GUAM’S medical oversight is broken and patients pay the price. Nearly 70 patient complaints have been filed with the Guam Board of Medical Examiners or GBME over the past seven years. Not one has resulted in a clear 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.
The problem is compounded by glaring conflicts of interest. Dr. Nathaniel Berg, current chair of GBME, also serves as CEO of Guam Radiology Consultants, the island’s largest imaging clinic. Physicians licensed by the GBME routinely refer patients to his clinic. How can the public trust disciplinary decisions when the regulator profits from those he regulates? Similarly, vice chair of the GBME, Dr. Joleen Aguon is both the administrator at Guam Memorial Hospital and a regulator of the very doctors she manages. She is simultaneously their boss and their judge. Even if she recuses herself, which she has not done in at least one case, the appearance of bias is unavoidable. Patients rightly ask: who is protecting us when the regulators are also the employers?
The Federation of State Medical Boards or FSMB, of which Guam is a member, 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 and ensuring accountability. In practice, Guam shows the opposite, again with its nearly 70 complaints in seven years having produced no rulings in favor of patients. Conflicts of interest are ignored, transparency is nonexistent, and citizen representation required by FSMB’s own standards is absent. FSMB’s lofty mission statement rings hollow on Guam, where oversight protects doctors instead of the public.
FSMB’s revenue model only deepens the problem. 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 again at its core.
The failure is not confined to the GBME. Guam’s 38th Legislature voted to keep the status quo by confirming Dr. Berg back to the Board, dismissing testimony opposing it. Senator Sabrina Salas Matanane, chair of the Committee on Health, once acknowledged the need for reform when she ran for lieutenant governor, supporting changes introduced by then-Speaker Therese Terlaje. Now, as senator, she has turned her back on the same problems at the Board. This reversal underscores how deeply 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? Its silence enables boards like GBME to operate without consequence. The danger is greater still: FSMB is courting other jurisdictions in the Pacific, including Palau, the Northern Mariana Islands, and American Samoa, while also engaging regulators in the Philippines and Asia‑Pacific. If these jurisdictions 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 and putting the medical consumers at greater risk.
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. Guam’s leaders must confront the reality that its medical oversight system is broken. That means reforming the GBME, enforcing strict conflict‑of‑interest rules, restoring citizen representation on the board, and ensuring transparency in complaint handling. Without these changes, Guam will remain a place where doctors are protected, patients are silenced, and justice is denied, not to mention leading to more deaths, injuries and even sexual misconduct.
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 to Palau, CNMI, American Samoa, and other Pacific jurisdictions: do 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.
DAVID LUBOFSKY, ED. D.
Advocate for improved medical care through accountability
