ST. THOMAS, VI – The 36^th Legislature of the Virgin Islands’ Committee on Health, Hospitals, and Human Services, led by Senator Ray Fonseca, met at the Earle B. Ottley Legislative Hall.  Lawmakers received testimony concerning the potential and observed public health risks associated with prolonged exposure to untreated sewage throughout the territory. Additionally, lawmakers also received testimony regarding cancer in the Virgin Islands, including but not limited to available patient services and support programs, opportunities for governmental agencies, healthcare providers, nonprofit organizations, and community partners to support the Charlotte Kimmelman Cancer Center once it is operational.  

Lawmakers first received testimony concerning health risks associated with exposure to untreated sewage. Walton Keith Smith, Chief of Wastewater at the Virgin Islands Waste Management Authority said that our wastewater system is one of the most critical public health assets in the territory. It serves the territory through 240 miles of sewer pipelines, over 4,200 manholes, 31 pump stations and eight wastewater treatment plants. Most of this infrastructure has exceeded its intended service live and now requires increasing levels of maintenance, while continuing to provide services to communities.  FEMA has concluded that the wastewater infrastructure in the territory is beyond repair and simply cannot be patched or rehabilitated, it needs to be completely rebuilt.  

When sewer infrastructure fails, untreated sewage can be released into neighborhoods, streets, storm drains, beaches, waterways and residential communities.  Sanitary Sewer Overflows expose residents and visitors to bacteria, viruses, parasites and other disease-causing organisms that lead to gastrointestinal illnesses, skin and eye conditions, respiratory irritation, and other health conditions. Young children, the elderly, pregnant women, and individuals with weakened immune systems are vulnerable. WMA’s Wastewater division launched the Wastewater Optimization Program in 2024 to improve operational performance while laying the foundation for long term infrastructure reliability. Through the federal recovery process, approximately $3.2 Billion has been identified for prudent replacement of the infrastructure. It is expected that full replacement of the wastewater system will be completed by 2034.  The Authority continues to advocate for continued legislative support so that the agency can effectively operate, maintain and protect the new wastewater system while being funded through the FEMA replacement program.

Senators then received testimony regarding cancer in the Virgin Islands, including but not limited to available patient services and support programs, opportunities for governmental agencies, healthcare providers, nonprofit organizations, and community partners to support the Charlotte Kimmelman Cancer Center once it is operational.

Darlene Baptiste, Chief Executive Officer for the Governor Juan F. Luis Hospital and Medical Center and Schneider Regional Medical Center delivered details on the completion of the Charlotte Kimelman Cancer Center. The facility is now transitioning from construction to operational readiness, which includes the validation of radiation therapy equipment, integrating oncology electronic medical record, completing regulatory and radiation safety requirements, finalizing procurement of IT and medical supplies and onboarding specialized staff. SRMC has already recruited key personnel for the facility, including a Radiation Oncologist and CKCI administrator. It continues to phase in hiring for radiation therapists, physicist, oncology nurses, and support staff.  The care model will launch with radiation oncology supported by diagnostic imaging, lab, pharmacy, nursing, and patient navigation, while partnerships with ACS, Cancer Support VI, DOH, and others strengthen patient navigation, education, and survivorship services. A PET/CT scanner has been federally funded to expand future cancer diagnostic capabilities, and a $4.9M FY 2027 operating budget has been developed to support CKCI’s first full year of operations. Breast imaging services at SRMC are disrupted do the mammography unit reaching end of life status. The manufacturer support ended in December 2024. The executive leadership is evaluating replacement mammography services to restore the services as soon as possible.

Darryl Smalls, Executive Director of the Territorial Hospital Redevelopment Team for the Territorial Hospital Redevelopment Team provided an update for the reconstruction of the Charlotte Kimelman Cancer Institute.  Reconstruction of the facility begin in March 2024 and is nearing completion. $34,932,144,84 has been billed out of the total contract value of $35,186,153.39. In Smalls’ testimony, the project encountered numerous challenges, such as modernizing an existing facility while working within the constraints of its existing building.  The most significant challenges were mechanical and electrical system upgrades, as current code requirements demand substantially larger equipment, increased ventilation rates, demand larger equipment, enhanced infection control measures, and greater system redundancy than what was required under previous codes. All critical infrastructure, such as mechanical, electrical, and plumbing, fire protection, and IT/LV systems have been installed and are operational.

The li accelerator and CT simulator have been installed and are awaiting a physicist’s sign off.  IT procurement is underway with the delivery of phones, printers, desktops, and clocks to be delivered shortly. Furniture is expected to be installed by September 2026.  Smalls states that procurement of minor medical equipment has been the biggest challenge, with multiple solicitations resulting in non-responsive bids. The highest priority has been paced for the physicist acceptance of radiation therapy systems.  The delays of delivery of the minor medical equipment or IT equipment could result in operational readiness, but not construction completion. Once CKCI is complete, it is expected to be fully code compliant, hurricane resilient, equipped with redundant utilities, such as water, emergency power, UPS and N+1 chiller, as well as being operationally independent from the future RLSH demolition and reconstruction. It is expected to be a state-of-the-art cancer treatment facility in the Territory.

Dr. Janis Valmond, Deputy Commissioner of the Department of Health Promotion/Disease Prevention Programs delivered testimony on cancer care in the territory. The Virgin Islands Department of Health has three programs that are the foundation of cancer control efforts. These include the Virgin Islands Central Cancer Registry, the Virgin Islands Comprehensive Cancer Control Program, and the Virgin Islands Breast and Cervical Health Program. These programs are federally supported provide care across the entire cancer care continuum, from prevention to screening, strategic planning, patient navigation and systems improvement.  The VICCR serves as the territory’s official population-based cancer-based surveillance system. It does not provide direct patient care or financial assistance. However, it collects information on the incidence of every reportable cancer diagnosed among residents of the US Virgin Islands. Cancer is one of the leading causes of illnesses and death in the territory. Malignant neoplasms were the second leading cause of death in territory.  VICCR also monitors cancer mortality through routine linkage with the Office of Vital Statistics.

An analysis of cancer mortality in the territory between 2011 and 2024 shows that prostate, colorectal, and breast cancers made up the highest number of cancer related deaths. Lung and pancreatic cancers however have disproportionally contributed to cancer mortality rates as they are often diagnosed at more advanced stages and have poorer survival outcomes. Between January 1, 2016 and December 31, 2023, the registry identified 2,910 reportable cancer cases among Virgin Islands residents. Of these cases, 1,538 (53%) occurred among males and 1,372 (47%) occurred among females. St. Thomas accounted for 1,450 cases, St. Croix for 1,290 cases, and St. John for 134 cases. An additional 36 cases were received through the National Interstate Data Exchange Program.  These cases are pending confirmation of island residence.  The most frequently diagnosed cancers through this time period included Prostate Cancer (656 cases), breast cancer (564 cases), colorectal cancer (344 cases), hematopoietic malignancies (233 cases), and lung and bronchus cancer (141 cases). In men, prostate cancer represented 43% of all cancers diagnosed, while breast cancer represented 41% of cancers diagnosed among women.

The Virgin Islands Central Cancer Registry provides essential data on cancer diagnosis, stage and mortality. However, its work is limited by incomplete provider reporting, population estimate delays and administrative barriers.  The Department of Health and its Cancer Coalition have expanded vaccination campaigns, screening programs, outreach and patient navigation. However, residents have faced long wait times, limited diagnostic capacity, and travel burdens for specialized care.  Valmond’s testimony highlights that the future reopening of the Charlotte Kimmelman Cancer Center presents a major opportunity to strengthen care in the territory as well as reducing the need for patients to travel off island for treatment.

Senators present at today’s Committee hearing included Ray Fonseca, Hubert L. Frederick, Marvin A. Blyden, Alma Francis Heyliger, Novelle E. Francis. Jr, Sr., Carla J. Joseph, and Milton E. Potter.

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