Health cuts hurt
Waianae Coast

'This is scary, very scary,
said one woman who went
to the health center

By Helen Altonn
Star-Bulletin

A Waianae woman who has suffered three heart attacks was surprised to see only one doctor and one nurse when she went to the Waianae Coast Comprehensive Health Center at 11:15 p.m. with chest pains.

"It was very unusual for the emergency room," said Barbara Napoleon, 53, explaining she has multiple medical problems and has had congestive heart failure twice.

She said the doctor drew blood, but the laboratory was closed and there was no technician. The doctor told her the whole facility was working with a skeleton crew, she said.

"This is scary, very scary. This is the only facility from Kaena Point to Waipahu," she said.

Center Director Richard Bettini said he had to eliminate 40 positions and reduce services the past year because of funding cuts and inadequate reimbursements under managed care plans.

"We scaled back our laboratory coverage and radiologists some nights are on call," he said. "Certain folks have to bypass the emergency room that didn't before. They have to go to town."

Napoleon said she had to go to St. Francis Medical Center-West by ambulance during a financial crisis at the Waianae center a few years ago.

She wanted to go to the comprehensive health center, but the ambulance wouldn't take her there, she said. "They said the facility is not prepared to take care of emergencies."

She was uncomfortable being in an unfamiliar place and it cost her $55 to get home by cab from St. Francis, she said.

Legislation is pending to provide a state subsidy for the Waianae center's emergency room. One bill calls for about $520,000; the other about $700,000.

Bettini said $700,000 is needed to restore laboratory and radiology services.

The center will update the community on discussions with the governor, the state Department of Human Services and Hawaii's congressional delegates.

The meeting -- usually attended by 100 to 150 people -- then will break into small groups so the center can get feedback from the community, Bettini said.

About 22,000 patients annually receive medical and dental care at the center, which has five clinic sites.

Bettini said the center "has been impacted tremendously" by the managed care movement. Most patients are below the poverty level -- either on Medicaid or with no insurance, he said.

The center abolished its home health, physical therapy and other programs because of dramatic changes in reimbursements for community health centers, he said.

"The last wave of cuts touched our emergency room."

He said the center has more than 12,000 emergencies a year and transportation is lacking for those who must go outside the community for late night services.

"The cost of a single ambulance unit is even more than what we're requesting," he said.

"We average six emergencies a night. To me, that is enough to justify emergency care and standby capability, but certainly it is not enough to pay the bills, particularly when they are on Medicaid or are uninsured."

He said discussions are under way with officials regarding a change in the state's QUEST health care program to provide adequate compensation for high risk patients instead of a flat amount.

Some of the center's board members recently met with Hawaii's congressional delegation in Washington, D.C., he said. "They signed a letter that QUEST should not be structured so that it forces community health centers to change their mission."

That mission, he said, is to go out and find high-risk patients, such as pregnant teens and substance abusers, and encourage them to get full medical care at the center.

Napoleon said, "We're the last to get anything (in Waianae). We're the end of the Earth here. This happened once already a few years ago. We can't let this happen again. You can't tell a baby with a raging fever you have to wait until 8 o'clock in the morning. Or, if you're going to have a car wreck, at least have it by 11 at night.

"That's (the health center) the only thing we have out here."

Speak up Discussion of legislation to provide funding for the Waianae Coast Comprehensive Health Center's emergency room: What: town meeting When: 7 p.m. today. Where: Waianae District Park multipurpose building