The impact of hurricanes, the gruesome injuries, the hindered services: 6 questions with Schneider Regional Medical Center CMO Dr. Luis Amaro

Two Category 5 hurricanes slammed the U.S. Virgin Islands in September, stripping off roofs, knocking out power and flooding streets.

Now, nearly four months later, many of those who once called those islands home have yet to return, and most places on the islands still lack power.

Schneider Regional Medical Center, the only hospital on the island of St. Thomas, which is part of the U.S. Virgin Islands, hardly made it through the storms. It lost a section of its roof, shut down its entire cancer center and suffered a drastic decrease in patient volume affecting staffing, revenue and the range of services available.

"We have a number of services that have been curtailed. As a census, we are doing half of the procedures that we were doing before the storm," said Luis Amaro, MD, CMO of Schneider Regional.

Dr. Amaro, going on his third year of service as CMO at Schneider, is working to ensure patients have access to the highest quality of care, and staff continue to provide this excellent care despite the challenges post-storm.

Becker's Hospital Review recently spoke with Dr. Amaro about the hospital's post-storm challenges, the most common injuries post-hurricane and his efforts to mitigate the devastation.

This story is part of a series of articles that will roll out over the next few weeks chronicling Schneider's journey through the hurricanes, the damage it experienced and its efforts to rebuild.

Note: This interview was edited for length and clarity.

Question: Can you describe how the medical services at your hospital have been affected since the storms?

Dr. Luis Amaro: [The storm] has not only impacted operations at our hospital system, but many of our providers' private practices as well. Due to facility destruction, some of our services have been directly impacted … including a total shutdown of specific facilities such as our cancer, radiation and oncology institute. Other services, such as OB-GYN, were hampered with the cessation of emergent C-section services for six to eight weeks post-storm. We have since resumed such services; however, many other services have been curtailed to contemplate length of stays that are limited to 72 to 96 hours. The services have been lessened and the length of stays for each service must now be considered and limited because of staffing concerns and capacity concerns ... because we have had severe losses in our professional nursing staff. ... Our emergency department has been limited by bed space due to facility damages, causing longer wait times and smaller patient volume. Because of our unique arrangement with physicians, many of these services were moved to offsite private offices so we can continue some level of care as we rebuild. Any care that could not be provided on the island will be transferred out … patients with longer lengths of stay would be transferred out … [generally] to facilities in the U.S.

Q: About how long were services affected?

LA: Services are still impacted because we have not begun any facility repairs to date, besides temporary repairs. We have still not started any level of permanent renovation to the facility. We have a number of services that have been curtailed. As a census, we are doing half of the procedures that we were doing before the storm.

Q: What injuries/illnesses were more common after the hurricanes hit?

LA: Our most common injuries post-hurricane included puncture wounds from debris, nails and glass that were evidence of the storm. Exacerbation of chronic illnesses [was seen] due to lack of medications or provocation of stress by the environment. We also saw increases in diabetic feet — where patients came in with horrid infections on their feet. Many times it resulted in partial amputations that involved below-the-knee removal — or above-the-knee — due to the aggressive nature of their infections post-storm. We also had a general overall number of community-acquired infections such as [methicillin-resistant Staphylococcus aureus], skin and soft tissue infections, as well as respiratory infections from both viral and bacterial sources.

Q: Have you seen any supply chain challenges post-storm?

LA: Our supply chain was impacted by the storm the most with the issues of the shipment of supplies. Getting them in on a routine basis was difficult, but besides that we didn't have any huge supply shortages.

Q: How are you handling the stark decrease in patient volume? Do you see it increasing in the near future?

LA: Our providers and our hospital are highly dependent on the patient volume that exists. With an average daily census of 65-beds, we boost an array of services that are unlike many other places of similar size — even on the continental U.S. But it is heavily dependent on having an appropriate patient census and payer mix. Goes to say with this huge decrease in census it has financially impacted our system and our providers. We are trying to engage our providers and adjusting contracts, realigning workflows to adjust to the new census.

[In regard to patient volume increasing] It is in flux right now. We are doing everything we can to provide high-quality care for patients and everything we can to reiterate to patients we are still accredited with the Joint Commission and that we continue to have conversations with CMS and the Joint Commission to keep quality up. We want to maintain a high opinion from our patients. The hopes are that this [opinion] will bring census back to where it was. Once we have the confidence from our patients and our providers have confidence that they will see enough patients to be financially stable, things will look up.

Q: How are you, as CMO, helping the hospital recover?

LA: As CMO, it is important to provide guidance and leadership that bridges the gap between the need for continued quality-driven medical services and an effective revenue cycle of the hospital system.  As CMO I am completing integral medical services, identifying external sources and communicating with external sources as needed to stabilize the system so that basic medical services required by patients are available.

We have a very fragile healthcare system that is again is based around the relationship between hospital and medical providers, which allows us to have as many services as possible in a small community. Directly post-storm, with the Department of Defense, HHS and other federal aid, it was very important for me as CMO to keep direct communication with the government and our own medical staff. It was vital that I relayed the message that any service given to us in aid entertains the services of our own medical staff. Usually, in most cases, federal aid goes in and gives respite care to alleviate some of the pressure from medical staff. But it's different here because medical providers bill for the patients they see, so it was very important that they were able to maintain services with patients and compete to see the patient in order to maintain their own financial welfare to have the confidence and financial support to stay on the island. I had to relay that information back and forth to [both the feds] and providers.

The hospital is still seeking medical supplies and monetary donations to mitigate the devastation. Please contact Shanique Woods Boschulte at 340-227-3557 if you are interested in donating.

Click here to read the remarks of Schneider Regional Medical Center CEO Bernard Wheatley, DBA.

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