Kahuku Hospital closing

The loss leaves the rural community an hour away from any emergency care

With mounting debt now at $3 million, 78-year-old Kahuku Hospital has announced it is shutting down by year's end.

The small rural hospital provides emergency services to Oahu's remote North Shore community, but has been unable to climb out of its financial hole.

ABOUT KAHUKU HOSPITAL Year opened: 1928 as a plantation hospital Closing date: Dec. 31, 2006 Number of beds: 25 Number of employees: 110 Losses: About $1.2 million a year Debt: About $3 million

"The hospital for the last three years kept thinking there was going to be improved support from the state through the Legislature," said Kahuku's chief executive officer, R. Don Olden. "The hospital board came to the belief that it wasn't going to happen."

The board voted Nov. 6 to close the hospital, and will likely file for bankruptcy in early December.

The hospital expects to provide emergency services for as long as possible, but not beyond Dec. 31. It will stop admitting acute in-patients that may need care past that date.

"For emergency services, the community is going to be experiencing a long drive," since it's 22 miles to Wahiawa General and 32 miles to Castle Medical Center, on mostly two-lane roads, Olden said.

Richard A. Price, Kahuku's Emergency Department medical director, said: "Without a hospital, they need a teletransporter to send them to the next-nearest facility. We have one ambulance which spans the entire community between Wahiawa and Castle." He said ambulance transport time is an hour or more between Kahuku and either hospital, and military medevac services are limited, no longer 24 hours a day.

"We have one hospital serving an area of 27,000 patients," Price said. "No way that they can adequately serve the needs of 27,000 patients, so you're going to be getting people dying on the highways."

Unlike other critical-access hospitals in Hawaii, Kahuku is the only stand-alone hospital in the state, Olden said. The others are run by the state hospital system, except for Molokai General, which is an affiliate of the Queen's Health System, he said.

"The small stand-alone hospitals are dinosaurs," Olden said.

The Legislature gave $1 million to the hospital last year, but it still fell short of the $1.5 million it needed.

Multiple issues have hurt the hospital, including bad debt and charity cases, which ranged from $600,000 to $800,000 a year.

State Health Director Chiyome Fukino said the Health Department worked to assist Kahuku and asked the Legislature for the $1.5 million last year.

Kahuku, with just 25 beds, required subsidies because it was unable to generate enough money, she said. The hospital did everything it could "to maximize their deficiencies, but they were saddled with an old debt."

"It was consistently not funded fully by the Legislature for the amounts requested, so each year the debt accumulated, so we find ourselves where we are," Fukino said.

She said the board acted in good faith to assure the financial integrity of the institution, and did what it had to.

"I didn't want that side of the island to go dark," she said. "Basically, once you turn off the lights in a hospital, it's really hard to turn it on again."

But the problem, she said, reflects a larger one.

"This is really the tip of the iceberg," Fukino said. "The health care system and hospitals are in crisis. ... The stresses that Kahuku felt that led to its closure are being felt by the larger institutions."

She pointed to the growing disparity between revenues generated and operating costs.

News of the closure jolted the community.

Creighton Matoon, a Punaluu resident for 36 years, said, "It comes as a shock, and my concern is there's nothing between Castle (Medical Center) in Kailua and Wahiawa General.

"What's going to happen to people who need emergency care ... unless they plan to beef up the medevac service?" said Matoon, who went to the ER after cutting his foot, which required stitches.

Gerry Nihipali, a Laie resident and Rehabilitation Services supervisor who's worked at the hospital for 25 years, said, "Those of us who have worked there for years, we have come to love the hospital, and it's just like family there. It's a sad day for this whole area."

Nihipali had her last baby at Kahuku, and had surgery there, too.

"It's nice to have family really close to go and visit," she said. "That's the way it's been for lots of families.

"Our family has used the ER several times -- when my kids were younger, my husband slipped, we had to rush him there. It's just been a security blanket. We can go five or 10 minutes down the road."

She said staff members are "very distraught. This is the wrong time of the year, with the holidays," worrying about mortgage payments and bills.

"Most of the people who work at the hospital live close by," and many are contemplating whether to stay in health care and travel an hour to work, Nihipali said.