The financially perilous state of the Hawaii Medical Center has put at risk its regional hospital that fills a crucial need in Ewa and its legacy facility in Liliha that would be sorely missed.

There’s a glimmer of hope that HMC will find a buyer — Hawaii Pacific Health at least has not shut the door on acquiring at least one hospital — but the prospect of either closing for good is worrisome.

The 240-bed HMC East in Liliha, formerly known as St. Francis Medical Center-East, has been a linchpin in the state’s health care system, achieving excellence in the organ transplant specialization, shouldering more than its share of the work serving the poor.

Hawaii must not let either fail without a fight.

Hospitals nationally have been buckling under the weight of mounting, often uncollectable expenditures. Many of the patients coming through emergency-room doors are uninsured, and federal law requires hospitals to treat them. The reimbursements for treating Medicare and Medicaid beneficiaries have not kept up with rising costs; now there’s concern over how increasing the government-subsidized subscriber rolls under the federal health care reform act may compound the fiscal pressure.

Those are strains difficult for the most robust operations, and HMC was under duress even before the economy cratered.

Under its second Chapter 11 bankruptcy reorganization in recent years, HMC sought to turn over ownership of the hospitals to its lender and former owner, St. Francis Healthcare System of Hawaii.

Unfortunately, St. Francis more recently decided it could afford to shoulder neither the large governmental liabilities nor "the financial contributions required to fund ongoing operations for Hawaii Medical Center," said HMC Chief Executive Officer Maria Kostylo.

Hawaii Pacific Health operates Pali Momi and Kapiolani medical centers, Straub Clinic & Hospital and Wilcox Memorial Hospital. HPH executives have issued a statement indicating interest extending west, as long as its core operations are intact.

The loss to the greater community that closures would represent can’t be stressed enough. HMC West, with its 102 acute-care beds, provides critical emergency services to a growing community. Without it, Pali Momi is the closest, and that gap in services to Oahu’s Second City can’t be tolerated.

HMC East provides the only transplant services in the state, is home to the Hawaii Bone Marrow Donor Registry, maintains the only ambulatory center treating liver diseases and serves patients with kidney ailments. And the economic distress to HMC’s nearly 1,000 employees also should be avoided, if possible.

If HMC is able to secure a new lease on life, the state needs to do its part by ensuring that it doesn’t add to the challenges, keeping reimbursement delays to a minimum. There is hope for more stable days ahead. Ultimately health care reform can bring more paying customers to support hospitals, and the various efficiency efforts should yield savings in the long term, but in the short term there are growing pains.

The saga of Hawaii Medical Center stands as testament to the fragility of the state’s health care infrastructure. And each hospital’s closure directs more of the patient load, including those paying little or none of the costs, to the remaining facilities. Hawaii is the world’s most remote location; maintenance of a robust medical-services network is critical everywhere, but nowhere more so than here.