Maui County hospitals scramble to provide care for patients

It’s not a good time to get sick on Maui.

Kaiser Permanente Hawaii, the state’s largest health maintenance organization, was scheduled to assume control of Maui Memorial Medical Center, Kula Hospital & Clinic and Lanai Community Hospital on July 1. But the 9th Circuit Court of Appeals on May 17 blocked the plan to consider claims from the United Public Workers union that its members will be hurt by the change.

Maui County hospital executives said many of their 1,100 employees are using vacation and sick days in anticipation of ending employment under the public hospital operator, Hawaii Health Systems Corp. As many as 50 hospital workers are taking leave daily, leaving executives scrambling to hire temporary workers to fill the gaps.

The workforce has already shrunk almost 4 percent, and the hospitals have stopped hiring permanent workers in anticipation of the transfer, said Dr. Linda Rosen, HHSC’s CEO, in court documents.

“Many employees have been using their sick leave, causing the available workforce to be severely reduced,” she said. “The safe operation of the hospital requires an adequate workforce. The injunction is causing very serious operational issues.”

It is a precarious situation for the hospitals, as no one knows when the court will allow privatization to proceed. The Maui region has more than 400 vacancies, positions that are left open indefinitely, said Wesley Lo, CEO for the Maui region.

There are 116 temporary workers currently staffing the hospitals, he said.

“We stopped hiring in anticipation of the July 1 transition due to the time it takes to get people cleared to work. This includes several critical positions that have been left vacant pending the changeover,” said Lo, who is slated to step down as head of the Maui County hospitals July 1. “The uncertainty this delay creates, further minimizes the appeal for potential job candidates. I potentially could not have physicians unless I figure something out. With every day that passes it becomes riskier and riskier. Because of a lack of resources we may have to start shipping patients to Honolulu.”

Of Maui Memorial’s 20 salaried physicians — including a neurosurgeon, interventional cardiologists, cardiothoracic surgeons, oncologists, gastroenterologists and orthopedic surgeons — close to a dozen have signed contracts with Kaiser, but others will be leaving Maui — and adding to the physician shortage, said Dr. Ron Boyd, a radiologist and chief of staff at Maui Memorial.

He described the situation as “scary.”

“It may be very dangerous to have a stroke or heart attack on Maui this summer,” he said. “You have no guarantee that you’ll have the personnel, physicians and supplies to provide safe care (after June 30). Critical vendor and employment contracts are terminating, diagnostic equipment, supplies have all been adjusted to reflect a changeover. It is near impossible to simply reverse course. This will lead to drastic gaps in coverage with no capacity to fill (them). This delay is devastating to the forward momentum to offering better care to Maui County.”

Stopped short

In 2015 the state Legislature passed a law allowing a private operator to assume control of the operations at Maui County hospitals.

On Jan. 14, HHSC’s board signed an agreement to transition to a new Kaiser entity, Maui Health Systems. UPW, representing 1,500 employees of HHSC, sued to stop it, arguing that the agreement violates the contracts clause of the U.S. Constitution and interferes with collective bargaining agreements that remain in effect until June 2017.

On Feb. 19, U.S. District Court Judge Helen Gillmor ruled in favor of the state. UPW appealed to the 9th Circuit Court of Appeals, which ordered the state to temporarily stop all activities related to the transition until Sept. 30.

“For a court and judicial system to put the health care of a whole community at risk is inexcusable. Serious consequences may result, and many of these may be unforeseen today,” Boyd said.

‘Firmly committed’

The Legislature appropriated $33.4 million to HHSC for the new Maui Health Systems, but those funds could be used to continue to operate the hospitals if the transfer doesn’t occur, Rosen said.

“Not only are we stopping our work towards the transfer, but we don’t know when it would occur or even in fact if it will occur,” Rosen said. “If the court were to issue a final ruling of an injunction it would stop things. If we are not able to basically meet all the conditions for the transfer, then Kaiser can walk away.”

Despite the setback, Kaiser said it is “firmly committed” to investing in the hospitals and to serving the people of Maui and Lanai. Kaiser previously said the facilities will remain community hospitals open to patients with all types of insurance plans. Kaiser said it offered jobs to more than 1,500 workers and that 95 percent accepted positions with it.

Indefinite limbo

“Our vision to continue to operate these facilities as critical community hospitals — open to all patients regardless of health insurance — remains unchanged,” Kaiser spokeswoman Laura Lott said in a statement. The HMO did not say how much a delay will cost the organization or what impact it could have on operations.

“Transitioning the hospitals from the state system is extremely complex, complicated and time consuming. New IT systems and equipment need to be installed and tested. Staff need to be trained and supplies ordered and stocked. We are unable to complete this transition work because the court order halts our access to the facilities and their personnel,” she said. “Once we know when the injunction will be lifted, we will re-examine our priorities and adjust work plans. Until then it is impossible to quantify the full impact. We are working to keep plans moving forward and ensure we are prepared to resume transition work on the campuses of Maui Memorial Medical Center, Kula Hospital & Clinic, and Lanai Community Hospital as soon as access is granted.”

More than a dozen doctors have signed contracts with Kaiser, and at least one oncologist and one of two neurosurgeons have elected to end their employment, which leaves the hospitals with “some holes in our medical coverage,” Boyd said.

Doctor shortages

The hospitals also are slated to end contracts with a number of physicians who provide on-call emergency and specialty services, as well as vendor agreements for IT systems, medical equipment such as MRIs and CT scans, and supplies, including IV fluids and medications.

“Turning this boat around is no easy matter and involves rewriting thousands of contracts. All of those contracts have been canceled at the end of June so there’s no guarantee that some of those physicians will be available,” he said. “The other thing people don’t realize is there’s a large number of contracted medical services in the hospital. Some of these vendors may be apprehensive to provide their services to a hospital that’s going to be very short of money in July.”

Boyd’s contract to provide radiology coverage for Maui Memorial ends June 30. Likewise, the hospital has canceled contracts for anesthesia coverage, pathology, pediatric services and 30 or so hospitalists and travel nurses, he said.

“We’re not, at this point, even raising financial concerns, it’s really about patient safety and the confidence in the community about their health care options,” Rosen said. “The community, after these past years working towards this transfer, they really have gone though a lot and they are anticipating a positive change for their health care services so it’s bound to be disappointing.”