(Originally published July, 2007, this article outlines the effect of government-controlled health care on Hawaii.  Since Hawaii's system has been pointed to as a model for socialized health care, other Americans may be interested to learn the fate which awaits them.)

By Andrew Walden

In the wake of a heated fight over construction of a privately funded hospital on Maui, the Hawaii Health Services Corporation (HHSC) is moving to improve its facilities by agreeing to provide Hawaii patients with equipment available in some African hospitals.

The June 29, Pacific Business News trumpets, “Hilo Medical Center, East Hawaii’s only acute-care hospital, will establish first first-ever cardiac unit …. Currently only two cardiologists serve Hilo’s population of 41,000 and neither can perform angiograms to detect blocked or damaged arteries on the Big Island because of lack of equipment and facilities.”

This step is possible because the normally sluggish state Health Planning and Development Agency in only six weeks gave their approval to Hilo Medical Center’s “Certificate of Need” (CON) application filed May 15.

This expansion of services will save lives and improve the Big Island’s ability to attract and keep cardiologists. Notably, the facility as currently planned will provide only diagnostic catheterization. No therapeutic catheterization will be available without a further CON request. This fits the HHSC’s plan to fly Big Island patients (and their dollars) away from first class Oahu hospitals to HHSC’s decaying Maui Memorial Medical Center (MMMC).

Jan Shields, RN, of the Association for Improved Healthcare on Maui writes:

“Hawaii Health Systems Corporation is $68 million in the red. With all of these financial woes, Maui Memorial has hired a cardiac surgeon. They will pay him $800,000 per year, twice the going rate of what a cardiac surgeon normally makes. He is only two years out of his fellowship, so he doesn’t have a whole lot of experience. He will not do vascular surgery -- just cardiac. There will not be a cardiac surgery program at Maui Memorial for three to five years. So he’ll work as a consultant. Even after the unit is possibly built, only two of the nine cardiologists will use it. Lots of money is being spent to build a cardiac center when the rest of the hospital is circling the drain.”

When completed, MMMC’s cardiac canter may be able to perform open-heart surgery. Nairobi Hospital performed its first open-heart surgery in 1993.

Currently Hilo-based cardiologists have to send patients to Oahu for diagnosis. According to HMC’s CON application, an estimated 812 Big Island patients go to O`ahu for diagnostic catheterization every year. Statistical models predict a current need for about 1600 such procedures annually on the Big Island. HMC’s plan is to provide about 250 procedures in the first year of operation, ramping up to 500 procedures in the second year.

If doctors continue to send their patients to Oahu for diagnosis, HHSC wouldn't be able to route patients to Maui Memorial. By building a "diagnostic cardiac catheterization services center" in Hilo, they can diagnose patients and send as many to MMMC as possible. Logically this HHSC money-making scheme means a similar facility should soon be planned and quickly approved for Kona Community Hospital.

How widely available is cardiac catheterization?  The June 22, 2007, Coastweek Kenya reports, “His Excellency, Mr. Walter Lindner, the German Ambassador, cut a ribbon and unveiled a plaque to formally open the new 89 million shilling Cardiac Catheterization Laboratory (Cathlab) at the Nairobi Hospital.”

Dr. Cleopa Mailu, the Chief Executive Officer at The Nairobi Hospital, explained, "Using the Cathlab we carry out diagnostic studies including coronary and angiography, which is the assessment of blood vessels that supply critical organs.”

Not only does Nairobi, Kenya have a hospital providing diagnosis, but also will provide therapeutic cardiac catheterization as well. Dr. Mailu continues: “The visualization of narrowings, or blockages of the vessels is of particular interest. Our new equipment is in frequent use for the routine implantation of heart pacemakers and stents in patients with narrowed or blocked arteries."

In Hilo, PBN quotes a HMC spokesperson explaining, “We need to make sure, with state funds, we do it right. We’re not going to hit it out of the ballpark. We need to start small and build it up, not necessarily to doing open-heart surgery, but identify where or how far we can go piece by piece.”

Cardiac catheterizations have been performed in Honolulu since 1954. The first open heart surgery in Hawaii was performed in 1959 at Queens Hospital in Honolulu. Ironically the first patient was a Hilo woman. Pacific Business News unwittingly explains why Hilo is behind Nairobi in medical facilities:

“Because the (Hilo) Hospital is part of the state’s 13-member public hospital network, the Hawaii Health Systems Corp (HHSC), movement on any project is subject to approval and funding from the Legislature.”

Dr Mailu continues: “Our facility is the leading Cathlab in the region and The Nairobi Hospital receives patients from other African countries including the Congo, Chad, Eritrea, Morocco and Zambia and has the potential to support a medical tourism sector for Kenya.”

Hilo Medical Center is actually one of the better hospitals in the HHSC system. How under-funded are HHSC’s more rural hospitals? The Star-Bulletin Feb. 24, 2007 reports that “Red Hat” Kau Community Hospital auxiliary volunteers held bake sales in front of the Hilo Wal-Mart raising over $29,000 to buy Kau Hospital its first two cardiac monitors. The May, 2007 Ka`u Calendar explains:

“It’s hard to get really frequent vital signs ... . Without the monitors, nurses would have to (keep track of pulse, blood pressure, oxygen saturation, and temperature) by hand.”

Ka`u Hospital employs HD6 Rep. Josh Green MD (D), who calls Maui’s privately funded Malulani Hospital proposal “substandard” while posing as an advocate of medical reform. Now Green is running for state Senate in District 3.

In contrast, Rwanda’s King Faisal Hospital reports that on June 29, 2007, they acquired new cardiac monitors. For another Rwanda hospital, Denver Colorado Rotary Club members pitched in to supply cardiac monitors and other equipment in 2005.

One of the Ka`u Red Hat volunteers told the Honolulu Star-Bulletin:

“The hospital does not have several of those individual instruments. She said a doctor commented that ‘it's like practicing bush medicine here.’"

Now thanks to the volunteers’ efforts Ka`u has some of what Rwanda has.

And thanks to the pressure created by Maui’s citizens’ attempts to free themselves from the HHSC/MMMC death grip, Hilo will soon have some of what Nairobi, Kenya has.

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Big Island patients headed for Maui Memorial: http://www.hawaiireporter.com/story.aspx?49a22754-064d-4991-8e67-5f555547e3a6

Open Heart surgery in Hawaii: http://hml.org/hmj/articles/hmj54794.pdf

Coastweek Kenya article: http://72.14.253.104/search?q=cache:f9lOKL3YpF8J:www.coastweek.com/3025-28.htm+cardiac+catheterization+kenya&hl=en&ct=clnk&cd=1&gl=us

Rwanda: http://www.thevalleyalmanac.com/article.php?id=60&PHPSESSID=cf351ce0cb209d3076a431b1f9167797

On June 29, 2007 Kigali, Rwanda’s King Faisal Hospital acquired new cardiac monitors. http://www.kfh.rw/news.html

Ka`u Calendar: http://www.pahala-hawaii.com/cgi-bin/web_store.cgi?page=5_07page23.html&cart_id