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Advocates for one hospital, two square off
By HARRY EAGAR, Staff Writer MAUI NEWS July 8, 2006
WAILUKU – Gov. Linda Lingle questioned the ability of state government to keep Maui Memorial Medical Center up-to-date Friday, throwing her influence behind Malulani’s application for a certificate of need to build a 150-bed, acute-care hospital in Kihei.
Her Maui liaison officer, George Kaya, read a letter from the governor that said Maui could support two acute-care hospitals, but that “the ability of the state to build a new hospital on Maui is limited.”
Malulani would be privately financed, at an estimated cost of more than $200 million, and Lingle backed that. The two hospitals, one public, one private, could “complement each other,” she wrote.
Mayor Alan Arakawa also endorsed Malulani.
“We cannot, as a community, be relegated to forever playing catch-up on a 50-year-old facility,” the mayor wrote in prepared testimony.
“I frankly do not believe – nor do I think that state officials themselves believe – that the State of Hawaii is prepared or even has the will to fund the literally hundreds of millions of dollars that will be necessary to modernize Maui Memorial Hospital to the level it should be to meet Maui’s present and future needs.”
More than 100 people testified during an all-day meeting Friday. About 30 more had signed up, and while some had left, some still were waiting at 5:30 p.m.
Chairman John Ornellas of the Tri-Isle Subarea Health Planning Council, recessed the meeting until 9:30 this morning at the Baldwin High School multipurpose room.
After completing public testimony, the council will ask questions of the applicant – it asked none Friday of testifiers – and then proceed to a second certificate of need application, this one from Maui Memorial for a cardiovascular care operation.
About two dozen physicians testified or had testimony read Friday, and even more came and waited before having to return to seeing patients. About 80 percent favored Malulani, with a couple straddling the fence and at least four opposed to a new, for-profit hospital. Some of those in favor are retired.
Dr. Howard Barbarosh, president of the Maui County Medical Society, said that his membership voted on the certificate in June, with about 65 percent in favor. However, he noted that many physicians who were not members attended, mostly also in favor.
Maui Memorial had a highly organized counterforce, including many of its nurses, to rebut Malulani’s pitch.
The council is not allowed to consider every argument pro or con, only 12 specific factors. These include Malulani’s relationship to the Hawaii Health Performance Plan, the need for new services and accessibility to them, quality of care, money, relationship to existing health services and resources.
Physicians and nurses, pro and con, focused on patient care. Bean counters focused on the financials and the supporting data.
Jim Dannemiller of SMS Research on Oahu (which was paid to do consulting work for Maui Memorial) said he believed Malulani used inflated numbers to estimate how many and how old Maui’s patients will be. He said he reran Malulani’s spreadsheet with government population estimates and that turned Malulani’s $3.1 million surplus in 2010 to a loss of $18.7 million.
A big question mark will be who gets a certificate of need for a cardiovascular/angioplasty unit, which will be worth tens of millions a year. A hearing on Maui Memorial’s application was to be heard later today.
That item, as big as $35 million, would influence powerfully any calculations.
Maui Memorial also questioned where the staff would come from. Tamara Koller, the hospital’s policy officer, said that Maui has added about 150 health and social jobs a year for the past 15 years, to a total of about 4,650.
She said Malulani’s investment partner Triad projects hiring 456 full-time equivalents in 2009 and another 318 in 2010.
She wondered where they would come from. Other Maui Memorial testimony pointed out that Triad projects paying less money in 2010 than Maui Memorial will be paying in 2008.
Malulani supporters could counter accounting objections with tales of long waits at an overcrowded hospital or of families separated when a premature baby had to be flown to Oahu.
Lynn Araki-Regan, the county’s economic development coordinator, broke down and wept when telling the story of her premature child, Riley, born last year. Her testimony got thunderous applause, the biggest of the day, although applause for both positions was loud and frequent.
Dr. Bobby Baker, who had to fight Maui Memorial objections to get his certificate for the Cancer Center of the Pacific, said he sensed “there is a very divided community today.”
He reminded decision makers that “it’s not about what’s best for Maui Memorial or myself or Ron Kwon,” but that Maui needs “some drastic improvement and expansion” of its medical facilities.
Wesley Lo, Maui Memorial’s chief executive officer, said: “Maui Memorial is not on trial” in the Malulani review.
And Dr. Ron Kwon, who has been the motivating force behind Malulani, said the numbers and statistics were not the key.
“What it really comes down to is about taking care of people,” he said.
In 32 years of medical practice, the Baldwin High grad said: “I’ve seen where the system works and where it falls apart. . . When are we going to stop protecting institutions and start protecting the health and safety of the people of Maui County?”
Dr. Rod Bjordhal – long a critic of Maui Memorial, though now is chief medical officer – on the other hand said he recently had seen the hospital administration move “from a no culture.”
“There has clearly been a change to a yes culture.”
But Judy McCorkle, a financial adviser and former chairwoman of the Maui Chamber of Commerce, countered that “there is not a culture here to improve health care. There is a culture to protect territory.”
Conrad Ventura, executive vice president of John Goodman and Associates, a consultant firm preparing Maui Memorial’s cardio application, predicted that if Maui had two hospitals, one would fail, but he couldn’t predict which one.
Jim Shannon, a vice president of Triad, said that the company history on the Mainland was different.
When Triad moved into Las Cruces, N.M., the public hospital failed. Maui Memorial has been using that against Triad.
But Shannon said the real story was that Las Cruces was much like Maui. Instead of going to Oahu for care, the New Mexicans would go to El Paso.
Today, he said, the former public hospital has revived under a different private management, the migrants to El Paso stay home for treatment and both hospitals thrive.
And so it went, thrust and riposte, for 7? hours.
Harry Eagar can be reached at heagar@mauinews.com.
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