Maui Memorial Medical Center will close its adolescent behavioral health facility, Molokini II, unless Gov. Neil Abercrombie and state lawmakers take action to stop the closure, according to an announcement.
Hospital officials expect new admissions of adolescent patients to be suspended in late October, followed by full closure in December.
"This was an agonizing decision," said Clay Sutherland, chairman of the Maui Region Board of the Hawaii Health Systems Corp. "We thank all the families and community members for sharing their stories and experiences, and we understand the difficulties this will create for all for them. But what it came down to was the physician shortage and the implications that may have on patient care."
After hearing public comments July 23 - much of it opposed to the closure - the Maui Region Board approved a plan July 25 to shutter the inpatient facility. That plan was ratified by the HHSC, which oversees most public Neighbor Island hospitals including Maui Memorial, on July 28, the announcement said. Formal notice was then sent to the governor, state Senate President Donna Mercado Kim and state House Speaker Joe Souki. The governor and lawmakers have 20 days statutorily to stop the closure.
The announcement said that the decision to close the unit was based on critical short- and long-term issues.
First, the only remaining employed adolescent psychiatrist quit as of Friday.
"This will leave just two temporary, contracted psychiatrists . . . to cover the adolescent unit as well as assist with the adult behavioral health unit," hospital officials said. "Furthermore, only one of the two physicians is board certified in adolescent psychiatry. This arrangement does not provide for sustainable medical staff coverage. Although the facility remains compliant, it will be continually monitored and assessed."
And the long-term issue is the challenge to recruit and retain specialized psychiatric physicians, officials said.
"There is a high demand, and MMMC, like many other rural hospitals, struggles to be competitive in its current position," the announcement said. "Without sufficient staffing, workload and schedule for current staff is often overwhelming, resulting in high turnover rates. It is a vicious cycle without a quick fix option."
In light of the decision to close the inpatient adolescent behavioral health unit, Maui Memorial is working with Kahi Mohala, the Queen's Medical Center, American Medical Response, Hawaii Life Flight and others "to ensure there is a safe and streamlined process to evaluate, stabilize and transfer these patients so they may receive the care they need," the announcement said.
Hospital officials left open the possibility of reopening Molokini II if it could get additional resources or forge alliances to continue caring for adolescents in need of psychiatric treatment.
Hospital employees affected by the Molokini unit shutdown will have 90 days to transition, or "bump," into other positions depending on their seniority or other employment factors.
"The decision on Molokini II provides insight into a larger systemic problem that we face," said Wesley Lo, HHSC Maui Region chief executive officer. "The unit's fate, as well as other vital services, in the long term is not only dependent on money but on being able to evolve our hospital system into a health care delivery system that supports the ever-changing health care environment and growing needs of our community."
The hospital system as a whole faces the same issue that plagues Molokini II, hospital officials said. Specialty physician numbers are decreasing and placing "a tremendous burden on those remaining," the announcement said. "Many are reaching retirement age and recruiting and retaining replacements is difficult."
"Our doctors have served this community with excellent care for many years and will be ready to move on soon," Lo said. "We need to initiate new systems to position ourselves as an attractive option for the next generation of medical staff and then be able to provide them the resources they need to provide high-level care."
The Maui Region includes Maui Memorial, Kula Hospital and Lanai Community Hospital. The closure of Molokini II is expected to save more than $1 million annually, making a dent in an anticipated $13 million shortfall for the Maui region for the current fiscal 2015 that began July 1. The shortfall is anticipated to increase in fiscal 2016.
Hospital officials said "economic realities" have left hospital administrators with difficult decisions.
"Medical inflation, salary increases and increased costs to take care of aging facilities have escalated expenses while revenues remain flat due to stagnant overall health insurance reimbursement levels, including decreased reimbursements from Medicare," the hospital's announcement said.