THIS is a cautionary tale, and sadly it has a few villains, but no heroes.

Let’s start with a few basic facts. GMH is broke. No money. The reason is not poor management, but rather the majority of its customers do not pay their bills. Sixty percent of patients are either self pay, Medicaid or Medicare. Worse still, our rates of reimbursement by those programs are stuck at 1990 levels. You could have Bill Gates or Warren Buffet run the hospital and it would still be broke. That is just an immutable fact. All the bashing of the GMH Administration will not change the laws of accounting.

So every dollar we spend is a choice. You want epidurals for everyone? Great, then you must fire 10 nurses. We can give you epidurals, but forget about streptokinase if your father has a heart attack. Those are the brutal choices we have to make at GMH.

As chief of staff and an obstetrician, this pains me greatly. I would love epidurals for everyone. Absolutely, but you see, I’m in a leadership position, and I know that is irresponsible if we want to keep our lights on.

A few more facts: We do not have enough anesthesiologists. We have lost three, and will soon lose a fourth. Staffing a full-time epidural service and hiring three more anesthesiologists will cost the tax payers $1 million.

Some of my colleagues will tell you: But in the states, even poor hospitals have epidurals. What they neglect to tell you is those hospitals also have doctors in training who work for a stipend. Basically that’s free labor. We do not have that on Guam.

So the administration and medical staff thought creatively. That is what you do, when you have a lot of needs but no money. We decided those anesthesiologists who would work extra hard, and do extra work, could set up a private practice, and do epidurals as private physicians. That is called privatization, or fee for service. We have been working on this for some time. It seemed like a logical solution. Women could receive epidurals, and GMH would not have to spend an extra million it does not have.

Got it?

So on to the day in question, when the “infamous epidural case” occurred. This is what basically transpired:

A woman’s husband wanted to make sure, when the time came, she could have an epidural. He did not speak English. I arranged for his translator to speak with a physician who was interested in pursuing the private practice option. They spoke, and of course the fee was discussed. This is normal. To not tell a patient about the fee would be unethical for an “elective” procedure.

During most of this discussion, the patient was sleeping, not thrashing or screaming as the media reported. The intrathecal was not placed for at least two more hours. It was much too early in her labor to place one. She was in no way denied the immediate care she needed, nor was she in any type of distress. Her pain was well-controlled by standard, conventional means, most likely what 99 percent of Guam women get when they have babies.

Due to the language barrier, the patient’s husband had no idea who or when to pay. He walked around with money looking for someone to pay; it was a strange sight to be sure, but in a multicultural situation, with the language barriers, somewhat understandable.

A doctor saw this, and took the opportunity to use this gaffe to further his own agenda of epidurals for everyone. He wrote to complain about why patients must pay for epidurals. Another politically and media savvy physician took his internal memo and leaked it to the press.

The press embellished the story, the politicians distorted the story, and the administration ducked the story.

That left me, Dr. Sidell, with my name in the paper as an extortionist.

The truth is far less sensational. The true story is the physicians, nurses, housekeepers, allied staff and, yes, even administration are hard-working, dedicated people, all doing the best they can.

Take care, and God bless.

Jon Sidell,
M.D.
Tamuning