Monday, November 29, 2004

Several plans emerge
for new Maui hospitals

Backers contend that aging Maui
Memorial is unable to support
a growing population

WAILUKU » For nearly a quarter-century of practicing medicine on the Valley Isle, Dr. Steven Moser opposed building a second hospital that would compete against the state-run Maui Memorial Medical Center.

He was concerned a new facility would dilute scarce health resources, said Moser, a former Maui Memorial medical director.

But inadequate improvements at the rural health system's flagship hospital and "poor" leadership by its governing body, the state Hawaii Health Systems Corp., have forced him to re-evaluate his position.

"If you look at our basic plant, we're falling apart," Moser said. "Many projects have been put on hold or abandoned."

Across Maui a number of physicians and community groups now favor an emergency hospital in West Maui and a full-service hospital in South Maui.

The West Maui Improvement Foundation wants to develop a 32-bed emergency hospital serving residents from Lahaina to Kapalua. And Dr. Ronald Kwon is leading a proposal by Malulani Health Systems Inc. to build a 100-bed hospital in Kihei, about a 20-minute drive to Maui Memorial.

Kwon said based on his group's study, Maui currently has a demand for at least 100 acute-care beds, and the population on the island is expected to grow by 20 percent in the next decade.

"We're just filling the needs," Kwon said.

Maui Memorial Medical Center has served as the acute-care hospital on the Valley Isle since the early 1950s, but two groups are advancing proposals for new hospitals on the island.

Inequity in hospitals

While Maui Memorial has made a profit in 14 of the last 18 years and has improved patient safety, critics say it has not progressed in some other important areas. That is why they are supporting new facilities.

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.

Hospital shortcomings

Moser said the state has financed $42 million for a new wing with critical care and surgery units, but that is not enough. Nearly $120 million in improvements have been identified. The morgue should be expanded, he said, and medical records should be computerized to reduce errors in laboratory tests and medications.

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.

Leadership problems

Moser said the problem stems from a lack of accountability: Maui Memorial has its own advisory committee and regional chief executive officer, in addition to the Honolulu-based Hawaii Health Systems and chief executive officer.

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.

Hospital's response

Hawaii Health Systems board Chairman Dr. Dwight Lyons said characterizing the organization as Honolulu-based is inaccurate because Maui residents serve as board and advisory committee members.

"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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