Patients endured limited facilities, poor bedding and children running wildly through the halls, the Beacon reported at time.

“There are problems at the hospital and lives are at stake,” Ms. Smith told the Legislative Council in April 1996. “A lot of people I talk to say that ‘if I get sick, don’t carry me there.’”

While concerns are still sometimes raised over the quality of care available at the hospital, several observers believe that the facility has made great strides in 15 years and is unfairly stigmatised by a bad reputation.

“At Peebles Hospital you have a multitude of emergencies on a daily basis and you don’t have a multitude of funerals. So somebody must be doing something well,” said Dr. Mitchel Penn, who practises at the hospital in addition to his private clinic.

Dr. Heskith Vanterpool, a private medical provider and a former chief of medical staff at the hospital, agrees with that view.

“Peebles Hospital is like a horse that everybody is always beating and banging up on, but Peebles Hospital actually provides pretty decent service on certain fronts,” he said.

Quality improvements

In order to counter negative perceptions and further improve quality, the hospital is working to update its policies, improve its human resources and provide better service, according to Pat Malone-Smith, the facility’s director of services.

“Some of the perceptions of what [critics] think happens in Peebles isn’t the whole truth, but they’ve never taken the time to get the whole truth and, in turn, we haven’t taken the time to tell our truths either,” Ms. Malone-Smith said. She added that the facility has stepped up its public relations efforts to educate the community on services offered and changes at the facility.

In addition, the hospital began taking an “evidence-based” care approach this year, starting with the obstetrics department. The approach, which has become popular in hospitals worldwide, uses the scientific method to make decisions involving patient care, she said.

Under the strategy, the obstetric department’s doctors review standards used by the American Congress of Obstetricians and Gynaecologists and the Royal College of Obstetricians and Gynaecologists in the United Kingdom and discuss those practices during weekly staff meetings.

“We ask how can we do it their way, because they have done a lot more of it, and based on the studies that they have done, this is what can happen — what the outcomes are and what the results look like. So we want to get evidence-based results,” Ms. Malone-Smith said, adding that the approach is being expanded to include other departments at the hospital.

Another change instituted in recent years is a move toward better communication with patients and their families, she added.

“It helps, because if everyone is aware of what’s going on, they can help the patient better,” she said. “If I send you home and you’re the only one I taught about diabetic medication, it’s good to know that [someone else] knows you’re a diabetic; you need this, this and this.”

Greater decentralisation of authority with the appointment of nursing managers and physician managers for each hospital unit has helped enable nurses to assist patients faster, she said. Previously, junior nurses with questions would have to track down the hospital’s director of nursing for an opinion. Now, they can get an answer within their unit.

“It’s a little more on-the-ground, real-time, right-now responses that can happen, and that improves care,” Ms. Malone-Smith said.

Despite the moves to improve staff communication and training, proper procedures are not always followed. Last week, the corpse of a newborn baby was “tragically mishandled” and cremated instead of being released to the parents, the BVIHSA stated in a press release. The release blamed the “unprecedented” incident on a “procedural error” and claimed that measures have been implemented to ensure that it doesn’t happen again.

Moreover, despite the organisational and procedural changes in the works, the physical layout and poor condition of the existing hospital facility are barriers to improving quality, Ms. Malone-Smith said.

Chief among these issues is a lack of privacy. Employees all sign an oath of confidentiality, but cramped quarters raise concern that confidential information might be overheard, Ms. Malone-Smith said.

To counteract this problem, hospital officials created a new visitors policy in June, expanding visiting hours but restricting the number of people who can visit a patient at the same time. Another newly instituted policy aims to restrict outsider access to the facility, Ms. Malone-Smith said.

“In the past, it has been whosoever will come,” she said. “In the past, people came and had services without registering for them.”

Such lenient registration practices hampered the hospital’s ability to bill patients and contributed to its perennial funding woes, she said.

“Folks were giving false names, wrong addresses. We provide all this care and then we can’t collect on it,” she said. “That’s one of the biggest challenges we have: revenue generation.”

Statutory board

The hospital’s operations are currently supported primarily through funding from the general government budget, Petrona Davies, the permanent secretary in the Ministry of Health and Social Development, said in a July interview. The 2011 budget includes a $17.1 million grant to the BVIHSA for its operations, and though recovering costs by billing patients brings in some revenue, it’s not nearly enough, Ms. Davies said.

“They do raise some money through fees, insurance and other minor sources of revenue, but the majority of their budget comes from government subvention,” she said. “They haven’t yet been able to cost out. At least they haven’t yet presented to me a costing of their operations for us to see how that compares to the money that we give.”

Ms. Davies said the national health insurance plan that government hopes to roll out next year will provide an opportunity to change the way health care is funded in the Virgin Islands, but it’s also a “critical” part of ensuring the territory can afford to provide good health care in a sustainable manner in the future.

“Reforming the health financing system is critical,” she said. “It’s central to the health reforms.”

Funding issue

The BVIHSA’s funding has been an issue since its creation as a statutory board in 2005. According to a report on the 2006 deliberations of the Standing Finance Committee, legislators asked Winifred Charles-Crabbe, the BVIHSA’s then-CEO, to collect revenues totalling 20 percent of the organisation’s budget — about $3.5 million — during the next year. Ms. Charles-Crabbe replied that although she expected to collect more than the $300,000 the BVIHSA collected in its first year of operation, the $3.5 million goal wasn’t feasible.

Five years later, though, the hospital has made some progress in updating its billing system, Ms. Malone-Smith said. Time is of the essence when asking insurance companies for reimbursement, because hospitals typically are only given 90 days to submit a claim, she added.

“How do you bill if you didn’t ask them for the right name or the right address and you don’t have a picture ID or proof of residency?” she asked. “I anticipate us to do a whole lot better as we improve the admissions/billing process going forward.”

Also in 2006, Ms. Charles-Crabbe asked legislators to consider raising the rates the hospital charges its patients, which are currently set according to the Public Hospital Ordinance, a law last revised in 1989. Those rates set the cost of a visit to the emergency room at $15, and charge residents $25 for a day’s accommodation in a hospital bed. Legislators declined to raise the rates, which have remained the same ever since.

Dr. Vanterpool, the former chief of medical staff at the hospital and now the owner of Eureka and Bougainvilla clinics, said the government fees are set “unrealistically, abysmally low.” He charges $395 per day per patient at Bougainvilla, and still loses money sometimes, he said.

“I can tell you that if there’s only one patient that day I can’t pay for the nurses, let alone the electricity or the cost of the bed itself,” he said.

In addition to the billing issues and low prices, revenue collection is also depressed by the number of people the hospital is required by law to treat for free: schoolchildren; seniors 65 and older; the mentally ill; the indigent; police, fire and prison officers; prisoners; health workers; and employees of the Adina Donovan Home for the Elderly. Ms. Davies, the MHSD permanent secretary, said that the ministry plans to carefully review that list in the future as it reforms health care.

“We don’t want basic health care to be denied to people based on their ability to pay,” she said. “People of a certain age — our children, the indigent — we certainly want to continue to protect their access to health care.”