FOR IMMEDIATE RELEASE (May 8, 2020 – Hagåtña, Guam) – Senator Therese Terlaje, Chair for the Committee on Health, and Senator Joe San Agustin, Chair for the Committee on Appropriations, held a critical oversight hearing today with the Department of Public Health and Social Services.  Attending the hearing along with senators from the committee were key staff of the DPHSS including its Director, Linda DeNorcey.

The main purpose of the oversight was to hear whether the Department had sufficient resources, including funds, staff and supplies, to be able to handle its continuing role in COVID response, risk mitigation, and recovery efforts as businesses and government services re-open.  This would gain a better understanding of the department’s available resources through the fiscal year and how federal funds may impact programs. 

The hearing particularly focused on whether personnel, equipment, supplies and allocations to DPHSS in the recent CARES budget prepared by BBMR are sufficient to respond to increased demand for public assistance, ensure testing capacity to support safe reopening of the community, and prompt contact tracing capacity to swiftly quell any spread.

Public Assistance

Tess Arcangel, Chief Human Services Administrator, clarified the eligibility and processing status of Supplemental Nutrition Assistance Program (SNAP) applications, stating that only income levels, citizenship and residency are considered.  An applicant must meet the income threshold of 165% of the federal poverty level and must be a US Citizen or legal alien.

If an applicant has lost hours or is unemployed, Public Health can cross check with the unemployment list provided by the Department of Labor or the applicant may attest to it under penalty of federal law.  Most applications are being processed within 24 hours.  Benefits may be uploaded and available within the same day.

According to DPHSS, SNAP recipients already qualify for the recently launched Prugåman Salåppe’ Ayudon I Taotao.  The list of eligible recipients has been provided to the Department of Administration for assistance checks to be cut.  New applications for the program are available for those who may not currently be on the SNAP program and residents are encouraged to apply if they meet the requirements.

Medicaid and MIP are also available to cover those who may have lost health insurance coverage due to unemployment. Senator Telo Taitague noted special concerns over the current appropriation for the MIP program as the $ 4.4 million dollars has already been spent.  Although $3 million was put back into the program with the expansion of Medicaid funding, there may still not be enough funding to carry through to the end of the fiscal year.

Procurement

Specific attention was paid to the role of the Department and its Director with respect to her authority under the Islan Guahan Emergency Health Powers Act under 10 GCA Chapter 19.  Although Section 19502 of the statute gives the director clear authority over procurement of facilities, she clarified her role has been procurement within DPHSS for supplies and contractual services with all requisitions routed through General Services Agency (GSA) and that she did not procure any of the services for isolation and quarantine facilities.

CARES Act and Funding

Director DeNorcey and Tommy Taitague, Administrative Services Officer, advised that there is a total of $16 million in awards from multiple federal grants that will cover various programs including senior citizens, crisis response and emergency preparedness.

There were concerns raised by the committee with regard to how the nominal $397,000 proposed in the government CARES Act budget would be expended.  Tommy Taitague shared that it is a partial reimbursement of $1.2 million already expended.  The request provided to BBMR only included expenses already incurred, but did not include projected expenses because they will be availing of federal grants.  When asked by the Chair if the money was enough to fulfill the agencies requirements to keep us safe, he admitted he was uncertain and that personnel costs were coming from the DOA allotment of $22 million to cover hazard pay but overtime could possibly come from the agency’s existing budget.

Enforcement of PCOR2

DPHSS created guidelines for which businesses could open under Pandemic Condition of Readiness 2 (PCOR2) as outlined in DPHSS Memo 2020-07.  Guidance has also been assembled which would provide those businesses with criteria on how to safely operate by implementing social distancing policies, required training, signage and the proper sanitizing of high traffic and high touch areas.

Senator Terlaje inquired about the role and available resources of the Division of Environmental Health (DEH) with regard to enforcement of these new reopening guidelines.  Tom Nadeau, Director of the Division of Environmental Health advised they don’t have enforcement authority for pandemic operational guidelines with the exception of businesses that fall under the Guam Food Code, and that they remain at the same staffing levels as before the pandemic.

There are no current plans by DPHSS to increase enforcement personnel and the division has traditionally been understaffed to meet their inspection mandates and public expectation.  Director DeNorcey advised that the federal funding is very specific to the grants that have been awarded, with none going to DEH.

Residents may call the department to report violations or concerns about these operational guidelines and the calls will be dispatched to the proper division.

Division of Senior Citizens

Most of the programs for Senior Citizens are in operation, according to Arthur San Agustin, Administrator of the Division of Senior Citizens, including meal deliveries, transportation and caregiver support.  There is a significant spike in services such as the nutrition program and food delivery program.  Though the division is understaffed, funding has been received from both the Families First Coronavirus Response Act and the CARES Act to enhance support services which includes the need to modify operations to comply with new health and safety guidelines.

Contact Tracing

Funding has been identified for hiring to expand investigations, contact tracing and surveillance, according to Annette Aguon, Contagious Disease Coordinator.  Cross training of existing employees and cooperation with the University of Guam was also being added for scalability of the program, as needed.

Aguon also advised that with the increase in staffing, it currently takes 1-2 days to complete an investigation which includes the home, workplace or community settings of a positive patient.

COVID-19 Testing Capacity

GeneXpert and ABI 7500 testing modules are currently being utilized by the public health lab.  The test kits are being ordered from the CDC with a weekly allowance being disbursed, although there have been shipping delays.  The department advised that even if there is a low supply of test kits, it shouldn’t prohibit testing because Diagnostic Laboratory Services continues to operate.  In addition, GRMC and GMH have also expanded testing capacity for the island.

Validation testing for samples tested with the Abbott ID module proved that the 1 ml transport medium did not affect the testing.  The machine was moved to the northern facility as recent guidance issued by the manufacturer requires swabbing to be done on the spot with samples tested immediately.

5000 more test kits will be arriving and DPHSS is coordinating activities with another company that would assist with expanding testing capacity to 1000 units per day.

In response to an inquiry from Speaker Barnes, Director DeNorcey confirmed that she disallowed the use of non-FDA approved tests.  Dr. Janna Manglona of DPHSS confirmed that EUA tests can be used according to the Physician’s Advisory Group.

“I recognize the huge burden that has been placed upon DPHSS to keep us all safe through this pandemic. I’m thankful for the director, division heads and all the hard-working staff for the proactive team approach they have taken to address this public health crisis on top of existing critical health and public welfare mandates.  The attendance and concern expressed by my colleagues at the hearing echo the public’s concern that DPHSS be able to attain the supplies, personnel, and other help it needs to adequately address the continuing health risk and expanded safety precautions going forward,” stated the Oversight Chair.

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FOR IMMEDIATE RELEASE (August 31, 2019)– This budget is not perfect, it still has some fat and some agencies will be hard pressed to achieve more than the status quo. We will have to rely not just on management, but also on every government employee to find efficiencies.

But this budget does have some good things in it. This budget adds 50 new police officers, if everybody can do their part to get those processed.

It also adds money to expand our children’s shelter and get at least 24 more of the 200+ homeless children safely off the street, and to support the Autism Shelter.

This budget sets aside for tax refunds, and sets aside a rainy day fund for reduction of the deficit.

This budget allows flexibility for the Governor in areas where there may be critical shortfalls and for DPW to focus on the roads.

This budget also locks up $10-million for the first time in years toward repairs and safety, and CMS approval at the Guam Memorial Hospital while we confirm the long-term plan. I hope in good faith that this money does not get diverted.

All the rest, we will have to work harder on throughout the year.

I would like to thank my colleagues for their debate of the issues and support of sometimes controversial amendments. I would like to thank the Office and Finance and Budget and the Legislature’s staff for their hard work.

Most importantly, I would also like to thank the people of Guam for their attention and for continuing to care about our island and government. Thank you for sharing your thoughts and advice with us throughout this entire process. Together, with focus and hard work, we can go forward and address even those long-standing challenges one by one. I humbly ask that you never stop asking questions and never stop expecting better.

Si Yu’os Ma’åse’

FOR IMMEDIATE RELEASE (August 29, 2019) — Hoping to lead by example, Committee on Health Chairperson Senator Therese M. Terlaje’s attempted amendment to cut the Guam Legislature’s budget in order to purchase medical equipment is ruled out of order.

Because the FY2020 appropriations for the Guam Legislature is above the FY2019 levels, Senator Terlaje moved to cut $424,345 and appropriate the funding to the Guam Memorial Hospital for medical equipment and supplies including an anesthesia machine and dialysis machine. The amendment was co-sponsored by Senator Amanda Shelton and Senator Sabina Perez.

With all due respect, everyone is working hard. We have seen a reduction in salary below many people in the Government of Guam, and we’re all in need of more staff. However, when we look at many of our government agencies, like GMH and DOE, who we’ve asked to tow the lines to 2019 levels with a reduced budget, we have to do the same in the Guam Legislature.

Senator Therese M. Terlaje, Committee on Health Chairperson

The attempted amendment was ruled out of order by the chairperson since it was not offered while on the page for the Guam Legislature’s budget. A motion to overrule did not receive enough senatorial votes.

While the amendment was not included in the budget bill, Senator Terlaje plans to introduce legislation regarding this proposal.

Lawmakers completed discussion on Bill 186-35 and rose from the Committee of the Whole. The budget bill was placed in the voting file. Session vote will resume Saturday, August 31, 2019 at 9:30pm.

FOR IMMEDIATE RELEASE (August 28, 2019)– Committee on Health Chairperson Senator Therese M. Terlaje thanks her colleagues for their unanimous support in moving forward with a budget bill amendment to help the Guam Memorial Hospital. 

A day after being shut down for trying to lock up potential Fiscal Year 2020 excess revenues, Senator Terlaje amended the budget bill to provide $10-million of excess Fiscal Year 2019 income tax and business privilege tax revenues and deposit into a newly created Hospital Capital Improvement. Use of these funds require a public hearing and legislative appropriation. The amendment passed late Tuesday night during session. 

The latest version of the budget bill only appropriates $28-million to GMH primarily for operations. Bill 186-35 did NOT address GMH’s critical Capital Improvement Projects. GMH outlined $57-million worth of CIP; however set its top three priorities including a new electronic health records (EHR) system, electrical panel replacement, and structural roof repair. The EHR system is estimated to cost $21.8-million, the electrical panel at $6-million, and the structural roof repair at $5-million. These projects have been looming for years and are critical mandates raised by the Centers for Medicare and Medicaid Services (CMS). 

According to the latest Consolidated Revenue and Expenditure Reports and further confirmed by the Bureau of Budget and Management Research during session, GovGuam is “tracking $14-million in revenue above the amounts appropriated for the general fund,” with two more months to go (until the end of FY2019). 

These projects are critical, and not a luxury. We can’t look the other way when we know there are critical issues that need to be addressed at Guam’s only public hospital. While these excess funds won’t address all of GMH’s critical projects, it’s a start to get at least one done for sure. With concerns raised by CMS, and more importantly the safety and care of our patients and doctors at risk, I want to thank my colleagues for prioritizing health and addressing these issues that have been ongoing for years.

Senator Therese M. Terlaje, Committee on Health Chairperson

STATEMENT FROM SENATOR THERESE M. TERLAJE:

I am extremely disappointed this amendment didn’t pass in the Budget Bill. I want to thank my colleagues who voted in favor of helping the Guam Memorial Hospital. 

This amendment was aimed at holding our government accountable. This fight is not over. We need to stand our ground in this Legislature and demand that we see where any excess money is spent. More importantly, the people of Guam deserve to know this information. 

As we move forward with discussions, I’ll continue to work with my colleagues to address these issues whether in this budget bill or in separate legislation.

During discussion on Bill 186-35 or the Budget Bill for Fiscal Year 2020 on Monday, Senator Terlaje proffered an amendment to set aside excess income tax and business privilege tax revenues collected every month and deposit into a newly created “Hospital Capital Improvement Fund.” 

Senators who voted with Senator Terlaje in favor of the amendment include Vice Speaker Telena Nelson, Senator Amanda Shelton, Senator James Moylan and Senator Telo Taitague. 

The amendment would have required that excess money collected would be set aside into the Fund, and safeguarded or “locked away” from transfer authority or expenditure. For full transparency, the use of these funds would have to be subject to a public hearing and Legislative approval. 

Bill 186-35 currently does not address GMH’s critical Capital Improvement Projects. GMH outlined $57-million worth of CIP; however set its top three priorities including a new electronic health records (EHR) system, electrical panel replacement, and structural roof repair. The EHR system is estimated to cost $21.8-million, the electrical panel at $6-million, and the structural roof repair at $5-million. These projects have been looming for years and are critical mandates raised by CMS.

Watch discussion on the amendment in the Budget Bill: http://bit.ly/2U3O4io

Media Coverage:

5 senators vote to assist GMH with infrastructure funding http://bit.ly/2zqbyEM (Guam Daily Post)

Administration balks at monthly budget surplus set-aside http://bit.ly/2U3iL7s (KUAM News)

Senators start trying to divvy up excess revenues for hospital, village roads http://bit.ly/3257NkA (Pacific Daily News)

Source: KUAM News Story
http://www.kuam.com/story/40442816/2019/05/Thursday/how-will-critical-hospital-projects-be-funded

How will critical hospital projects be funded?

By Chris Barnett CONNECT

How will the hospital’s urgent capital improvements projects be funded in the Fiscal Year 2020 budget? That’s the question health oversight Sen. Therese Terlaje is asking. 

She said the governor’s Guam Memorial Hospital budget request is missing funding sources for major capital improvement projects.

“In particular three that are urgent that are not at all included in their budget request,” she said. “So I haven’t heard a plan as to how those are going to be funded and why they’re not included in the regular budget request.”

The hospital asking for $61 million for FY2020. $25 million would come from special funds. The remaining $36 million – which cites no funding source – slated to be used for capital improvement projects and operations.

Three of those projects deemed “urgent” by GMH – a $20 million information system the hospital has noted would help answer Centers for Medicaid & Medicare Services reporting requirements quicker.
– A $6 million power upgrade to GMH’s electrical panel. CMS citing this as a hazard for the hospital
– A $5 million structural roof repair

“The roof that’s just common sense at this point,” Terlaje said. “We can’t have patients and our families walking in there with a leaking roof. They’re not going to have any comfort in the care they’re going to receive if we can’t fix the roof.”

The senator said she’s not sure why Adelup would leave these projects’ funding source off the table. These three items raised the eyebrows of CMS, jeopardizing GMH’s Medicare status.

“I’m trying to keep my eye on the revenues that are being brought in,” Terlaje said. “The revenues that were projected to be brought and the reports right now look like they’re bringing in more that they’ve projected to bring in and if that’s the case, then I can’t see why we’re going to delay giving to the hospital what it needs especially for these projects.”

Magah’aga Lou Leon Guerrero, during a tour of the hospital in February, pledged $30 million to GMH and that’s how much Terlaje says these projects will cost. The governor said at the time she would address GMH’s yearly $30 million shortfall with $6 million from a CMS adjustment to GMH’s base rate and by stepping up tax collections.

“We don’t really need to wait for a dedicated funding source to fund the hospital,” the governor said. “My contention has always been that if the hospital needs $30 million from the government to make sure that our patients and our people are given the quality of health care than we need to give the $30 million.”

We tried to follow up with the governor, but our requests for an interview were declined, and Adelup Spokeswoman Krystal Paco said KUAM may have taken the governor’s comments “out of context.”

Meanwhile, Terlaje says if there are excess revenues available, they need to be put on the table for an accurate read of GovGuam’s finances heading into the FY20 budget hearings.

“If they’ve got another source of funding this, I think that should be put up front,” she said. 

Hospital CEO Lillian Posadas tells KUAM News from February to April, the hospital received $10.7 million from CMS’ rebasement. That money covering FY 2014-2018.