By Leland Kim
KEALAKEKUA, Big Island (KHNL) -- Orpheus Dillard is a patient at Kona Community Hospital. He's noticed a shrinking population of doctors on the Kona side.
"It's going to be a major crunch," said the 47-year-old Kealakekua resident. "I think people are really going to suffer. I think we may have a lot of our population leave because of that."
Surgeons like Dr. Larry Peebles say the problem is Hawaii has one of the lowest reimbursement rates in the county.
"If I'm expected to do some work, and I'm being paid at a rate that doesn't cover my cost, I'll stop offering that service," said Dr. Peebles, a general surgeon and Kona Community Hospital's chief of staff. "And then, what happens is, patients have to go elsewhere for that service."
That means having to go off island for complicated, potentially life-threatening illnesses.
"If you look at the statistics on the island of Hawaii, in the state, we're the worst in strokes and cardiac care in terms of final results," said Dr. Peebles. "And the reason is because there's delays in treatment."
The high cost of malpractice insurance also makes it difficult to keep doctors. It's about $150,000 just to defend a lawsuit.
"So every time someone sues a physician, whether they win or lose, it costs $150,000, which comes out of my overhead, which of course, bounces back down to the patient," said Dr. Peebles.
So, the Kona side is underserved, especially with subspecialty care.
In January, Dr. John Bellatti was the only orthopaedic surgeon taking calls in Kona.
"Any one month could seem like a gun lap in a race," he said. "You can go faster, faster and faster and then you have another month, and another month, and another year."
He and others advocate medical liability reform, similar to measures that transformed health care in Texas.
Before voters there passed a tort reform law in 2003, nine orthopaedic surgeons closed their practices over three years. Since then, Texas saw a dramatic jump in the number of orthopaedic surgeons, attracting more than a hundred in two years.
Doctors say something similar could work in Hawaii, but patients must get involved.
"When the patients stand up and let the legislature know that they will vote them out if they don't take action, then I think there will be action," said Dr. Bellatti. "But I think doctors going to the legislature and telling stories and giving statistics isn't going to work."
So unless something changes, doctors say patients will continue using the ER as a doctor's office.