Debate over Proposed Maui Hospital Continues

Published: Feb. 13, 2007 at 11:41 PM HST|Updated: Feb. 15, 2007 at 7:06 PM HST
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Malulani Hospital
Malulani Hospital
Emma Starr
Emma Starr

By Diane Ako

KAHULUI, Maui (KHNL)- The Starrs are a happy family. Brook and Emma are grateful for every day they enjoy with their infant daughter Lily. 6 months ago, they weren't so sure this day would come. Emma recalls, "Lily was born at 27 weeks. And we were flown to Oahu - I was still 26 weeks- which is really scary. It's so early."

They stayed on Oahu for 2 ½ months. Starr, a registered nurse, says Maui Memorial Hospital had no facilities for her high risk premature baby. "If Lily had been born on Maui we probably wouldn't be sitting here today. Once the babies are born here and have to be taken over by air ambulance, it's as you say: time is precious. In emergencies you have a short space of time."

Maui Memorial clarifies it does have the ability to stabilize premature, critically ill newborns for transport to a tertiary care facility and can care for stable premature babies in its newborn nursery. Shirley Chun-Ming, Head Nurse in the OB department, says, "The determination of which babies are kept at Maui Memorial is made by the condition and degree of prematurity each case presents. We have kept babies that are premature by 2 or more months that were discharged home in good condition after being with us for a few weeks. They received appropriate care for a premature infant. Babies needing highest levels of care, say neonatal III, are routinely transferred from all hospitals to Kapiolani, the state's tertiary center. This includes Queens, Tripler, etc."

That's where the proposed Malulani Health Systems, Inc. (501(c)3), comes in. It would be proposed 40 acre site, adjacent to the Maui Research and Technology Park in Kihei. It's been trying in vain for years to get permission in the form of a "certificate of need" or "CON" from the state to build the hospital.

The State Health Planning and Development Agency rejected both Malulani's proposal to build a $212 million private hospital in Kihei. When he issued his decision against Malulani, SHPDA Administrator Dr. David Sakamoto said, among other things, that a proposed second hospital would negatively impact Maui Memorial.

Sakamoto wouldn't speak about the specific decision because it's an ongoing issue, but he talked to KHNL about the CON in general. "Please note that a CON decision is very narrow in that it applies to one specific application. There is also no 'dismiss with prejudice' clause. The applicant can redo an application so that it meets our criteria and submit it at any time (the applicant must pay the same fee each time). Last year we had an applicant withdraw an application when it appeared that it would be disapproved - he resubmitted it a few months later and SHPDA approved the project."

Both Malulani and an independent group of supporters called People United to Support a Second Hospital (PUSSH) will continue a public appeal to bring attention to Malulani's proposal and to the certificate-of-need process, which is required of all organizations and individuals seeking to establish new medical services in the state.

PUSSH supporters say Hawaii laws governing the certificate-of-need process must be either modified or abolished. They argue the state law protects entities, such as the state-subsidized Maui Memorial Medical Center, and does not allow competitive medical services to exist.

Joe Bertram III, the South Maui state House representative and a leader of PUSSH, said not having a second hospital puts Maui in a "health care crisis." Emma Starr agrees. Drawing on her experience with Lily, "It's your baby. It's the most important thing in your life. The thought of other families going through what we went through, that's why we need the new hospital."

Even Governor Linda Lingle supports Malulani. "It involves no government funding yet it brought in state of the art technology, gave an opportunity to attract more doctors to the island because they do have an upgraded facility."

The day after SHPDA denied a request for reconsideration, Governor Lingle issued this statement: "I share the disappointment of thousands of citizens, particularly those who reside on Maui, whose efforts to build a new state-of-the art hospital on Maui were rejected yesterday by the State Health Planning Development Agency. The decision does not make medical or economic sense. This hospital would have been built with $200 million in private funds.  It would have given Maui a second acute care facility at a time when Maui is the only island that must depend on one State-run hospital for all of its hospital care. I want to thank the numerous concerned individuals who came to O`ahu, yet again, to plead their case. In particular I want to applaud Dr. Ronald Kwon of Malulani Health Services, Inc. who has worked tirelessly to make the vision of a second hospital for Maui a reality. I will not stop in my efforts for a second hospital for the people of Maui. I am asking the State Legislature to immediately grant an exemption to the Certificate of Need (CON) process to allow the Malulani project to proceed.  Further, I am asking the State Legislature to change the Certificate of Need process so that other communities do not have to suffer the same setbacks in attempting to bring modern medical services into their communities. I urge the Senators and Representatives to act on these bills before we see an exodus of doctors and health care professionals leaving or retiring because they have lost hope in our health care future."

Wes Lo, president of Maui Memorial, defends his hospital. "We were never against a second hospital. What's more important for a community, especially Maui county, is that there's a comprehensive delivery system which takes care of the whole county."

Critics say Maui Memorial lacks state of the art technology. Lo maintains, "The perceptions of Maui Memorial are historic. Over the years we do have an older hospital but the improvements we've been making over the last years are pretty incredible."

Lo says a second hospital would split an already small pool of doctors and nurses. "When 2 hospitals provide the same service, you're not going to have the critical mass of doctors to provide the care in any one place."

The latest round between the state and Malulani brought more defeat for Malulani. Supporters guarantee you haven't heard the last from them. Doctor Kwon says he will consider a class action lawsuit on behalf of Maui citizens. He also joins the governor in taking this to the legislature, asking lawmakers to change the way the state processes hospital permits.