Maui has outgrown emergency room
With only one hospital, it's a problem
By Don Gronning, Haleakala Times, March 15, 2006
Ellen Bellerose waited two hours before she was able to see a doctor when she went to the emergency room at Maui Memorial Medical Center in February with chest pains.
"I went two or three times to the desk and they kept telling me there were no beds," she said. "It was terrifying to know I could have died, with the last words being 'there are no beds'."
She was eventually placed in an observation bed. She waited with three or four others, in observation, she said. While her medical problem turned out to be coronary spasms, not a heart attack, one of the people she was waiting with wasn't as fortunate. He died.
Problem not unique to Maui
Bellerose's situation isn't uncommon. The problem is complex and not unique to Maui according to Wes Lo, Regional Chief Executive Officer of Maui Memorial.
The problem is getting to patients in a timely manner, says Lo. He says there is a backlog of long-term patients who need care but don't need emergency room care. When the hospital beds get filled, there is no place to send them.
"I'm not going to kick them out," he says.
He says another problem is the lack of nurses.
"Sometimes we have the beds and can't get nurses to staff them," he says. He says the hospital has about 60 open positions.
Whether or not patient care is compromised depends on how you define it, says Lo. He says when the staff does see a patient, they get good health care.
"When someone is sitting in a waiting room with chest pains, that can be a problem," he says.
Nurses starting to leave
Nurses say the problem goes deeper than that. Some say that management hasn't done a good enough job recruiting nurses and has even turned down qualified nurses. They say their pay is less than what they could earn elsewhere. They question why elective surgeries aren't postponed when there is a shortage of beds. The combination of factors is causing many nurses to leave Maui Memorial.
Marilyn Griffin has been a registered nurse at Maui Memorial for 12 of the 30 years she has worked in nursing. She is leaving the end of March. She estimates something like 16 nurses have left in the last year. There are about 37 emergency room nurses at Maui Memorial.
"The problem is there is not enough staff for the activity," she says. Pay is also a factor. She works two 12-hour shifts a week at the emergency room and also works as a realtor. She says she makes as much in three months selling real estate as she does in a year at Maui Memorial.
Elaine Bridge is shop steward for the Hawaii Government Employees Association, the union that represents the nurses. She says nurses at Maui Memorial make about $8 an hour less than nurses at Kaiser Permanente. They lag behind hospital nurses on Oahu by a similar amount.
Bridge says nurses at Maui Memorial earn about $28-30 an hour. Since they work at a public hospital, they are prohibited from striking.
Management in 'state of denial, nurses say
Some nurses say management is in a state of denial about the severity of the emergency room problem.
"You don't correct a problem by denying it exists," says Connie Layer, who has worked at Maui Memorial 18 of her 25 years as a nurse. She says she worked at a hospital in Florida that had a similar problem and was able to turn it around. But the process started with an acknowledgment of the problem.
Debbie Protacio has worked in the emergency room for five years. She says the case load has been increasing for some time and should have been anticipated. The winter time, when there are many visitors here, is especially busy.
"It's not like this is a news flash," she says. "It happens every year."
The need is real and people should be concerned.
"This could be yourself or your family member waiting for a bed," she says.
"We need more beds and nurses, that is the truth," says Lorraine Hanson, another emergency room nurse.
Some think second hospital is the answer
Some think the answer is building another hospital. Maui is the only island with one hospital. Ron Kwon, a physician, is heading up an effort to build a for-profit hospital in Kihei.
Griffin, whose husband is a physician, says such a hospital is needed. Kwon says he has 120 doctors on the island who would support another hospital.
But one of Maui's state senators, Roz Baker (D. 5th District), says another hospital would just pull resources from Maui Memorial. Baker, who chairs the senate's Health Committee, says a new hospital would require doctors, nurses and technicians, who are in short supply as it is.
"Honolulu is much larger and has a hard time attracting nurses," she says. "I just don't think Maui can afford two (primary care) hospitals."
Officials fear for-profit hospital would hurt poor
She says since Maui Memorial is a state hospital, it is required to accept all patients. The new hospital would not be and that would lead to a class-based health system, one for the haves and one for the have nots, she says.
Lo agrees. He says there are three hospitals on the Big Island but no one has specialists in all areas.
A $4.2 million emergency room will add an additional nine exam/treatment rooms, bringing the number of emergency room beds to 30. Construction is expected to be completed by 2008.
Bridge says that will help. "It's a step in the right direction," she says.
Lo says the answer lies in education and prevention. He says on any given day there may be 29 people in Maui Memorial beds because of lifestyle diseases, that could be prevented. These are diseases like diabetes that could be prevented by changes to lifestyle.
The goal is not to get people to come to the emergency room, he says. The goal is to educate people so they don't need the emergency room except for truly unpreventable situations. Getting regular medical care before a health condition becomes so bad it is necessary to go to the emergency room is also important.
Baker says people should not use the emergency room as their primary medical facility. She says she had a friend who needed a release to go back to work and went to the emergency room to get it.
Though the end result of Bellerose's experience with Maui Memorial' emergency room was good, she is still concerned.
"As a patient and private citizen, I don't want to not get treated," she says. "I think the Governor and Sen. Baker should know."
