Luis Hospital CEO gets earful on dialysis and mental health issues

ST. CROIX - People who wanted to relate the experiences they had at Luis Hospital - and how they want the hospital to change - crowded into Villa Morales Monday night, as hospital officials conducted their second community forum in a week.

Dialysis patients expressed frustration at the hospital's failure to adequately progress in meeting the mandates of a settlement agreement. They questioned why, after being told last year that they had the choice of continuing to receive dialysis at the hospital, that 20 of them now will have to receive treatment at a privately-owned dialysis facility if they want to stay on island.

An advocate for the mentally ill asked when the hospital's acute psychiatric patients may be able to return to St. Croix, after they were transferred to Schneider Hospital on St. Thomas last week when there was no staff psychiatrist available at Luis.

And people related a wide variety of experiences, from one woman saying the air conditioning in the hospital is too cold to another who discussed having to hire someone to care for a family member as she was dying in the hospital, because the family felt staff was not providing the care that was needed.

Jeff Nelson, Luis Hospital chief executive officer, listened to it all.

Nelson, hired in January because of his reputation for coming into troubled hospitals and turning things around, is having the forums to get input from the community on the changes they want to see at the hospital.

Throughout the two forums, he has welcomed comments from the public, good and bad.

Monday he said that however painful those comments may be, listening to them is necessary.

"The patients and the families are our customers, and if we don't listen to the customers, we can't improve it," he said.

Before it can meet or exceed expectations, the hospital first must know what those expectations are, Nelson said.

"To build trust, you have to listen first," he said.

Trust is a key concept in the goal that employees have come up with for the hospital: "To be the most trusted, patient-family centered health system in the Caribbean by 2020."

On Monday night, Amelia Headley Lamont, of the Disability Rights Center of the Virgin Islands, told Nelson a task force with a goal of improving the mental health system in the territory needs representation from Luis Hospital.

The task force was one of the mandates of a settlement agreement stemming from a lawsuit the center filed several years ago against the local government and the hospitals, charging that the territory's system of providing care for the mentally ill was entirely inadequate.

Headley Lamont also reiterated the need to recruit psychiatrists to the territory - and to offer them a competitive salary.

Luis Hospital last week transferred the patients from its inpatient psychiatric unit to Schneider Regional Medical Center when neither staff psychiatrist on St. Croix was able to provide medical coverage for the unit.

The hospital is working to recruit a psychiatrist, but at this point, he did not know when the inpatient psychiatric unit would reopen, Nelson said Monday. He also told Headley Lamont that the hospital will be at the next task force meeting.

In other discussion at the forum, some hospital dialysis patients told Nelson that they felt betrayed.

The hospital is operating its dialysis unit under a Centers for Medicare and Medicaid Services settlement agreement mandating a myriad of improvements. A recent addendum to that agreement requires the hospital to reduce the number of patients receiving dialysis by about 20 so that staff can get mandated training and education.

Those patients will have to go to the privately-owned Caribbean Kidney Center if they want to stay on-island.

The same issue occurred last fall, after the hospital entered the agreement, but patients refused to go, and officials eventually conceded that they had the right to choose where they received treatment.

Now, the hospital is renewing the effort to transfer 20 patients out.

"Where is the trust when you want to tell me where I can choose to have my dialysis done?" one woman asked Nelson.

Aminah Saleem, co-director of the dialysis patient support group, said that members feel betrayed.

"They are in that hospital more than anybody else in the community," Saleem said. "They have a special feeling for that hospital - and they have been betrayed."

Bert Bryan told Nelson he had read the CMS inspection reports that led to the settlement agreement and said the problems should have been fixed long ago. Officials cannot expect to do the same things and achieve different results, Bryan said.

"Same people, doing the same thing, it's not going to change," Bryan said. He also questioned whether the choice of dialysis patients for transfer would be based on whether or not they have insurance.

Nelson said officials are not considering insurance in making transfer decisions.

CMS required the census reduction "because the hospital has not been able to perform," according to Nelson.

The hospital, he said, has set a goal of reaching compliance with the settlement agreement in mid-May and anticipates that CMS regulators will do an inspection in June. It will be up to CMS when - or if - patients who will be transferred can return to the hospital's dialysis unit, Nelson said.

Former Health Commissioner Vivian Ebbesen-Fludd welcomed Nelson and gave him some advice.

"You will continue to fight the battles that you fight until you get the governor and the Health Department to take care of the public health issues," she said. Without a functioning public health system providing clinics and preventative care, the hospital will continue to have its resources overtaxed and the problems will not go away, Ebbesen-Fludd said.

She and another audience member also encouraged Nelson to tap into the expertise of retired nurses and hospital workers to help the hospital move forward.

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