Federal rescue needed to save Kahuku Hospital

THE ISSUE Kahuku Hospital has announced it will close by year's end because of mounting debt.

THE only hospital on Oahu's North Shore is scheduled to be shut down by the end of this year because of its soaring debt, but state and federal officials should find a way to keep its doors open. A national policy aimed at protecting rural hospitals from extinction cannot allow such a large area to be placed on the critical list.

Kahuku Hospital, opened 78 years ago as a plantation hospital, has experienced severe financial shortfalls for several years. Like most of the nation's other rural hospitals, which provide care to more than 54 million people, including 9 million Medicare beneficiaries, Kahuku Hospital also is the community's largest employer.

The federal critical access hospital program was created to provide financial stability to rural hospitals with cost-based Medicare reimbursements. Kahuku, with 25 beds, is among six Hawaii hospitals given such status. The others are less vulnerable because they are part of the state hospital system or, as in the case of Molokai General, affiliated with the Queen's Health System.

Larger hospitals or health organizations have been reluctant to embrace Kahuku because they face their own financial problems, leaving Kahuku stranded. That is unlikely to change unless Kahuku is invited into the state hospital system.

Kahuku's debt is estimated at $3 million, and it has been running in the red about $1.2 million a year. The hospital asked the Legislature for $1.5 million last year but was provided only $1 million.

With the Kahuku facility closed, North Shore residents will face drives of 22 miles to Wahiawa General or 32 miles to Castle Medical Center to receive emergency care. Ambulance time in either direction is an hour or more, says Richard A. Price, Kahuku's Emergency Department medical director.

"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."

Contrast that to a situation on the outskirts of Ames, Iowa, that has raised eyebrows. An 18-bed critical access hospital about nine miles from the 195-bed medical center in Ames is expected to receive millions of dollars from the federal government for replacement by a new hospital. Most of the $13 million cost will be borne by Medicare, hospital leaders told the Des Moines Register.

The Ames experience indicates that Medicare assistance is available to critical access hospitals beyond the parameters that many hospital administrators might assume. The situation facing the North Shore amounts to a medical emergency that should be setting off sirens all the way to Washington.