Ellen Bellerose rushed to Maui Memorial Medical Center's emergency room on her cardiologist's recommendation after she felt severe pain in her neck, chest and arms. As the pain intensified over the next two hours, she walked up to the counter three times to report difficulty breathing. She was told there were no beds available. "I was becoming terrified that I could die, unattended, in the emergency room." Although registered as a patient for 27 hours, she never entered the main hospital that February 7, 2006, but was billed as if she had.
Bellerose is one of many Maui residents with complaints about Maui Memorial, the island's only acute care hospital. She along with several dozen other Maui residents and medical professionals shared their agonizing stories in 2006 with the Hawaii State Health Planning and Development Agency (SHPDA), a division of the state Health Department, in hopes the agency would agree to allow competition for the island's only hospital. But SHPDA blocked the plan to open Malulani Health and Medical Center, a 150-bed acute hospital facility, largely at Maui Memorial's insistence, because Maui Memorial claimed competition would put the state hospital out of business.
Today, as debate rages nationally on whether healthcare should be controlled by government or the free market, the battle continues over what healthcare should encompass on Maui - an island with a growing population of about 140,000 people and another 2 million visitors annually. Should there be just one acute care hospital to service an island of 727 square miles, much of the land remote and accessible through just one road?
The current hospital system's supporters say yes, including Maui union-backed lawmakers. However, many Maui residents are deeply troubled by the conditions at the 231-bed hospital, managed by the Hawaii Health Systems Corporation (HHCS), an entity created in 1998 by the state Legislature to manage a dozen state-owned hospitals.
While most in the community don't disparage the hospital's doctors and nurses, they are critical of the old facilities, outdated and broken medical equipment and mediocre management.
Whether it's the smell from the morgue contained by a towel stuffed under the door, battles with toxic mold, the aged, out-of-date medical equipment or the archaic record-keeping computer system, several medical personnel question whether the facility is "safe.”
Wes Lo, CEO of Maui Memorial, maintains his hospital is safe, that national benchmarks are met, that his staff does its best to provide quality care, that the hospital has passed quality and accreditation tests and that they are working to improve.
That doesn't stop the island’s medical personnel from criticizing Maui Memorial for poor fiscal and patient management, overcrowding, and the administration’s hard fought battle to keep private competition out.
The lax management and unwillingness to work with doctors frustrates Jane Kocivar, an MD in private practice who is on call at Maui Memorial.
Jeffrey M. Drood, M.D., private practitioner and cardiologist and electrophysiologist on staff in the Maui Memorial Medical Center Department of Cardiology since 1999, says every hospital makes errors, but there are an inordinate number at Maui Memorial.
They note that at a cost of millions of dollars, a new cardiac unit was established this year when patients can be flown to Oahu for better care. "Cardiac surgeons are hired and are not doing any work, yet we don't have basic services and supplies like beds that work, oxygen monitors, blood pressure cuffs, recliner chairs, utensils, napkins, and paper towels for the nurses," says Kocivar.
FACILITIES SUFFER FROM 'OLD BUILDING SYNDROME’
Medical staff members complain about working conditions, particularly in the old wing of the hospital constructed in 1952, where a perpetual battle with mold continues.
Some staff have been reassigned to other hospital areas because of health issues that have arisen likely due to exposure to mold. They are also being treated by physicians for respiratory symptoms similar to what patients experience if they breathe in black mold spores.
Lo agrees Maui Memorial does encounter mold issues from time to time, but makes its best effort to validate and mitigate concerns immediately and was recently cleared.
However, two independent mold tests taken for this report found traces of multiple kinds of dangerous mold. Pro Lab, a professional mainland lab that analyzed a wall swab sample, detected "Fusarium", which in severe cases can produce hemorrhagic syndrome in humans characterized by nausea, vomiting, diarrhea, dermatitis, and extensive internal bleeding. Enviro-Cure Services Inc. says Fusarium causes "extremely dangerous skin infections with symptoms similar in appearance to Strep A, 'the flesh eating' bacteria" with many experts comparing the symptoms to that of leprosy.
COMPETITION: A FRIGHTENING PROSPECT?
Maui Memorial is not financially self-sufficient with an operating income of $142 million and operating expenses of $172 million, so in FY 2009, the state contributed $20.8 million and authorized a $10 million loan.
When there was a chance in 2006 for a private competitor, the hospital and its contractors mobilized against Malulani utilizing the anti-competitive Certificate of Need (CON) process.
CON state and federal laws were passed around the country in the 1960s, and were repealed federally in 1987, but Hawaii did not follow suit.
When denying Malulani's CON application, SHPDA relied almost entirely on the testimony of interested parties who claimed competition would hurt them.
"I got mad because I saw how corrupt it is and how they squashed what the public wanted," says Jane Kocivar MD.
Ron Kwon, MD, a Maui-born, Harvard-educated physician, raised $1.3 million and spent 10 years working to build Malulani before leaving in 2008. Kwon says the healthcare crisis in Maui “is doomed to get worse before it can get better."
The bureaucrats’ resistance to competition in favor of mediocrity and subsidies – even when human lives are on the line – should serve as a warning to advocates for government-run healthcare.
Political will – and a healthy dose of competition – would result in job creation, an economic boost, and more choice and save ultimately lives.
For more information, log onto http://www.grassrootinstitute.org. For the extended version of this report, log onto "Special Grassroot Institute Report - Maui’s Life and Death Medical Challenges".