Maui doctors call for free regional testing center

Physicians: Clinics don’t have staff, resources to handle influx of patients

Registrar Casi Moreno and Jerry Grey (in the background), Critical Department lead, assist with flu and COVID-19 specimen sampling at Maui Medical Group on Monday morning. The clinic set up a separate sampling area away from the main clinic lobby in Wailuku. The Maui News / MELISSA TANJI photos

Maui doctors working on the front lines to catch COVID-19 cases are calling for the state to set up a free regional testing center, saying they’re not equipped to handle a rush of patients.

“The big issue in physicians’ offices is the risk of further community spread of the virus,” said Dr. Kenneth Kepler, medical director of the Kihei-Wailea Medical Center. “Most physicians’ offices do not have the appropriate personal protective equipment that is required to manage large amounts of these types of patients, and in addition, even if we did, physicians’ offices aren’t designed to prevent a highly contagious illness from spreading within the waiting rooms.”

Kepler and four of his colleagues are among 14 physicians at clinics, medical groups and two hospitals who are asking the state Department of Health in an open letter to provide a testing site separate from hospitals and clinics. They said that physician offices on Maui do not have enough staff or access to resources to carry out testing, and that many offices are already out of personal protective equipment. Access to test kits for patients suspected of having the virus is limited.

“A large influx of COVID-19 could rapidly exhaust the capacity of our hospital,” the physicians said. “We are very concerned that if we do not act quickly, we will face the exponential spread of the virus with a high incidence of very sick patients overwhelming the resources of our health care community.”

The letter asked the state to activate Disaster Medical Assistance Teams to set up a regional COVID-19 testing site on Maui “as soon as possible.”

Jerry Grey shows the swab used for the COVID-19 test at Maui Medical Group.

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said during a news conference with the governor on Monday afternoon that there are 21 hospital emergency rooms across the state that can screen for COVID-19, in addition to 11 screening clinics, six urgent care centers, two community clinics and two federally qualified health centers.

Maui Health, which operates Maui Memorial Medical Center, Kula Hospital and Lanai Community Hospital, said that contrary to a recently posted state Department of Health document, the hospitals are not doing community screening and testing. They only offer emergency care.

“Maui Health is working closely with the county and state to assist in the placement of a public testing site in the very near future,” Maui Health said in a statement on Tuesday.

Spokeswoman Lisa Paulson added that Maui Memorial can take samples if a person is sick and has symptoms, but the hospital is not a community testing site.

State health officials have explained in the past that samples still need to go to the state lab on Oahu for testing and confirmation, or to private labs, which send samples to the Mainland and usually get results within a few days.

Jerry Grey, Critical Department lead at Maui Medical Group, shows the swab used for the flu tests. For those seeking the COVID-19 test, Maui Medical Group first gives a flu test to rule that out.

The state relies mainly on primary care physicians to identify patients who may need a test for COVID-19. However, physicians said it’s not feasible for clinics to serve as testing centers.

“A lot of the clinics are short on a supply of PPE (personal protective equipment), and they don’t have the time to prepare for the testing because they have to put on full protective gear — safety glasses, a shield to protect their eyes, an N-95 respirator mask, and ideally a full gown,” said Dr. Kai Matthes, a pediatric anesthesiologist at Interisland Medical Group, which represents anesthesiologists and ICU doctors at private clinics and the hospital.

“That’s logistically difficult to do in a practice that’s understaffed,” Matthes continued. “The other thing is the risk of infecting other patients. When you bring somebody who has COVID-19 in, you put the other patients at risk. There’s no dedicated area for them to get tested.”

Matthes said that the shortage of available test kits and the changing criteria for testing also creates challenges. He said Hawaii needs to follow the examples of South Korea, Taiwan and other places that have done widespread testing of patients with respiratory symptoms in separate facilities “where one patient gets tested at a time and the person who conducts the test in full protective gear and has the knowledge to do the test appropriately and safely.”

A dedicated testing facility also would “take the load off the clinics that are already busy.”

“We don’t see as many patients right now in the hospital, yet that can change in about one or two weeks,” Matthes said. “Right now, we just don’t know where we are. We don’t know how many people are affected, and that creates a lot of fear, fear of people not knowing what we’re dealing with.”

At the Kihei Wailea Medical Center, doctors are trying to reduce the risk of exposure to their staff as well as patients. Kepler said the clinic is discouraging routine appointments for healthy people over 60. It has reduced appointments to two per hour so patients can be put into offices immediately and don’t have to linger in the waiting room. And, doctors are doing as much over-the-phone care as they can.

Kepler said they’re asking patients to call ahead before coming to the clinic so their symptoms can be noted and precautions taken.

Like Matthes, Kepler said that it’s not feasible for primary care physicians at a clinic to wear protective gear all the time; not only are they short on equipment, but they’d have to change every time they enter another room or deal with another patient. He explained that a dedicated testing facility would only require a handful of health care workers, and if it were a drive-thru, workers could wear protective gear for a much longer period of time, perhaps only changing gloves after taking a swab through a car window, for example.

“I fear, and most local physicians fear, that if this type of a facility isn’t set up very quickly, the community is going to be rapidly left with zero primary care physicians available in the community,” Kepler said. “And so that’s the real big issue, is that we’re trying to prevent physician offices from becoming a place of potential contagion.”

Meanwhile at Maui Medical Group, staff took samples for COVID-19 testing from 40 patients from Thursday until mid-morning Monday, according to President and CEO Dr. William Mitchell.

Administrator Cliff Alakai said four specimens sent to a Mainland lab for testing last week came back negative Monday morning.

By Monday morning, Maui Medical Group set up a larger specimen sampling site in a procedure room on the first floor of the clinic’s Wailuku site.

Visitors to the clinic are screened and are allowed up to the main offices if they do not have any symptoms. Those who have symptoms or fit the criteria for COVID-19 are directed away from the first floor check-in and directed to Maui Medical Group’s lanai. Nearby is an indoor procedure room that is now set up as the sampling site.

At the sampling site, nasal samples are taken for the flu first. If the person doesn’t have the flu, then a COVID-19 test is administered, Mitchell said.

He added that the test is not pleasant, with swabs inserted into the patient’s nose.

Alakai said they are helping Maui residents who fit the criteria to be tested, which include fever or symptoms of respiratory infection, a history of travel outside the state or close contact with a person suspected or confirmed with COVID-19.

Mitchell said one person came in who was asymptomatic but had been told they could have been exposed to the virus. He said the clinic did test the person.

“The Maui community needs us. We want to be sure we are here for them,” Alakai said.

On Monday, Lt. Gov. Josh Green’s office did not respond to a request for comment on a disaster team and testing center. The state’s Joint Information Center also did not address specific questions but said “the Department of Health is working with the Healthcare Association of Hawaii (HAH) and Lt. Gov. Josh Green to ensure hospitals have the resources needed.”

* Colleen Uechi can be reached at cuechi@mauinews.com. Melissa Tanji can be reached at mtanji@mauinews.com.


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