Proponents of teaching hinge hope on private health facilities

As a Senate bill to transfer Hawaii’s public hospitals to a private nonprofit circulates the Legislature, nearly 150 Maui doctors and other health care providers envision its passage as the only means of incorporating teaching medical centers across the islands.

A statement that was reviewed by the supporters and released by Maui Memorial Medical Center’s Chief of Staff Dr. Melvin Burton to The Maui News last week calls for the Valley Isle to be the “second medical hub” in Hawaii, “providing the complete spectrum of medical services that current science and technology will allow.”

“To that end, we will need a high-quality partner to help us provide the level of care that (people) deserve,” according to the statement.

Burton and other physicians in favor of the measure pointed to the current operating losses of Hawaii Health Systems Corp. as one of the chief reasons for their support.

The corporation, which manages and operates MMMC as well as Kula Hospital and Clinic, Lanai Community Hospital and three facilities on the Big Island, had an estimated $46.7 million in operating losses in the Maui Region last fiscal year.

Overall, HHSC had an estimated operating loss of $163.9 million.

“We’re limping along with the state,” said Dr. James Jones, a kidney specialist at MMMC. “They have no money. That’s why we’re going to start over again and say, ‘Let’s be really smart and find a partner that really wants to be with us.’ “

Opponents of the bill have expressed concern over the lack of collective-bargaining language and assurance of long-term health care services. State officials questioned how it would be implemented and how it would impact the state’s general fund, and had questions regarding the state’s responsibility to meet employee obligations under collective-bargaining contracts.

“Right now, in the absence of privatization, the public system is struggling just to pay the bills,” said Burton. “It’s certainly not in a position to do anything more than that. I seek privatization not only to become fiscally responsible to pay your bills . . . but now you can begin to look toward the long range.

“The public system is constantly trying to catch up, so you can’t really plan for the future.”

The future that Burton and others picture is one where doctors, nurses, students and residents promote deeper thinking and active training every day at Maui County health centers.

“As a result, everybody learns,” he said. “The whole environment has growth and, as doctors, we all start in that type of environment. I’d like to see that on the islands.”

While more educational programs within hospitals improve overall care and attention for patients, Burton added that residents “become rooted in their communities” and typically stay at the hospitals they trained under.

The total number of doctors at MMMC is currently 357, but the number actively working is 175.

“It is extremely difficult to get people here, and what people don’t realize is that services are threatened because of that,” Burton said of MMMC. “To give you an example, in gastroenterology some of the older members that have been here for years are now retiring and that creates a gap in terms of doctors that are available. Outpatients with intestinal problems, or whatever their illness may be, will now have to wait, which can progress and they end up in an emergency room.”

Burton said that some physicians have had to work up to 20 days in a row due to staff shortages.

“The cost of living is high and the reimbursements are low,” he said. “People starting families look at that.”

MMMC currently has two residents in its obstetrics and gynecology wing led by Dr. Colleen Inouye.

In previous years, Jones helped oversee two residents from St. Joseph Hospital in Colorado, who each spent one month working at MMMC and taking part in group rounds and daily conferences.

Jones figures the net cost of each resident, who also receive grants from Medicare, to be about $50,000 to $70,000.

“A small amount of money when you’re dealing with quality of care as the outcome,” he said.

MMMC Chief Executive Officer Wesley Lo has been in support of the bill and welcomed the idea of the hospital becoming an educational hospital. However, Lo said, there is always a balance of “taking care of patients right now.”

“It boils down to money,” he said. “With a small department, it does cost money to run these programs and I have to ask, ‘Do I fix that scanner or machine, or have a teaching program?’ “

If the bill is passed, Lo hopes that MMMC will find a partner that has a background in education and can provide “human and financial resources.”

“Teaching is the fabric of health care. It’s a human resource industry,” Lo said. “You have to keep on delivering on the human aspect and we certainly aspire to do that.”

Dr. Nicole Apoliona, medical director at Kula Hospital and Clinic, hopes that the partner will consider adding her center as well.

The Upcountry clinic has 100 long-term-care beds and five temporary beds for those undergoing rehabilitation. As an administrator, Apoliona said that recruitment is always her biggest concern and she believes a private partnership may help her chances of hiring more staff and residents.

While the doctors and other health care providers stand in agreement with the intent of the bill, they are against a provision that limits nonprofit entities to those incorporated in Hawaii before Jan. 1, 2000.

“Not to say there aren’t perfect partners in Hawaii, but right now we have a doctor shortage and I’m not certain that if we partner within the state that it will get us where we need to go,” Burton said. “You don’t want to limit your choice in a business decision, you want to keep all your options open and have some dialogue.”

Senate Bill 3064 is scheduled to be heard by the House Committee on Health at 10:25 a.m. Wednesday. Online testimony must be received at least 24 hours before the hearing to be considered.

* Chris Sugidono can be reached at