Patients or Profit?
The Juan F. Luis Hospital Board is reviewing a contract that has, for the past 10 years, provided one medical group with significant financial incentives and a monopoly on the administration of radiology and nuclear imaging services (CAT scans, MRI’s, and Nuclear Medicine Services) on St. Croix.
This no bid contract defines a “joint venture” between the Hospital and Advanced Radiology, LLC. The Hospital Board is a “partner” in this enterprise, but the contract gives Advanced Radiology manager Marcel Galiber sweeping autonomy over the daily management, operation, administration, and billing practices of the Nuclear Medicine Diagnostic Laboratory located in the Hospital. The agreement outlines a 60-40 net profit split between Advanced Radiology (AR) and the Hospital and positions them as the sole provider of these services on St. Croix.
The initial term of the contract was 10 years, with an automatic renewal provision of 5 years after the initial period. However, it does provide for some elements of the agreement to be renegotiated prior to renewal. After reviewing the document, there are several areas we hope are being reviewed before an extension is signed. The information below is taken from the contract, which is attached at the end of this article.
- Rent – AR currently pays $1,358 a month for the 326 square foot lab. That includes all utilities, including water, electricity, telephone and other services; and use of darkroom and laser camera equipment used to develop images taken with the nuclear medicine equipment.
- Referrals - AR gets all CT and MRI referrals from the hospital inpatient and emergency room, and all referrals from any facility affiliated with the hospital – including any facilities constructed after the contract was executed, AR also receives all referrals from the Dept. of Labor, Division of Workman’s Comp; Medical Assistance Program (MAP); Medicare or Medicaid; PHPP; Veterans’ administration; and private doctor’s offices.
- AR controls all billing – not the Hospital or the Hospital board, for all categories listed in above except MAP patients, which they define as indigent. They also direct bill for all private patients. All of this billing is handled outside of Hospital or Board control.
- AR controls purchasing of equipment. Even if the hospital wanted to replace equipment or provide more up to date services, a “non-compete” clause prevents the hospital from acquiring its own equipment.
- AR controls maintenance, upkeep and replacement of all equipment including purchase, shipment, insurance, etc. Despite equipment being more than 1o years old and not being up to current standards, AR either refuses to or is unable to replace the equipment.
- AR does its own internal and external quality control and quality assurance reports. They regulate themselves. Neither the hospital administration nor staff physicians oversee the operations or care given in this facility
- AR hires its own physicians to read and interpret images from the procedures it performs EXCEPT for indigent patients, whose films are read by hospital staff.
- AR is responsible for securing nuclear waste in the proper containers. However, the hospital is responsible for removal, disposal and handling of these potentially radioactive materials. Hospital staff also is responsible for cleaning and maintaining the facility.
There are many other areas of concern that arise from this arrangement; the availability of services in the event of equipment failure; accountability for financial reporting; oversight on compliance for the numerous regulatory agencies who are associated with this type of service provider, including the Joint Commission on Accreditation of Hospitals and the Nuclear Regulatory Commission; the obvious concerns about having responsibility for both quality control and quality assurance under the auspices of the Laboratory itself; the list goes on.
But what’s most surprising is that all of the provisions outlined above are stated in the Contract and were approved by the then Hospital Board. This was agreed to by all parties involved at the time. From a strictly financial perspective, and even taking into account the initial outlay AR made in outfitting the lab, and the 60-40 split, the financial advantage in this agreement seems to lie squarely with AR.
The current Hospital Board has the opportunity to amend these provisions to be more reflective of the economics facing the parties today. We hope that this review process will include getting feedback from patients and physicians about the quality of the service they receive, and from Hospital staff physicians who should also have some say in the evaluation of this critical function.
We hope the negotiations in this renewal process are practical and not political.
(Editor’s Note: The only other imaging facility on St. Croix is Imaging Center PC, an outpatient facility in the Sunny Isle medical center. The physicians at the Imaging Center are Angelo Galiber, M. D., CCD; Andre A. Galiber, Jr., M. D.; and Coralee Lewis, M.D.)
Wow!!!! Shame on the Hospital board.
Who in their right minds signs a 10-year exclusivity for anything! It is simply NOT done. In any business environment, this kind of deal would raise serious red flags. Someone’s getting greased!
Exclusivity or monopoly is the way of life in the Virgin Islands, Seaplane, Ferry, Radiology, Topa, and so forth.
Is everyone missing the point? The Governor’s wife is an owner in this business along with her brother…talk about more egregious conflict. He appoints the board that negotiates the contract, he sends down the budget with a line item to pay the contract, and his wife negotiates. the contract. Their duty was to put all of their business interests with the VI Government in blind trust or outright divest themselves as soon as they won the election. At present, it is said that they are owed 3M dollars and they are renegotiating a contract that prohibits the hospital or anyone else from competing with them.
Together we can fleece this community. Together we can box you into a corner so that you are forced to defend our actions despite the risk to your future and freedom. Together we can convince you that the fate of Biggs and Plaskett is not in the stars for you…
Shame on you!
If the First Lady is an owner of Advanced Radiology than wouldn’t that make the Governor an owner? Conflict?
Senator Nellie O’Reilley mentioned this obvious conflict of interest at the budget hearings for the hospital last month. Something about the First Lady was picking up check for Advanced Radiology. This is a huge problem and again very disappointing.
What a twisted web we mortals weave…
what else is new?
see them all in handcuffs will be new
Maybe this contract has something to do with the governor’s recent visit to chat with the JFL Hospital Board.
http://governordejongh.com/blog/2009/08/Governor-Meets-with-Leadership-at-Juan-F-Luis-Hospital.html
The more contracts this administration signs, the deeper the hole dug for our future generations. Let’s hope this one isn’t signed without significant changes.
Busted do you think the governor’s AG has been approving the legal sufficiency of these business transactions? These business transactions will be illegal if the AG is involved. What a bunch of crooks.
It might not be so bad if half the time the equipment wasn’t broken or the techs wouldn’t refuse to come in to do an emergency study because it was their day off. If you have an exclusive contract, then don’t you have a responsibility to provide top notch, second-to-none service?
Please remember that this contract was signed into agreement 10 years ago, this was BEFORE our scheming Goovernor got into office.
PRESIDENT OBAMA DELIVERS HIS STATE OF THE UNION SPEECH ON HEALTH CARE FOR AMERICA. THE PRESIDENT ADDRESSED CONGRESS AND DELIVERED HIS MOST DETAILED DESCRIPTION OF HIS IDEA OF HEALTH REFORM. SEE PRESIDENT OBAMA STATE OF THE UNION SPEECH AT LINK:
http://edition.cnn.com/2009/POLITICS/09/09/videos.obama.health.care.speech/index.html
PRESIDENT OBAMA WAS ALSO HECKLED BY SOUTH CAROLINA REPRESENTATIVE JOE WILSON WHILE DEFENDING HIS HEALTH CARE PLAN BEFORE CONGRESS AND THE AMERICAN PEOPLE. IN AN UNPRECEDENTED MOVE, REPRESENTATIVE WILSON GROSSLY DISRESPECTED PRESIDENT OBAMA ON THE HOUSE FLOOR BY SHOUTING “YOU LIE”. SEE OUTBURST AT LINK:
http://edition.cnn.com/video/#/video/politics/2009/09/09/obama.heckled.cnn
WE WILL CONTINUE TO MONITOR THIS DEVELOPING STORY.