by Andrew Walden

The same problems which are driving doctors out of Hawai`i are forcing cutbacks on services and staffing at the already under funded sister-island Hawai`i Health Services Corp hospitals and now the only privately-operated hospital in Hawai`i County—North Hawai`i Community Hospital.

For two years in a row Democrats in the State Legislature have flatly rejected demands for medical malpractice reform. The Hawai`i Congressional delegation has failed to increase Medicare and Medicaid reimbursements for Hawai`i. The Legislature has failed to force an increase in HMSA reimbursements top doctors and hospitals in spite of a widely publicized lack of doctors and an on-going crisis in hospital care for sister-island resident legislature’s slavish fealty to HMSA and trial lawyers has forced the Waimea hospital to cut 51 staff positions and to put on hold plans to establish the a heart-brain center.

Who profits? Trial lawyers will continue to be able to extract huge payments from insurance companies who will in turn continue to charge high rates to both hospitals and doctors. The HMSA insurance monopoly will continue to build up its $600 million dollar ‘surplus’.

Government employee union members, who have invested so much of their dues money in electing what they thought would be friendly Democratic legislators are getting a rude awakening. Their support is taken for granted. Now dozens of HGEA-represented hospital employees are being laid off as well as hospital personnel at NHCH. Even worse, medical services in West and North Hawai`i as well as Kaua`i County is being sharply curtailed, although legislators will claim otherwise in order to avoid triggering the state constitutional requirement that they approve any HHSC reduction in services.

With the elimination of “on-call” doctors available to respond to emergencies in Kona, many more emergency and acute-care patients will have to be transferred to O`ahu by air-ambulance. This can only hurt patient outcomes and may soon be an identifiable cause of patient deaths. The only major hospital on the Big Island to escape staff reductions is Hilo Medical Center, but even there management has responded by eliminating overtime.

The HHSC management has announced a $62 million budget shortfall for the fiscal year starting July 1. The legislature provided only $14 million for the fiscal year ending June 30. Governor Lingle is pledging to speed up state Medicaid payments in order to avert insolvency, but that is just a holding action. Another early cut: physician recruitment programs, although Governor Lingle signed a bill providing state funding for physician recruitment efforts. What they will be recruited to is questionable. One laid-off vocational nurse at NHCH said with other hospitals cutting back, her opportunities for employment were very limited. That is the price Hawai`i pays for socialist health care. On the mainland, there is a huge shortage of nurses and hospitals are recruiting overseas to fill the gap.

Socialized medicine is just as much a failure in Hawai`i as it is world wide. This latest mess comes after the state bureaucracy last year denied a request for a so-called “certificate of need” for a privately-funded hospital on Maui. While government run medicine is unable to hold its own even with a monopoly, privately funded hospitals are continuing to attempt to break into the rural Hawaii medical care marketplace. This implies that the medical crisis is an entire political creation unrelated to any underlying truths about the demand for health care in Hawai`i or the ability of patients to pay for it. After all, Maui, Kaua`i and the Big Island have some of the largest concentrations of millionaires anywhere on Earth.

Because of the legislature and Congressional delegation’s aggressive refusal to address the problems facing HHSC, the public call for private hospitals to be allowed on the sister islands will only increase. In Maui County and Kaua`i County there are no private hospitals. Without HHSC health care, the nearest hospital for most would be on O`ahu.

In spite of the long and loud warnings, some Democrat Senators and Representatives are still claiming that there is not much of a problem. Lawyer Dwight Takamine, now seeking a Big Island Senate seat claims, “there will be no reduction in service at any of the hospitals.” Expressing doubt that legislators will return from their busy legal practices to attend to the problem Sen Russell Kokubun passes the buck: “(HHSC is) running out of money, and they need to take some measures to address that.”

Any reduction in services must be approved by the Legislature. Many legislators do not want to be in the position of voting to cut services in an election year. So the likely solution is that the problem will be allowed to fester until after November 4.

HHSC is the nation’s fourth-largest public hospital system with 4,200 employees and 800 affiliated doctors.