KAHULUI - The state's ability to care for mentally ill adults and children and to control virus outbreaks in Maui County will be hampered once layoffs of state health care employees take effect in November, health officials told members of a Senate ad hoc committee on Wednesday night.
The effects of staff reductions through frozen positions already were being felt, said Maui Adult Health Center Manager Trina Tom, who said employees at the center have resigned themselves to picking
up office trash and handling clerical duties they had never had before.
"We're going to do it because there's no one else to do it," Tom told state senators at a meeting held at the Baldwin High School Multipurpose Room.
Layoff notices have already been sent to approximately 10 percent of the 3,000 workers in the state Health Department. Aimed at reducing costs to address the state's budget shortfall, those cuts affect about 20 employees on Maui, according to Health Department spokeswoman Janice Okubo.
Representatives of state health agencies said the layoffs, coupled with the inability to fill frozen positions, leave them with bare-bones staffing levels. When the full impact of job cuts felt in November, remaining employees will see their workloads increase while services to clients will decrease, they said.
Also testifying was Maui Memorial Medical Center Chief Executive Officer Wesley Lo.
He said the hospital's semiautonomous status has shielded its employees from layoff notices, but the state's financial crisis has forced Gov. Linda Lingle's administration to issue a memorandum prohibiting the Hawaii Health Systems Corp. from spending approximately $31 million in its special ceiling fund.
That fund holds money hospitals generate, including an estimated $10 million to $12 million annually that would affect the Maui region hospitals. The latter are Maui Memorial, Kula Hospital and Lanai Community Hospital.
Lo was quick to point out that the Health Department layoffs will have a direct impact on the hospital. With services cut to mentally ill adults and children, the hospital would need to step in to care for those patients, some of whom may need treatment in the emergency room, he said.
Layoffs of state employees at the Maui Adult Health Center could result in more mentally ill patients needing hospitalization or being kept behind bars at Maui Community Correctional Center, Tom said.
Clinical staff at the health center now oversee the care of approximately 490 adults, some of whom are labeled as the "most difficult" clients because of their troubles with the law, Tom said.
"These are not your everyday Joe," she explained Wednesday night. "These are hard-core people."
About 40 of the 490 adults are categorized as "forensic" cases, meaning they are adults who have committed crimes, ranging from trespassing to illegal firearms possession to attempted murder and manslaughter, Tom said. The center's clinical staff members work with these adults' attorneys in the Office of the Public Defender and with their probation officers to keep them out of jail and/or hospitals.
As of July 1, the center lost 10 vacant positions, and six current employees are expected to be laid off in November. Most of the employees provide direct care to patients, Tom said.
She also pointed out that her agency has covered much of its operating costs for the last five years through billings to insurance companies for client services.
The layoffs also will affect clerical staff members who process billing paperwork, she said.
Tom said she would have no choice but to have remaining employees take on the extra work of billing.
"It's not going to be good," she said, because employees would not be focused on their primary job of overseeing the care of clients. But if staff members don't do the clerical work, the bills won't be paid in a timely manner and the center could lose the revenue it would earn for its services.
In the Maui District Health Office, Dr. Lorrin Pang said that about 10 percent of his 150 employees have received layoff notices, including four of the six currently staffing the Vector Control Branch.
The Vector Control Branch was especially important in stopping the spread of dengue fever in East Maui in 2001. Pang had cross-trained the vector control workers to conduct vaccination clinics for the H1N1 swine flu and had hoped to assign them that task this fall as well as monitoring the effects of the vaccinations.
Pang said he's been told he could tap a list of 70 volunteers to work if a crisis arises, as in the event of a swine flu outbreak. But he said he's unsure about how reliable untested volunteers will be.
"I like volunteers. They're high-powered people, but they are volunteers," he said. "Good idea, but that's a little bit iffy," he said.
Also, the number of working public health nurses in Maui County has been reduced by 20 percent because of a hiring freeze, Pang said. On Lanai, the only public health nurse there retired, and her position has not been filled. Another public health nurse retired on Molokai, leaving that island with just two other nurses, he said.
Child and Adolescent Mental Health Branch Chief Virginia Shaw, who oversees the Maui Family Guidance Center, testified in response to a subpoena from the Senate ad hoc committee.
She said the layoffs plus the ongoing hiring freeze would mean a loss of 55 percent of her staff over one year.
According to Shaw, employees who manage the care of mentally ill and troubled youths would be forced to increase their caseloads from the ideal 15 to 20 cases up to 42 cases a month.
State Sen. Roz Baker, who represents West and South Maui residents, asked Shaw if the staffing situation concerns her and whether the state would be running the risk of a possible lawsuit because of the lack of access or quality of care.
"That is a great concern," Shaw said.
Pang said he and his staff would support furloughs, but he would like the ability to schedule them throughout the year, depending on when his workers would be most needed.
For example, during the flu season he might need all of his employees working, but once a potential crisis has been averted or is no longer a threat, the workers could take days off.
Tom said she personally supports furloughs instead of layoffs. She said her employees are dreading the decision to have to "bump" others with less seniority to keep their own jobs.
"The people who got layoff notices, they are stressed. . . . Nobody wants to hurt anybody. There's a team spirit here," she said.
* Claudine San Nicolas can be reached at claudine@mauinews.com.
