The Chairman of the Government Hospital & Health Facilities Corporation in the US Virgin Islands (USVI), Dr Jerry R. Smith, has called for structural reforms to stabilise USVI hospitals, including reliable funding sources, centralised systems, CRNA law updates, and Medicaid match changes to break the cycle of emergency relief. Photo: Team of Reporters

Both the Juan F. Luis Hospital on St Croix and Schneider Regional Medical Center on St Thomas have been facing financial distress. Photo: VI Consortium

In a letter sent to Senate President Milton E. Potter, Dr Jerry R. Smith laid out a plan that he believes will ensure the long-term stability of the territory's hospital system. Photo: Team of Reporters

In a letter sent to Senate President Milton E. Potter, Dr Smith laid out a plan that he believes will ensure the long-term stability of the territory's hospital system.

The letter comes ahead of a special session of the 36th Legislature convened after months of public discourse about the financial distress facing the Juan F. Luis Hospital on St Croix and Schneider Regional Medical Center on St Thomas.

Dr Smith, the former Commissioner of the Virgin Islands Trade Commission, said short-term stabilisation support is urgently needed, but argued that “it must be accompanied by structural changes to ensure stability and avoid the cyclical nature of emergency relief.”

Reliable funding source

One of these changes should be the establishment of a “reliable funding source” by the Legislature, Dr Smith suggested. This would support the issuance of bonds, “enabling the system to make vendors whole and responsibly manage future debt service obligations,” he wrote.

Given some breathing room by immediate support measures, the Territorial Board could then focus on projects that will be beneficial in the medium term.

In his letter, Dr Smith, the owner of Therapy Works in the Virgin Islands, outlines three priorities for the board: completing the strategic restructuring initiative currently underway, implementing a new revenue cycle management system, and overhauling the current physician compensation model.

A fourth priority would be in the hands of the Legislature – updating the territory's laws to allow greater practice authority to Certified Registered Nurse Anesthetists (CRNAs).

Many of the long-term fixes proposed by Dr Smith would also depend on legislative action.

Dr Smith proposed that the Legislature ensure that the local Medicaid match be paid through the Department of Human Services, and emphasised that this sum should be in addition to, not within, the monthly hospital allotment. Having DHS file a State Plan Amendment with Medicaid could also allow the hospitals to bill more, boosting revenue and improving recruitment and retention efforts.

The Legislature must also allow the hospitals to reform their retirement structure, Dr Smith argued, pointing to the University of the Virgin Islands as a model that can be followed.

Senior abandonment penalties 

Legislation to penalise the practice of senior abandonment is also necessary, Dr Smith said. Hospitals have long grappled with the task of caring for elderly or otherwise incapacitated people who no longer require hospitalisation but remain abandoned by their family. As a result, bed space is limited, revenue is challenged, and the hospital's ability to provide services to those in need is compromised. “Legislation would provide a legal framework for appropriate discharge planning, coordination with long-term care services, and family accountability,” Dr. Smith said.

His final long-term recommendation was something to be worked on by the Territorial Board – facilitating the establishment of a medical technology industry in the territory.

Dr Smith's letter, dated April 11, 2025, was copied to Governor Albert A. Bryan Jr as well as Congresswoman Stacey E. Plaskett, along with members of the Legislature and other Territorial Board members.