Guam's medical care system is critically ill and has been so for a long time.
There is one dilapidated, bureaucratically burdened, and under-equipped hospital for us non-military folk. They can't pay all their bills and employees worry whether they'll get paid. Our hospital, owned by GovGuam, doesn't come near qualifying for accreditation -- so they don't even try.
Physicians, weary of the nonsense here, pack-up their black bags and go elsewhere to practice. So there is a doctor shortage -- especially in the specialties.
And now the Guam board of medical examiners is having a sissy fit -- interpreting the US territory's bizarre medical code in such a way as to suggest that off-island doctors can't be consulted unless those doctors first obtain a Guam medical license.
Routine reciprocity common in the States seems out of the question. Apparently no other US jurisdiction could possibly live up to Guam's high standards.
The particular institution which set off the current controversy is a second-rate hospital in Los Angeles called Cedars-Sinai. They were doing a free telemedicine consultation for a six-month-old baby.
Many places in the "less developed" world have better medical options than Guam. People often have to leave the island for care in Manila. Sometimes Guamanians travel to Bangkok for surgery. If their families can scrape up enough cash they might go to Honolulu. Medical care and travel is way more than what most islanders, who are generally of very moderate means, can afford. The poor suffer the most.
Sometimes small islands generate small minds.
Defend the weak and the fatherless; uphold the cause of the poor and the oppressed. Rescue the weak and the needy; deliver them from the hand of the wicked. ~ Psalm 82:3-4