GMH cash crunch threatens to halt non-emergency surgeries
The cash crunch at Guam Memorial Hospital is causing a supply shortage that threatens to cancel all non-emergency surgeries, according to this month's GMH board meeting.
One doctor has turned to using his own money to obtain supplies needed to continue providing anesthesia for surgeries.
Hospital Administrator Lilian Perez-Posadas asked all members of the GMH board to appeal to senators to increase the hospital's subsidy for fiscal 2025, in light of the "dire financial situation" that the hospital faces.
Perez-Posadas said GMH recently came close to suspending all elective surgeries because the hospital owes money to medical suppliers that provide pharmaceutical and surgical supplies.
She said the governor had to approve a cash advance of $5 million so the hospital could pay off vendors and get more supplies, but that advance came out of money that's supposed to fund GMH in the next fiscal year.
The issue isn't over, as the hospital is down to about a month's supply worth of supplies needed for the anesthesia machine, called "circuits," GMH Assistant Associate Administrator of Medical Services Dr. V. Kwasi Nyame said.
Nyame said the operating room head recently came to him, concerned because GMH was down to 12 circuits for anesthesia.
"That means that we're going to do 12 surgeries, because after those 12...we can't do anymore," Nyame said.
He said he had to call the hospital on Saipan and "literally beg" for 40 more circuits, and then flew to the island himself to pick them up.
Nyame said he also "borrowed" another 40 from the Guam Regional Medical City, his former employer, and used paychecks still owed to him to cover it.
Those supplies will sustain GMH's operating room for "maybe a month," and after that, the hospital will be back in the same situation, and will likely have to cancel all elective surgeries.
Nyame said he's now looking to use HEPA filters to essentially reuse circuits for the anesthesia machine, but the hospital has to buy the filters, and then figure out whether that move is allowed by the Centers for Medicare and Medicaid Services.
GMH will eventually have to pay back the supplies he's borrowed, Nyame added, and their bad credit means they will end up paying more money.
Hospital Chief Financial Officer Yuka Hechanova earlier this month reported GMH was $17 million behind on vendor payments.
That shortfall comes after the hospital got $30 million to catch up on vendor payments from the Legislature last October.
GMH is also short on more basic supplies, hospital Trustee Dr. Teresa Borja reported to the board.
She said sponges are being limited for bleeding patients in surgery, the hospital is running out of linens, and patients are now bringing in their own towels and face cloths, because of supply shortages.
Borja said she has brought up the issue with the governor.
Budget battle
Perez-Posadas said a supplemental budget bill from Sen. Joe San Agustin would allocate about $36.7 million worth of excess revenue GovGuam has this fiscal year. But Bill 355-37 does not mention GMH at all, she said.
The administrator said she plans to appear at the Oct. 3 hearing on the supplemental budget bill to ask, "maybe even beg," for additional money for GMH.
"We don't want to get to the point where we're going to have to really look at, OK, what services are we going to cut?" she said.
Another measure, Speaker Therese Terlaje's Bill 354-37, seeks to provide $20 million to GMH but no public hearing is scheduled yet, and it's uncertain if the bill will pass, Perez-Posadas said.
GMH legal counsel Jordan Pauluhn noted that both bills seek to tap into the same pot of money. If the supplemental budget passes, Terlaje's proposed $20 million for GMH won't, Pauluhn said.
Gov. Lou Leon Guerrero last week said she thinks the full balance of $37.9 million in excess revenues for fiscal 2024 should go to GMH.
Terlaje, chair of the legislative committee on health, said she was glad to see the support, but questioned why the administration had not backed additional funding for GMH before the fiscal 2025 budget was finalized.
"I don't know if the Legislature knows how dire the situation is," Nyame remarked at this month's board meeting.
Budget cuts
GMH has been scaling back on expenses for fiscal 2025, reducing its budgetary shortfall from $42 million to about $24 million, the hospital CFO said.
If GMH gets the $20 million the speaker has proposed, "it would really help," Hechanova said.
"Our revenues are actually doing pretty good against our targets," Hechanova told the board, but GMH's expenses continue to rise.
The hospital has pulled money from vacant positions that need to be filled, scaled back on contractual costs by $5.5 million, in part by planning to cut travel nurses, and made some minor cuts to hospital supplies, Hechanova said.
GMH's fiscal 2025 budget also had about $6 million more than what management anticipated to get, and cut retirement contributions back from 33% to 30%, reducing the shortfall further, she added.
Hechanova said she is helping the Guam Economic Development Authority review bids for hospital consultants, which will help GMH improve billing and collections, among other things.
