Guam’s medical oversight failures must not become the Pacific’s futureDear Pacific Leaders:
Guam’s medical oversight system is broken — and the danger is that its failures could spread across the Pacific. The Federation of State Medical Boards (FSMB) is actively courting jurisdictions including Palau, the Northern Mariana Islands, American Samoa, and others. Before joining, these governments must understand what FSMB has enabled in Guam: conflicts of interest, no citizen representation, and a record of never siding with patients. If FSMB expands without reform, Guam’s failures will not remain Guam’s alone — they will become the Pacific’s problem.
Over the past seven years, nearly 70 patient complaints have been filed with the Guam Board of Medical Examiners (GBME). Not one has resulted in a ruling in favor of a patient. Complaints languish, hearings stall, and outcomes vanish into opacity. This is not oversight — it is obstruction. The institutions entrusted with protecting patients have entrenched themselves in a culture of self‑preservation. GBME, responsible for licensing and disciplining physicians, has become emblematic of a system where accountability is absent at every level.
Conflicts of interest sit at the heart of the problem. GBME Chair Dr. Nathaniel Berg is also CEO of Guam Radiology Consultants, the island’s largest imaging clinic, where physicians licensed by GBME routinely refer patients. Vice Chair Dr. Joleen Aguon is both Administrator at Guam Memorial Hospital and a regulator of the very doctors she manages. She is simultaneously their boss and their judge. Even if recusal were attempted, the appearance of bias is unavoidable. Patients rightly ask: who is protecting us when the regulators are also the employers?
FSMB declares its mission is to “support state medical boards in protecting the public’s health, safety, and welfare through proper licensing, regulation, and discipline of physicians.” In theory, this is about safeguarding patients. In practice, Guam shows the opposite. Citizen representation is absent, transparency is nonexistent, and conflicts of interest are ignored. FSMB’s lofty mission statement rings hollow on Guam, where oversight protects doctors instead of the public.
FSMB’s revenue model only deepens the concern. Its income comes almost entirely from physicians and medical boards through licensing, credentialing, and exam fees. Patients pay nothing into FSMB. That means FSMB’s financial interest lies in protecting doctors — its income stream — rather than defending patients. The result is a system where the regulator’s survival depends on those it is supposed to regulate, leaving victims without a voice and accountability compromised at its core.
Guam’s Legislature has compounded the failure by confirming Dr. Berg back to the Board despite testimony opposing it. Senator Sabrina Salas Matanane, Chair of the Committee on Health, once supported reform but now turns her back on the same problems. Accountability has eroded not just within GBME but across Guam’s political leadership.
FSMB insists that local complaints are not its responsibility. Yet if FSMB claims no role in ensuring accountability, what benefit does it provide to the people of Guam? Worse, FSMB is courting other jurisdictions in the Pacific. If these governments join FSMB without reform, they risk importing Guam’s failures — conflicts of interest, lack of citizen representation, and a record of never siding with patients. Instead of strengthening oversight, FSMB’s silence could spread a model that protects doctors across the Pacific while silencing victims.
This lack of accountability extends beyond GBME. Guam’s Medical Malpractice Forced Arbitration Act already strips patients of their right to sue in court, funneling grievances into a process tilted toward providers. When the medical board also fails to act, patients are left with no impartial recourse at all. Accountability is not optional in healthcare. It is the foundation of public trust.
Pacific leaders must act now. Palau, CNMI, American Samoa, and others should not compromise impartiality by joining FSMB until it demonstrates that it can enforce accountability and protect patients rather than shield physicians. Guam’s failures must not become the Pacific’s future.
The people of Guam deserve better. Oversight must serve the public, not the profession. Until accountability is restored, every patient remains at risk — not just from medical error, but from a system that refuses to hear their voices. And the Pacific deserves better too.
DAVID LUBOFSKY
Advocate for improved medical care through accountability
Section: OpinionTags: Conflicts of interest
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