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EMS budget cuts are not ‘set in stone’

DOH has no timeline but asks providers to be prepared

Maui County officials say that a proposal to slash 10 to 20 percent from Emergency Medical Services is not “set in stone,” though they’re still bracing for cuts as the state looks to save money during the pandemic.

The state Department of Health, which proposed the changes last month, said it has been in talks with EMS providers in all four counties over the past few months in preparation for potential statewide budget reductions for the coming year. The Maui County Paramedics Association held membership meetings last week to discuss ways that EMS could meet those cuts.

“Nothing is set in stone, nothing is for sure going to be cut, according to what they say,” union officer Kapena Hill said Wednesday night. “We just won’t know until whatever deadline they give themselves.”

Hill said he understood the decrease in revenue and financial hardship that everyone is facing but said now was not the time to scale back health services.

“During a health care crisis like this, if you cut any health care services, especially the emergency services, it just doesn’t make any sense,” he said.

The DOH said Thursday that the proposals are for “discussion purposes,” and that no timeline for a decision has been established. They asked the four county EMS providers to develop budget scenarios based on possible funding restrictions.

“The Department of Health recognizes EMS is an essential public health service and is committed to doing everything in its power to maintain Hawaii’s EMS service during this pandemic,” DOH said in a statement to The Maui News.

West and South Maui Sen. Roz Baker, who chairs the Senate Commerce, Consumer Protection and Health Committee in the state Legislature, said that from her understanding, “it was just an exercise.”

“I’ve explained to them that these are essential services,” Baker said. “These are not services that can be cut. We have no alternatives. We have one supplier on Maui, we have one supplier for Molokai and Lanai. I believe that the concerns were heard, and I don’t anticipate there being any cuts in EMS that would curtail services.

“And if I find out I’m wrong, Haleakala will probably start to smoke again.”

The current state budget allots about $90 million for Emergency Medical Services, and Hawaii’s EMS network also produces about $45 million a year in revenue by charging for ambulance and related services, according to Baker.

Maui and Kauai County operate under American Medical Response to provide emergency response services, which means the Fire Department cannot provide transportation to the hospital even though they are usually dispatched to calls first, Hill said.

In contrast, Oahu and Hawaii island rely on AMR as a backup behind the Fire Department and emergency services. Each county operates differently, and thus received different budget proposals.

Baker said that two ambulances are potentially up for cuts, but she still didn’t believe EMS would lose funding.

“I don’t want any of the EMS services to get cut, you just can’t do that,” she said.

Across Maui, there are two ambulances for West Maui; two for South Maui; one for Kula, as well as a private unit that conducts interfacility transfers and is not under government contract; one in Wailuku; one in the Makawao-Haiku area; a single paramedic unit in Maalaea that does not transport but can provide emergency medical support; and one ambulance each on Lanai and Molokai.

There’s also a helicopter available for remote areas like Hana, Kahakuloa, Lanai and Molokai in the event a patient needs emergency transportation to an advanced medical facility.

If cuts are made, Hill said he’s worried about services getting stretched thin.

For example, if the Kihei unit is out on a call, then the Wailea ambulance would respond to a second emergency call in South Maui. If one of the South Maui units were cut, then the Wailuku unit would have to be the secondary response.

“Now if someone calls in Wailuku, then we have nobody there to respond,” he said. “It’ll increase the wait time or the response time by a good 10 or 15 minutes when it goes into the hands of the next district.”

While shortfalls in the state’s budget are the main push behind the cuts, another reason could be that call volumes have dropped and demand for EMS has decreased while the stay-at-home, work-from-orders were active and the tourism industry ground to a halt.

Prior to COVID, about one-third to one-half of the emergency calls were made by visitors in popular tourist areas, such as Kihei or Lahaina, Hill said.

Although emergency responses have been down, Hill anticipates an uptick in calls once the island ramps up again and welcomes back more visitors, and as the flu season approaches around October and November.

“When someone wakes up with a fever, chills, runny nose or cough, they think they have the virus, and 99 percent of them call 911, and they don’t go to their doctor or the emergency room on their own,” he said. “It’s all going to happen at the same time, so it’s going to affect what’s left and what’s available to respond.

“It’s just such a strange time to consider cutting services when you should almost be expecting an increase in the number of possible and confirmed COVID cases between now and Christmas.”

* Dakota Grossman can be reached at dgrossman@mauinews.com.

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