
"We drafted some memorandums of understanding with (the Guam Power Authority and Guam Waterworks Authority) such that the governor can go ahead and request that they begin doing their assessments as far as what the infrastructure investment needs to be for the potential site," she added.
Dr. Ellen Bez, a retired internist, said facilities like the proposed complex are now the standard of care in the mainland U.S. “The standard of care is to have specialties in-house now,” she said. “So the luxury that many specialties have had of being able to stay home and wait for a call is not the standard of care anymore.”
Several mainland health care providers say “the wave of the future is to have a medical complex, not places all over the community but in one place where all the services can be.”