An open letter to the people of Guam from GMHA

The purpose of this letter is to assure the people of Guam that our Guam Memorial Hospital is safe and completely prepared to care for the community’s needs through services available at this hospital.

First and foremost, I wish to assure each and every citizen in this community that patient care is the top priority at the Guam Memorial Hospital. If you have a need to come to the hospital, please do so knowing that we take our commitment to your care as seriously as you do. We are a community hospital, and therefore face issues that community—and many private hospitals throughout the United States face. However, you can rely on this hospital to provide you the very best care available through our resources, and to commit ourselves to the best possible outcome for your care.

There have been questions raised with regard to surgery safety and an allegation of a number of preventable deaths. Any surgery has risks, however the allegation of preventable deaths is not supported by the facts. GMH has a verifiable and reliable system of checks and balances to ensure the best possible care and identify critical events such as a preventable death. We rely on three mechanisms to report any case of medical error, equipment or system failure, or unanticipated patient death.

GHM manages a detailed tracking and incident reporting system channeled through the hospital’s risk manager. Critical events such as an unanticipated death are reported via incident report to the risk manager. There have been NO incident reports to the GMH risk management system whatsoever identifying any types of preventable death involving a surgical case or post operative care in the past 24 months.

The second mechanism for checks and balances is medical peer review conducted by the Department of Surgery and the Medical Executive Committee. Physicians in the Department of Surgery are responsible for reviewing cases of potential error and taking corrective action when warranted. The Department of Surgery has reported a number of equipment and supply issues that are being addressed; however, there have been NO critical event reports during the past 24 months from the Department of Surgery or the Medical Executive Committee concerning any death whatsoever.

It is a grave concern that the people’s confidence in our hospital has been damaged by these unfounded allegations. I have therefore ordered as a fourth check and balance an independent review firm that specializes in review of our surgical records to review and conduct a causative analysis of all intra-operative and post-operative surgical deaths, a review of all pathology reports, and all other operative records so as to objectively and independently determine any basis for these allegations and reasons for non-reporting by responsible parties should any such circumstance actually exist.

My second point is to assure the people of Guam that GMH has adequate medical staff and supplies to meet the needs at the hospital. You have heard me report for years now that our hospital requires additional staffing and funding. This remains true. For these reasons it is also true that GMH cannot yet provide ALL items we would LIKE to have to serve our patients. However, to quell any anxiety on the part of the public, GMH has taken extraordinary measures to expedite additional supplies and equipment, spending in excess of $1 million to do so.

In addition, GMH is taking an additional and extraordinary safety precaution of calling a 72 hour stand down for elective surgeries effective Wednesday, Jan. 19, 2005. We will continue to perform emergency surgeries and provide labor and delivery care as we always do, but the surgery and recovery nurses and materials management staff involved with surgical supply will take this time to review policies and procedures, evaluate lines of communication and individual and group priorities. Again, let me make it very clear that emergency surgeries will continue. The surgery stand down has been thoroughly discussed with Dr. Ron Kobayashi, chair of the Department of Surgery and with Senator Mike Cruz, MD, chair of the Committee on Heath, both of whom concur with this approach to reassure the people of Guam.

I will be personally monitoring supply management for those items GMH is required to have on hand. GMH must acknowledge instances wherein arrival of procured items has been delayed. In those cases, we are thankful for the partnerships we have with the department of the Navy, the Seventh Day Adventist Clinic, Guam Surgicenter, Hafa A’dai Specialist Group, and our medical supply companies to assist us when needed. I also want to encourage any patient or family member to contact me directly if there is a perceived shortage of supply that is reasonable for GMH to try to provide, and one of our senior management staff or I will personally attend to that request.

Third, I must state that this hospital heavily relies on its surgical staff, and is committed to meeting the needs of our surgeons so that they can provide the quality of care we all deserve. I would like to advise the people of Guam of the ways GMH is addressing surgeon requests:

In August, the Department of Surgery submitted to me a list of requests. I would like to publicly respond to the actions taken to meet those requests:

Request for more anesthesiology staffing—this request was addressed and we now have two full time equivalent anesthesiologists and can provide care according to the schedule requested by the surgeons.

Request for better scheduling—understandably, with anesthesiologist and nursing shortages, the capacity to schedule elective cases was limited. This has been substantially addressed, and while we do have a full compliment of surgery nurse staffing now, we need more nurses to care for patients after surgery. Once financial and civil service limitations can be overcome to hire more staff, GMH will address this request.

Request for emergency surgeries not to interrupt elective surgery schedules—ideally, GMH will one day be able to have enough operating suites and staff to completely handle emergency surgery independent of elective surgery schedules. However, at this time, it is my job to assure the people of Guam that emergent cases will take priority over elective surgeries. This is standard in other community hospitals where resources are limited.

Request for a neurosurgeon—our surgeons have requested that Guam and/or GMH recruit a neurosurgeon. GMH would love to have this as well. However, a population of 140,000 does not typically support a neurosurgeon without substantial subsidy, and even then the case load for a full time neurosurgeon would not be sufficient to financially or clinically support this type of specialist. This remains a long term goal for the community to work together to achieve.

Request for an increase in beds—GMH will soon open its renovated wards destroyed by typhoons, which will add an additional 20 beds. However, this will not be enough to meet our overall needs. GMH agrees with the surgeons that more beds are needed, and has therefore been working diligently with the Office of the Governor to devise financing mechanisms and community support for a completely renovated or new hospital.

Request for an increase in availability of medications—again, GMH agrees with the surgeons on this point. This hospital is continually plagued with an antiquated procurement system and cash flow restrictions that impact our buying power. However, this is an explanation, not an excuse. It is still the responsibility of this hospital to have adequate stock of medications and supplies at all times, and we will continue to work on this matter with the resources available. GMH will not begin any surgery when there is not 100 percent assurance that all supplies and medications needed are available.

Request for availability of angiography—the surgeons requested that GMH assure that angiography services—where diagnoses can be made through injected dye—be restored. These services have been restored and are now available to the people of Guam.

Request for ultrasound services—our surgeons are correct in stating that ultrasound services at the hospital are needed. However, this is a situation where civil service pay limited on ultrasound technicians are not sufficient for recruitment. Even the rule allowing to hire at the highest step via an exception request is not enough. We will continue to recruit for a qualified sonographer.

Request for nuclear medicine services—again, our surgeons are correct in stating that nuclear medicine—or the service to diagnose through injection of radioactive dye—would be ideal at the hospital. Again, this is not a service GMH can supply within current resources. We have not been able to recruit a nuclear medicine technologist who will work for the current civil service pay scale. However, Guam is advantaged to have these services available in its private sector, and GMH uses private sector resources to meet its nuclear medicine needs.

Thank you for the opportunity to address the people of Guam about the Guam Memorial Hospital. While we hope you only have to visit the hospital for celebratory reasons such as the birth of a child, we welcome you and your family for all your hospital needs, and look forward to providing you the best possible patient care.

Put Respetu,

William I. McMillan
Administrator & CEO