Tuesday, August 2, 2016

How to destroy a hospital

It has taken 20 years but the job is almost finished.
Looks nice in this light

I never said so in print, since in those days I was a reporter and supposed not to report my own opinions, but it was obvious from the start that the Hawaii Health Systems Corp. was going to be a disaster morally, operationally and financially.

(Besides, I was not the reporter who dealt with the hospital; most of the reporting – some of it very critical – was done by Claudine San Nicolas and Val Monson. I did interview Wes Lo, the administrator, and several physicians to satisfy myself that the problems I was identifying were the real ones. But those didn’t result in any reports by me.

(I limited my reporting to a column pointing out the obvious, that the West Side did not need its own hospital as long as the little red-and-white rolling hospitals were available to bring sick and injured people to Maui Memorial. The West Side is now getting a hospital of limited capacity, which will not succeed; and its emergency room will close soon enough for lack of physicians and nurses – and of patients. But that is another story.)

The history of HHSC on its website is thoroughly dishonest. Here is what the situation really was:

By the early ’90s, Oahu (like many metropoles) had too many hospital beds, and the Neighbor Islands too few. Of the 10 or so Neighbor Island hospitals, only Maui Memorial was covering expenses. It was throwing off large amounts of cash, which should have been reinvested in expansion; at the time it had 100 beds, many fewer than necessary.

Hawaii is an ohana; we wish all residents to have access to a minimum level of hospital care. Places like Lanai can never cover the costs; these should have been covered out of state general funds.

The Oahu-centric legislators did not (and still do not) give a damn about the Neighbor Islands, and they resented losing general funds they wanted for their own pet projects to support small hospitals in places like Waimea and Kula San. So they raided Maui Memorial by rolling it into a largely phony “corporation” to own, oversee and manage all the hospitals.

That was 20 years ago. Every year Maui memorial was plundered of around $25 million to subsidize losses at small hospitals. The total stolen approaches half a billion dollars.

Meantime, to expand Maui Memorial had to seek state subventions, which were grudgingly and inadequately given. So some services languished; obstetrics and mental health were probably hit the worst. Legislators find it easy to ignore babies and crazy people.

(Here we must follow a digression. As MMMC deteriorated, Dr. Ron Kwon and others decided the solution was to kill off the public hospital. This fight distracted political actors from the real issue. Kwon and his allies had no more interest in babies or crazy people than the legislators; their private hospital was not even going to pretend to offer metal health services.

(The private hospital, like the West Side hospital, was designed to provide more services to the already well-served and to starve services for people getting the least. Among the casualties of that fight was a fine public servant, Dr. David Sakamoto, churlishly sacrificed by Governor Linda Lingle.)

The moral point was obvious: the requirement to subsidize health delivery for Hawaii’s rural residents was an obligation of all, not just of the customers of Maui Memorial Medical  Center. (I do not believe that the old-timers would have stood for it, not Senator Mamoru Yamasaki and certainly not Governor John Burns. They understood ohana and collective responsibility and were opposed to using the fisc to provide luxuries to the rich.)

Maui Memorial stopped throwing off cash several years ago. This was the direct effect of the Legislature’s stupid decision in 1996.

Operationally, the effects are now becoming acute. The takeover by Kaiser is going to be at best a kludge, if it happens; and meantime the hospital cannot retain or recruit staff. There is a real possibility that the hospital could close. Parts of it already have, like the Molokini Unit for young mental patients.

Kaiser is losing $500,000 a week and will not wait forever for the governor, the Legislature and the unions to do what is pono. (And where is the lieutenant governor; many thought he had designs on the governorship. He is rapidly disqualifying himself from consideration as a serious person.)

And where is the business community? Do they think TripAdvisor and the other websites will ignore the collapse of health care delivery systems on the Valley Isle?

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