By Fili Sagapolutele

PAGO PAGO, American Samoa (Samoa News, Sept. 26, 2008) – A report released yesterday by the Interior Department's Office of Inspector General (OIG) states that LBJ physicians are "left making guesses about patient diagnoses" due to the lack of medical specialists and critical equipment.

The report, "Insular Area Health Care" "At the Crossroads of a Total Breakdown" cites LBJ staff as saying "patients coming to the hospital suffering from head injuries and heart attacks have died because specialist[s] were not on island to treat them."

The report combines OIG personal observations and interviews of LBJ staff members to provide an idea of the difficulties and challenges existing in the seven insular areas which include American Samoa.

Overall, OIG states that the most notable communality challenge among the seven insular areas is that hospitals struggle to recruit and retain nurses, physicians and specialty practitioners, with salaries not enough to attract personnel.

According to the report, one of the LBJ's most serious problems is recruiting and retaining physicians and overworking the ones it does have.

LBJ staff told OIG low salaries and lack of benefits (pension or life insurance) are the reasons the hospital isn't able to attract specialists or skilled medical personnel.

According to the report, of the 36 physicians on staff at the hospital, six are U.S. medical doctors, six are practitioners licensed under local law, and 24 are practitioners working under a "license issued without completing the requirements for licensure."

LBJ staff members also relayed to OIG the continuous battle over the licensing of physicians.

The difficulty in obtaining specialists has affected patient care. The report states LBJ has three specialists that work on a revolving contract (two nephrologists and a cardiologist) and they visit the hospital for one week each quarter.

One senior hospital staff said there is a great need for a vascular surgeon due to the high number of dialysis patients.

With the lack of specialized treatment locally, patients are sent on an off-island medical referral program and due to the high cost, LBJ can only afford to pay for life threatening cases.

Referral costs are dependent on the illness and severity and a staff member says the per patient care averages $43,000. Patients are required to sign a promissory note for any costs above $100,000 and LBJ pays the cost and then bills the patient, but often, collection is impossible, according to the report.

According to OIG, LBJ's physicians have attempted to use "telemedicine" to assist in their duties but the hospital's current system has a poor screen solution and "times out", locking up sessions and preventing staff from getting needed diagnosis information.

"Staff have been told that improvements to upgrade the system would cost around $38,000," OIG said. "Patients are sometimes left depending on the diagnosis of LBJ physicians who do not have expertise in certain areas."

Another critical need for LBJ is modern equipment but there is not enough funds for such purchases, or even to replace equipment when it breaks, the report states.

For example, because the radiology ultrasound is broken, patients and radiology staff must go to the obstetrics unit to use their equipment. This creates long lines of patients needing treatment.

Last year, the CT scanner - which assists in pinpointing tumors, bleeding in brain and aneurysms - broke down and the replacement cost is $280,000 which exceeds LBJ's total equipment budget.

"We just diagnose without the service," a senior staff member told OIG. "Physicians have to 'take more of a guess at a diagnosis than know for certain what is going on'."

In the dental clinic, the X-Ray machine is obsolete and mended with duct tape. The X-Ray chair was so worn out that a dentist personally reupholstered it and spray-painted the foot rest.

The report also states the dental clinic staff are being exposed to elevated levels of radiation because the walls enclosing the X-Ray area do not have lead in them.

Hospital staff also expressed a need for items such as birthing beds, an ultrasound machine, incubators, a defibrillator, an infant warmer system, bassinet baby warmers, suction regulators and a fetal monitor just to name a few.

Due to the lack of equipment, babies are frequently "doubled up" in incubators, according to the report.

The report's release coincides with the 2008 Insular Areas Health Summit that opens Monday in Honolulu, sponsored by DOI, which Gov. Togiola Tulafono and LBJ hospital chief executive officer Patricia Tindall will attend.

The health summit is to find ways to improve health care of the Insular areas' communities, said Interior Secretary Dirk Kempthorne earlier this week.

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