NHCH executive: No set plans in women’s center restructuring

North Hawaii Community Hospital’s chief executive says no decisions have been made about the future of the Waimea Women’s Center, despite internal reports saying two nurse midwives may lose their jobs.

Hospital employees say they’re still concerned about the long-term implications of comments CEO Ken Wood made in a letter sent to employees Wednesday, particularly about Wood’s desire to limit the number maternal health patients from outside the hospital’s immediate service area.

That service area runs from about Laupahoehoe, along the Hamakua and Kohala coasts, then south to about Kukio, Wood said. The hospital is losing about $1.4 to $1.5 million annually on maternal health services, about half of which is from births to patients from outside that service area, Wood said. But, he added, the money isn’t his primary concern.

“I’m more concerned about the volume and being sure we have a safe environment,” Wood said. “Then we can work on the financial side.”

Low Medicaid reimbursements are one reason for the disparity, he said. Reimbursements from other insurers are also low.

Several hospital employees Wednesday and Thursday told West Hawaii Today they were told two of three nurse midwives the hospital employees would be laid off.

What are the chances midwives would lose their jobs at the hospital?

“I don’t have any idea of the chance notion,” Wood said.

Employees may have misunderstood a “theoretical model that said, ‘Would the island be better off if we had one of our midwives in Kona, one in Hilo and one here,’” Wood said.

A formula for calculating how many births a hospital should expect, based on population and other figures, projects North Hawaii Community Hospital should see about 500 to 550 births, he said. The hospital has more than 660 a year. He stopped short of saying that figure was more than the staff could handle.

“Our staff is phenomenal,” he said. “I don’t think that a single woman has received poor care for it.”

But when a high number of women arrive in a small period of time — Wood gave the example of 12 women delivering within a 36-hour span — “those women didn’t get the experience they thought they were going to get.”

Wood said he asked employees to begin thinking of ways to cut costs, but also to address changes that might occur when the hospital begins looking for a replacement for Dr. Gerald Sczygiel, who is retiring June 1. Wood said the big picture concerns he was trying to raise had more to do with what the best care model would be for the hospital than just a focus on the lost revenues.

Hospital employees said they didn’t believe him.

“It very much feels like a done deal and Ken’s backtracking,” one hospital employee said Thursday.

The employees are not being named because they are fearful of retribution. They also questioned Wood’s assessment of the department’s financial situation. Yes, one employee said, maternal health services was not profitable. But a previous hospital employee in charge of billing had told other employees the services seemed to be gaining financial ground.

“We need to see the numbers,” one employee said.”I don’t necessarily believe the numbers being bandied about.”

They also questioned Wood’s comments about the rates of patients, particularly out-of-area patients, getting Cesarean sections.

Wood said the hospital is legally allowed to tell patients who are trying to preregister to give birth that the Family Birth Unit is booked, although that has never happened.

One employee said doing so may result in women intent on delivering at the hospital just not registering and arriving while in labor. Hospitals may not, by law, turn away a patient in an emergency situation.

Wood said discussions about the program’s future will continue, and he hopes to have some suggestions from a working group on how to address the situation as early as next month.

One of the hospital employees said they brought suggestions to him, to no avail. One, an employee said, would be to do a better job of advertising the available gynecological services the women’s center offers.

Wood said he doesn’t see a huge need in North Hawaii for additional gynecological services.

Both employees and Wood agreed that events several years ago, including layoffs and other management decisions, led to employees’ being concerned about any proposed changes at the hospital.

“Some of the changes that happened four, five, six years ago were not handled well,” Wood said. “That has left an impression and a lack of trust.”