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Keeping the health ‘safety net’ in Ka‘u stirs debate


PAHALA — The need to keep Ka‘u Hospital operating as a “safety-net” facility was the major topic of discussion during a public meeting Saturday of the Hawaii Health Corp. East Hawaii Board of Directors.

About 25 braved a flash flood watch brought about by the remnants of former Tropical Storm Wali to attend the meeting at the 21-bed Pahala hospital.

HHSC East Hawaii Region CEO Howard Ainsley, who is leaving Aug. 9 to become CEO of Morehead Memorial Hospital in North Carolina, noted that many rural critical-access facilities are going out of business, and referred to those still in operation as “the walking wounded.”

“We’re very challenged in many ways here,” Ainsley said. “… We’ve got to make sure that the safety-net hospital survives.”

Board Vice Chairman Wayne Kanimoto noted that Ka‘u is rural, but added “the whole island is rural.”

“What does it mean by rural?” he asked. “We don’t have the population, but … because we’re rural, we should expect services. … The other thing is, we are all part of the state and we all pay taxes. And there is a social contract we should have, being in a rural community. And if we don’t have enough people to pay for the service, but we consider it essential, … we look at the Legislature to appropriate funds so we can have those services.”

Two state legislators were present, Rep. Richard Onishi of Hilo and Rep. Richard Creagan of Naalehu, the latter a physician.

“We may not have always appreciated what Ka‘u Hospital means to this community but we do now,” Creagan said.

Ka‘u Hospital Administrator Merilyn Harris said the hospital is vitally important to the community because Hilo Medical Center and Kona Community Hospital are both more than 55 miles away.

She said being a critical-access hospital is a federal designation given to hospitals in remote areas and it’s important to Ka‘u Hospital because of federal funding tied to the designation.

“In order to get critical-access designation, you have to do two things,” Harris said. “You have to provide 24/7 ER coverage and acute inpatient skilled care. It can’t be just ER.”

She said a community satisfaction survey completed in December and January found “100 percent of respondents said they would recommend our ER to their family and friends.”

Harris said medevac helicopters are now able to land in the hospital’s parking lot.

“That’s happened about five or six times in the past year,” she said, adding it’s “a good thing” medevac services were not needed more.

She also noted $4.7 million in state-funded vog mitigation improvements have recently been completed.

“This project started some time back when the vog was really bad,” Harris told Stephens media Hawaii. “… In those days, prior to the renovations, all our windows were jalousies, many of which didn’t close because our hospital was built in 1971. We had doors that didn’t close properly, our external doors, so … when we closed all the doors and windows, the vog still came in and often would get trapped in here because we didn’t have air conditioning.

“The money was to replace all the doors and windows and to install air conditioning and filtration throughout the facility.”

When the meeting was opened to the public, concerns were raised about a possible takeover of HHSC by a mainland health care company.

Banner Health, a Phoenix nonprofit, expressed interest in taking over Hilo Medical Center last year, but that fell through.

“I’d personally hate to see a company come in from New York or Chicago, purchase our hospital and run it without knowing anything about Ka‘u,” one woman said.

“Based on what I know, I think it’s very unlikely an outside mainland company (will take over) in my estimation,” Ainsley replied. “There’s a real interest in trying to keep it local. … It’s better to have a local partnership for the long term. But you have to ask: Why would anyone want to partner in a system? … Why would this be necessary?

“Hospitals are distressed. The reimbursements are going down. So, you really have to understand what’s changing here, why this is even in the discussion. And so it’s really important to build these relationships with our local providers in the state that could have the ability to assist us with the economies of scale. … We need to survive so we can provide medical assistance to the patient. That’s what it’s all about.

“This board has been really solid in building the relationships that have to occur. The relationships with (The) Queen’s, … our Kaiser or whoever has to occur. This board has to build those relationships for the future because HHSC (has to go to) the Legislature every year for money. The state has to decide whether it wants to be in health care or not. If it’s gonna be in health care, it’s got to help these state system hospitals.”

Onishi said there has been “a push-back from the Legislature” when HHSC seeks funding.

“It hasn’t helped that we had the bad economy the past few years,” he said. “… The picture out there in the general public is that HHSC is falling apart.

“… We are up against 34 legislators from Oahu, many of whom have no clue how important this is. They can go to any hospital on Oahu within 20 minutes, depending upon what their needs are. But if you have a need in Volcano, which way do you go? And they don’t understand that.”

Email John Burnett at jburnett@hawaiitribune-herald.com.