Too Many Chiefs; Not Enough Workers At J.F.L., Testifiers Say

ST. CROIX — The Juan F. Luis Hospital has too many nurse managers and not enough certified nursing assistants (CNAs), a situation that has left the small amount of registered nurses who are actually working in patient care, strained. The problem has slowed the pace of care in the hospital, and patients have had to wait sometimes well over 12 hours in the facility’s emergency room before being tended to.

But that’s just for starters. Upper management appears not to have a handle on the daily operations of the hospital. Yet, J.F.L. is a top-heavy establishment with managers in many areas, a lot of which were deemed unnecessary by board members, employees and senators at Tuesday night’s hearing at the Fritz E. Lawaetz Legislative Hall here.

Theresa Frorup-Alie, a J.F.L. board member, and Jacqueline M. Canton, executive chair of the Registered Nurse Leadership Union, both spoke of the medical facility as being laden with  multiple issues.

“When I hear about $15,000, and $10,000 and $20,000, and then I receive letters from the head nurses that they’re lacking in so many ways, I don’t see how if CMS comes tomorrow we will be in good standing, based on what you’ve just received,” Ms. Canton said. She was referring to a letter sent to her by nurse managers in the hospital, as well as the recent scandal over bonuses that former C.E.O. Ken Okolo and Tim Lessing gave themselves.

Ms. Canton said the letter highlighted a lack of staffing; an unsustainable nursing ratio in a 41-bed unit of eight patients to one nurse; no unit secretary even if one was requested since last year; a lack of functioning equipment and a surge in the amount of duties that nurse managers are forced to perform even while taking care of staff duties. And there’s a problem of nurses being overworked as well, which has resulted in an increase in call-outs and nurses who leave the hospital altogether. Ms. Canton estimated that about 40 nurses had left the facility from 2012 to present.

She noted that nurse managers are always on call, and if a unit is not staffed, they could be called even out of vacation. “Those are the staff who need bonuses,” she said. And nurses retirement money in some instances are not being sent to the Government Employees Retirement System, Ms. Canton said. Furthermore, there’s an education department within the hospital where nurses — who no longer work on the floor — are paid $100,000 salaries. The education department, which includes a director, two associate directors and one nurse, are supposed to educate nurses if they’re struggling in a particular area of their practice, as well as to serve as an in-house clinic for the nurses, according J.F.L. Interim CEO Richard Evangelista. But Mr. Evangelista was unable verify whether the nurses in the education department were performing their duties.

Board member Frorup-Alie shared Ms. Canton’s concerns, and added some of her own as well.

“I am in agreement that the hospital is top-heavy administratively. It has entirely too many chiefs of this and chief of that, and manager of this and director of the other. And I have a problem with when I go to the emergency room with my husband, who suffered a heart attack week before last Wednesday, and you have one ER doctor, and there are 27 people in there waiting to be seen.

“When I see a little child 15 years old sitting there from after 5:00 p.m., crying, and I got there at 7:19 p.m. and his father is telling me he broke his hand riding bike and can’t be seen yet by somebody in the ER, I have a problem with that.

“And when we pull RNs and put them in administrative positions to walk up and down in a suit and wave a paper, talk on a cellphone, post things on Facebook — I have a problem with that when we have urgent care that needs to be taken care of.

“We have to many hierarchical bureaucracy and we’re playing with the lives of the people that walk into that institution,” Ms. Frorup-Alie said.

She said the hospital is saturated with non-essential individuals, and that for ever $1 the hospital takes in, $.77 is used for payroll, a ratio that is not sustainable, she said.

Senator Kurt Vialet, who, along with members of the Committee on Health, Hospitals and Human Services will meet J.F.L. board and hospital top brass in two weeks, said he could not understand why it was taking the hospital so long to implement simple changes.

He noted that many of the issues facing J.F.L. could be rectified through straightforward actions. But “it seems like you need all types of decision-making meetings before you could make a basic decision. Anybody who walks into the hospital could tell that you need more CNAs,” he said.

“These concerns are so serious that you guys need to address these concerns directly, and develop a plan as to how you’re going to deal with these concerns,” Mr. Vialet  went on, admonishing the board. “All of that politics — who’s getting this money and who’s getting that — those are the real concerns.”

Upper management seems to be so out of touch with its rank and file that a nurse who has been working at the hospital since April, and who as already made plans to exit the facility, is doing so because she hadn’t been paid since starting work at the hospital. Asked about her situation, none of the board members could explain, but Mr. Vialet was able to produce a document that showed her name on a list — yet hospital officials failed to explain why the employee hadn’t been paid. All of this while Mr. Lessing was able to pay himself a bonus of $15,000.

A myriad of other issues were discussed at the momentous hearing. And senators were united in expressing frustration and demanding change. Senator Kenneth Gittens, a non-committee member, used his eight minutes to assail the board and senior staff of the hospital, and said he would request additional funding for the Office of the Inspector General to perform an all-encompassing audit of the hospital.

Even so, Mr. Vialet sought to end the discussion on a positive note, stating that while the problems are many, he believed the end result would be a medical facility that could provide optimum care to its patients.