Proposal for Magistrate Judge to Screen Malpractice Claims
FOR IMMEDIATE RELEASE (June 3, 2021 – Hagatña, Guam)— The Committee on Health announces a series of hearings and invites public input on Bill 112-36. The measure is intended for those harmed by medical negligence who cannot afford mandatory arbitration while ensuring confidential screening and protection of doctors against frivolous claims. The bill would enact a case screening system in place of costly Mandatory Arbitration. Costs of arbitration on top of cost of potential trial have deterred the filing of claims by those who cannot afford the upfront costs.
Bill 112-36 (COR):
– Replaces the costly three (3) person arbitration panel
– Allows a local magistrate to confidentially consider claims, consider expert testimony and identify frivolous claims
– Allows for alternative confidential arbitration or mediation with consent of both parties
– Applies only to those healing arts professions covered under the current MMMA Act
– Applies the current standard of care
– Continues application of the Government Claims Act for Government providers
Informational Hearing on Wednesday, June 23rd at 5:00 p.m. – 8:30 p.m.:
The Informational Hearing on June 23rd will feature an introduction of the bill and comparison with current mandatory arbitration law, provided by the bill’s sponsors, members of the Guam Bar Association, and malpractice insurance representatives.
Public Hearings on Wednesday, July 7th and Monday, July 12th at 5:00 p.m. – 8:30 p.m.:
Medical professionals and the public are invited to submit testimony on the bill on July 7th or July 12th at the Guam Congress Building or via Zoom. Those interested in presenting written or verbal testimony should contact the Office of Speaker Therese Terlaje at (671) 472-3586 or senatorterlajeguam@gmail.com by July 6, 2021.
All hearings will be broadcast on GTA TV Channel 21, Docomo Channel 117/112.4, and via Guam Legislature Media on Youtube. Recordings of the hearings will be available on the Guam Legislature Media YouTube Channel after the hearings.
The bipartisan Bill 112 was sponsored by Therese M. Terlaje, Telo T. Taitague, Joanne Brown, Tina Rose Muña Barnes, Joe S. San Agustin, V. Anthony Ada, Telena C. Nelson, Christopher M. Duenas, Clynton E. Ridgell, Amanda L. Shelton, Jose Pedo Terlaje, and Sabina F. Perez.
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Attachment: Bill No. 112-36(COR) – AN ACT TO ADD A NEW CHAPTER 10 TO DIVISION 1, TITLE 10, GUAM CODE ANNOTATED; TO ADD A NEW § 42A101(i)(20) TO CHAPTER 42A OF DIVISION 3, TITLE 7, GUAM CODE ANNOTATED; TO AMEND § 42A101(j) OF CHAPTER 42A, DIVISION 3, TITLE 7, GUAM CODE ANNOTATED; AND, TO REPEAL CHAPTER 10 OF DIVISION 1, TITLE 10, GUAM CODE ANNOTATED; ALL RELATIVE TO MEDICAL MALPRACTICE IN THE TERRITORY OF GUAM.
Bill No. 430-35 (LS) Prioritizes Access to Justice for Victims and Fairness for Medical Community
FOR IMMEDIATE NEWS RELEASE (December 15, 2020- Hagåtña, Guam)
Today, Health Oversight Chairperson Therese Terlaje and Minority Leader Telo Taitague introduced Bill No. 430-35 (LS) which replaces Guam’s nearly 30-year-old Medical Malpractice Mandatory Arbitration Act (MMMAA) with a less costly pre-trial screening proposal. The MMMAA requires individuals claiming to have been victims of medical malpractice, to first arbitrate their complaint before filing suit in court.
If approved, Bill No. 430-35 (LS) allows a claimant (plaintiff) to file their claim in court where a Magistrate Judge is responsible for determining whether there is evidence to support the conclusion that a healthcare provider (defendant) failed to comply with the appropriate standard of care. The Magistrate Judge may consider expert testimony, and shall keep the complaint, proceedings, and opinion sealed until 30 days after issuance of opinion; however, the Magistrate may order the opinion sealed temporarily for an extended period or permanently upon agreement by the parties, if a trial is not pursued. Either party may pursue their right to a jury trial within 30 days after the Magistrate Judge renders his or her opinion by notifying the court of the party’s intent to proceed to trial.
Additionally, parties may at any time by mutual consent, submit their dispute pursuant to the provisions of either the Guam International Arbitration Law or Guam’s Mediation statute. Claims against any defendant that is for $10,000.00 or less shall be exempted from the new legislation if they are filed with the Small Claims Division.
“Given that we are nearing the end of the term of the 35th Guam Legislature, it is our intention to immediately enlist public feedback but it is likely additional hearings on medical malpractice reform will have to be further pursued in the 36th Guam Legislature. We value the input of everyone in the community and look forward to further discussion regarding this legislation,” stated Senator Therese Terlaje.
Last year, the 35th Guam Legislature – through the leadership of health committee Chairperson Therese Terlaje – held a series of informational hearings on Guam’s MMMAA. The very difficult but necessary dialogue brought to light legitimate concerns from families of alleged victims about the high cost of the arbitration process serving as a barrier to asserting viable medical malpractice claims and to the pursuit of justice. We also heard the concerns from doctors that a repeal of current law may increase frivolous lawsuits, potentially increase malpractice insurance costs, deter doctors from providing emergency care outside their specialty, and ultimately impact the quality and extent of patient care they provide.
“Following the hearings, I have been working diligently, to consider alternative pre-trial procedures used in other jurisdictions and to draft viable and balanced legislation for Guam that takes all concerns into account, as much as possible yet provides some justice for those who cannot afford arbitration,” stated Senator Therese Terlaje.
“Senator Therese and I introduced Bill No. 430-35 (LS) after many months of research and discussions with families of medical malpractice victims, healthcare providers, and a series of public informational hearings conducted by the legislature. This measure prioritizes access to justice for victims and fairness for Guam’s medical community, particularly after the U.S. District Court of Guam recently issued an order asking the Supreme Court of Guam, ‘is failure to comply with the MMMAA’s arbitration requirement equitably excused when an indigent party cannot reasonably afford the non-administrative fees of any organization authorized to arbitrate under the Act and no alternate means of completing arbitration is available?” Senator Taitague stated.
“It appears the constitutionality of the MMMAA is in question. If there is a determination by the court that the MMMAA is unconstitutional, healthcare providers could be left vulnerable to baseless medical malpractice lawsuits which would harm not only their practice but the broader healthcare system on Guam. Bill No. 430-35 (LS) protects a victim’s right to legal action – while ensuring that a medical malpractice case is properly reviewed before moving forward through the court system, mediation, or arbitration.”Senator Taitague further stated.
For additional information regarding the bill or press release, please contact Senator Senator Therese Terlaje’s office at 472-3586 or send an email to senatorterlajeguam@gmail.com or Senator TeloTaitague’s office at 989-8356 or send an e-mail to senatortelot@gmail.com.
FOR IMMEDIATE RELEASE (October 19, 2020 – Hagåtña, Guam) – During the close of its regular session today, the 35th Guam Legislature has confirmed the appointment of Arthur U. San Agustin as the Director of the Department of Public Health and Social Services.
Senator Terlaje, Chair for the Committee on Health, Tourism, Historic Preservation, Land and Justice, stated, “I felt it was important to contemplate the gravity and responsibility of this position during this particular time when our island is facing a health pandemic and is struggling to control a virus that has taken many lives over the last 9 months, that has shut many businesses down and put more than 30,000 people out of work, that has kept many of us isolated and limited from spending precious in-person time with our family and close friends, and that has completely overwhelmed our health care system.”
Carrying out the burden of leading Guam out of this pandemic comes with the full unprecedented Health Emergency authority which also entails the management of millions of dollars of procurement and federal funds, and tremendous pressure from the administration, hospitals, health care companies, lawyers, doctors, business owners, the legislature and the entire community.
The Health Chair noted that the appointment by the legislature should come with the commitment to provide the department with needed resources, that DPHSS is not scapegoated when it is everyone’s responsibility to improve our situation, and that that the advisory groups and the private sector truly work with them to implement a clear exit strategy that has been communicated effectively to the public.
“I expect the Director to serve the people of Guam first and foremost… that he is direct and completely forthright with the community he serves, and to remove any impediment that keeps information from the public,” said the Senator.
Recognizing the many challenges presented to the new director, Senator Terlaje also outlined some of her expectations including advocacy on behalf of the people of Guam without political interference stating on the session floor, “I expect denunciation of scare tactics or the threatening of furloughs of Public Health staff in the middle of the biggest public health emergency our island has seen and I expect policy to be driven by data and by an unwavering allegiance to saving lives.”
Mr. San Agustin declared his willingness to take on the leadership responsibilities over the Department and his intentions to work towards the improvement of the well-being of the island during his confirmation hearing. Art San Agustin has dedicated his career to serving those in need, to Public Health, often called upon to serve as Acting Director during his long tenure with the agency and 32 years of government service.
Visit Video (1:07) for full remarks on this confirmation below.
FOR IMMEDIATE RELEASE (October 1, 2020 – Hagåtña, Guam) – As the community continues to learn how to adapt to life with COVID-19, Senator Therese Terlaje, the Oversight Chair on Health, continues to monitor progress with the Department of Public Health and Social Services (DPHSS) to get a clearer picture of the trajectory of the reopening of Guam businesses, tourism as well as restoring some semblance of normalcy for residents.
The third in a series of Oversight Hearings took place on the first day of FY2021 via Zoom with members of the 35th Guam Legislature and administrators from DPHSS to get an update on the progress of COVID-19 response measures including the Contact Tracing and Investigations capacity, implementation and results of COVID-19 tracing apps, public disclosure protocol for case investigations and contact tracing information, status of the CARES Act funding request and other federal funding, and Public Health Authority Powers under Chapter 19, Title 10, Guam Code Annotated.
“Since the first oversight on contact tracing held in May through today, these hearings have been essential to getting information to the public when there has been so much uncertainty. Hearing that there is progress is encouraging and lets everyone in our community know that DPHSS is working hard to keep them safe, while also considering their need to get back to work,” said the Oversight Chair.
The DPHSS Workflow has been streamlined for contact tracing and containment, and they can now contact a positive case, close contacts, plan isolation, and instruct on quarantine for family members within 5-8 hours of test results. According to Dr. Chima Mbakwem, Projects Coordinator for the Office of HealthCare Associated Infections Epidemiology, the new strategy is a time-saving mechanism where the containment team identifies family members and close contacts and immediately hands the data to the contact tracing investigation team who completes their investigation within 1-2 days while those identified are already under quarantine and are being monitored for 14 days.
Annette Aguon, COVID-19 Epidemiology/Surveillance Branch Lead, also updated the Oversight Chair on contact tracing investigation resources stating that there are currently 22 investigators, 25 contact tracers, plus 3 contact tracers with Dr. Mbakwem’s team. Also assisting in this effort are approximately 42 DOE nurses, 38 existing Public Health staff, among others. In addition to public and private partners, a pilot project has started at UOG which will augment the investigation team at a separate site. Santos and Mbakwem attributed the increased staffing, household contacts in multigenerational homes already under quarantine, and the current lockdown in assisting them to complete investigations sustainably until Guam starts reopening and shifting gears.
Although the Guam COVID Alert App has only seen a 19.6% adoption rate, short of the recommended 60% gold standard, efforts are still ongoing to increase the levels through various outreach and incentive programs. Public Health also launched the SARA Alert technology which will eventually replace most of the manual monitoring, allowing a more robust way for patients and close contacts to report their symptoms daily via telephone, email, smartphone, or text messaging.
Though much progress has been made regarding containment and contact tracing, Dr. Ann Pobutsky, Guam’s Territorial Epidemiologist, advised that they are behind on data management and migration, stating that it will be at least another month until we get more robust weekly surveillance reports, which will break down community spread by activity categories. The categories are a work in progress but could contain the information that the community has been pressing for, to make well-informed decisions about what activities could be riskier for them and their families and to help the government determine what businesses could be classified as lower or higher risk.
Senator Terlaje stated, “I continue to urge the Department to provide more data to the public to help them understand what information is driving the decisions so that they have confidence in this process going forward.”
Acting Director Art San Agustin updated the Chair on the latest changes to quarantine protocols, noting that those who wish to test on day 6 and test negative, can opt to fulfill the remainder of their 14-day quarantine at home. Dr. Mbakwem clarified that these individuals are on restricted movement, which means they can go to the store for essential items and exercise because they have a lower probability of testing positive. This is different from quarantine for close contacts who have been exposed to COVID-19.
Although the ongoing community positivity rate averages approximately 8% according to the JIC, Aguon advised that DPHSS is still confident in their ability to adequately trace contacts and control the spread of infection, especially with the recent adjustments made with the isolation and quarantine team and updated internal protocols with the trace investigation team.
“I am optimistic about the progress made in just the past few months regarding containment and contact tracing, however, I cannot stress enough about the importance of transparency in the process and data-driven decisions being the key to public participation,” stated Senator Terlaje.
View the full oversight hearing by clicking here or below:
FOR IMMEDIATE RELEASE (September 15 2020 – Hagåtña, Guam) – Bill 398-35 (COR), AN ACT TO APPROPRIATE QUARTERLY EXCESS REVENUES TO THE DEPARTMENT OF PUBLIC HEALTH AND SOCIAL SERVICES IN FISCAL YEAR 2021, was introduced by Senator Therese Terlaje, the Oversight Chair on Health, as she continues to fight for more funding for the operations of the Department of Public Health and Social Services.
The proposed measure appropriates all fiscal year 2021 withholding and corporate income tax revenues collected in excess of the revenue level budgeted per quarter, as reflected on the monthly Consolidated Expenditures and Revenue Report, to the Department of Public Health and Social Services for the expansion of its environmental health inspections, its other regulatory purposes, and other DPHSS operations, not to exceed $5.8 million for the fiscal year.
The policy was initially proposed as an amendment during a Committee on Appropriations meeting as a way to get additional resources for Public Health without having to increase already optimistic revenue projections but failed to garner enough votes in committee.
Terlaje stated, “This bill is a compromise and instead of raising revenue projections beyond what the body is comfortable with, we would dedicate any actual revenues collected every quarter that is above what is in the budget to Public Health to shore up any shortfalls.”
The Department’s budget amount in Sub Bill 282-35 covers all existing payroll with Senator Terlaje successfully passing a provision that carries over their expected lapses into FY 2021, and provides them flexibility tools to shift money around to address any immediate needs for health and social programs, however, the shortage for their operations could exceed $13 million, pending a final accounting on carry-forwards.
“The economic impact from COVID-19 has taken its toll and that includes the government of Guam. We must use our federal funding to direct resources to our COVID response while strategically using our local funding to continue to prop up DPHSS. We must support them to ensure our community is safe from COVID-19 and to continue with the numerous mandates we have placed upon them, including protecting our children and our manåmko’ among their many other duties. I humbly urge my colleagues to consider this option to truly prioritize public health,” stated the Senator.
FOR IMMEDIATE RELEASE (September 10, 2020 – Hagåtña, Guam) – Senator Therese Terlaje, Chair for the Committee on Health, held a critical oversight hearing today with the Department of Public Health and Social Services (DPHSS) and a confirmation hearing for the appointment of Arthur San Agustin to be Director of DPHSS. The focus of the oversight hearing was to get a clear picture of where we are today with the department’s case investigations and contact tracing resources and its protocols regarding public disclosure of investigations to prevent the spread of COVID-19. The Chair addressed concerns about the capacity of the department to mitigate risk through contact tracing in anticipation of opening businesses and the economy.
The oversight chair, through several oversight hearings, meetings, and letters over the course of the last six months has consistently asked about contact tracing and the release of more information and sought action regarding these vital functions of DPHSS.
Senator Therese Terlaje stated, “Our goal has always been to ensure that DPHSS has the support it needs to effectively mitigate the impact of this virus in our community and that the public has confidence in the plans and implementation of the Department’s contact tracing efforts.”
Recently, DPHSS has publicly stated that with the surge in positive cases, there has been a lag with the initiation of a trace investigation from a targeted 24-hour period, aligned with CDC guidelines, to 2-3 days. The department advised that a call-out was made for help to close that gap and shared their current status and progress to address recent issues as well as short term and long-term plans for the island.
Workforce Capacity
Annette Aguon, Administrator for the Bureau of Communicable Disease Control, stated that they started out with 6 contact tracers and 6 investigators which has since increased to 20 investigators and 24 contact tracers to address the latest surge in positive cases. DPHSS is in the process of getting 14 more tracers and investigators through an Epidemiology and Laboratory Capacity grant and assured the Committee that they will have sufficient human resources to meet the need and catch up on the backlog from last month’s surge.
They also have plans to multiply their efforts through a recent training at UOG in conjunction with UCSF which trained 85 individuals that can be utilized in the private sector and other government agencies. In addition, they are looking at a pilot project of a team of 5 contact tracers at UOG to give some relief to their personnel, with plans to expand.
In addition, Dr. Suzanne Kaneshiro, Public Health Officer for the Division of Public Health, advised that the Department is using federal grants to open a new Bureau of Emerging Infectious Diseases, which will be fully staffed with contact tracers, nurses and microbiologists. Acting Director Art San Agustin is hopeful the Bureau will be fully operational next year and for the long term.
Funding
In response to inquiries from the Oversight Chair on the status of funding, Tommy Taitague, DPHSS Administrative Services Officer, advised that the Governor budgeted $313,000 of Coronavirus Relief funding for testing but it was reprogrammed for quarantine services for the first two months. An additional $397,092 was also allotted to DPHSS from this same funding source and currently is still available for the Department’s use for immediate needs and response to the pandemic. DPHSS also submitted a supplemental request in June to the Governor for $3 M for 30 additional staff, PPE, and equipment for DPHSS divisions directly responding COVID-19. This request was approved by the Governor but has not been allotted yet to DPHSS.
Public Health has received $6.1 M through an Epidemiology and Laboratory Capacity (ELC) grant and $1.2 M from a Community Health Clinic (CHC) grant. To date, $1.1 M has been used from these two funding sources, and about $6.2 M is still available for use on contract tracing, testing, and investigations and the division through 2022.
Containment and Technology
Dr. Chima Mbakwem, Projects Coordinator in the Office of Health Care Associated Infections Epidemiology at the Bureau of Communicable Disease Control, clarified that it is important to note the role of containment with respect to contact tracing. He stated that isolating positive cases and quarantining high-risk individuals and family members helps the contact investigation team by cutting off the infection at the point of testing by giving them time to investigate community transmission.
The SARA Alert app, an open-source tool that automates the process of public health monitoring and reporting of individuals exposed to or infected with COVID-19, is currently being used as a containment and monitoring tool for DPHSS. In addition, this app allows for a second module to be deployed when Guam opens its doors to tourists. This digital platform will replace the Emocha technology that will be phased out by the end of the year.
What was originally called SafePlace, or Pathcheck was launched under the name Guam COVID Alert today, which will function as another tool to help contact tracing to be more efficient and effective.
DOD Contact Tracing Data
Aguon advised that she meets weekly with representatives from AAFB, USNH, and GUNG who conduct their own contact tracing. Civilian contacts are referred to Public Health for testing if they are overwhelmed and cases or clusters are discussed at their meetings. Aguon advised that some delay in information was attributed to capacity limitations such as the ones we see in her bureau. DPHSS receives case summaries and breakdowns of veterans, dependents, service members which will be added in the planned weekly summaries that will be issued by the department.
Public Disclosure of Information
After months of urging by the Committee to disclose information that would be useful to the community to determine if they are at risk of exposure, DPHSS is currently reviewing a legal opinion it received yesterday from the Attorney General regarding the public disclosure and the parameters of information that can be released to the public. Acting Director San Agustin advised that the AG opinion recommended that disclosure of information be related to the work of contact tracing.
With plans to streamline the daily situation report and release a weekly surveillance report that provides more information, protocols are being developed based on the recent AG opinion, that will inform the release of the type of establishments or activities where there are known COVID clusters.
Senator Therese Terlaje emphasized the importance of disclosing information immediately regarding establishments and gatherings in order to ensure the community can take necessary precautions to keep their families safe.
“All of the businesses are clamoring for this data. They want our closures to be data-driven and risk-driven” said the Senator. She reiterated that the public will be supportive if it makes sense to them. “Residents want to know why certain businesses are closed and why certain ones are open and that all of our lockdowns are based on solid information.”
The Senator closed by congratulating the department on the release of the Guam COVID Alert App today and is encouraging the community to download it. Assurances of privacy were given by Apple and Google and the experts in the non-profit foundations and MIT. The app will not be effective for Guam unless we get 60% of our population signed on within the next week.
To see the full public hearing, click on this link or the video below:
As the oversight chair for Health, I am sharing facts regarding Substitute Bill 282-35 recently passed by this body and forwarded to the Governor for action. I have confirmed with the Director of DPHSS that the budget amount provided in Sub Bill 282-35 is enough to fund current staff and will not necessitate furloughs or reduced hours, despite threats in recent press releases or media reports. This is consistent with what OFB assured us during budget deliberations. DPHSS also told me last week that about $4 M in direct federal CARES Act funding may be used to hire 80 to 90 additional staff to respond to their needs related to COVID-19 response. In addition to this direct federal funding, DPHSS has yet to receive from the Governor the supplemental request made by former Director Linda Denorcey in June for $3 M in Coronavirus Relief Funds to support its divisions, like the Division of Environmental Health or Division of Senior Citizens who provide services on the frontlines or enforce the mandates under the public health emergency.
During discussion on the Public Health budget section, DPHSS testified and I also confirmed last week again with the Department that while the local funding amounts in the original Sub Bill were not adequate to meet the Medicaid match, the anticipated prior year lapses for Medicaid and MIP, included in the bill as amended, should be enough to match and access the full federal Medicaid amount of $129 M for FY 2021. The local match appropriation for the Children’s Health Insurance Program (CHIP) is about $2 M less than what is needed to access the full federal CHIP potential, however, Sub Bill 282 provides the same amount of funding that BBMR proposed in its rebuttal budget to OFB for CHIP. As described during budget deliberations, DPHSS must receive its lapses and transfer authority as provided by law and reaffirmed by Sub Bill 282, as amended, to maximize Medicaid, CHIP and MIP during FY 2021 for the many displaced workers who may have lost jobs and health insurance.
OFB estimated that the Governor’s 15% transfer authority would equal approximately $27 M and would be more than adequate to meet the $2.5 M overall shortfall for DPHSS compared to FY 2020.
As I repeatedly stated during our budget deliberations, prioritizing DPHSS is imperative to getting the island through this public health emergency, taking care of our residents, reopening our schools and businesses safely, and bringing back our tourists. However, I do not believe it is prudent to merely pretend to fund agencies or balance the budget by adopting higher revenues than what could be justified by OFB amidst all of the economic uncertainty. The Legislature must act reasonably under the current circumstances to hold government spending within its means and not exacerbate the challenges we face in making debt payments, prompt payment of tax refunds, the provision of healthcare and critical services and to meet the new challenges families face because of the months-long health emergency. There was some support for my proposed amendment to the budget that attempted to appropriate an additional $6 M for DPHSS operations on a quarterly basis based on actual excess collections of quarterly withholding and corporate revenues, but ultimately that failed. This option would have ensured additional revenues are appropriated to DPHSS on a quarterly basis but only when and if they are actually collected, and should be considered anew by the Legislature moving forward.
I plan to introduce this option again as a separate bill and have other proposed legislation that may tap other possible funding sources for DPHSS’ needs. Thus far there have only been four options presented with the FY 2021 budget and that is to either (1) adopt higher revenues than what OFB is predicting, (2) take any excess revenues each quarter and appropriate to DPHSS as the actual revenues come in, (3) allow the Governor to transfer funds from other parts of the budget to meet any shortfalls or (4) cut more than the $64.6 M already being cut from agencies. The bill as amended also allows the Legislature to examine excess revenues on a continuing basis and appropriate those collections as needed. We all must continue to look for alternate ways to assist DPHSS beyond the limited options discussed during our budget deliberations.
Sub Bill 282 with its $64.6 M in spending cuts from FY 2020 is by no means the easy way out. Yet it attempts to reflect the gravity of our current economic conditions, and provides tools for maximum flexibility under the circumstances by allowing the Governor to transfer approximately $27 M to any agency in need, envisions the continued use of CARES Act and federal stimulus to supplement public health and safety requirements, and allows for focused allocation of excess collections on a quarterly basis during FY 2021 to meet the critical needs of our community yet without appropriating beyond our proven means.
It is important as we move forward in addressing any shortfalls in the budget that actual facts and figures are used from the agencies impacted, and that misdirection and intimidation are left out of the budget process.
Senseramente,
Therese M. Terlaje
CC: Art San Agustin, Director, Department of Public Health and Social Services
FOR IMMEDIATE RELEASE (September 1, 2020 – Hagåtña, Guam)
After months of hearings and weeks of budget discussions, the FY 2021 budget passed with a vote of 13 – 2. Senator Therese Terlaje, the Oversight Chair for the Committee on Health, Tourism, Historic Preservation, Land and Justice, voted in favor of Bill 282-35 as substituted by the Committee on Appropriations.
We should all be horrified that Public Health was not the priority of the original bill in the middle of a pandemic. A $66 million cut across the board would definitely impact services provided by the government of Guam, but it should not have been on the back of the very department that we must trust to get the island through this public health emergency, take care of our residents, reopen our schools and businesses safely and bring back our tourists. “We tried our best to support the projections of the Office of Finance and Budget, with or without the cooperation of the administration, but the bill in its original form would have left the Department of Public Health and Social Services budget with a $13 M shortfall in operations and short on the local match to ensure Guam accessed the full availability for Medicaid insurance,” said Terlaje.
“Through our amendments, we fully funded the Medicaid local match according to DPHSS testimony and restored approximately $1.4 M to DPHSS operations. We removed all earmarks from other Public Health funds except Medicaid allowing them flexibility and leaving them overall a total of only $2.1 M less than FY20,” stated the Health Committee Chair. The Senator attempted to dedicate an additional $6M for DPHSS operations through quarterly excesses in withholding and corporate revenues, but ultimately that failed, noting that additional funding sources will be sought through the rest of the term and faith will have to be placed in the Governor to utilize federal funding and her 15% transfer authority of approximately $27M to shore up $11M in public health operations during the emergency.
The Oversight Chair also noted that GMH will be receiving $750,000 more than in FY20 to improve patient care and safety, that it is authorized to hire nurses and respiratory therapists without limitation, and that it will be paid 2.8 million for services provided to DOC.
Senator Terlaje stressed that Public Health must succeed in FY21 as the safety net when all other possibilities have failed: in rapid tracing and isolating the COVID virus, in inspections and guidelines for the safe opening of businesses in our new economy, providing childcare so parents can work, safe guidelines for schools, the prevention of cancer and diabetes that are killing our people too early, expanded community health centers and health insurance, and food for families who have lost their income.
In closing, Senator Terlaje stated, “For Public Health and all agencies to succeed despite the cuts, we must wisely use the transparency and flexibility tools provided to us by this bill, as a legislature and as a government, to act swiftly and focused and to work together for all of our community who are counting on us.”
Other amendments Senator Terlaje incorporated into the Budget include:
Prioritized the Guam Memorial Hospital and Fought for DPHSS Operations
Funded and support for the hiring of nurses, public health personnel, respiratory therapists, contact tracers and investigators along with other health professionals for frontline agencies with required reporting for accountability
Authorization for DPHSS to utilize all unexpended balances
Removed restrictions on funding MIP and carried forward lapses for MIP and Medicaid to ensure maximum access to federal match
Gave transfer authority to DPHSS, providing flexibility to address shortfalls as needed
Prioritized DPHSS for any excess revenue from the Healthy Futures Fund
No cuts to GMH Operations from FY20
Ensured the payment to GMH for health services provided to DOC
Supported a fee study allowing for the alignment of GMH rates and fees with Medicare rates
Carried over the appropriation of $10 million for the GMHA Capital Improvement Fund which remains unpaid from FY2020
Alignment of Judicial Agencies and Protection of Funding Sources
Supported access to qualified and experienced attorneys for the Judicial Branch
Carried forward lapses for indigent defense to ensure full funding for Public Defender Service Corporation and Alternate Public Defender
Protected the Victim/Witness Housing/Travel Fund
Accountability Measures for the Government of Guam
Supported the public vetting of exemption to the ban on hiring a lobbyist
Ensured public scrutiny of bond refinancing
Mandated the reporting of payments toward prior year obligations for increased transparency
Pushed for progress past the planning stage by appropriating funds for the construction phase of Simon Sanchez High School
Support and Protection for Land and Historic Preservation
Provided CLTC access to legal services for non-litigation and land registration matters
Protections for CLTC Survey and Infrastructure Fund
Appropriated excess Tourist Attraction Fund revenue to DPR for the maintenance of restroom facilities, public parks, cultural sites, and the Guam Historic Resources Division
Rebuilding Tourism
Lump-sum funding and the carry forward of lapses for greater flexibility for GVB
Aligned public law for GVB procurement to correct audit deficiencies
Protects GVB’s access to Tourist Attraction Funds at the end of the Fiscal Year
FOR IMMEDIATE NEWS RELEASE (August 24, 2020- Hagåtña, Guam)
During today’s budget hearing, Senator Therese Terlaje attempted to lock up any excess revenues collected under withholding and corporate taxes for the Department of Public Health and Social Services in FY 2021. The proposed amendment would have appropriated all fiscal year 2021 withholding and corporate income tax revenues collected per quarter in excess of the revenue level adopted (or ‘revenue budgeted’) for that quarter as reflected on the monthly CRER to the Department of Public Health and Social Services for expansion of its environmental health inspections, its other regulatory purposes and other DPHSS operations, but not to exceed $6 million for the entire fiscal year.
“We are being tasked to make hard decisions and difficult cuts. The Office of Finance of Budget has cut DPHSS by $3.5 million overall and $13 million in operations, and the Department is still short $9.8 million to fund our full match in Medicaid and $2 million in CHIP. This amendment simply ensures that if there is excess revenue, that it is appropriated to the agency that is going to continue to get us through this health emergency for their operations over any other priority of the Government of Guam,” stated Senator Therese Terlaje.
Senator Terlaje further stated, “If we don’t lock this money up right now for public health we may never see it again. Last year we appropriated $10 million in excess revenues from FY 2019 for capital improvements at GMH and have yet to see these funds transferred by the administration, even though it was signed into the FY 2020 budget law and there was more than $30 million in excess revenues available.”
During the discussion, Senator Terlaje noted that the current substitute bill for FY 2021 appropriates $13 million less for DPHSS operations than what was earmarked in FY 2020 for the basic operations of public health that could not be funded by new CARES grant funding.
The Terlaje amendment failed with 7 votes in favor and 8 votes against. Senator Therese Terlaje thanks Vice Speaker Nelson, Legislative Secretary Shelton, Minority Leader Senator Taitague, Senator Perez, Senator Moylan, and Senator Castro for their support on the amendment.
Senator Perez Introduces Bill to Clarify Emergency Health Powersand Create Task Force
Hagåtña, Guam – On July 30, 2020, Bill No. 386-35 (COR), introduced by Senator Sabina Perez and co-sponsored by Senator Therese Terlaje, will tie emergency health powers to local procurement law and create a public health emergency purchasing task force.
During the coronavirus pandemic, the government of Guam cited its emergency health powers to bypass traditional emergency procurement laws when contracting quarantine facilities. Emergency procurement laws are intended to provide a means of speeding up the process by which the government purchases goods and services during an emergency, while still maintaining safeguards to prevent abuse or waste. Following the local decision to utilize emergency health powers instead of emergency procurement law to contract hotels, it was found that several facilities were paid for prior to securing signed contracts.
“The initial procurement of the quarantine facilities underscores the need to update our laws to ensure the entire government is on the same page,” said Senator Perez. “We cannot continue to have differing interpretations of the law. Bill 386-35 ensures consistent application of procurement processes when emergency health powers are declared, improves transparency, and holds accountable those involved in the procurement process,” Senator Perez added.
Bill 386-35 clarifies that all purchases made under emergency powers must go through established procurement processes. By having emergency purchases conducted within the scope allowed by procurement law, the bill closes the loophole of purchases being made without proper safeguards. The procurement law is intended to protect the people’s money and ensure that government is following the law.
Bill 386-35 also creates a task force that must be ready to respond in the midst of an emergency, such as the pandemic, and also prepare for future emergencies. This task force, which includes the Chief Procurement Officer, will be responsible for all procurement, management and staffing of the procurement for all supplies and services needed to address a public health emergency. “This task force will facilitate communication with frontline agencies and the Governor and respond to the needs of agencies and the community during the pandemic,” said Senator Perez.
The bill requires that properly trained procurement personnel be involved from the start of an emergency. This ensures procurement decisions are not made in isolation by one branch, but collectively by the task force.
“I want to sincerely thank Senator Perez for holding an oversight hearing on the emergency procurement conducted during the COVID-19 health emergency and for introducing this legislation. The oversight hearing uncovered the blatant disregard of Guam’s procurement law. I understand we were in an unprecedented health emergency at the time, but we have faced many other emergencies before and managed to work within the law. Our government must do better at adapting and improving emergency procurement rather than ignoring it,” stated Senator Therese Terlaje.
“During these uncertain times, it is even more critical that our government utilizes public funds wisely. Our local procurement laws safeguard public funds through transparency and accountability measures. As a result, it is essential that government officials work for the public good by upholding and implementing our local procurement laws,” said Senator Perez.
