Hospital Staffing Shortages Put Pressure on Territory’s Top Health Needs

For the average patient, staffing shortages translate into longer wait times in the Emergency Room and turnaround time for test results. For healthcare providers, staffing shortages translate into bigger workloads, decreased morale and, in some cases, total burnout.

For patients that require higher levels of definitive care beyond the ER, staffing shortages also deprive local hospitals the ability to provide specialty services. Those speciality services apply to some of the most common health issues affecting members of the community.

When a hospital lacks those services, the hospital must transfer the patient to another facility that does in fact have the resources to provide definitive care. In the case of the Virgin Islands, the area’s hospitals frequently have to transfer patients off-island which not only delays that definitive care for patients, but gouges much-needed revenue from the hospitals.

In response to questions posed by Senator Alma Francis Heyliger during a January 14th session of the 34th Legislature’s Committee on Health, Hospitals and Human Services, top representatives from the USVI’s hospitals cited patients requiring advanced cardiology and neurology care as some of the most frequently transferred patients off-island.

“The two major service lines affecting offline transfers for JFL are cardiology and neurology,” said Doug Koch, who has served as Juan F. Luis Hospital’s CEO for the past two weeks. “And specifically regarding cardiology, one of the main issues is not having a functioning cardiac [catherization] lab and an interventional cardiologist. That has caused many of our transfers off-site.”

In short, a cardiac catheterization lab allows doctors to perform tests that show the heart’s blood flow in cases where professionals suspect that a patient is experiencing a life-threatening cardiac event such as an acute myocardial infarction, known commonly as a heart attack. Through the testing conducted in a cardiac catheterization lab, doctors can target how to proceed with further treatments if necessary.

As noted by the new CEO of JFL, St. Croix’s hospital system remains hindered in its ability to provide care without a cardiac cath lab and an interventional cardiologist for which a cath lab needs to operate. On St. Thomas, however, the Schneider Regional Medical Center reported that it has expanded its cardiology services since the opening of the Heart and Lung Center in 2016.

“We have made big strides in our cardiology services that are available here,” said CEO of Schneider Regional Medical Center, Tina Comissiong, Esq. “We have a permanent cardiologist who provides support to all of our teams and our Emergency Department. And we have a rotating program where interventional cardiologists come in and work with our Heart and Lung Program Center to do scheduled cases and also to do emergent cases while they are on-site using our on-site cath lab.”

With a rotating program of interventional cardiologists, the presence of such a highly skilled and specialized provider may not always be guaranteed, which leaves the lights off in the cath lab and patients with life-threatening ailments left to wait for either an off-island transfer or an appropriate doctor to arrive. And as health care professionals often say: time equals tissue. In other words, a patient’s body sustains more damage as it waits for definitive care in the case of an acute, life-threatening event.

The absence of guaranteed, round-the-clock cardiac catheterization care can certainly be troublesome in a community where ischemic heart disease is the leading cause of death in the USVI, according to a 2019 study published in the medical journal, The Lancet.

A highly prevalent and associated cause of death in the USVI, according to the study published in The Lancet, was stroke. That would fall under the purview of a neurology team. While both of the hospital’s CEOs noted the challenge in expanding neurology services, which also covers issues such as seizures, neither touched on the efforts being waged in that area during the HHS meeting on Jan 14th.

Yet, representatives from the Territory’s two major hospitals clearly stressed staffing shortages as a major challenge. Despite only serving in the role of JFL’s CEO for two weeks, Doug Koch offered insight into the factors that help dissuade health care providers from seeking employment within the U.S. Virgin Islands.

“Recruitment and retention of healthcare personnel have been routinely, negatively impacted by the competitive short-term contract salaries offered on the mainland,” said Koch. “Coupled with the high cost of the Government Employees Retirement System, cost of living and the availability of affordable housing have all created a perfect storm of a great recruiting challenge.”