Company Profile
LBJ TROPICAL MEDICAL CENTER
Company Overview
HOSPITAL OVERVIEW SUMMARY
Emergency Medical Services
Emergency Medical Services (transport to LBJ) is available locally. The EMS Unit is run as a subsection of the Medical Center. The EMS Unit currently employs 5 paramedics, and about 45 other EMTs, plus various assorted other staff and volunteers. Our EMS headquarters are in a separate building from the hospital, although on the same grounds. Transit times can be in excess of 45 minutes due to the “out and back” model from the hospital’s single dispatch area, but this is projected to improve with remote sub-stations. The EMS’s scope of practice is guided by a policy and procedure document that is reviewed and certified by local physicians. The Unit operates several EMS “rigs” that are outfitted with U.S. equipment, albeit limited in scope and capability.
Department of Emergency Medicine
The Department of Emergency Medicine is the department that provides 24 hour a day emergency and urgent care on a walk-in basis for all age groups, as well as urgent and some routine care on an appointment (as needed) basis. The ER handles all emergencies, urgencies, traumas, and some lower acuity “walk-in” patients, and commonly treats about 70-90 patients per day. Typical diagnoses managed in the ER include acute myocardial infarctions, hypertensive emergencies, diabetic ketoacidosis, cerebral vascular accidents, acute abdomen, lacerations, fractures, upper respiratory infections, and viral syndromes. Obesity is prevalent in American Samoa, and the ER also manages a wide range of complications associated with it. Tropical diseases commonly seen in the ER include Rheumatic Fever, Dengue, and Leptospirosis.
Inpatient Services
Our inpatient services include Internal Medicine, Pediatrics, a combined Nursery and NICU, Surgery, Labor and Delivery, Maternity, and the shared Intensive Care Unit.
The Department of Internal Medicine provides inpatient medical services in the Medical Unit and the ICU. The majority of adult inpatient diagnoses stem from non-communicable diseases, such as diabetes mellitus, hypertension, cardiovascular disorders, chronic obstructive pulmonary disease, and their complications. Other common conditions are pneumonia, cellulites, and other skin infections.
Our renovated Pediatric Unit has two isolation rooms and eleven semi-private rooms, including two observation rooms. The majority of our inpatient pediatric care is for respiratory illnesses, such as bronchiolitis, asthma, and pneumonia, and for dehydration from conditions like gastroenteritis. Other common diagnoses typically managed in our Pediatric Unit are neonatal infections, seizures, rheumatic heart disease and its complications, acute glomerulonephritis, and hyperbilirubinemia.
Our Nursery Unit cares for all normal newborns, and our adjacent 4-bed NICU provides additional therapies for premature as well as all other ill newborns. Common diagnoses in our NICU include prematurity, transient tachypnea of the newborn, sepsis evaluations, hyperbilirubinemia, meconium aspiration, and genetic disorders. Services provided in the NICU include umbilical line placement, intravenous fluid and medication administration, phototherapy, total parenteral nutrition, mechanical ventilation, and surfactant administration.
Our General Surgical Unit provides peri-operative care for surgical patients outside of the pediatric population (who can be admitted to the Pediatrics Unit). Typical surgical services that are provided locally include wound debridement, laparoscopy, appendectomies, cholecystectomies, and venous access procedures for dialysis. We also offer same-day surgeries, such as circumcisions. Our Orthopedic Service complements our Surgical Unit by providing trauma care and general musculoskeletal care for all ages.
Our Labor and Delivery Unit is comprised of an eight-bed unit with two birthing beds and a separate delivery room, and typically manages around 110 births per month. Laboring patients are admitted to the L&D Unit, where they receive care until post-partum transfer to the Maternity Unit. In addition to laboring patients, the L&D Unit cares for patients with pregnancies complicated by pre-eclampsia, diabetes, pre-term labor, and other common perinatal morbidities. Our newly renovated Maternity Unit has 23 beds, where stable pre-term patients and post-partum patients are managed.
The Intensive Care Unit (ICU) has a shared 7 beds with patients from Internal Medicine, Surgery, and Pediatrics as well as other inpatient services. The ICU is also used at times for post-operative recovery after regular hours. Care offered in the ICU includes central line placement, ventilator support, cardiac monitoring and defibrillation. Respiratory therapists assist with blood gasses and ventilator management.
Outpatient Services
LBJ has busy outpatient clinics in Internal Medicine, Pediatrics, Surgery, Obstetrics and Gynecology, Dialysis, ENT, Ophthalmology, Physical Therapy, Dentistry, and Psychiatry/Mental Health.
The Internal Medicine Clinic sees ambulatory patients by appointment and on a walk-in basis. Common diagnoses managed there include diabetes, hypertension, gout, dyslipidemia, obesity, asthma, skin infections, and musculoskeletal pathology.
The Department of Internal Medicine also oversees the Dialysis Unit, with the assistance of a remote consulting nephrologist. The Dialysis Unit has 21 general stations and two stations for hepatitis positive patients. The patient load varies from 100-110 patients, depending on the number of visitors from outside of our Territory. Our consulting nephrologist is based in Hawai’i and makes on-site visits every few months to review management plans and to conduct quality assurance activities as mandated by CMS, the primary funding source for our Dialysis Services.
Our Pediatric Clinic sees ambulatory patients by appointment and on a walk-in basis. Common conditions managed in the Pediatric Clinic include respiratory illnesses, ear infections, asthma, skin infections and infestations, and anemia. We also manage a large population of rheumatic heart disease patients in the Clinic for the administration of prophylactic Bicillin injections and regular cardiac examinations.
Our Surgery Clinic provides pre-operative evaluations and post-operative follow-up for all of both our general and orthopedic surgery patients.
The Obstetrics and Gynecology Clinic provides services primarily in pre-natal care, gynecology, and post-partum care. Typical high-risk prenatal care in American Samoa includes pregnancies complicated by obesity, hypertension, gestational diabetes, rheumatic heart disease, and hyperemesis gravidarum. Common gynecologic diagnoses include abnormal uterine bleeding, uterine cancer, and other morbidities associated with the high prevalence of obesity. Family planning counseling is provided at the OB-Gyn Clinic and through referral to the nearby Family Planning Clinic. The Family Planning Clinic offers prenatal counseling for women considering tubal ligations as well as post-partum family planning services, such as condoms, Depo-Provera, oral contraceptive pills, and intrauterine devices. The outlying Public Health Clinics, located in the villages of Amouli, Leone, and Tafuna and staffed by generalist practitioners, provide low risk prenatal care up to 36 weeks of gestation as well as family planning.
LBJ normally also offers more specialized outpatient services in ENT, Ophthalmology, Physical Therapy, Dentistry and Psychiatry/Mental Health.
Off-Island Transfer/Referral Services
We have visiting sub-specialists who generally provide 1-2 week-long Clinics several times a year for our patients with serious chronic conditions. These sub-specialists while present also provide diagnostic and therapeutic recommendations for new presentations of difficult cases. Generally we have sub-specialists in cardiology, neurology, nephrology, rheumatology, ENT, and vascular surgery rotating through LBJ.
Our medical center participates in the Pacific Island Health Care Project, based at Tripler Army Medical Center in Hawai’i. This project allows practitioners at LBJ to consult sub-specialists at Tripler via a web-based telemedicine network. Additionally, LBJ maintains an Off-Island Referral Program, which provides access to reduced airfares for patients requiring care unavailable here in American Samoa to travel to a higher level of care outside the Territory, generally in Hawai’i, New Zealand, The Philippines, or the Mainland U.S.A.
Funding/Budget
As projected for the upcoming Fiscal Year as usual, LBJ’s direct medical care is largely funded by the United States Medicaid Block Grant Program (approximately $17M/year). The US Department of Interior funds us with technical assistance and infrastructure development programs (approximately $8M/year). US Medicare and all other “Federal” forms of insurance contribute as well (about $6M/year). Matching funds from American Samoa Government appropriations ($2M/year), patient participation in the form of facility/user fees ($4M/year), Grants ($2M/year), and other revenue from cafeteria sales, as well as medical records retention and a local fuel excise tax ($1.5M/year) also help to fund LBJ. Total annual Medical Center budget for next year is expected to be approximately US $ 40 million, corresponding to over US $720/year per capita. The bulk of that budget clearly goes to curative medical activities along with chronic care.
Medical Education
LBJ has been fairly active in the training of both resident physicians and medical students. Residents wishing to complete clinical electives at LBJ have been well-accommodated, and have come from various countries including Canada, Fiji, Germany, and the U.S.A. Physician assistant residents, medical residents, medical school students, ancillary program residents, and physician fellows from diverse Universities (Vancouver School of Health Sciences, Brown University, Loma Linda University, University of Connecticut, Duke University, Jefferson College, University of Hawai’i and more) have all participated in the program, and have clearly benefited from this unique training environment. Human resource development in medical sciences has become a priority in American Samoa, and partners such as PIHOA and The WHO are participating in “Human Resources for Health” collaborative programs.
Licensed practical nursing degrees are attainable locally at the American Samoa Community College. Registered nursing degrees are also attained through overseas programs and distance learning, in conjunction with the local program. The American Samoa Health Services Regulatory Board (ASHSRB) requires nursing qualification and certification through the regular American Nursing Board(s) (NCLEX).
Work Ethic/Cultural Implications
The intersection of the fa’a Samoa (“the Samoan way”) and the predominantly western-style medicine at LBJ hospital creates a varied work ethic. During work hours, the traditional/familial hierarchy that our staff lives with outside of the hospital is replaced with an experience/training/capability driven model.
Ancillary Services
Inpatient and outpatient services are complemented by quite a full range of ancillary services, which include laboratory, radiology, pharmacy, emergency medical services, medical information systems, and several others. Our laboratory provides basic chemistry, bacteriology, serology, hematology, blood bank, and urinalysis testing. Other laboratory investigations required by the attending practitioner can be sent for off-island processing as needed. Our Radiology Service includes plain films, ultrasonography, fluoroscopy, and computed tomography. We also have capabilities for basic adult and pediatric echocardiography. Our pharmacy offers a full range of basic prescription medications from our approved Formulary. The Pharmacy and Therapeutics Committee of the Medical Staff can be petitioned to include other medications if the need justifies the cost. Medications not found on our Formulary can often be specially ordered for patients who agree to pay market price, for example for newer or for less commonly used specialty medications. Our nutrition and diabetes education programs provide not only dietary services to our inpatients, but also consultations and patient education for the larger outpatient population. Our medical social workers assist practitioners in counseling families and coordinating care in sometimes very challenging situations. The EMS Unit is integral to our population in providing both access to and greater efficiency of our overall medical care. LBJ’s documentation system utilizes the U.S. Veteran Administration’s “VISTA” and “CPRS” Systems, which enable practitioners to electronically order medications, laboratory services, radiology studies, and consultations, as well as to view those results and document patient care in one unified electronic medical record. We also have a fairly new “PACS” system for digitalized radiological imaging. Our goal is to move towards a totally “paperless” system as soon as later this year.
Human Resources
Applications are available, please forward and inquiry to hr@lbj.as. For questions regarding the application process, please contact our office:
LBJ Tropical Medical center
P.O. Box LBJ
Pago Pago, American Samoa 96799
Phone: (684) 633-1222 Ext. 444
Fax: (684) 633-1869
Email: hr@lbj.as
Company History
The Lyndon B. Johnson Tropical Medical Center (henceforth “LBJ”) was opened in 1968. It is a regional acute care facility licensed for 150 beds, and located on the island of Tutuila, the main island of the American Samoa group; it serves the entire population of Tutuila, Aunu’u, and the Manu’a Islands. LBJ offers a full-range of primary care services and some subspecialty services to the population of American Samoa, which includes approximately 60,000 American Samoan, “Western” (Independent) Samoan, Korean, Chinese, Filipino, American and other population groups. LBJ is a semi-autonomous agency of the American Samoa Government and is funded primarily through Medicaid/Medicare Block Grants, the U.S. Department of Interior funding, and the (local) American Samoa Government appropriations. LBJ provides emergency care, general medical and primary care, acute care, as well as limited specialty department care to the whole population of American Samoa.
Benefits
Long Term Contract 1 to 2 years or Short Term/Locum Stints (6 months or longer) is welcome. Relocation assistance for two years contracts with fringe benefits. Travel and accommodation provided for Locum stints.
May we suggest American Samoa, the only U.S. Territory below the equator. You can live in a lush tropical environment, rich with tradition and alive with Polynesian culture. Come and experience the lovely Island in the South Pacific. Beautiful beaches, clear blue waters, friendly and warm people awaits you! Make a difference in an underserved area.