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By Steve Limtiaco

HAGATNA, Guam (Pacific Daily New, Jan. 6) - The Guam Memorial Hospital has restored operating room privileges for two surgeons who were protesting conditions at the only civilian hospital on the island.

Two surgeons who are protesting the conditions at Guam Memorial Hospital by refusing to respond to some emergency room calls had their operating room privileges temporarily taken away this week, which means they were not allowed to operate on their private patients.

The operating room privileges for Dr. Ricardo Eusebio and Dr. Kia Rahmani were restored yesterday afternoon following a meeting to address their concerns, said hospital Administrator Bill McMillan, who added the doctors will be penalized again if they continue to disobey hospital rules.

"It's up in the air right now," McMillan said of their status at the hospital. "Physicians in the hospital are required to take call. These two physicians took themselves off the call schedule and they informed us that they would no longer treat hospital patients, but they wanted to use the (operating room) for their patients. I felt that that was not appropriate."

The hospital responded January 3 by canceling the surgeons' operating room cases, McMillan said, on the grounds that if Eusebio and Rahmani are not available for hospital patients, then they are not available at all.

Both sides in the issue say their actions are guided by the desire to improve the quality of patient care at the hospital.

Eusebio said he decided to reject some hospital calls, except for life-threatening cases, because the hospital has done nothing to address inadequacies at the facility.

"The fact of the matter is there is a problem. The problem is continually lack of drugs, continually lack of supplies, continually having an inability to do our operations," Eusebio said.

He said surgeons last year threatened to boycott calls to the emergency room, but decided to continue based on assurances that things would improve. They have not, he said.

Eusebio said some doctors in the past have been allowed to use the operating room, even though they were not required to respond to hospital calls.

"They had no authority to (take away operating room privileges), but they did it," Eusebio said. "It's just harassment, that's all. Basically what they are doing is limiting my ability to practice my trade."

Eusebio, Rahmani and three other surgeons on January 5 signed a letter to the hospital board, calling for the removal of Medical Director Dr. George Macris, "as a first step towards trying to repair this great rift."

Macris yesterday said some doctors are participating in a "hi-tech lynch mob" because the hospital under new leadership is starting to enforce its rules and is punishing doctors who break them. He said as medical director it eventually falls to him to ensure regulations are enforced.

"Patient care is the most important thing, and we've got a good handle on how to make it better. ... It's just holding physicians accountable to professional codes of conduct, which they often treat lightly. Of course you make enemies along the way," Macris said, adding that he does not believe anything will come of the request to fire him.

Macris said he believes some doctors do not want to see hospital patients because those patients are less likely to have insurance or money to pay the doctor's bill.

Eusebio said some have incorrectly attempted to tie the issue to money.

"The fact of the matter is, it was never a money issue. The issue has always been, ... it is a quality-care issue," Eusebio said.

Macris said it is hypocritical for surgeons to claim the operating room is inadequate to treat hospital patients while at the same time trying to schedule it for their private patients.

"Quite honestly the (operating room has) got some problems. We're not 21st century (technology) but we might be mid-90s in our technology or occasionally 2000," Macris said. "But it ain't all that bad. It's hypocrisy. They're dying to load the (operating room) with patients, but we're only talking about paying patients."

Dr. Edwardo Cruz also has stated his intent to reject some emergency room calls. But Cruz did not lose his operating room privileges because he has not rejected any calls to treat hospital patients, Macris said.

"The distinction is both of those doctors crossed the line and said, 'I'm not coming in,'" Macris said.

McMillan said a compromise was reached yesterday morning during a meeting of the hospital's Medical Executive Committee that prompted the administration to restore the operating room privileges of Eusebio and Rahmani.

He said the compromise requires the hospital to: hire its own surgeon; hire a permanent nurse manager for the operating room; correct equipment deficiencies in the operating room; and determine whether the medical director should be replaced.

McMillan said federal bioterrorism grant money and federal compact-impact money could be used to buy operating room equipment, "because the surgeons do need the basic set of equipment to do what they need to do."

Dr. Cruz yesterday said, "We have some disagreement about the care of the surgical patients at the hospital. We, as surgeons, think that there is a better way to handle the care at the hospital for our surgical patients. We've been complaining to the administration, and the administration so far has come up with nothing. Instead, they turn around and start retaliating because we're protesting their mismanagement."

Democratic Senator Lou Leon Guerrero yesterday weighed in on the hospital's problems and encouraged the hospital to use this year's $3.7 million subsidy to address the needs of the surgery department.

Leon Guerrero also encouraged the governor to borrow money on the bond market to improve the hospital facility. Laws passed during the last Legislature allow the governor to borrow money and to use the island's annual compact-impact reimbursement to pay off the bonds.

January 7, 2005

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