In The U.S. Virgin Islands, Health Care Remains In A Critical State

Feb 4, 2018

Health care in the U.S. Virgin Islands remains in a critical state, five months after Hurricane Irma and Hurricane Maria pummeled the region.

The only hospital on St. Thomas, the Schneider Regional Medical Center, serves some 55,000 residents between the islands of St. Thomas and St. John. Schneider's facilities suffered major structural damage, forcing a decrease in its range of services, mass transfers of its patients, staff departures and significant losses in revenue. Only about one-third of the beds are currently available for patient care.

In early September, when Irma hit the Virgin Islands, most of Schneider's staff members were on duty. At the height of the storm, a large window on the hospital's top floor gave out. "You had winds of 175, 180 miles per hour whipping through here," says the hospital's Vice President Darryl Smalls.

The screws holding the window in place failed. The window itself, made from hurricane impact glass, remained intact. It's here, leaning against a nursing station that's now in shambles. Ceiling panels are gone, exposed pipes and ducts are damaged and sagging in places. A large plywood barrier covers the window opening.

When the window tore off, Smalls says the staff worked quickly to evacuate some 20 patients to a safer part of the hospital. They couldn't use the elevator in the middle of the storm, so staff transported patients from the fourth floor to the third floor using the emergency stairwells. "We literally took the patients on the mattresses, slid them down the stairs, down to the third floor, across the building and up onto the other side," Smalls says. "We have a surgical unit which was not compromised and capable of handling patient care."

Eventually, all of the patients who were at Schneider during the storm were evacuated off of the island. But even as staff dealt with a host of problems, the hospital remained open. In the emergency room, which flooded badly from a leaky roof, Smalls says, "You probably had about 3 to 4 inches of water on the floor in here. I had pumps. I think we probably had 50 people in here at any given time just trying to evacuate as much water out of the facility."

Today, the hospital continues to provide surgery, labor and delivery care, radiology and lab services. But its cancer center, a $28 million facility, remains closed because of extensive storm damage. The hospital can now only provide limited services for patients requiring dialysis.

Meanwhile, Schneider Medical's sister center, the only hospital on St. Croix, the U.S. Virgin Islands' other major island, suffered even more extensive damage to its operating rooms.

Without adequate medical services available, Schneider Regional CEO Bernard Wheatley says most patients who evacuated St. Thomas have not been able to return. "It's over 400 that have been transferred off island," Wheatley says. "And to this day, we're still transferring some patients, especially the ones requiring extensive length of stay."

Along with the lack of facilities, another major problem is staffing. Wheatley says he's lost 150 of the hospital's 600 employees — many of whom left the island after the storms destroyed their homes. "The sad part of it, we've lost a lot of nurses," he says. "If you ask me right now, what's my key entity in terms of shortages, from a clinical standpoint it would be the nursing staff."

Shanique Woods-Boschulte, who directs Schneider's foundation says, "Every day we get one or two resignations." After five months, Woods-Boschulte says, the daily struggle is wearing down many staff members. "The morale was really high after the storm because we saw what we were able to accomplish — no patients hurt," she says. "But now things are trickling down and everyone is leaving a broken hospital and going home to a broken home."

Adding to the woes, the hospital is in desperate financial straits. Revenues are half of what they were because there are far fewer patients. The government-supported hospital is projecting a $7 million loss.

With all the competing problems on the islands, CEO Bernard Wheatley says it's not clear how much help the local government can provide. "The territory itself is projecting a $400 million loss," he says. "They don't have the hotel rooms, tourism is down. It's just not the same island."

The U.S. Virgin Islands is now looking to Congress to help decide what to do about its battered hospitals. The local government is in talks with FEMA and the Army Corps of Engineers to determine whether the hospitals can be rehabilitated, or if new facilities will be needed.

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It's been many months since hurricanes Irma and Maria hit the Virgin Islands, but hospitals there are still recovering. Even now, patients are being flown to the U.S. mainland for certain surgeries and specialized care, as NPR's Greg Allen reports.

GREG ALLEN, BYLINE: There's just one hospital serving some 55,000 residents of St. Thomas and St. John in the U.S. Virgin Islands - Schneider Regional Medical Center. Only about a third of the hospital's beds are available for patient care because of damage from Hurricane Irma and Hurricane Maria. Darryl Smalls is hospital vice president.

DARRYL SMALLS: Where we're walking right now, during the height of the storm, you literally had winds of 175, 180 miles an hour whipping through here.

ALLEN: Right through here because you lost a window.

SMALLS: A window on this side.

ALLEN: The nursing station is in shambles. Ceiling panels are gone. Exposed pipes and ducts are damaged and sagging in places. A large plywood barrier now covers the window opening. On Sept. 5, when Hurricane Irma hit the Virgin Islands, Smalls and most of the staff were on duty. When the window blew out, he says they worked quickly to evacuate some 20 patients to a safer part of the hospital.

SMALLS: We literally had to put the patients on the mattresses. Four people slid them down the stairs, down to the third floor, across the building and up onto the other side. And when I say the other side, we have a surgical unit which was not compromised and capable of handling patient care.

ALLEN: All of the patients here during the storm were eventually evacuated off the island. The hospital remained open even as staff dealt with a host of problems. Smalls takes me to the emergency room, which flooded badly from a leaky roof.

SMALLS: You probably had about three to four inches of water on the floor in here. I've had pumps. I think we probably had about 50 people in here at any given time, just trying to evacuate as much water out of the facility.

ALLEN: Five months later, the hospital continues to provide surgery, labor and delivery care, radiology and lab services. But its cancer center - a $28 million facility - remains closed because of extensive storm damage. The hospital also now is providing only limited services for patients requiring dialysis. Hospital CEO Bernard Wheatley says most patients evacuated because of the hurricanes have not been able to return to the island because adequate medical services aren't available.

BERNARD WHEATLEY: It's over 400 that has been transferred off island. And to this day, we're still transferring some patients, especially the ones that require extensive length of stay.

ALLEN: Wheatley says it's a similar situation for the Virgin Islands' other hospital located on St. Croix. It suffered even more extensive damage to its operating rooms. Along with a lack of facilities, another major problem is staffing. Wheatley says he's lost 150 of the hospital's 600 employees, many because their homes were destroyed, and they've left the island.

WHEATLEY: The sad part of it - we've lost a lot of nurses. If you ask me right now, what's my key entity in terms of shortage from a clinical standpoint? - would be the nursing staff.

SHANIQUE WOODS-BOSCHULTE: Every day, we get one or two resignations.

ALLEN: Shanique Woods-Boschulte directs the hospital's foundation. She says after five months, the daily struggle is wearing down many staff members.

WOODS-BOSCHULTE: The morale was really high after the storm because we saw what we were able to accomplish. No patient hurt. But now things are trickling down. And everyone is, you know, leaving a broken hospital and then going home to a broken home.

ALLEN: Adding to the woes, the hospital is in desperate financial straits. Revenues are half of what they were because there are far fewer patients. The government supported hospitals projecting a $7 million loss. With all the competing problems on the islands, CEO Bernard Wheatley says it's not clear how much help the local government can provide.

WHEATLEY: The territory itself is projecting a $400 million loss. They don't have the hotel rooms. Tourism is down. It's just not the same island.

ALLEN: The Virgin Islands now is trying to decide what to do about its battered hospitals and is looking to Congress for help. The local government is in talks with FEMA and the Army Corps of Engineers to determine whether the hospitals can be rehabilitated or if new facilities will be needed.

Greg Allen, NPR News, St. Thomas, U.S. Virgin Islands. Transcript provided by NPR, Copyright NPR.