Resolution to renovate LBJ rather than building new facility introduced

Pago Pago, AMERICAN SAMOA — After the official opening of the Second Regular Session of the 38th Legislature on Monday, the Senate introduced a resolution, which recommends Governor Lemanu P. S. Mauga adopt the US Army Corps of Engineers’ recommendation to renovate and rehabilitate the existing LBJ Tropical Medical Center.

The Senate Resolution introduced by Senate President Tuaolo Manaia Fruean and ten other senators “recommends to Governor Lemanu P. S. Mauga and the American Samoa Government follow the recommendations of our local medical experts and allocate the full $300 million of the American Rescue Plan Act (ARPA) capital investment into the healthcare facilities of LBJ Tropical Medical Center and support their efforts to follow the recommendations of the US Army Corps of Engineers to renovate and modernize the current facility at LBJ instead of building a new hospital.”

According to the resolution, the United States Federal Government in 2021 implemented the ARPA, which gave American Samoa $479,135,254.00 to be used for various COVID-related healthcare response projects.

Of this amount, approximately 95% of the ARPA funding was apportioned directly to the public health emergency. Out of the 95% of ARPA funding, $300 million was assigned to Capital Investment into a Healthcare Facility.

The resolution states that the “need to improve the quality of our healthcare services and improve our treatment options is self-evident and critical. Our territory and our people would have suffered tremendously had we not heeded the lessons history taught us and closed our borders when we did. Our one acute-care medical facility would not have been able to handle the high numbers of COVID-19 patients experienced by everywhere else in the United States and the world. Our territory and our people would have suffered greatly.”

In 2019, the United States Army Corps of Engineers  (USACE) issued a report to Congress addressing the condition of the LBJ Tropical Medical Center. The report presented the cost of renovating and modernizing the current facility, constructing a new facility and whether a renovated facility will have sufficient capacity to meet American Samoa’s needs. 

The 278-page study states the LBJ Tropical Medical Center is a 50-year-old single-story 150,000 square-foot facility, consisting of 18 buildings in a campus setting, which resides in a harsh environment of constant high temperature and humidity. Since its original construction in the mid-1960s, the facility has been repaired, renovated, and expanded. The current infrastructure of the LBJ TMC is in a state of failure due to age, environmental exposure, and lack of preventative maintenance.

It further stated that, “extensive repair and/or replacement of facility sections is required to ensure compliance with hospital accreditation standards and to ensure the life, health and safety of staff, patients and visitors. 

 “While the facility structure has held up relatively well, it is not in compliance with current seismic and wind requirements and retrofits would be expensive and disruptive. The electrical and mechanical systems are in poor condition and in need of immediate repair.

Moreover, “architectural deficiencies have led to mold and mildew growth in critical areas, exposing staff and patients to significant health risks. The nurse call system is inoperable in key locations, plumbing, water treatment and medical gas systems are all in failed or failing condition. 

It concluded that “based on an extensive review of clinical capabilities, the existing facility is incapable of providing enough space to meet the long-term needs of the patient population.  The facility is dependent on funding from the Center for Medicare and Medicaid Services (CMS).”

The report outlined three options;

1. To repair the infrastructure of the current facility with no additional space expansion with an estimated cost of $161.4 million.

2. Construction of  a new multi-story hospital on the current LBJ campus (150,000 SF) with an estimated cost of $375-$425 million.

3. Construction of a new multi-story hospital (370,000 SF) on a proposed site on the western side of the island, with an estimated cost of $700 million.

Based on the USACE report and in response to COVID-19, Governor Lemanu opted to go with the third option recommended by the USACE and build a brand new standalone, multi-story hospital in the Lion’s Park area.

However, instead of the $700M price tag, it would be $300M of the capital improvements monies of the ARPA funding. It is further reported that $50M of the $300M of the ARPA funding is to be utilized for recruitment, retention, and re-training of staff at LBJ and for the new 40-bed hospital.

Earlier this year, in an effort to move the project forward, the Department of Health Director Motusa Nua was appointed to be the Chairman of the Steering Committee overseeing the New Hospital Project. A Medical Subcommittee was formed with local doctors, nurses, and medical officers of both DOH and LBJ. Their task was to review the USACE report and make a recommendation based on their knowledge of AS medical infrastructure and the USACE report.

The Medical Subcommittee issued an Executive Summary dated April 3, 2023. It was endorsed by nine medical doctors from both LBJ and DOH and four senior nurses.

The report states after further discussions, ASG decided the $300M ARPA funds designed for capital improvements projects, i.e., the new hospital at Lion’s Park would now be divided into $100M being reserved for LBJ repairs and service expansions and $200M allocated to build a new specialized acute care 40-bed specialty hospital to capture new medical services.

It is also noted that the decision to split the ARPA funds — with $100M to go to LBJ and $200M to build a new specialty hospital — was made without consultation with medical planning experts. The LBJ Board was not consulted. LBJ doctors and nurses were not consulted until very late in the process. Thus, the original proposal recommending the building of a standalone 40-bed medical facility is flawed, unworkable and unsustainable.

The Medical subcommittee offered their own recommendations in its report:

Option A: Return the $200 million to LBJ Hospital and follow the recommendations of USACE on improvements. This option provides the maximum healthcare benefits for the ARPA funds. LBJ can build and manage a chronic care/rehabilitative care facility at the current LBJ site for less money and provide better management of its patients if it is located closer to the current hospital. The Medical Subcommittee urged ASG to adopt this recommendation.

Option B: Build a long-term, chronic care/ rehabilitation specialty hospital, but only if Option A is not chosen. This option will allow LBJ and DOH to also make significant upgrades and improvements to their services with the additional funds allotted to them.

Option C: Build a “Mini-LBJ.” This option is not recommended by the Medical Subcommittee. A “Mini-LJB” cannot be built within the allocated budget of $200 million. It will duplicate medical services. It will only serve a small segment of the population of American Samoa. It is inequitable and unfair. The operational costs will be prohibitively expensive. Maintaining such a facility will drain our resources. There is no stable funding source to continue such an operation.

In conclusion, the resolution emphasizes that it is the “Senate’s strong recommendation to Governor Lemanu and ASG to follow the recommendations of the Medical Subcommittee and return the $200 million to LBJ so they may make the needed and necessary improvements recommended by USACE. 

 “It is the Senate’s recommendation that Governor Lemanu and ASG follow the advice of our own local medical professionals, our own local doctors and nurses who run our healthcare industry, day in and day out.

 “The Senate recommends we do not squander the financial blessings we have received through the ARPA program on an unsustainable, unrealistic, unviable “Mini-LBJ.”  It is incumbent on all of us to be great stewards of the federal funding we have been blessed with.  We do not need another hospital.  We do need to upgrade and take care of the hospital we currently have.”

In Tuesday’s Senate session, chairman of the Health/Hospital Committee Sen. Tuiasina Dr. Salamo Laumoli announced that the resolution will be discussed in a committee hearing next week Tuesday morning.