Innovative Health Care Program Seeks Emergency Funding at Senate Hearing

Ambulance runs for chronically ill elderly and disabled patients account for the largest share of services provided in the Virgin Islands, Health officials said. (Pafford Medical Facebook photo)

Funding for an emergency service that provides care for the elderly and disabled recently sought approval from the 34th Legislature Finance Committee. Testifiers appearing at a hearing held Friday said the Emergency Mobile Integrated Health Care Program began on St. Croix after the passage of Hurricane Maria.

Testifiers said the practice of delivering urgent care to chronically ill elderly or disabled patients where they live is relatively new and has become part of emergency medical services in several U.S. states. Because the 2017 storm damaged roads and hospitals on St. Croix, delivering urgent care at home became the most practical option, said Deputy Health Commissioner Reuben Molloy.

Molloy and EMS Coordinator Jacqueline Greenidge-Payne spoke in support of Bill No. 34-0298, a request for $300,000 from the emergency service fund to V.I. Territorial Emergency Management Agency, the Fire Service and Health. The three agencies work together to provide emergency medical services to the territory.

About $250,000 would pay mobile care teams consisting of a nurse and a paramedic; $50,000 would pay for needed supplies, they explained.

“The service seeks to reduce the reliance of emergency medical services for those who already have identifiable medical needs. Since the program began it has served 1,800 chronically ill patients, also called acute status patients,” Molloy said.

“One of the primary populations the program seeks to serve are those elderly and ill patients who have unmet needs because the territory lacks nursing homes,” the deputy commissioner said.

When questioned by committee members, Greenidge said integrative care delivers home care to 59 patients. “It’s a way to make sure the ambulance service can service those individuals who have a true health emergency,” she said.

One of the immediate concerns she expressed was the status of the St. Croix team as contracted workers from Pafford Medical Services. There was a registered nurse working with Health who was part of the team but had retired. Another Health Department nurse has expressed interest in joining the care team, but no action has been taken yet to bring them on board, Greenidge said.

Finance Committee Chairman Kurt Vialet asked about the duration of Pafford’s contract. Molloy said the contract ends Dec. 30.

His response released a flood of questions from the chairman.

“That’s 29 days from here,” Vialet said. “If Pafford leaves now, do we have sufficient nurses for (intensive care), the integration that took place for the ambulances that are driving around? Do we have sufficient staffing for the Virgin Islands?”

Funds from disaster recovery after Hurricane Maria and COVID-19 federal relief funds after 2020 help pay for Pafford’s services, Molloy told the committee. As long as federal funding remains in place, payments can continue, he said.

Vialet called the integrative service concept “an excellent idea.” Finance Committee member and Senate Health Committee Chair Novelle Francis called the program a best-kept secret. Other committee members asked how integrative care was regulated under the Department of Health.

Molloy said prior to the merger of Fire and EMS in April, integrative care existed under EMS without a formal structure. When the merger occurred, the program was left undefined.

But the deputy commissioner added that Health did not try to hide the program’s existence. “The establishment of our EMS brought this to the forefront. It was being done as a part of EMS’s services. We have reported out … we have reported out on these activities regularly,” Molloy said.

The explanation was greeted with an admonishment from the Health Committee chair. “The reason why we set down the legislation is so we can get proper placement of these employees,” Francis said. “The services we have heard about here are vital and very much necessary. Clearly, we want to be able to make sure there is a program and a policy in place. That protects us as a government entity.”

Vialet added that formal structuring is needed because continued funding would make integrative care sustainable. “What we are trying to do is not establish a one-time funding source … We want to know what is the cost to have this unit,” he said.

The committee agreed there were strong arguments for keeping and expanding the integrative care, but it would have to be defined as an EMS service and be funded as a budget line item. It was suggested that the bill that established the merger between Fire and EMS be amended to include the new program.