Tinian clinic is ‘in crisis’

The lack of a full-time physician at the Tinian Health Center has become a “crisis,” according to the Medical Licensing Board and the Tinian physician assistant.

The Tinian clinic has been without a full time physician on staff since July, when Dr. Ronaldo Toledo resigned.

To cope with the loss, the Medical Licensing Board has repeatedly issued emergency orders allowing physician assistant Terri Clawson to prescribe drugs with certain stipulations, including close supervision by a doctor.

Members of the Licensing Board voiced concern that Clawson had not been in close contact with Dr. Christine Brown and had prescribed a high number of narcotic drugs, a concern Clawson said she feels is unnecessary.

“I guess I’m a little concerned that you were concerned that I didn’t have any daily, twice daily or five times daily phone calls to Dr. Brown,” she told members of the board during a meeting, adding that she was comfortable with the work she was doing.

Brown signed off on all the prescriptions after evaluating the charts and notes, Clawson added.

The issue has brought to light the need for regulations regarding physician assistants and the scope of authority they can have in prescribing narcotics in the CNMI especially in remote locations, said board member Janet McCullough.

McCullough expressed the need for the Tinian Health Center to find a full-time doctor, the difficult task it may be.

“I think the board certainly understands the hardship and, in fact, we really want to find the right fit. And Tinian is unique as a community and we understand that, but we also would like to emphasize that the situation that Terri has unfortunately found herself in the last several months is not because of any roadblocks we have put up. But because, really, Tinian has not hired a physician,” McCullough said.

Joey Hofschneider of THC said the clinic has been actively recruiting doctors and came close on two occasions. The clinic was about to hire one doctor but received a recommendation not to, he said.

“[The doctor] was right there,” he said. “It would have solved all those problems.”

“The second one, we really thought we were going to get as of a week ago or two weeks ago,” he added. “The mayor and the Tinian Heath Center are mindful of the pressures placed on you [the Licensing Board], you’ve got to ensure the regs are followed. But the reality is recruiting doctors on Tinian has been difficult,” Hofschneider added.

The Tinian clinic is working with the Department of Public Health to try to recruit a doctor to the island, something that has not always been the case, he said.

“What has happened in the past is we had some bad experiences,” he said. “At certain points in time, the municipalities of Tinian and Rota would try to bypass the Secretary of Health and try to hire doctors wherever they may be. We recently had two very bad experiences with doctors.”