Am. Samoa Hospital Board Allegedly Improperly Issuing Licenses

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Revelation included in Governor’s letter about deteriorating care

By Joyetter Feagaimaalii-Luamanu

PAGO PAGO, American Samoa (The Samoa News, July 27, 2015) – In a letter Governor Lolo Matalasi Moliga sent to Chairman of the the American Samoa Medical Center Authority (Hospital) Board, Mase Akapo, it was revealed that part of the board’s improper involvement in personnel matters, also includes issuing temporary licenses to doctors and nurses from off-island to practice in the Territory — bypassing the Regulatory Board, which is the legal authority to issue such licenses on island.

According to the letter, dated, July 9, 2015 and leaked to Samoa News, the governor is highly concerned about what he sees as the "deterioration of the quality of healthcare services being delivered by the LBJ Hospital."

The letter was written after Lolo called an emergency meeting with the hospital board, hospital management and DOH officials earlier this month due to the shortage of physicians at the Medical Clinic and Medical Ward. The meeting was called to address factors contributing to what Lolo says are the people’s frustration "over waiting hours before receiving treatment due to the lack of doctors."

He told Mase that attending the meeting was Acting Director of Health Fara Utu, Acting Chief Medical Officer Dr Annie Fuavai, Dr Reese Tuato’o, CEO’s Executive Assistant Rene Clemens, the Hospital CEO, Governor’s Chief of Staff Fiu Saelua and Governor’s Chief Executive Assistant, Iulogologo Pereira.

In particular Lolo writes, "my concerns… were validated specifically by the total involvement of the ASMCA Board over personnel matters such as the hiring of employees, overriding management decisions, recruiting physicians, along with setting their salaries, and issuing licenses for the doctors to practice when it lacks the legal authority to perform such functions, which belong to the Regulatory Board."

In the letter, Lolo points out to Mase that the current practice of issuing temporary licenses to physicians or registered nurses from outside must "cease as of today" as it exposes the government to potential financial liability.

Further, he says, the ASMCA "does not have legal authority to issue licenses to allow physicians to practice in American Samoa, or nurses from abroad," and notes that "no doctor or nurse is allowed to practice without first obtaining a license from the Regulatory Board."

"More importantly, the applicants must present educational credentials, license to practice medicine at the previous place of employment and other required documents pursuant to established policies."

The governor also said that the regulatory board is not to use any license unless all required documents are presented, along with the results of background checks. "Doctors or nurses who are now working but have not been issued their licenses to practice are to be told to complete and submit all required documents before continuing to work."

Lolo said "to meet the letter of the law relative to the mandatory requirement for the physicians to pass the United States Medical Licensing Examination (USMLE) examination, all the old doctors were grandfathered into the workforce, but any new hire must comply with the law."

He continues, "given the results of physicians who took the USMLE exam, it is imperative that a training regimen should be established to continually upgrade the skills of the current cadre of physicians and nurses."

The governor tells Mase that "to ease our dependence on US and foreign physicians and improve our self-reliance, we 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."

"A scholarship program will be set-up specifically for doctors to attend accredited schools in off island medical institutions," he states, adding that he urges "the board and management to collaborate with the American Samoa Community College to upgrade the nursing program to meet standards so their probability of passing the National Council Licensure Examination (NCLEX) to become registered nurses are improved."


Lolo told Mase that the involvement of the Board in Human Resources’ decisions is undermining the authority of the CEO. "There are pending incidents of doctors going directly to the Board when the salaries approved by the management are not to their liking."

The governor reminded the board that their function is to set policies which will govern and guide management in the execution of their duties and responsibilities, and demanded from Mase copies of the board policies and board bylaws before the end of July. He also wants to see the list of the outcomes that the board expects the CEO to accomplish.

The governor said this administration owes it to the people to provide the finest quality of healthcare services.

"I contend that most of the challenges can be overcome with little or no funding at all if the doctors and nurses demonstrate the spirit of unselfish service, reflected in their individual and personal commitments to treat every patient as if he/she is your father, mother, son, daughter, sister or anyone that is dear to you."

Lolo told Mase that he expects the CEO and the DOH Director to prepare a plan to ensure close collaboration between the two entities not only to maximize benefits, derived from the limited financial resources, but also to establish healthcare service quality standards to assure the same quality of health care in both the hospital and DOH.

At the beginning of the letter, the governor tells Mase that to "promptly mitigate the services at ER after hours, management has taken steps to utilize physicians from the other clinical services to cover the ER or the medical clinic," and he has instructed Utu (the acting DOH director at that time) "to assign their doctors to work at ER or in other clinical service areas where help is needed, " and to provide assistance to LBJ when the CEO asks for it.

Lolo said he expects to receive a long term program to abate replication of these challenges which are causing public frustration.

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