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SIXTEENTH LEGISLATURE COMMONWEALTH NORTHERN MARIANA ISLANDS Honorable Jesus P. Mafnas Memorial Building, Capitol Hill Saipan, MP 96980 September 18, 2009 Honorable Benigno R. Fitial Governor Commonwealth of the Northern Mariana Islands Capital Hill Saipan, MP 96950 Re: Public Health Crisis at the Commonwealth Health Center Dear Governor Fitial: The situation at the Commonwealth Health Center (CHC) has reached a state of crisis that demands your immediate action, As a result of continued stafling shortages, regular physician turnover, and low employee morale, the quality of care at CHC has steadily declined. Commonwealth residents are reluctant to seek treatment following a series of unfortunate and high-profile reports of accidents involving CHC patients. ‘The modest resources of the Department of Public Health are continually drained by expensive off island referrals, the practice of engaging medical headhunters (at cost of $25,000 per successful physician hire), and an inefficient billing system, Finally, the CNMI Government continues to pay out malpractice judgments that in many cases could be avoidable under proper operating conditions. We are alarmed by the absence of a competent management team at the Department of Public Health and CHC. We understand that the Secretary of Public Health is currently unable to discharge his official duties. We do not understand, however, the failure to appoint qualified interim managers to oversee the Department's and CHC’s daily operations. We call upon you to act immediately to hire these critical staff members before the crisis escalates. ‘As a point of reference for identifying and hiring a capable healthcare manager, we direct you to the provisions establishing a “Chief Executive Officer” proposed in House Bill 16-9, HS1 §2807(a)-(c) (referenced below). In addition to our request for the immediate retention of qualified public health professional/s, we wish to inform you that the Commonwealth Legislature will soon begin CHC oversight proceedings. We feel it is our constitutional duty to protect the health and welfare of our residents through diligent monitoring of the Commonwealth's financial outlays. ‘To this end, the House Standing Committee on Health, Education, and Welfare and the Senate Standing Committee on Health and Welfare will conduct public input and CHC oversight hearings beginning next week, We are aware that the commencement of oversight proceedings could be perceived as political posturing, particularly during an election year. At the same time we are sure that you agree that the situation at CHC is now so acute that any and all remedial measures must be explored. Not only are patients potentially at tisk, so too are payments from the Medicare and Medicaid programs. The Legislature is ready to work with your administration to develop both immediate and longterm solutions to the problems at CHC, provided that swift, effective action is our guiding: principle. We feel that any corrective action must begin with the retention of a Qualified médical management team, but there are other measures that may be taken as well: The comprehensive assessment of CHC begun by Dr, Donald Bader (but not complétéd due-to a lack of funding) is an important first step in identifying systemic problems, in the department and conftonting them before they adversely impact public ‘health, For our part, we are willing to support corrective legislative action, including but riot limited to House Bill 16-9, HS1, entitled, a bill for an act establishing a corporation for public-healthcare and related public health services, H.B. 16-9, HS1, now pending in {the Senate, is a top legislative priority that has received support from your office in the past, At its core the CHC crisis is a problem of effective governance, In the long term, ILB. 16-9, HS1 provide a foundation for a “high quality, efficient, and market-oriented public healthcare delivery system” for the people of the CNMI. In the near term the task is more pressing: the Executive Branch must recruit qualified professional staff to effectively manage CHC operations. We urge you to give this effort top priority, ‘Thank you for you for your immediate attention to this serious matter. We look forward to working together to develop a solution that will best protect the health and welfare of the people of the CNMI. Sincerely, th P. REYES. ee tive La I. PALACIOS President of the Senate Sfeaker of the House of Representatives CC: Senate Memory ~ House Members Senate and House Clerk Senate and House Legal Counsels