In a territory where continuity of dialysis care has long been a critical concern — especially after the costly off-island transfers following hurricanes Irma and Maria — lawmakers on Monday confronted what many called an avoidable crisis: the abrupt closure of Caribbean Kidney Center’s St. Thomas facility with just two hours’ notice — leaving 32 patients scrambling for care, and Schneider Regional Medical Center left picking up the slack.

At the center of the controversy was Dr. Walter Gardiner, CKC’s longtime medical director, who told the Senate Committee on Health, Hospitals, and Human Services that the July 1 shutdown was a “painful but necessary” decision triggered by a wave of personal health emergencies among his key clinical staff. Three of CKC’s most critical personnel — two with relatives undergoing chemotherapy and one with a mother in the ICU — suddenly stepped away, leaving the facility unable to meet the federally required staff-to-patient ratio.

Faced with what he described as an urgent and unsafe situation, Gardiner said he made the decision alone to cease operations temporarily and notify the government and patients by email.

“If anything had gone wrong with the hemo patients, we would have been crucified,” Gardiner said. “I make no apologies for the decision. Yes, I apologize for the inconvenience, but not for protecting patients from harm.”

That comment sparked immediate backlash.

“You gave us two hours’ notice that you were closing a center where lives were on the line, and you sit here saying you make no apology?” Sen. Ray Fonseca fired back. “That pissed me off.”

Lawmakers said they were stunned by the lack of coordination and even more concerned by the financial backdrop. CKC, a private entity, had received more than $2.8 million in public funding through various appropriations over the years, including $75,000 under Act 8130, $700,000 under Act 8729, and another $2.1 million in emergency support. Yet, when pressed on what it would take to remain open or reestablish services, Gardiner offered no clear financial figure — only that staffing had become “untenable.”

“This testimony is lacking in detail,” Sen. Marvin Blyden added. “What exactly made the staffing situation so dire? And what would it cost to bring you back online?”

As lawmakers dug for answers, it was Schneider Regional Medical Center CEO Tina Comissiong who painted the clearest picture of the fallout. According to Comissiong, SRMC received an email from CKC at 3:47 p.m. on July 1 announcing that it would cease operations by 5 p.m. — just 73 minutes later. No formal clinical handoffs were made. No calls to nephrologists. Just a notice, followed by silence.

By the next morning, patients began arriving — many without complete records, prescriptions, or any indication of recent medical history.

“Our team of nephrologists started evaluating patients at 4:30 a.m.,” Comissiong testified. “The records we received were piecemeal. There was no doctor-to-doctor communication. No coordination with our case management or dialysis teams. We had to reassess and recertify every single patient to ensure they could be safely treated.”

SRMC’s ability to absorb the patients was made possible only by a 2024 expansion that added 12 new dialysis stations and the hospital’s annual stockpiling of hurricane supplies. But Comissiong made it clear that the system is straining. To keep the service running smoothly, SRMC now needs three more hemodialysis-trained nurses, at least five or six new technicians, and up front funding to contract them.

“We estimate a need of $300,000 to $500,000 right now just to stabilize operations,” she said. “Over the long term, with consistent volume, the service could become more financially viable, but we’d still need about $500,000 to $1 million annually to maintain it at full capacity.”

Despite these clear needs, SRMC has yet to receive the $1 million appropriation authorized under Act 8876 — legislation passed in 2024 specifically to support and expand dialysis services.

Sen. Milton Potter questioned the holdup. “Why hasn’t the money been disbursed?”

Comissiong responded that it was likely a matter of central government cash flow but reiterated the urgency: “Releasing those funds now would make a significant difference.”

Further complicating the situation is a lawsuit filed July 1 by Puerto Rico Hospital Supply, one of SRMC’s vendors, seeking more than $317,000 in unpaid invoices for dialysis-related equipment. The lawsuit, filed in Superior Court, alleges the hospital failed to pay for shipments made as far back as September 2024. Comissiong confirmed that the vendor is one of many included in the payment list tied to the $10 million in emergency appropriations passed earlier this year, of which SRMC has received $6.5 million and disbursed nearly $5 million to date.

“We expect to process the full list within 30 days of receipt,” Comissiong told senators.

Still, the concern wasn’t just about unpaid bills — it was about system capacity and the risk of future breakdowns.

Sen. Hubert Frederick stressed the need for redundancy. “If something catastrophic happens at the hospital, then what? Where do these patients go?” he asked. “We can’t afford to be caught off guard again.”

He added that SRMC’s use of emergency supplies to meet this unplanned surge created another layer of risk, especially heading into the height of hurricane season.

Meanwhile, Sen. Carla Joseph called for an Inspector General audit into how CKC used previous government allocations and whether proper oversight had been in place. “If CMS pays for dialysis, why are we scrambling for money to keep the service running?” she asked, echoing frustrations voiced by other members of the panel.

Though Gardiner insisted that no patients were in immediate danger and that CMS guidelines were followed in terms of discharging and transferring patients, SRMC’s Chief Nursing Officer, Delphine Olivacce, contradicted that account. In her testimony, she said many patients lacked key documentation, which required SRMC’s medical team to start from scratch.

“There’s a very specific CMS-prescribed protocol for safe discharges and facility handoffs,” Comissiong added. “That was not followed.”

Despite the chaos, senators praised SRMC staff for stepping up under pressure, but made clear that gaps in the system remain.

Despite the criticism leveled at CKC, several senators acknowledged the broader issues at play — including the need for stronger oversight, faster disbursement of critical funds, and a long-term plan to safeguard dialysis care in the territory. As of Monday, Schneider Regional continued to treat all 32 patients formerly under CKC’s care, with staffing reinforcements and supply orders pending.

The Health, Hospitals, and Human Services Committee said it will continue monitoring the situation as SRMC works to stabilize services and the future of CKC remains uncertain.