LOS ANGELES — On June 6 Guam residents temporarily displaced to Los Angeles rose with the sun to meet for coffee on the third floor of the majestic Weingart Guest House. The Weingart is located on the west corner of the Good Samaritan Hospital campus in downtown Los Angeles.

As the day begins the smell of home cooking wafts through the 12-story guesthouse while the women chase hungry men away. They are humming and singing Misericordia Divina “Divine mercy ” a traditional Chamorro song to the protective saints. Each woman is busily preparing a part of a traditional breakfast of Spam eggs and hot rice for all to enjoy. No one goes hungry here. This day Bertha A. Quinata Helen C. Candaso and Diane C. Ullola also prepare a delicate custard latiya. Meanwhile morning small talk develops quickly particularly about the passing of former president Ronald W. Reagan the day before at his Bel-Air home just across town from the hospital.

Those who are part of a unique group share laughter and happy moments in this place where some come to die and others get a new lease on life.

Meanwhile members of the Siguenza and Ignacio families arrive from the airport after a 12-hour flight from Japan. They are immediately greeted and welcomed. They are from Guam and therefore carry an invisible passport into a caring and special community that works to keep each other comforted and in positive spirits.

However all is not as kopesetic as it may seem on the surface.

Unless money is no object Guam residents who head for Los Angeles in need of medical treatment are in for an shock.

They will find they are dependent on the goodwill and personal resources of the four staff and volunteers of the Guam Medical Referral Office an outreach office of the governor of Guam.

Mounting patient numbers a trickle of inadequate finance and deteriorating equipment are the facts of a situation that staff told the Journal has met with no support from the office of the governor.

There are Guam medical referral offices in Guam Honolulu and Los Angeles. The Manila referral office closed in April 2003 but is about to reopen under a private arrangement. Since hospitals in Hawaii are no longer accepting patients from Guam without various up-front payment conditions (See “Micronesia patients rejected by Hawaii hospitals ” in the Dec. 29 issue of the Journal.) the Los Angeles office has seen its numbers increase dramatically.

The Journal was able to observe conditions at the referral office and talk exclusively to referral office staff hospital officials and patients affected by the reduced circumstances.

Ernesto P. Cruz manager of the Los Angeles referral office said he has become frustrated.

He said needed funds are only trickling in. Cruz said he faces an unusual increase in patient arrivals the rising cost of fuel telephones disconnected for non-payment cancellation of the office Internet/e-mail account and daily trials to keep vans on the road. The vans are pushing the 150 000 mile mark.

Cruz a former resident of Agana Heights and a retired United Airlines employee said he has been managing the office on a shoestring budget. The Los Angeles office receives approximately $90 000 a year for operations. Cruz receives a salary of $26 000 per annum. He said it was $48 000 under the previous administration. Four part-time staff receive just under $500 each biweekly pay period. Salary checks are FedExed to Los Angeles from Guam. The $90 000 includes $1 000 per month for expenses.

Cruz said “I only get $1 000 a month in petty cash. We don’t even have a credit card for fuel and oil purchases. Keeping appointments for patients is a real problem because my guys are only paid part-time with no benefits. Yet they put in the time to make sure that most appointments and schedules to and from the airport are met. I really have to hand it to these caring people for having the fortitude to carry on under such difficult conditions. They need to be made full-time ” he said.

Cruz said the Los Angeles office is in the worst condition it has been in since he started working there in 1997.

“It’s really nobody’s fault. We aren’t getting the support we need to keep up with the increase in the patient load ” Cruz said. “Right now there are 36 people here and by the end of the month more than 60 will have been assisted in one way or another. This means our highest month to date since opening this office.”

Cruz said he is not laying the blame on any one cause or with any person. “Simply put the time has come that alternative sources of funding be sought and the people back on Guam are informed of our deepening dilemma here.”

Joseph A. Farfan a 1965 graduate from Father Duenas High School and a former resident of Mangilao was a volunteer for nearly a year before becoming a part-time government of Guam employee in October 2003 at the Los Angeles referral office.

“We have some real problems and they are not getting any better. We need some help here and it needs to come soon ” he said. “We are using our own money to help get people to and from medical appointments and drive them to and from the airport. “

Farfan said he shares the financial burden and the obligation to help people from Guam. “People come here and they don’t know what to do. They are apprehensive and many are downright scared. Helping each other through difficult times is what our culture has taught us to take care and make comfortable those that are hurting in one way or the other.”

“I just want to help the people from my island ” Farfan told the Journal.

Gov. Felix P. Camacho visited the referral center in January. The governor facilitated payments totalling $150 000 to Good Samaritan Anaheim Hospital and Loma Linda Clinic for past due payments The governor’s office said it had heard there were problems with phone lines at the L.A. office. Shawn Gumataotao director of communications in the governor’s office said “We are aware of their concerns. They have been very fiscally responsible. We are assisting to make sure they have all resources.”

The chief of staff in the office of Sen. Lou A. Leon Guerrero majority leader and chairwoman of the Committee on Rules and Health of the 27th Guam Legislature said the senator’s office had received a call that the L.A. referral office had closed. The senator’s office had contacted Anthony Sanchez chief of staff in the office of the governor. According to the senator’s office Sanchez called back and said the L.A. office had experienced some problems with phone lines.

The Guam Medical Referral Program was started under the Ada/Blas administration in 1992. The program helps Guam residents needing specialized medical attention not available on Guam. The office had a budget of $600 000 in fiscal 2004 and can expect the 2005 budget to mirror that. During the Gutierrez administration the office and patients received additional monies from People Helping People a non-profit organization set up by first lady Geri T. Gutierrez. Clients who visited the Guam Medical Referral Office would be offered application forms and reportedly received sums ranging from $50 to $500.

The Guam Medical Referral office has a staff of three. Teresita Barnhart staff assistant said she has been at the referral office since the beginning of the Camacho administration. Bernhart said the Guam office dealt with about 75 patients a month. She told the Journal the Honolulu and Los Angeles referral offices dealt with a similar number of patients each and that summer months were considered “heavy season” for services. Bernhart said she was not aware of any problems in the Los Angeles or Hawaii offices.

Celestine T. “Sal” Manalisay of Barrigada previously worked with Locksan International Aircraft Cleaning Services headquartered in Indian Head Md. but with ties to Guam International Airport. He now works as a staff member at the Guam Recovery Coordinators Office assisting the Department of Education in Federal Emergency Management Agency-related projects.

Manalisay was accompanying a family member who was scheduled at Good Samaritan for surgery.

He said “I feel so bad when I see these people in such need and there is such limited support coming from our island. This is the most important program that exists within the government of Guam for people in need.”

Manilisay said employees of the referral office pay for gas for the referral office. “It’s just not right and my heart is crying.”

Manalisay said dwelling on the problem was counterproductive. “I have been a businessman in the private sector for most of my life and I know the solution is not to turn to the government but rather away from it. This could be done by forming a not-for-profit foundation which will mean a total revamping of the program in general. I have already been pricing new vans and working out a budget. I am formulating a proposal that includes going after federal grants and asking for private donations from Guam businesses all of which would be tax deductible.”

Manalisay said he will be talking to the governor the speaker and with friends in the private sector.

“There is an answer and I think we really don’t need local government money to solve this problem. Only time will tell but like a patient in need of resuscitation time is running out.”

Cruz said he would appreciate any effort that would shed light on the deepening problems.

Thomas W. Baumann is director of physician development for Good Samaritan Hospital which owns the Weingart located in the hospital grounds.

He said hospital officials have talked with lobbyists in Washington D.C. who said there are funding alternatives for the L.A. referral office but it would take some creative problem solving and an “out-of-the box” approach.

“There is so much pork barrel money available from the strangest places our lobbyists have informed us. If Ernie had some support from planners that understand the grant process combined with a concentrated public-private partnership that could provide tax incentives to local Guam companies a win-win solution could be found quickly so this important one-of-a-kind program continues ” Baumann said.

He said Good Samaritan supported the office and its mission. “While we understand that there is a tight financial situation in Guam the group here will be given the flexibility it needs to carry on from this end. This program has a special place in my heart because I don’t believe there is any other like it in all America.”

Baumann credited Cruz and his three employees for making the best of the situation. “To Ernie’s defense there are many uncontrollable pressures that he is dealing with the best he can and through these changing times we will continue to provide support.

One avenue he suggested was that Guam assume responsibility for one or two floors of the Weingart overseen by a non-profit organization.

A floor at the Weingart would require about $100 000 a year to maintain while also making money available for higher salaries for full-time employees. “This can be done and we would support it wholeheartedly ” Baumann said. “The Guam medical referral office is one of the finest examples of people helping each other that we have ever supported.”

Good Samaritan allows Guam Medically Indigent Patients to stay free for up to one week and then charges $30 per night. The Weigart also houses people from across the U.S. and from overseas. “We also have some very generous long-term programs in place for those undergoing long-term out-patient care because it is all about the well being of our patients ” Baumann said.

The Weingart is undergoing a $6 million facelift and is struggling to open more rooms in part because of the increased numbers of patients and family members coming from Guam. Renovations include a 24-hour coffee shop and a concierge for patients and families to get information on activities in Los Angeles.

Farfan said that there have been cases that have saddened him greatly.
“ Our people are having to figure ways to pay for their stay here. They are worrying about selling property — like family real estate and their cars borrowing money from family or friends or turning to high-cost loan institutes. They get up to their eyes in debt. Stress follows and it’s unhealthy.”

Cruz said health-insurance providers on Guam should put more into their health-insurance packages for both public and private plans. “The health-care providers should also be put on notice because they do not compensate us in any way for the things we do to help their policyholders and that is wrong. The Staywells Net-Cares Calvos SelectCare and others should be working out plans that include air fare and authorized Weingart stays paid up front as part of the policies. If this program goes away what then are the health providers going to do? We help them a lot without any compensation.”

Cruz told the Journal that he was considering retiring to spend more time with his wife and family. “I just want to make sure that the program does not suffer a cruel death but gets a vibrant new start with some energetic blood from somebody that can push the right buttons in the right places. This is just too important for my beloved Guam and its people.”

Editor’s Note: Say was in Los Angeles for medical treatment at the Good Samaritan Hospital and stayed at Weingart House.