It’s going to take more than the $10 million per hospital cited by lawmakers to pull the territory out of its ongoing health care crisis, according to medical staff at the Gov. Juan F. Luis Hospital, who placed the immediate need Thursday at closer to $22 million for JFL alone, just to pay off vendors and have enough left to operate.
In a remote meeting Thursday afternoon, nearly two dozen JFL physicians met with Delegate Stacey Plaskett to lay out the gravity of the situation, including critical shortages in staffing, medications, and supplies. According to those present, some doctors have already submitted their resignations, citing unsustainable working conditions and the lack of timely intervention.
“We’re at a breaking point,” one physician said in a call with the Source before and after the meeting, describing the environment as “barely safe” after years of underfunding. “We’re losing physicians and we cannot hire because the last contract negotiation was in 2002. That’s why no one’s coming.”
The concerns echoed those raised in a letter sent last week to Senate Health and Hospitals Committee Chair Ray Fonseca, where physicians warned of deteriorating conditions and urged the Legislature to act quickly, saying the hospitals were “on the verge of collapse.” They described being forced to beg for supplies, operating without essential medication, and preparing contingency letters for nurses in case support failed to materialize.
The $22 million is needed to get the hospital out of credit hold with vendors and resume ordering vital medical supplies, doctors said. Physicians speaking to the Source also emphasized that the hospital’s baseline monthly needs must be reevaluated, with annual appropriations adjusted to reflect those numbers.
Doctors added that the crisis is also a reflection of long-standing federal funding structures that have left the territory’s hospitals at a disadvantage for decades. Until recently, the federal government covered just 55 percent of Medicaid costs in the Virgin Islands — far less than in many states, where funding is tied to poverty levels. That rate was eventually raised to 83 percent under the American Rescue Plan Act, but the federal contribution remains capped. Once that cap is reached, the territory has to cover the rest on its own, and physicians said the territory is once again hitting that ceiling — creating a growing gap in what hospitals can afford to provide and what they’re reimbursed for.
Another challenge lies in the outdated TEFRA reimbursement system, according to the staff. Named for the 1982 Tax Equity and Fiscal Responsibility Act, TEFRA was designed to control Medicare spending by setting fixed, facility-specific reimbursement rates based on historical cost data. In the Virgin Islands, those rates are still based on hospital costs from the early 1990s. Since then, the cost of delivering care has climbed dramatically, but the reimbursement rates have stayed largely the same.
Speaking to the Source Thursday, V.I. Government Hospitals and Health Facilities Corporation’s territorial board chair Jerry Smith confirmed that the executive committee of the board will meet Sunday to review the concerns recently made by physicians to the Senate and finalize a plan outlining initiatives already underway and those set to launch in the coming weeks.
Smith acknowledged the urgency of the crisis but emphasized that both hospitals remain open and fully committed to meeting the community’s needs. “There is no need to panic – both hospitals continue to provide the care our community needs,” Smith said. He noted that in addition to short-term operational adjustments, the corporation is pursuing broader structural reforms aimed at long-term sustainability. One of those initiatives includes a Request for Proposals for a unified revenue cycle management system — a key step in streamlining financial operations. According to Smith, the evaluation committee is set to review the submissions and issue its recommendation ahead of a scheduled board meeting on April 23, where further strategic planning is expected to take place.
Meanwhile, the 36th Legislature will convene an emergency session at 10 a.m. Monday, April 14 on St. Thomas to address the financial crisis. Senate President Milton E. Potter said lawmakers will introduce a comprehensive bill that includes dedicated budget allocations for urgent hospital needs, strict spending restrictions to prevent misuse, and an accountability framework to ensure transparency. In a separate interview with the Source last week, Fonseca said that at least $10 million per hospital is needed as a starting point — though many believe far more is required to truly stabilize operations.
Physicians insist the clock is ticking. “The timeliness and the size of the rescue are everything,” one said. “A drop in the bucket won’t get us out of this.”
