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Several plans emerge
To some degree, support for the planned hospitals stems from inadequate funding of Maui Memorial and the lack of implementing a long-term strategy for health care, critics said.
Supporters of new facilities note that Maui, larger in size than Oahu, has an estimated resident population of about 130,000 and only one hospital. Kauai serves its 60,000 residents with two acute-care hospitals.
The Big Island serves 150,000 residents with five acute-care facilities.
The list of problems is long, critics claim.
General surgeon Dr. Camilo Rosales said the hospital sometimes takes 10 to 12 hours to get blood supplies from Honolulu, and the lack of a modern CAT scan sometimes forces physicians to resort to more invasive procedures.
And some physicians said the hospital could be performing certain surgical heart procedures to boost its revenues significantly.
Dr. Joseph Kamaka III, president of the Maui County Medical Society, said the rural health system should not be operated like a corporation, and lawmakers should realize it is not a moneymaking venture.
"It's not a business. It's not a profitable entity," he said.
He said Maui Memorial has been through three chief executive officers in the last six years and usually takes the brunt of the blame, although the decisions are made by Hawaii Health Systems officials.
Moser said another problem is the lack of fiscal control in employee costs, with labor negotiations handled between the unions and the state Legislature.
"Those who have to manage and live with the budget should have control over expenses," Moser said.
"These Maui citizens generally serve without compensation and are rewarded largely by the opportunity to be advocates with considerable influence for Maui projects in HHSC," Lyons said.
Lyons said Hawaii Health Systems' investment in the Maui community far exceeds Maui Memorial profits by tens of millions of dollars.
Maui Memorial's Chief Executive Officer Wesley Lo said his group has been working with West Maui Improvement officials and will support a new facility where it makes sense.
But the proposed South Maui facility does not make sense at all, Lo said. "We believe it will become a vanity hospital catering to the wealthy," he said.
Lo said a new hospital also could jeopardize Maui Memorial's $10 million in annual revenues from the federal government as a designated sole provider for Medicare.
Comparing the number of acute-care facilities on each island is "very misleading," Lo said. It is better to compare the number of acute-care beds.
He said Maui has 207 beds, compared with Kauai's 95 and the Big Island's 244.
Lo said that computerizing medical records has been "cost-prohibitive," but Hawaii Health Systems is now evaluating several vendors for this service.
He said Maui Memorial's CAT scan is about 3 years old, and officials are working with radiologists to determine the next generation of equipment.
Lo said Maui Memorial is in discussion with its cardiology department to determine the feasibility of doing heart procedures on the Valley Isle and that part of the final determination hinges on many issues, including rapid transport, a blood bank and new cardiologists to perform open-heart surgery.
He said surgical equipment is purchased through the two largest suppliers in the nation, and a committee of physicians determines the suppliers.
Tom Driskill, Hawaii Health Systems chief executive officer, said in addition to building a new wing, the group has provided Maui Memorial with other funds, including $5.5 million for its heart center.
"MMMC continues to provide a high level of quality and capability compared to the best hospitals in the state," he said. "HHSC's purpose is to partner with the state to promote quality health care as a benefit and a shared responsibility of all Hawaii's citizens. This is a noble purpose that is worthy of protection and support."
Officials at Maui Medical Group said they also opposed the development of Malulani Hospital because the primary need in the next 10 years will be for long-term beds on the Valley Isle and not an acute-care hospital in South Maui.
And even if a new facility is built, finding personnel will not be easy. The proposal comes at a time when the islands are facing a serious nursing shortage, Lo said. And Group Vice President Dr. William Mitchell said his organization is worried there will not be enough physicians to adequately staff the hospitals.
"We just don't see how that can pan out," he said.
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