Commonwealth Northern Marianas (CNMI) Home Health Blog: Tinian Clinic in News Again

Once again, as a reminder to all patients in the Commonwealth of the Northern Mariana Islands (CNMI), we are available for home health services.

Apparently the Tinian Health Center is in the news again due to issues with blood testing. It is reported that Freedom Air refused to deliver certain blood tests from the Tinian Health Center that were to be sent to CHC Hospital in Saipan due to issues with the Mayor's account. Hopefully this issue can be resolved soon. Non-payments of invoices is a major problem in the CNMI and is plaguing the CHC medical referral patients as well. It is estimated the that CNMI is behind hundreds of thousands of dollars in payments to Travel Agencies for tickets to Guam, Hawaii, and the Philippines for medical treatment.

Saipan Tribune Article

Dr. Priyawathan Wijay of Tinian Health Center loses employment contract

The Saipan Tribune had an article today about the failure to renew the contract of the sole doctor on Tinian, Dr. Priyawathan Wijay. There are apparently 10-20 applications for the upcoming vacant position incuding one doctor who formerly worked at the Clinic. We would definitely like to remind all patients that Pacific Home Health Care is willing to serve the patients of Tinian. We do still require a licensed Doctor's Order, but we can communicate with CHC on your behalf. Give us a call today at 670-234-CARE. For patients that are admitted to either Tinian Health Center or CHC, we can cooridinate immediate home health services upon your discharge from the hospital.

Nursing Cruise Ship Jobs

I recently received an email about finding cruise jobs in Saipan. There are a few cruise ships that actually do stop in the Port of Saipan. I thought the e-mail was a strange request until I saw that the Saipan Home Health Blog was listed as one of the top 25 cruise ship nursing blogs at Nursense.com (number 4).

As far as working as a nurse on a cruise ship, I don't believe that U.S./Australia/Japan visas are required, so I can imagine that the wages are not as high as working in those respective countries. There are benefits involved with working on a cruise ship including travel, and the new experiences people will encounter. I would suggest reading Cruise Ship Jobs : The Insiders Guide To Finding And Getting Jobs On Cruise Ships Around The World for more information.

As far as working in Saipan in a cruise ship or otherwise for foreign applicants, the U.S. federal government was supposed to have transitional visa regulations in place by March of 2011 that would allow for the hiring of immigrants without H1B or immigrant visas, however they have still not been released. I expect within the next few months that the CNMI-Only Transitional Worker Visa regulations will be released that will allow for hiring from abroad. For U.S. applicants, there may be positions available at many government and private sector employers.

Frequently Asked Home Health Questions

Q: What if I am unhappy with my current home care provider. Can I change to another agency like Pacific Home Health Care, LLC.?
A: Absolutely, you have a right to choose who provides your care. Your current provider can "transfer" your care to Pacific Home Health Care, LLC. and you will not lose your home health benefit.
Q: How do I get home health services?
A: Typically your doctor would recommend that you get home health care, however if you have a skilled nursing or therapy need and aren't well enough to go out and get those needs fulfilled you would typically qualify for the home health benefit. Call your doctor or Pacific Home Health Care, LLC. and we can typically advise if you qualify or not.
Q: Is my physician still involved with my care?
A: Yes, your physician manages all your care while in home health. The home health staff communicate and coordinate your care with your doctor via phone or faxed memo/notes.
Q: What does homebound mean?
A: Homebound means it takes considerable taxing effort for you to leave home; if you do leave home, it is for short trips to the doctor or church services or for once-in-a-lifetime events, such as weddings, funerals, specials & events.
Q: What are the criteria to qualify for the Medicare home health benefit?
A: You must have a skilled need; care must be provided in your place of residence; you must be under the care of a physician and you must be homebound and must have Medicare Part A. Many insurance companies pay for home health, also.
Q: What makes Pacific Home Health Care, LLC., better or different from other agencies?
A: Pacific Home Health Care, LLC., staff practice under the guidelines of consistency: One client - the same staff members throughout the course of care, reliability, dependable trustworthy staff that can be counted on to do what is ordered by your physician, and presence - fully attending to the needs of the clience from a holistic perspective
Q: Who pays for home health care?
A: If you require the skilled services of a nurse, physical therapist or speech therapist and you have Medicare Part A, then Medicare pays for home health care as long as you meet the criteria. Additionally many Medicare Advantage plans cover these services but require some co-pay level, check your plan documents.

Marianas Baptist Missionary passes NCLEX PN Exam

Li Li, a Chinese Emmanuel College Practical Nursing stduent, and Marianas Baptist Academy Missionary recently passed the NCLEX exam on her first try. Li Li is an August of 2009 practical nursing graduate. Li said she plans to seek employment at the Commonwealth Health Center or other private clinics on the island. Congratulations, and I wish her well in her employment search.

I am trying to keep track of any new CNMI laws or bills, but it appears that no one realizes that both the CNMI Labor Law (private employers) and 3 CMC 4434 (government employers) prohibit the hiring any nonresident worker without 2 years of experience. There was an exception in public law 15-45 which allowed NMC graduates to work at CHC, however that exemption expired on January 1, 2010 and was never renewed. Since most private employers are afraid of the CNMI DOL umbrella permit position, and CHC is a government agency, until the CW regulations are issued, these new graduates and NCLEX passers are in a terrible position.

Additionally, does anyone realize that the CNMI Board of Nursing will issue a graduate PN License to any Emmanual College graduate that is good for 1 year? I have never heard of any nurses working under the provisional license.

Emmanuel College (Saipan) Valedictorian Passes NCLEX Exam

Read Article in Marianas Variety

We would like to congratulate Leonora Angello for passing the NCLEX PN exam on her first try. Unlike many nursing schools in the mainland, Emmanuel College offers students an opportunity to take nursing classes without years of prerequisites and it a great idea for students here on Saipan.

I have previously written about PL 15-45, the law waiving the 2 year experience requirement for CHC non-resident nurses who attended northern marianas college EXPIRING on December 31, 2009, however it doesn't appear that anyone is concerned. PL 15-45 doesn't apply to Leonora Angello, since she is a U.S. resident worker, and hopefully she can find employment at CHC or a local clinic.

SEAS Nurse Staffing Agency has labor permits revoked again.

Read article in the Marianas Variety.

I hate writing about bad news, but it seems that the SEAS Nurse Staffing Agency had all their nurses' work permits revoked, again. Apparently their previous unpaid medical claim of $20,000 is still partially outstanding. There was talk about how the workers weren't paid for 3 months previously and now this. I feel bad for the employees.

Saipan Physician Recruitment at CHC Hospital

I have been recently receiving quite a few recent search inquiries relating to Physican Recruitment. Some of the information on this blog is meant to be informational however I do believe that some of the information is outdated and unfairly biased. Saipan is actually a great place. It does have some wonderful beaches, some of the best people and is the closest thing to an expat lifestyle while still having the protections of U.S. law and being able to earn a U.S. salary. There are complaints about the salary is low, however unlike Guam and the U.S. mainland there is virtually no federal income tax, which is quite a savings. Also maids and nannys are available and inexpensive (due to the low minimum wage), and even some nurses at CHC hospital have their own live in maid. As far as housing, there are executive style houses for rent, and if you really think you will stay for a while, for 55yr lease.
Saipan recently began being able to process the J1 visa for U.S. licensed residents. Instead of working in a rural town in West Virgina, you may be considerably more happy working in Saipan.

****UPDATE**** 6-5-10
CHC is currently processing an application to participate in the Conrad 30 J1 visa program. I will post any new information as soon as I hear anything about it. The ability to recruit under the H-1 visa (unlimited cap) does exist as of 4-1-10.

****UPDATE**** 2-6-11
CHC is rumored to be hiring a number of foreign residents under the J1 visa to start after the completion of their residencies in May. This will be welcome news to CHC who recently lost the medical director, Dr. Shirish Balachandra.

****UPDATE*** 4-16-11
CHC has recently hired 4 doctors including an anesthesiologist and a family practicioner. The salaries were substantially higher than reported non-locum contracts. Maybe the CNMI realizes that they need to pay medical professionals a fair salary.

20.1 Million Budget for CHC in FY 2011

There was an article in today's paper about CHC eyeing 380 hospital employees for next year with a budget of 20.1 million. That is higher than last year's budget of 19.5 million, however 2009 expenses for CHC totaled 26.5 million. I fail to see how it is possible for the hiring of any new employees. Link in Saipan Tribune

Recently it does seem that the CHC has taken steps in the right direction in the administrative department. There have been 2 training classes in medical coding and their collections should be increasing. Additionally, CHC has recently opened up the idea for outsourcing some of their collection activities to private firms. With over 100 million in collections outstanding, hopefully, CHC and the CNMI Government will be able to tap into some of those funds.

Update 4/16/11*****************
Unfortunately, the medical coding classes have produced less than stellar collection efforts. Due in part to austerity measures, CHC collections have actually decreased. I was watching a local channel and a commercial appeared for reporting fraud in medicaid activities. I believe that the CNMI really needs to watch for improper and fraudulent kickbacks, steering and claims from physicians, health care companies, and their patients. The book, License To Steal: How Fraud bleeds america's health care system by Malcolm Sparrow is a great insight into how some of these fraudulent activities can occur and how they affect the funding of the health care system.

 

Palau Hosts 32nd Annual Asian Pacific Nurse Leaders Council Conference

The dates have been set for Monday June 14, 2010 to Friday June 18, 2010. The deadline for registration is May 16, 2010, or there will be a late registration fee assessed.

On-line Registration Dates, Deadlines and Fees:
Early registration is from March 1 to May 14, 2010.
Fee $25.00 will be charge per individual which will be collected at conference site.
Late registration starts from May 17 to June 14, 2010.
A registration fee of $35.00 will be charged and collected at conference site.
Payment to be made in cash.
Other information:
Other Fees:
Jurisdiction Fee: $250.00
CE Fees for Duration of Conference: $50.00/Person
ROP Departure Tax: $20/Person (To be paid upon departure)
ROP Green Fee Tax: $15.00/Person (To be paid upon departure)

Contact people if any questions:

Patricia Maech

patmarch2002@yahoo.com
p_maech@palau-health.net
Phones: (680) 488-2552 Ext. 211 (Work)
(680) 587-2264 (Home)
Cell Phone: (680) 778-6260

Terry Ngirmang

terryn@palau.edu
terry_ngirmang@yahoo.com
PHones: (680) 488-2240 ext. 272 (Work)
(680) 488-3533 (Home)
Cell Phone: (680) 779-6727

Magrina Aderiano

beltikerreng@yahoo.com
m_aderiano@palau-health.net
Phones: (680) 488-2552 Ext. 178 (Work)
(680) 488-8326 (Home)
Cell Phones: (680) 778-1354

Guard Gate at CHC Hospital

The contruction has been going on for a while. I am surprised that I haven't heard any news about it. It appears that there are 3 guard gates and fencing surrounding the entire CHC grounds. It is a nice black fence. I wonder if all three gates will be manned 24 hours a day?

Former CHC Hospital employee admits using "ice", and barely escapes machete attack

Unbelievable story in Mvariety

All I can say is wow. Completely unbelivable. It was previously reported that Thomas Asack (I assume that is the same person) was planning on filing suit because he had not received his housing allowance, and had resigned because of that. It appears that there may have been other issues involved in his resignation. I don't put a lot of stock into the comments of the Mvariety, but someone wrote "I don't work at CHC but have heard reports of this individuals drug use for years. It was common knowledge at CHC. But nobody did a thing..."

If the report from Thomas Asack himself is true, the island really needs to take a look at the "ice" problem and may want to try to develop a rehab program to assist people in getting off the drug. Obviously strange things seem to happen when drugs are involved and people are not thinking clearly.

One thing about the article that seemed a little stange was that Asack's backpack was taken and there was no report of theft. What exactly was in the backpack, and did Asack have some of Cristosomo's "property"?

From the Saipan Tribune Article on Feb 5th, 2010. "The suspect stood in front of the vehicle and swung the machete, damaging the hood's front right portion. Crisostomo then allegedly moved to the driver's side and swung the machete, damaging the top left portion of the front windshield. The driver-motorist drove the car to McDonald's parking lot where they called police for assistance. When Asack returned to his scooter, he found that his backpack was missing."

Three New NCLEX Passers from Northern Marianas College

click to read full article in the Saipan Tribune

Congratulations to Genevieve Bahatan, Ji Sook (Julia) Kim, and Emily Young. The article states that the 3 are part of the 8 first time NCLEX passers from the May, 2009 graduating class.

I'm not sure what options are currently available for non-resident nursing graduates. PL 15-45, the law waiving the 2 year experience requirement for CHC nurses only applied to hires before December 31, 2009. No local clinic can hire a nurse without experience because HB 16-208 was never enacted into law. Local lawmakers may want to reconsider allowing the NMC, Emmanual College and the University of Loyola-CNMI graduates who have studied for years, spent months studying to attempt to pass the U.S. licensing exam permission to work.

7000 doses of H1N1 Vaccine Now Available

read full article in the Saipan Tribune

The Department of Public Health has just received 7000 new doses of H1N1 vaccine and they are going to be conducting a few vaccination drives during the Month of January for the general public.

* Jan. 12: Tuesday Market in the Garapan Fishing Base;

* Jan. 14: Thursday Garapan Street Market; and

* Jan. 16: Saturday Sabalu Market in Susupe

Happy Twenty-Ten!

Dialysis R.N. Dandy posted some pics of the CHC Hemo Dialysis department over at CHC wishing all the nursing staff a Happy New Year.

CHC to hire 6 new Doctors

Saipan Tribune Article

"Six new doctors will soon be joining the medical staff at the Commonwealth Health Center early next year, according to Public Health Secretary Kevin Joseph Villagomez.
Most of the six physicians will come from the U.S. mainland, he said.
Three will be for internal medicine, two for pediatrics, and one for the emergency room. “We're now in the process of bringing all these physicians from the States, hopefully early next year,” he said."

This article seems to conflict with earlier reports of recruiting from the Philippines four days ago. That article stated " Untalan described all recruitment efforts as “ongoing” in both U.S. and Manila hospitals.
He said five potential doctors may soon join the hospital workforce if negotiations with Manila hospitals prosper.
“The extension will give us breathing room to recruit the people that we need,” he said, adding that the emergency declaration is a way to resolve the decade-old problem of manpower shortage at the lone hospital on island."

Are the Doctors coming from the U.S. or from the Philippines? And what does it mean exactly that they are "in the process" of bringing in all these physicians from the States? Are these J-visa graduates? If they are, it will take much longer than early next year, and if they are regular doctors, have they accepted a position or have they been offered a position, or do the over-the-cap salaries need to be approved first?

Philippines POEA approves 51 job vacancies for nurses and PT's in Saipan

As of November 19th, the Philippine POEA, their version of the CNMI department of labor certified 51 positions for nurses and physical therapists for Saipan. I recall earlier a job posting on the CNMI Department of Labor website about Marianas Medical Institute with $20/hr nurse vacancies, so I guess this is related to that. It still seems strange that with all the unemployment and underemployment of nurses on Saipan that we would need an additional 51 nurses and physical therapists.

The website for the recruitment agency is 21st Century Manpower Resources and they were approved to hire 51 nurses on November 19, 2009 as confirmed on the POEA website, and the jobs are still active.

With hundreds of thousands of nurses in the Philippines I wonder if there is a company out there that is taking advantage of the Unlimited H-visas for the CNMI and plans to recruit for the mainland hospitals and nursing homes, by having securing a H-visa and they having them transfer to a mainland affiliated company?

Updated 4/16/11 ***************
Due to the CNMI blockage of the CW-Transitional Worker Visa Regulations, there have been zero off-island hires since November of 2009. The United States USCIS orginally stated they would have the regulations released by September of 2010 and that date was pushed back until March of 2011. Since March as already come and gone, there is no update when the regulations will finally be issued. Depending on the new regulations there may or may not be a number of new off-island hires from the Philippine and other neighboring Asian countries for employment in Saipan.

Dr. Cornett, tell us how you really feel.

Recent article from the Marianas Variety

In the Marianas Variety article, Dr. Cornett is saying that instead of hiring unlicensed (U.S.) doctors, CHC really needs a 64 slice CT Scanner and a Cath Lab. Normally the scanner would cost 1.5 to 2 million and the Cath Lab is between 1 to 2 million.

CHC would probably pay 15 million for both, so it is not economically benificially in the short term to take care of those things. Additionally, I think some people are happy with the status quo. This is a small island, and if all the equiptment were on the island, and all the doctors were here, we would not get a medical referral with family members to the Philippines, Guam, Hawaii, and the U.S. mainland. 2 million each year in non-medical patient costs is actually not that high. Numbers keep being thrown out about $60,000 to send a patient to the Philippines or $20,000 to Guam are clearly outliers and are for shock value only. The medical referral office is probably being run efficiently.

I am actually surprised that Dr. Cornett would write something like that in the paper. I guess the memo not to speak to the Oversight Committe, didn't apply to newspaper.

Administration to take over hospital

Read article from the Marianas Variety

The goverment is set to declare a state of emergency to hire doctors from the Philippines. To become U.S. certified, normally a doctor will take the USMLE during his/her second year of medical school which will determine if he is able to attend a residency program in the United States. The residency program is a post-graduate program which after 4 years of college and 4 years of medical school can take from 1 year for general practice to 7 years for a surgeon to complete. Doctors from the Philippines that are not U.S. licensed either did not take the USMLE, or they did score well enough to obtain a U.S. residency.

Due to the pending federalization of the CNMI, I will say that the timing of the E.O. is perfect. The doctors can be hired without regard to the prevailing wage rates of the H-Visa, and can save quite a bit.

Guam Prevailing Wage for Physicians and Surgeons
Level 1 Wage: $51.72 hour - $107,578 year
Level 2 Wage: $65.33 hour - $135,886 year

The level 1 wage is for no experience. This is a great fix for 2 years, however, I question whether this can continue after their 2 year contracts are up and CHC will have to get H-Visas not only for the Doctors, but a large percentage of their medical staff.

House Oversight Meeting On Public Health

I attended the House Oversight Meeting on Public Health yesterday at the Garapan Cafeteria. It was actually a pretty good turnout with about 40+ people coming and going throughout the night. Most of the discussions were confined to the problems at CHC. It was very intesting to hear from the nurses working at CHC at to what the problems were. One nurse in particular stated that she thought that the salaries of the doctors were actually not that low considering that doctors would not be required to purchase malpractice insurance and the tax rate of the CNMI is lower than the mainland. She went on to say that the salaries of the nurses however were a major problem. She cited a specific example of a nurse in her department that was there for 25 years and was making less than 30,000 a year. She stated that most doctors stay a few years and then leave, but many other health care professionals such as nurses have been on the island for many years, but they are often overlooked. The nurse that spoke stated she had been on the island for 15 years and instead of a bonus they had cut her housing allowance. Afterwards a physical therapist working at CHC, almost in tears spoke about her loss of her housing allowance, and then stated it seems that the salaries for nurses are getting worse and worse. At first the nurses lost the night shift differential in pay, then the housing allowance.

I'm not sure that any of the testimony of the nurses got through to any of the legislators, but at least they were able to hear it. Many people who spoke mentioned not only problems with doctors, but the support staffs, supplies, equipment, and even food that needed looking in to.