Dogs and chickens abound on these premises
This is American Samoa's only full service medical facility

Advocates for Change at LBJ Tropical Medical Center

A diverse group of medical professionals and citizens with extensive experience and personal ties in American Samoa are gravely concerned about the appalling state of healthcare delivery at the LBJ Tropical Medical Center.

Within this group, dedicated to improving the delivery of healthcare services for the people of American Samoa, we will employ all necessary efforts to accomplish this end, including the use of mass media outlets in various modalities. We will also contact those entities, both local and Federal, who are responsible for funding the provision of healthcare in American Samoa.  Additionally we will not forget to include those Agencies charged with the oversight of this funding.  Finally, we will take on the role of whistleblower to bring this deplorable situation to the attention of our entire nation, as well as the outside world.

Many things can happen, even in a small community such as American Samoa, that can impact healthcare elsewhere.  One immediate example is the current lack of control of the Zika Virus, not to mention the serious challenges faced in diagnosing and treating it.  It is well known that Zika is present in American Samoa.  It is also well known that mosquitos are essentially omnipresent there, and it appears as though very little is being done to control them.

Zika is only the most current public health crisis however.  There are numerous others, such as Dengue Fever, Chikungunya and Leptospirosis.  There is also a huge burden of illness involving non-communicable diseases in the Territory, such as Diabetes and Morbid Obesity.  We will additionally be discussing these, as well as many other public health issues among these pages, since their treatment and complications normally require heavy use of the Medical Center.  Due to the fact that control and prevention of these types of public health issues generally fall under the purview of the local Department of Health (DOH), you will also find many references to the DOH throughout this website.

Current State of Healthcare in American Samoa for U.S. Veterans?

This annual Holiday reminds me of the great debt of gratitude that we all owe to our veterans, and everyone knows that American Samoa has way more that its "fair share" of them...  Has there been any progress made towards getting a permanent, full-service VA Medical Hospital established in the Territory?  In the meantime, has the LBJ TMC done anything to improve its most basic services for the many former servicemen/women that still reside there?  Is at least the ASG Off-Island Medical Referral Program back up and running again, even if it is still not fully-funded?  Finally, what do the Residents of AS think about all of this, and what are the Territorial/Healthcare leaders doing (or even saying) about it...?  Everyone there deserves better, but ESPECIALLY our veterans!

The public's observations and opinions can make a real difference.  THANK YOU to all who have served and are serving our country!  May you have a blessed Veteran's Day, and may your medical needs never be neglected.  Warm Regards, Dr. JIM MARRONE

Congress Looking Into LBJ

Congressional panel discussion LBJ Hospital

 

Our Congresswoman Aumua Amata is taking a strong stand on matters relating to LBJ Hospital.  She wants to know why we are not spending all the money the Federal Government is making available through the Medicaid program.  She also wants Congress to evaluate feasibility of building a new facility and staffing it with true professionals.  This news report by Talanei tells the story pretty well.

You can also see more on the Congresswoman's website by clicking here.

It is time for the people to be heard and this site is a good place to speak out.  Please comment.

 

Medical supplies shortage at American Samoa hospital

This article from Radio New Zealand.  Read full story on RNZ

Nurses at American Samoa's LBJ Hospital say the hospital's shortage of medical supplies is affecting the quality of patient care, with nurses forced to use bed sheets as dressings.

Nurses say dressing supplies and other basic supplies such as gloves and gauze pads have run out, and LBJ Hospital is also reported to be out of some IV solutions.

The chair of the hospital board Leilua Mase Akapo says the hospital is in a grave financial situation because of the government's failure to transmit funds to the hospital.

Our correspondent in American Samoa, Monica Miller, says nurses who have spoken out are describing a dire situation.

"According to these nurses, they're using trash bags as underpads for the beds, to cover under the sheets. So that's a very worrying situation. I know that there's been a series of meetings between the governor and the people at the treasury. And the governor has basically told the treasurer that he should find money to pay the hospital."

Ms Miller says off island vendors are requiring the hospital to pay up front for orders before they release any supplies.

Last month the Hospital Authority Board informed the governor that LBJ's account payables had reached US$8 million, with sources at LBJ saying unpaid bills for medical supplies represents about three quarters of this.

The chairman of the hospital board told the governor that the funds the government has failed to pay to the hospital include a monthly subsidy of US$500,000 per month, a two percent wage tax and Medicare and Medicaid payments.

A report that the chairman provided for the governor, shows that the amount the ASG owes LBJ was US$5.7 million as of December 28, 2015.

Doctor shortage fears in American Samoa

This article from Radio New Zealand point out a very serious problem but, unfortunately, the problem is much more severe than just the lack of a few medical staff. 

Read full story on RNZ

Medical sector workers in American Samoa say there is an urgent life and death situation with the hospital relying on a single pediatrician.

Two doctors from the Department of Health have been sent to help out at the Pediatric Department of the LBJ Hospital, after the sudden death of long serving pediatrician, Dr Tagilima Iatala, last week.

A replacement is due on island next week.

The chief medical officer at the LBJ, Iotamo Saleapaga, said the two public health doctors would mean they could manage until then.

But some medical staff said the situation was more serious than what the LBJ management is making it out to be.

They pointed out that the work load for the remaining pediatrician was too much and had been for a long time.

They said it had taken the hospital more than a year to recruit new pediatricians and one additional doctor was not enough.

They said some inpatients had conditions where the pediatricians had to keep an almost 24-hour watch because of seizures and other complications.

The medical staffers said this was an urgent life-and-death situation and the leaders needed to come and see for themselves and not take the management's word for it.

Concern for the Children of American Samoa

My name is Tangra Broge and I am a pediatrician. I too have been gravely concerned for the wellbeing of American Samoan children. While on-island I was privileged to work under Dr Marrone's leadership and deliver excellent medicine to the children on the island. At a time when the healthcare was/is in dire straights, I witnessed hospital administration push qualified physicians and other mid-level practitioners out for their own personal gain. Dr. Marrone was one of those individuals.

Dr. Marrone has impeccable credentials and is board-certified in pediatrics and tropical medicine. During Dr. Marrone’s 14 years of leadership the pediatric department was historically well staffed with ample local, international, and U.S trained pediatricians. A thriving rheumatic heart disease program was instituted with marked improvement in medication adherence and heart failure prevention. Dr. Marrone spearheaded biannual cardiology clinics in partnership with off-island pediatric cardiologists, providing invaluable specialized care and echocardiograms for high-risk pediatric heart patients. A “preemie program” for high-risk infants was instituted with tremendous success. Like many other qualified, trained providers, Dr Marrone eventually resigned due to the undue pressures from the CMO. 

During my time on-island I also saw the closure of the Primary Care Clinic at the LBJ Medical Center. This forced the resignation of the board-certified chief of Family Medicine, Dr. Sean Stracensky. In a territory with obvious need for preventative adult care this decision has resulted in a significant decline in services for adult patients and unprecedented wait times at the emergency department for refills and non-emergent services.

And recently I saw in Samoa News that distraught nurses were forced to use garbage bags for underpads in patient hospital beds and tearing and utilizing bedsheets for dressing changes! In a hospital that is funded by U.S. federal dollars, I think the need for action and correction of mismanagement is obvious. I still have many dear friends on the island and had hundreds of patients and families that I was privileged to care for. I hope that someone takes notice and intervenes for the people of American Samoa.

Fa'afetai Dr. Marrone

 

Having worked in the medical field for over almost 3 decades in several states on the mainland as well as in Europe, Dr. Marrone stands out as one of the most talented and dedicated physicians I have ever worked with.  While I only had the honor of working side by side with him for 8 months, he certainly left a lasting impression.  The intention of this letter is not to criticize or judge anyone but mainly to recognize an exceptional physician, human being, American, who gave his entire professional career and a good part of his young adulthood for the welfare and health of the children of American Samoa.  His contributions to your island should be recognized and not forgotten as he has saved countless of children, the island’s future.  

I met Dr. Jim Marrone at a childrens medical conference in Jacksonville Florida in the spring of 2014.  Prior to meeting him, my husband and I had several discussions about the possibility of living and working in American Samoa.  My husband highly praised the island and it was his dream to have his children experience American Samoa.  So I was really excited when I saw that there was a talk about Newborn hearing screening in island nations by Dr. Jean Johnson.  I attended this talk and it was there I introduced myself to Dr. Marrone and expressed my desire to help in anyway that I can in American Samoa.  I was beyond excited to tell my husband of the news and naturally this pleased him.  After several phone discussions with Dr. Marrone and LBJ administration (actually 9 months later) I received a letter of offer to join the pediatric team at LBJ Tropical medical Center.  I informed my current place of employment that I would be leaving to move to Samoa.  As a mother of 4 children, naturally my main concern at the time was, would they be happy, would they adjust, how would the island receive them?  So, I arranged for them to visit American Samoa during Easter break in 2015.  They were completely struck by the islands raw beauty and the openness of the people.  Unfortunately during my visit, I was informed by hospital administration that I did not have a job with LBJ and also I missed the deadline for the national health service corp (NHSC) to pay back my school loan because LBJ did not check off a box to verify my employment with them. The NHSC, funded by the US government, offers financial and other support to primary care providers and sites in underserved communities, American Samoa is considered an underserved community.  Needless to say I was heartbroken and out of a job, however Dr. Marrone was able to negotiate with the powers to be at LBJ and a new offer of employment was awarded to me albeit $13,000 less than what they previously promised and half of what I was earning in Seattle.  I prayed hard and decided the best thing to do was to be grateful for the offer and do the best job possible.  So my family and I traveled back to Seattle packed our things, rented out our home and moved to the village of Failolo.  

I quickly jumped in to my new role as a member of the pediatric team learning about the various tropical diseases that afflict the nations children.  I was especially amazed and distressed at the compelling incidence of rheumatic heart disease, a disease that has declined dramatically over the past century in the mainland.  Just so sad to see kids walking around with failing heart valves from a preventable bacteria and no pediatric cardiologist to treat them.  However, because of Dr. Marrone’s efforts, US trained practitioners have been recruited throughout his time there who have championed programs to treat this issue.  He has also helped raise tens of thousands of dollars to bring trained cardiologists to the island to treat children afflicted with this disease despite criticism from LBJ’s powers to be.  I remember attending a Wednesday morning continuing medical conference (CME) at LBJ and listening to a presentation by a Stanford trained cardiologist who spent her vacation time to travel to samoa to help with the RHD program.  She discussed her study identifying risk factors for the disease.  Her talk however was not well received in fact was dismissed by one of the powers to be at LBJ while the other power to be let out a loud yawn.  During my time at LBJ, I saw 2 trained US physicians leave because of the hospitals conditions and then the dreaded news of the failed negotiation between Dr. Marrone and LBJ admin in regards to his contract.  I too considered leaving the hospital with Dr. Marrone’s departure.  Again, I prayed hard and decided to stay and do the best job possible in a safe manner without Dr. Marrone’s guidance.  However things just weren't the same without him.  It felt as if a light went out in the hospital with his departure and furthermore that no one had the courage to do anything or even say anything about it.  As for me, I felt less than a pawn in a game of chess.  The beautiful smiles of the children and the gratefulness of their aunties and or parents gave me strength as well as Dr. Maria and the nurses.  During my time there, several rumors about the powers to be at LBJ circulated such as they wont be happy until the last palagi leaves the hospital, that they don't want or need US trained medical staff, that the palagi just wants to colonize the island.  I tried hard to ignore the rumors but they weighed heavily on me in an already severely understaffed department with very sick, sick kids.  At the same time the administration stated that they are actively trying to recruit US trained practitioners so they can bill and receive the necessary funds to run the hospital.  Does American Samoa want US trained practitioners?  Would they prefer that the US breaks away altogether?  Currently it is a US funded hospital that requires US trained practitioners to bill appropriately.  Therefore it is understandable the chief of pediatrics at the time, Dr. Marrone would advocate for healthcare standards equivalent to those on the mainland.  

Presently, my family and I have returned back to Seattle with a void in our heart and confusion in our spirit.  My children absolutely loved living there and hopefully have made lifelong friends.  My 14 year old came home from football practice excited to tell me about a kid on his team who is Samoan…I cried.  I cried for the kids who I know would benefit from Dr. Marrone’s care, the pediatric team who desperately need help, a sense of personal failure, and an end to my husbands dream.  Yet, I am grateful we had this experience.  My kids are that much richer in their world view and hopefully the island will invite them back.  I am grateful for my Seattle community welcoming me back.  Actually one of the first days back to work at Seattle children's I met a Samoan woman and her daughter….from Failolo. 

Fa’afatei tele lava.
Patricia Cleary Nurse Practitioner, Seattle

 

Today's Samoa News article

Talofa,   Thanks for the opportunity to join in this important effort.

Thought you all might be interested in today's Samoa News front page article entitled: "LBJ CEO says scholarship offered to ensure "Samoan" doctors continue at LBJ".  If you have access to Samoa News online you can read it in its entirely there.   Just a couple of interesting quotes here:

" The hospital CEO hopes that students who are interested will take up this opportunity as it's fully funded by the LBJ."    Don't know of any other hospital that uses its operational funds to finance scholarships for medical students.  I thought this was a function of government. (my comments) 

Samoa News reporter also notes: " (Samoa News should point out this is not the first time LBJ has offered a scholarship for medical studies.  During Taufete'e's first tenure as LBJ CEO a scholarship was awarded to one of his immediate family members)"

Also this:  "Last year July, Governor Lolo Matalasi Moliga in a letter to former hospital board chairman Mase Akapo, said the hospital needs to set up a scholarship program, specifically for students to attend accredited off island medical institutions or schools.

He said that is one way to ease the hospital's dependence on US and foreign physicians and improve LBJ's self-reliance and the board must reactivate the practice of sending "our people" to the Fiji School of Medicine with the provision that they will sit and pass their USMLE exam before a license is issued to practice in American Samoa".   Another example of political interference in the decision-making process of the hospital.  A fundamental problem with our Hospital Authority type organization, with Governor appointed board. (my comments).

"Samoa News asked Taufete'e about the hospital's requirement for physicians to be United States Medical Licensing Examination (USMLE) certified; and the CEO said that such certification is no longer required of physicians hired by the hospital for the time being.

He said the reason why its important for physicians to be USMLE certified is for the hospital to have "easy access" to Medicare and Medicaid funds, but its not required by the hospital itself."

Food for thought.  Just keeping up with the news.              Mick

 

Processes subject to medical favoritism

While I am on the subject of news, another article in today's edition of Samoa News caught my eye, and brought to mind a situation that others also have found troubling.  At Monday's Senate hearing on the status of the Government Retirement Program there was discussion on why retirement payments have been escalating. 

Here is a quote:  "Responding to questions from senators as to why the increase in payouts, Talia (Iaulaualo) explained that there are more retirees, including a lot of people taking medical retirement and qualifying for disability."  "Sen. Uti Petelo questioned if there is a physician used by the Fund to sign off on the paperwork qualifying a person for medical retirement and Talia responded that the Fund utilizes the service of LBJ hospital's Dr. Iotamo Saleapaga, who conducts the medical evaluation and signs off on the paper work". 

This brought to mind the problem I encountered with the medical off-island referral process when I was Director of Medical Services back in 1987.  Necessity for off-island medical referral was supposed to be determined by the off-island referral committee, of which Dr. Saleapaga was chairman.   I soon discovered that approvals for off-island referral of patients were being approved by the chairman alone in many instances without the approval of the other committee members.  I put a stop to this as soon as it was revealed to me. 

In a small island Territory like American Samoa, where family, and political connections play such a strong role in the decision-making of individuals in power, it is important that processes be enforced to ensure that medical related decisions are made in an unbiased manner based on medical merits only.  Having only one individual making determinations of medical retirement qualifications, like one individual making off-island medical referral approvals, subjects the process to family and political influences that should not be part of the approval/disapproval process.  

For this reason, and because of personal experience, I would highly recommend that medical retirement decisions be made by a committee of qualified persons, rather than a single individual.

Just keeping up with the news.             Mick

 

Loss of Many Qualified Staff

Well, hoping to spark some conversation and at the same time get some answers posted...

As we know, in the past several years we have lost many valuable staff, some leaving by choice ( had enough, disgusted) and others via un-renewed contracts. ;The decision to not renew the contracts has been due to " high salary " and with the exception of Dr. ;Maronne, kept very low profile. I would like to know what are these high salaries?
What are the salaries of the current CMO, CMO assistant, CFO, and CEO?

If we have saved all these salaries ( no one was replaced), where is the money? We are still short on supplies, staff, space, etc etc.

How much more can we lose and still function?

The docs at  over worked, tired, and fear we may lose more if they have a place to go...

One patient report today arriving at the clinic at 8 am where she had an appointment and did not get seen until 3 pm.  Are we back full circle to poor service again all because of some administrative. _________________(fill in the blank, cannot find the words)
 

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