The current problems at Wilcox, having to do with the corporate (Hawaii Pacific Health) ownership of the hospital, and the desire of the nurses to have better working conditions, especially nurse-to-patient ratios, have been a long time coming. I would
The current problems at Wilcox, having to do with the corporate (Hawaii Pacific Health) ownership of the hospital, and the desire of the nurses to have better working conditions, especially nurse-to-patient ratios, have been a long time coming. I would share some very general comments, some of which may be the target of nitpicking, but are written here to give a general idea of what has brought us to July 2006 and our local dilemmas.
By way of my credentials, from 1969 to 2000, I held various positions in medical capital equipment companies including sales, management, and later President/CEO and vice chairman of the board. Later, after moving to Kaua‘i in 1998, at the kind invitation of the Wilcox leadership, I was elected to the board of directors of the Kauai Medical Clinic, and later moved to a similar position with the Wilcox Healthcare Foundation. This has provided me a sweeping historical view of health care as it was, as it changed, and as it is now, and also of the inner workings of local health care. A few years ago conflicting demands required me to regrettably resign from the fine Wilcox organization.
By the way, I myself have been a patient in Wilcox, and always received great care. These included inpatient care for a severe infection from river bacteria, orthopedic surgery (Dr. Mori), and laparoscopic surgery (Dr. McGreevy and Dr. DeNigris). In addition, I have been a long-time patient of the Kauai Medical Clinic, and received similar excellent care.
For the decades preceding 1992, American hospitals were compensated for expenses on a cost-plus basis by the government. Hospital officials, doctors, and nurses, were receptive to new and useful technologies, and the average American hospital offered products and services easily the equal to flagship medical centers in the first world (many of which I visited and observed first hand). A patient entering a local American hospital, in most instances, received state of the art care. It mattered little that some countries might have better statistics for, say, life expectancy, in large part because they were small nations and not the population giant of the USA.
In 1992, an election year, Mr. and Mrs. Clinton sought issues by which to gain votes, and they seized upon health care. They stated, “The American health care system is broken and we are going to fix it,” as a major political issue. Since only a minority of voters had been in a hospital at all, they accepted this claim as truth. In fairness, the issue of cost (I believe at that time the total cost for American healthcare was about 12 percent of the gross national product and growing) was a legitimate concern, but it was the price for getting the best medical care in the world. Personally, I am willing to pay more for the best medical care.
Ironically, and ignorantly, the Clintons touted the “Canadian Model’ as the gold standard, when in fact wonderful Canadian medical centers were closing down completely for lack of funds (I visited every major hospital in British Columbia and Alberta during the early 70s, and at that time they were excellent, but they could not withstand the constant government budget cuts inflicted over the ensuing decades). Doctors were fleeing Canada in droves, in spite of severe financial penalties legislated by the Canadian government.
So after Mr. Clinton won the election, beginning in 1993 Hillary Clinton was the person who in large part began “Health Care Reform.” In later years, her program was widely regarded as a total and humiliating failure. Healthcare was no longer cost plus. Some hallmarks included the rise of for-profit hospital conglomerates (many of which enriched a few, and later failed), and a general ‘fire nurses, cut costs, and hire accountants’ management strategy. Thus over time and up to this moment, hospital services have been cut back, costs have risen anyway, and nurses are on strike right in our own back yard. Less well known is that several dozen fine medical doctors and executives have also left, usually for more lucrative, or at least financially viable, positions on the mainland.
Hawaii Pacific Health, owner of Wilcox Hospital, along with Straub and Kapi‘olani in Honolulu, is running a business, and no business can survive if they don’t at least break even. They go out of business, i.e. close their doors, if they lose lots of money. One manages costs by keeping labor, material, and overhead under control, and bringing in enough money to cover these costs and maybe some extra reserves to fix things and keep the facilities in good shape. But healthcare money comes almost entirely from governments and insurers. In Hawai‘i, HMSA insures perhaps 80 to 90 percent of all those covered by private insurance. Medicare covers costs for all those over 65, but dictates what they will pay, not what it costs the providers (hospitals, doctors, nurses, etc). All these payers have cut reimbursement steadily over the years. This is an inexorable formula for disaster. I suggest there are no villains here, just people caught up in an impossible situation.
What might we do? Well, the only other acute care hospital on Kaua‘i, West Kauai Medical Center (sometimes referred to as West Kauai Veterans Memorial Hospital, in honor of WW II vets, not a Veterans Administration hospital), relatively isolated in Waimea, is owned by the state of Hawai‘i. I confess I am not privy to their financial issues, but in years past, if there was a break-even shortfall, the state (taxpayer money) made up that shortfall. What if HPH sold or otherwise transferred ownership of the Wilcox facilities to state ownership? Now, there will be some very loud and angry voices raised against this concept, but the idea may solve a lot of problems which are in the present context un-fixable.
It is not my purpose here to write a scholarly, bullet-proof compendium of the healthcare issues of the past 50 years, but rather to share a general overview, and make a suggestion on what we might do to improve things. Thanks for listening.
• Tom Rice is a resident of Princeville.
