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By Fili Sagapolutele

PAGO PAGO, American Samoa (Samoa News, July 19) - LBJ board chairman Charles Warren says a lot of the "turmoil" surrounding the hospital now is because policies are being enforced, in particular the requirement that all LBJ doctors need to pass the U.S. Medical Licensing Exam (USMLE).

The doctors affected by the USMLE policy are anyone who did not graduate from an accredited school of medicine in the U.S. Canada, Papua New Guinea, Australia, New Zealand, Great Britain, Switzerland, France, Belgium, West Germany, Norway, Sweden or Denmark, or the Fiji School of Medicine prior to January 1, 1987.

Warren said yesterday that this law has been in place for 20 years now and about 32 physicians in the territory have yet to comply with local regulations, which he says the Health Service Regulatory Board is supposed to enforce.

During a House committee hearing last Friday, Warren said it's the responsibility of the board to ensure that medical practitioners employed at LBJ are qualified and appropriate licensure is one of those qualifications.

"Many local physicians should not be licensed because they are not properly certified" by completing the USMLE test, he said.

Warren told Samoa News yesterday that the USMLE test has three parts and LBJ physicians not certified are given until June 8, 2008 to comply with parts one and two. Part three will most likely need to be completed by June 2009 and this deadline will be finalized at the July 27 board meeting.

Part of the certification process requires a physician to serve a one year residency at a U.S. certified hospital or medical facility but LBJ does not have residency certification, he said.

"The board will work with physicians on getting them into a residency program," he said.

Warren also said that LBJ has offered to provide on-site and on-line review courses for those doctors that need to take the USMLE exam.

"To my knowledge, few if any of the doctors have taken advantage of this program," he explained. "LBJ will pay for the actual cost of the exams for current employees of the hospital."

"I believe a lot of the turmoil right now dealing with the hospital is because the hospital is enforcing long standing rules and policies," said Warren.

"We have so many doctors that are so far out of compliance that if they were working in the states, they would lose their jobs," said Warren. "But we need doctors and we want our Samoan doctors working with patients but they must pass all regulations."

"Our focus and objective is to have all physicians certified because we have an obligation to ensure they are certified," said Warren, adding that being certified also means the physicians will receive their provider identification number, or PIN, to submit a bill for Medicare services.

He dismissed allegations that the hospital is enforcing this policy just so physicians could get their PINs and therefore that means more revenue for LBJ from the Medicare program.

"Right now the hospital - as well as the government, which owns the hospital - is at risk for non-compliance," said Warren. "So it's either current law needs to be fixed or doctors must comply with certification."

Warren also points out that these regulations are enforced by the Center for Medicaid and Medicare Service (CMS), which administers the Medicaid and Medicare programs.

CMS regulations say that physicians must be "properly licensed under state law" and "we must abide by it," said Warren, adding that CMS is aware of the current situation faced by LBJ, where there are many doctors who have worked at the hospital but are not U.S. licensed.

He said physicians, like all other employees of the hospital, have to comply with set policies, especially those policies that LBJ must follow in accordance with local and federal law.

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