75¢169th YEARUSVI SUNDAY-MONDAY, NOVEMBER 10-11, 2013, NO. 261

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STEPHANIE HANLONManaging Editor

ST. CROIX — Hospital officials have beenwarning for more than two years that theGov. Juan F. Luis Hospital and Medical Cen-ter will close if it is not adequately funded.

Local funding for the hospital went from$32 million in 2008 to $18 million in2013. With unfunded care at the hospitalhovering around $30 million, the local gov-ernment is no longer providing the fund-

HOSPITAL, PAGE 2

Systemfailure

“You have to fundthe hospital better.Essentially, you getwhat you pay for.”

Dr. Kendall Griffith,chief executive officer!of the Gov. Juan F. Luis Hospital

and Medical Center

Physicians and senator addressJFL problems, needed reforms

PAGE 2 The Avis SUNDAY-MONDAY, NOVEMBER 10-11, 2013

ing needed to ensure the islandhas a public hospital able to serveall residents.

The territory is currently losingabout $56 million a year in careprovided to local residents at off-island facilities.

Hospital officials also have warnedfor years that if the current systemof employing physicians is notchanged the hospital will not beable to attract specialists and there-fore will not be able to offer thesame quality of care as the statesidefacilities that Virgin Islanders areleaving for.

Several past and current hospitalphysicians and administrators havetold The Avis that the hospital is los-ing millions of dollars from physi-cians directing insured patients totheir private offices, leaving the hos-pital to pay for the care of the indi-gent and uninsured population.

The physicians union, however,says private practices also supportthe hospital and the problem isn’tthe physician-employment struc-ture. They contend that overhaulingthe current system would jeopardizeprivate practices throughout theterritory.

The debate over hospital reformsand a lack of funding has come intothe spotlight recently as the hospi-tal faces diminishing compliancewith the Centers for Medicare andMedicaid Services, reports of a toxicwork environment and a lack ofquality care.

JFL Chief Executive Officer Dr.Kendall Griffith says before hospi-tal reform is considered, the gov-ernment needs to provide criticalfunding to support operations. Hesays efforts have been, and contin-ue to be, made to improve quality ofcare and tensions within the hos-pital but significant progress is beinghindered by a severe lack of fund-ing.

Dr. Kendall Griffith: Inadequate funding equals slow improvements

Griffith said the hospital can bare-ly make payroll, they are havingdifficulty purchasing critical sup-plies and equipment, and the staffis overworked and frustrated — allbecause the government isn't fund-ing the hospital appropriately.

“You have to fund the hospitalbetter,” he said. “Essentially, youget what you pay for.”

He said they have plans forimprovement, many of which areunderway, but without funding theirhands are tied.

“Year after year, the fundingdecreases as the situation getsworse,” he said. “If we were able toget funding right now, we couldimmediately resolve the staffingissue and the quality of care issuesthat has led to the regulatory defi-ciencies. It would be immediate.”

Not being able to bring on morestaff is hampering their ability tomake improvements in carerequired by CMS. On top of beingoverworked, he said hospitalstaff doesn't have all the tools theyneed, which adds to the stress.

Reforms at the hospital are need-

ed, he said, but first the situationneeds to be stabilized. And in orderfor that to happen, they need animmediate infusion of cash.

“Our sprinkler system is notworking, we need a high level ofnurses to take care of patients, weneed to ensure our vendors are paidso we don't have an interruption inmedications and supplies — thoseare the very key things,” he said.

Then, the IT infrastructure is incritical need of upgrades, whichGriffith said could help them bettermonitor inventory and generatemore revenue.

Even though the hospital doesn'thave a vascular surgeon anymore,he said the one trauma surgeon onstaff, along with several general sur-geons, can adequately handle emer-gency surgeries coming into thehospital. The loss of the island'svascular surgeon last month andthe suspension of a general sur-geon two weeks ago has decreasedmanpower, but he said they arevetting two new candidates rightnow.

“We do have adequate coveragefor general surgery,” he said.

Altering the hospital's model forhiring physicians is not an optionright now, he said, because thatrequires money to pay competitivesalaries, which they don't have. Itcould save money in the long run,but they don't have the initial invest-ment needed.

To improve the situation withphysicians, he said the hospitalwants to decrease its use of travel-ing physicians, which are neces-sary under the current systembecause on-call physicians get paidfor annual leave. On-call physicianswork anywhere from five hours to100 hours a week. Griffith said theway the hospital schedules physi-cians needs to change to make itmore equitable.

“The system really has beenabused,” he said.

But until recently, he said thecurrent system worked well. TheVirgin Islands is in such a uniqueposition with being federally under-funded and the current system wasborn out of that inequality.

When asked if the union is con-trolling the way in which the hos-pital hires physicians, Griffith saidthe union only controls the salaries.But, he added, “It definitely inhibitsmy ability to attract.”

He said the union has agreed tobring in certain specialties at a high-er rate, such as neurosurgery andneonatology, as well as to bring inothers with a temporary sign-onbonus of $150,000 for a year to givethem time to establish private prac-tices before going to the $90,000base rate set by the union.

“I agree that once the governmentdecides to appropriately fund thesehospitals to the level that they can

truly operate at and fund the hos-pital for the salaries that are com-mensurate with the United States,then we would be able to assume ahospital-employed model,” he said.“Until that time, it would be cata-strophic for us to do that modelbecause we couldn't afford it, rightnow we can barely afford to makepayroll on a biweekly basis.”

If and when they did decide to goto a hospital-employed model, hesaid, they would still need to makecapital improvements to the hos-pital to support overall reform.

“The system is broken, the gov-ernment … now has to make it apriority that they are going to fundthese hospitals to make them oper-ational and profitable,” he said. “Ithink the government as a wholehas not made it enough of a prior-ity.”

There have been reports that CMSis on the verge of taking seriousaction against the hospital inresponse to compliance issues.

“I've been in touch with CMS andthere is no indication that they aregoing to take over the hospital, theyhave been very clear — they want usto fix the deficiencies that theyfound,” Griffith said. “They feel thatwe have not done that well and thatwe need to fix that, but actually wehave been fixing them.”

He said the hospital is on its wayto turning a significant corner anddespite the uphill battle, they havebeen making progress where theycan. He said reports in the mediaabout the situation at the hospitalhave resulted in the communitylosing confidence.

“We are better than how we havebeen depicted and we will let theresults speak for themselves,” hesaid.

Dr. Robert Centeno:Major reforms are needed

Dr. Robert Centeno, chief medicalofficer at JFL from Aug. 2009 toMarch 2012, said major reformsneed to take place at the hospital ifit is going to survive.

First, he said, the governmentneeds to take financial responsibil-ity for uncompensated care becausethe hospital is mandated by law toprovide care to citizens regardless oftheir ability to pay. Legislative appro-priations are tied to salaries whenthey should be tied to uncompen-sated care costs, he said.

Centeno said there also needs tobe a comprehensive needs studydone to determine what medicalservices the local community is inneed of so new doctors can berecruited and residents can remainin the territory for their health care.This, he says, can’t happen withthe current union pay structure forhospital physicians.

During his tenure at JFLhe appealed to the physician’s union

to allow specialized physicians to beoffered competitive salaries, but hesaid they refused. The union foughtit, he said, because it was seen asa threat to the current system andadds potential competition to localphysicians.

He said the hospital eventually gotapproval from the board to bring inspecialized physicians, particularlysurgeons, at a higher rate as a tem-porary sign on bonus because theneed to the community was sogreat. This led to the physician’sunion filing a suit against the hos-pital for an alleged attempt to unionbust. This suit is still pending. Cen-teno said it wasn’t union busting, itwas an attempt to fill critical spe-cialties that the territory didn’t haveand that residents were seeking offisland.

At the time, they also attemptedto have an independent agency drafta community health assessmentand medical staff development planto track the health needs of VirginIslands residents and specialtiesbeing sought off island. This wouldhave provided the financial justifi-cation for attracting certain spe-cialists. Centeno said medical staffat the hospital overwhelmingly votedagainst the proposal a year and ahalf ago.

Centeno said the current systemfavors doctors who have establishedpractices but that not all doc-tors want to open up a private office.Specialists could be recruited witha competitive salary, which would beoffset by the additional revenuesthe hospital can make by billing forthe entire service provided. In thecurrent system patients are chargeda hospital fee and a physician’s fee.

Physicians with privileges at thehospital get a base salary of $90,000a year, plus half of their malpracticeinsurance paid for, all medical legalfees paid for and annual paid leave.The time they put in varies depend-ing on their specialty, but can be aslittle as one day a week or as muchas every day of the week. Theamount of money the hospital hasto pay traveling physicians to fill induring annual leave is almost equalto what it is paying the physicians.

If the union would allow the hos-pital to bring some specialists on asstaff physicians at a competitivemarket salary, Centeno said thehospital would retain the rights totheir earnings plus recoup all themoney leaving the territory for spe-cialists.

One of the reasons they are fight-ing this, he says, is because all theirprivate practices would be in jeop-ardy because they would have tocompete against a health systemwith many different specialties.

He said many local physiciansmoved to the Virgin Islands becauseof the current system and becausethey want to be independent. But

without major reforms, he says theentire system is in jeopardy. Hebelieves wholesale reform is needed,but said there are compromises,such as a hybrid system with somehospital-employed physicians andother on-call physicians with privatepractices.

“I think they can coexist quitenicely,” he said.

The bottom line for Centeno isthat the territory’s health care costsare really high per capita but theoutcomes are far from compen-satory, meaning the current sys-tem simply isn’t working.

“There are tremendous ineffi-ciencies and gaps in the system,”Centeno said. “I don’t understanddefending the status quo, it’s inde-fensible.”

Centeno, born and raised in theVirgin Islands, said he left last yearfrustrated that the medical com-munity wasn’t willing to make thenecessary reforms to make the hos-pital viable and improve the quali-ty of life for residents and physi-cians.

Dr. Jeffrey Chase: Local physicians do not support a hospital-employed model

Dr. Jeffrey Chase, an orthopedicsurgeon and president of the physi-cians union with a private practiceon St. Thomas and privileges atboth hospitals, says there are nolocal physicians who want to con-vert to the physician-employmentmodel.

“A lot of times when you have ahospital-employed physician they’reoften inexperienced, they don’t wantto start their own practice,” he said.“Here you have people who haveinvested large sums of money,worked their tails off for years andnow you’re gonna come in andundermine them? That’s not moral-ly or ethically right.”

Chase doesn’t think the hospi-tal-employed physicians model, oreven a hybrid model with both typesof physicians, would work in theterritory.

“Certainly the hospital-employedmodel is one of the recognized mod-els in the U.S. but it’s not the mostpopular,” he said.

He says local physicians haveinvested lots of money and timeinto building their practices andthey continue to provide care at thehospital that they aren’t compen-sated for.

“You would be undermining theprivate practices of those who arenot hospital employed,” he added.

He said the government needs tohonor union contracts and thereneeds to be fair reimbursement forthe work they do on call. He does-n’t believe the physicians are beingtreated fairly under the current sys-tem. In the States, he said, on-callphysicians get paid for every hourthey work at hospitals, while local-ly physicians are putting in so manyhours that it would barely equalminimum wage if it were calculat-ed.

He hasn’t heard of the hospitalproposing a study of needed spe-cialties, but agreed that a new oneis needed. He said there have been

HOSPITAL:FROM PAGE 1

HOSPITAL, PAGE 4

“There are tremendous inefficiencies and gaps in the system.I don’t understand defending the status quo, it’s indefensible.”

Dr. Robert Centeno, chief medical officer at JFL from Aug. 2009 to March 2012

PAGE 4 The Avis SUNDAY-MONDAY, NOVEMBER 10-11, 2013

a lot of improvements in availablespecialists over the last 13 yearsand an increase in high-qualityspecialized care in the territory.

In the end, he said the interestsof the physicians are in line withthose of the hospital.

“It doesn’t do us any good toundermine the hospital or to havea hospital that’s gonna fail becauseit undermines our whole practice,”he said.

Dr. Christopher Seaver:

Some physicians just

want market pay

Dr. Christopher Seaver, a vas-cular and general surgeon who leftthe hospital after allegedly receiv-ing threats and vandalism, wasrecruited outside the union fouryears ago at a higher rate thanwhat is union sanctioned. Afterthe threats, experiencing a hostilework place at the hospital and hav-ing his salary cut, he left.

He says the hospital is nevergoing to fill coverage gaps unlessthe current physician structure ischanged. Physicians just don’twant to take the risk of coming tothe territory and trying to open upa private practice. Instead, he said,they just want a job that pays mar-ket-based salaries. The hospitalcan benefit from such a system, hesays, because all the profits staywithin the hospital and the physi-cians are fairly compensated.

He recently was hired by a non-profit private hospital in Floridathat brought him on at a market-based salary for two years with theoption to then stay on at the mar-ket-based model or gain private-practice employment.

Since he left on Oct. 18, St. Croixhas been without a vascular sur-geon.

Dr. Anne Treasure:

No major reforms needed

Dr. Anne Treasure, an OB/GYNwith privileges at the hospital, alsodoes not believe major reform is theanswer to JFL’s problems. She ispresident of the Virgin Islands Med-ical Society, but said they haven’tmet to discuss the issues at thehospital so she could just speak asan individual.

She thinks the situation is actu-ally opposite to physicians taking

money from the hospital. She seesphysicians bringing business tothe hospital through proceduresthat can’t be done in their privateoffices and through advertisementspaid for by private physicians pro-moting services they providethrough the hospital.

“The hospital makes most of itsmoney by surgeries in the operat-ing room brought in by physicianswho bring their patients into thehospital,” she said.

As for the national trend wherenew medical school graduates areprimarily gaining employment asfull-time staffed physicians at hos-pitals, she said that is driven moreby the physicians’ desires ratherthan a change in hospital struc-tures. She says more and moregraduates want a regular job anddon’t want to have to deal withrunning a business in addition tobeing a doctor, so they opt forstaffed positions.

She doesn’t think any reformsare needed to the current structurebut suggested a change be made toinsurance reimbursements to keephealth-care dollars in the territory.If local providers had higher reim-bursements for visits to the localhospital and lower reimbursementsfor stateside hospitals, peoplewould be more inclined to get carelocally, she said.

Union supports paying

some specialists a higher rate

Treasure said the union has sup-ported a hybrid model where somephysicians, particularly special-ists, are brought on as staffedphysicians with a competitivesalary to bridge the service gap.She maintained, however, that nomajor reforms are needed because,“What’s good for the hospital isultimately good for the physicians.”

She said one specialist the hos-pital is in need of is a neonatologistwho cares for newborn babies. Shesaid millions of dollars in Medicaidis being spent off island becausepatients are being transferred tohospitals that do have a neonatol-ogist.

“There is a financial justificationfor certain specialists,” she said.

Making critical investments inthe hospital and bringing in morespecialists will help the hospitalto become profitable by retainingpatients who are leaving islandand attracting patients from theregion. The hospital has been cry-ing for an investment for a longtime but the government isn’t lis-tening, Treasure said.

Despite the challenges and thelack of funding to support the pop-ulation, she said hospital employ-ees still are providing decent careto patients.

While Chase doesn’t supportwholesale reform or partial reform,he does agree that certain special-ists should be brought on as hos-pital-employed physicians, but onlyspecialties that don’t require a pri-vate practice. He also suggested aneonatologist or other internistswho primarily operate in a hospi-tal setting and don’t need a privatepractice. He says the governmentreneged on their salary promisethat would have added a new fifthphysician category for certain spe-cialists.

Medicaid inequalities

add to the problem

Centeno said private physicianshave had difficulties in receivingMedicaid reimbursements, whichwas causing Medicaid recipientsto not seek preventative care andthen coming to the hospital withserious illnesses that are moreexpensive to treat.

The expansion of Medicaid underthe Affordable Care Act shouldhelp, he said.

The Medicaid situation is beingrectified, Chase said, throughimprovements to filing claims elec-tronically. Private physicians arenow being reimbursed in a timelymanner, he said. Prior to theseimprovements, which were made afew months ago, he said physi-cians were hardly being reim-bursed at all.

Expansion of Medicaid underthe Affordable Care Act should

help the high proportion on unin-sured people in the territory, Chasesaid. But still, as health care costsgo up, government appropriationscontinue to go down.

Treasure said the unequal treat-ment of the territory when it comesto Medicaid is one of the reasonsit’s hard to compare the local sit-uation to that of the States. SinceMedicaid was only reimbursingpatients for care through the hos-pital, she said, doctors had to gothrough the hospital. This is whythe current system was set up, shesaid, so physicians get a salarythrough the hospital to care forindigent patients and to take callswhen needed.

Griffith said the territory is“extremely limited” because it doesnot get the same funding as statesget.

Warnings of a failed system

Former hospital CEO Jeff Nel-son, who died of a gunshot injuryat his Minnesota home on Oct. 22,warned the Senate that the currentsystem of employing local physi-cians is inhibiting the hospital fromrecruiting more physicians andfrom offering more affordable ser-vices to the community.

“In fact, the current physicianunion clearly admits its sole inter-est is for the economic interest of itsphysicians members while at thesame time JFL pays each physicianmore than $90,000 per year, thegovernment cover half of their med-ical liability insurance premiumand pay all of the physicians’ legaldefense costs for medical liability,prevent JFL from offering compet-itive services, and allow the physi-cians to earn hundreds of thou-sands of dollars each through theirprivate practices,” Nelson told theSenate in September 2012.

He said JFL pays about $10 mil-lion a year for physician compen-sation and fees to traveling physi-cians, yet people are still leavingisland for care.

“The existing physician paymentarrangement restricts JFL fromrecruiting needed physicians on

St. Croix while saddling JFL withhigh costs to maintain existing ser-vices and physicians,” Nelson toldthe Senate. “There is no place in theentire U.S. that offer physicianssuch extraordinary compensation.”

Sen. Nereida Rivera-O’Reilly:

Proposed compromise

Sen. Nereida Rivera-O’Reilly saidallowing physicians to open a pri-vate practice while working at thehospital is having a negative impacton the hospital.

“Now that has to change becauseit is draining the hospital resourcesbecause doctors take the privatepatients away from the hospital,”she said.

O’Reilly said part of the agree-ment between the physicians andhospital is that the physicians earna salary that is not competitive withhospitals on the U.S. mainland inexchange for their ability to have aprivate practice. She said, howev-er, some physicians are takingadvantage of the situation.

“I understand some of them areeven using hospital supplies onpatients they saw in their privatepractice,” she said. “It’s a big mafia,and it’s time for a change. Changeis hard, but it’s necessary, and doc-tors need hospitals and hospitalsneed doctors.”

O’Reilly said she thinks it’s anabusive situation where insuredpatients are being treated by physi-cians in their private practices,which takes away from the hospital’srevenues.

Considering the dire financial sit-uation of the St. Croix hospital,O’Reilly is proposing a physicianrevenue-sharing initiative betweenthe hospitals and physicians.

“I think they now have a respon-sibility, I hope they see it as aresponsibility, to help the hospitalstay afloat,” she said about thephysicians.

Bill No. 30-0207, which has notyet been discussed by the Senate,would require physicians employedby the Virgin Islands governmentat either of the territory’s hospitalsto contribute 30 percent of the feescollected from hospital patients intoa Hospital Capital ImprovementFund for their respective hospital.

The physicians would have a sayin how the funds are spent withregards to capital projects in the

HOSPITAL:FROM PAGE 2

“It’s a big mafia, and it’s time for a change.Change is hard, but it’s necessary, and doctors need hospitals

and hospitals need doctors.”Sen. Nereida Rivera-O’Reilly

A Special Report on the Gov.Juan F. Luis Hospital andMedical Center published inThe Avis on Oct. 29 revealedthe following:

• The hospital is dangerous-ly close to losing CMS compli-ance, which could force theclosure of the hospital.

• The operating room is over-run with tension and disputesamong physicians and staff.

• No vascular surgeon at thehospital since Oct. 18. This

means patients with ailmentsimpacting the circulatory sys-tem, like gunshot wounds ordialysis emergencies may betreated by a trauma surgeonwithout specialized training invascular surgeries, have to waitfor a vascular surgeon to flyover from St. Thomas or haveto be airlifted off island forcare.

• Vascular surgeon Dr.Christopher Seaver resignedafter allegedly finding spray

painted on his car “Your pieceof s---,” finding dead chickenson his car with a note that read“We’re watching you,” and hadhis salary cut.

• General surgeon Dr. AlbertTitus was suspended at theend of October although hos-pital officials are not confirm-ing the reason.

• A Centers for Medicare andMedicaid consultant foundspray painted on her car "YouAre Next" after a dispute in the

operating room.New details highlighted:

• The lack of a functioningSt. Croix hospital board ismaking a difficult situationworse.

• The territorial hospitalboard did not re-certify Titusduring a meeting on Thursday,Oct. 31. The board againdenied his privileges during ameeting Friday.

• JFL is in the process of hir-ing five operating room nurses,

two surgical technicians andthree certified nurse anesthe-siologists. Officials say issuesin the operating room havebeen resolved.

• The hospital has stoppedhiring traveling nurses butremains short staffed and inneed of 25 nurses immediate-ly and 58 nurses to operate atcapacity.

• JFL announced plans tocut surgery options during ameeting Friday.

Hospital in crisisHOSPITAL, PAGE 5

PAGE 5SUNDAY-MONDAY, NOVEMBER 10-11, 2013 The Avis

hospitals and needed supplies,O’Reilly said. She said the fundscould even be used to makeimprovements to the EmergencyRooms and Operating Rooms.

“All of these things can beaddressed if they are willing to bepartners with the hospital,” shesaid.

O’Reilly said the bill would notreduce their salaries and wouldnot touch the profits at their pri-vate practices. She said her mea-sure will allow the physicians tocontinue treating patients in theirprivate practices, but it seeks tohave them share proceeds withthe hospital when it comes to col-lecting fees from patients theytreat at the hospital while usingthe hospital’s facility. She said themoney would go into a specialfund solely for funding capitalimprovement projects at the hos-pitals, which she said will benefitthe hospital, physicians andpatients. Each hospital wouldhave its own fund.

The governing board for eachhospital would be responsible forestablishing the rules and regu-lations governing the revenue-sharing initiative. Each hospitalboard also would be required torecommend to the Legislature cap-ital projects to be funded throughthis initiative. The money deposit-ed into the hospital funds would

be appropriated by law exclusive-ly for the purchase of equipment,improvements, patient care andcash flow for the hospital.

O’Reilly said the bill is intend-ed to deal with the way physi-cians are paid, which she said isa model that was created for theterritory in an effort to make iteasier to recruit specialists to theVirgin Islands.

O’Reilly said her bill was sup-posed to be heard in committeelast month, but it was resched-uled. She said she has forwardeda copy to Griffith so he can shareit with his colleagues.

“This shouldn’t be somethingadversarial,” she said. “Everybodyshould be willing to participate inthis, especially after what we readin the media about the status ofthe hospital.”

O’Reilly said she would likeGriffith and as many physicians aspossible, as well as members ofthe community, to offer testimo-ny when the bill is discussed incommittee.

“Doctors are important people inour community,” she said. “Welove them and we love the factthey have given so much to usand we want to make them part-ners to rescue the hospital fromfiscal collapse.”

O’Reilly said she is working onother measures in the event herrevenue-sharing initiative isn’tsuccessful.

“We have other things in the

hopper we are willing to come withuntil we can stabilize the hospitaland change the way things aredone,” she said.

Financial emergency has been brewing

In December 2011, territorialhospital board Chair Lynn Millin-Maduro reported to the board thatshe had been meeting regularlywith senators and the governor toappeal for a capital injection intoJFL. She said they were exploringalternative hospital models to gaincapital through partnerships andfinancing options. She said recruit-ing additional physicians wouldhelp regain the millions being lostto residents seeking off-island care.

In March 2011, the hospital offi-cially declared a financial emer-gency.

On June 16, 2011, the hospitallaid out a set of objectives toachieve their goals. By 2013, theyhad planned to be fully accreditedand licensed without reservations,have an integrated health systemwith unified hospitals andemployed physicians. Their goalswere never achieved and the situ-ation is now worse.

On Jan. 31, 2012, hospital offi-cials told the Senate that theyneeded more funds or they wouldbe forced to lay off 100 or moreemployees.

On Feb. 28, 2012, the hospitallaid off 86 employees, mostlylicensed practical nurses and cer-

tified nursing assistants. Manyblamed Nelson and held protestscalling for his resignation.

In March 2012, Nelson told theSenate, “JFL is financially bank-rupt.” He announced that alongwith the previous layoffs, medicalsurgical inpatient beds werereduced from 40 to 22.

Even though the Senate relievedthe hospital of $52 million in debtowed to the government, JFL stillowed $30 million to other creditorsthat they relied on for critical sup-plies and equipment.

“Without more capital, higherrevenues and profitable opera-tions, JFL will not be able to pur-chase food, pay payroll or serve itspatients. Without immediatechanges in JFL’s financial perfor-mance, the hospital is at risk ofclosing its doors. More hospitaljobs could be lost without moretax appropriations or capital fromother sources,” Nelson told sena-tors.

He said the loss of Hovensawould cause a reduction in annu-al revenues by about $3 millionstarting in fiscal year 2013.

“For JFL, commercially-insuredpatients provide the profit to off-set the losses incurred when serv-ing uninsured patients and otherunprofitable care patients. To off-set the loss of Hovensa patientsmeans JFL will either have to raiseratios higher and/or reduceexpenses,” Nelson told the Senatein March 2012.

In August 2012, Nelson said,“JFL remains in a financial emer-gency and still needs additionalcash and capital. Without addi-tional capital, JFL will reduce ser-vices and could close. JFL’s pleafor additional cash for the last 18months has gone unanswered.”

He said the more than $56 mil-lion being spent by residents forcare off island is mostly going tothe Mayo Clinic and the Cleve-land Clinic in Florida.

“In fact, I have had senatorsfrom this very Legislature tell mepersonally they seek their carefrom physicians and hospitals inFlorida rather than those on St.Croix,” he said in August 2012.“People in the territory, who can,are taking their health-care dollarselsewhere and leaving the mostvulnerable patients on St. Croixwith historically less than the bestcare. This is not right.”

He noted that hundreds ofhigh-wage jobs can be createdat JFL by gaining more patientsand providing the same quality ofcare as offered by the Mayo Clin-ic and the Cleveland Clinic. Hemaintained that it was possible toimprove care to the point whereVirgin Islanders could stay in theterritory for care and that profitscould be made by attractingpatients from throughout theregion, but investments by thegovernment or private compa-nies, along with reforms, wouldbe necessary.

HOSPITAL:FROM PAGE 4

Venezuela churning out beauty queens amid crisisCARACAS, Venezuela (AP) — For

most Venezuelans, these are try-ing times. Inflation is running at atwo-decade high, salaries are beingcorroded by a plunging currencyand basic goods like milk and toiletpaper are in short supply. But evenas the economy shows signs ofimploding, the country still churnsout beauty, as evidenced by MariaGabriela Isler’s pocketing Saturdayof the country’s third Miss Universetitle in six years.

Within minutes of Isler’s crown-ing in Moscow, President NicolasMaduro sent his congratulationsover Twitter, celebrating her per-formance as a “triumph forVenezuela.”

Opponents of his socialist gov-ernment also expressed pride.

“There’s no doubt we have themost beautiful women of the world,”said Marco Sandoval, a 68-year-oldretiree, as he and dozens of othersmarched in Caracas against thegovernment in a protest hastily-organized over the Internet. “Butnothing is perfect. We also have themost corrupt and shameless politi-cians in the world.”

Born in the city of Valencia, the25-year-old Isler works as an anchorfor Venevision, a channel owned bythe Cisneros business group thatalso has the rights to the annualMiss Venezuela pageant, one of thenation’s most-watched televisedevents. The 5-foot, 10-inch brunette

edged out finalists from Spain,Brazil, Ecuador and the Philippinesto take the crown in its 61st edition.

Venezuela has won more majorinternational beauty competitionsthan any other nation, includingnow seven Miss Universe titles, andbeauty queens rank alongside base-ball players and oil as the coun-try’s biggest exports. A whole indus-try of grooming schools, plasticsurgeons and beauty salons hasemerged to prepare young womenfor the thousands of pageants thattake place each year around thecountry in schools, army barracksand even prisons.

More recently this obsession withbeauty has taken a backseat tomore mundane concerns, as soar-ing inflation of 54 percent and wors-ening shortages of basic goodsmakes it harder for families to putfood on the table.

Driving the crisis has been a col-lapse in the currency, which hasplunged to a tenth of its officialvalue in illegal black market trading.To arrest the fall, Maduro last weekordered the military to inspect pricesand shut down businesses found tobe charging abusive prices. A dayafter the government seized controlof a nationwide chain of appliancestores, doors reopened Saturday tothrongs of shoppers seeking to buytelevisions, washing machines andrefrigerators at a fraction of theirlisted price.

Associated PressMiss Universe 2012 Olivia Culpo, from the United States, right, places the crown on Miss Venezuela Gabriela Islerduring the 2013 Miss Universe pageant in Moscow, Russia, on Saturday.