Wilcox Health and the broken promise

The nurse’s strike has been going on for close to a month.

Hawaii Pacific Health’s (HPH’s) latest proposal is to fire all of the Licensed Practical Nurses (LPNs) employed at Wilcox.

I have remained quiet up until now as I was concerned that raising new issues might hinder the strike resolution. However, it is time for the people of Kaua‘i to know more about the serious problems between Wilcox and HPH.

I have been a physician at Wilcox for 27 years. I was CEO of Kaua‘i Medical Clinic and Wilcox Hospital at the time I resigned, nine months ago. I am knowledgeable about the promises made to Wilcox and Kaua‘i by HPH because I was part of the negotiating team that created the merger and I helped present HPH’s written merger points to our board of directors and to the state agency that oversees healthcare mergers (SHPDA). SHPDA is a state agency that tries to make sure that healthcare changes are good for a community.

The merger with HPH has not turned out as we were led to expect.

Although HPH has lived up to some of its promises, such as building a new operating room suite and providing electronic medical records, serious problems have emerged. Two of the issues driving this strike are a loss of trust between the nurses and HPH management and the clash between our rural hospital setting and the O’ahu-based corporate management style.

Please find below the written statements made by HPH to the State Health Planning Agency (SHPDA) in 2001 and to the people of Kaua‘i, followed by what actually occurred:

Written statement by HPH:

“The merger will not impact the access to care at Wilcox or its clinics.”

What happened:

Access to care, particularly in the specialty areas, has been dramatically impacted. A flood of nurses and physicians has left Wilcox since the merger and the flood is worsening. This month alone, the entire Kilauea clinic resigned and another Wilcox orthopedic physician announced his resignation. This spring and summer two pediatricians and the island’s only board-certified cancer specialist resigned and have left, or are leaving Kaua‘i. Over the last several years, Kaua‘i’s only board-certified specialist in stomach and intestinal disease left the island as well as two cardiologists and two OB-GYN physicians. In addition to the above specialists leaving the island, six internists, one lung specialist, one kidney specialist, one radiologist, and one orthopedic surgeon have left the Kaua‘i Medical Clinic. Many of our highly trained ICU staff have also resigned.

Written statement by HPH:

“There are no anticipated or planned changes to patient care staffing levels.”

What happened:

Since the first day of the merger, those in charge of staffing in the clinic and the hospital have been under constant pressure to terminate employees. The current plan to terminate all LPNs is further evidence of this.

Written statement by HPH:

There will be “no change in bed counts or licensed types.”

What happened:

Within months of the state’s approval of the merger, HPH began planning to sell Wilcox’s 110 long-term care beds and Wilcox’s laboratory. They sold both in 2003. In other words, after promising “no change,” the hospital became 60% smaller.

Written statement by HPH:

The merger will decrease operating losses at Wilcox by “12.86 million over the first five years.” Numerous spreadsheets were presented showing these projections.

What happened:

Operating losses under HPH dramatically increased and a major cause of those dramatic losses was a cost not shown in those pages of spreadsheets. Wilcox Health has been charged millions of dollars each year to help pay for the cost of HPH’s O‘ahu-based administration.

Written statement by HPH:

“Intent of the merger was not to take control of Wilcox’s operations.”

What happened:

By the end of 2005, every single one of the original administrators, VP level and above, had been replaced. This included four VPs and two CEOs. In addition, numerous other management positions were either downgraded or eliminated. It is very clear that O‘ahu is fully in charge of Kaua‘i operations, both directly and indirectly.

I think it is also very important to point out that Wilcox was not purchased by HPH. In fact, we contributed the $18 million we had in reserves to HPH, with the intention that we were going to be equal one-third partners in this relationship with Straub and Kapiolani.

In 1998, we were chosen as one of the top 20 hospitals (in the small hospital category) in the country as part of the very prestigious top 100 hospitals in America award. We had one of the best health care systems on the outer islands, and were proud of our community focus. I have no doubt that overall care at KMC and Wilcox continues to be excellent due to the hard work of our staff and physicians (KMC and independent), but there are serious concerns that need to be addressed to maintain that quality of care.

So where do we go from here?

Here are my suggestions:

1) The entire community needs to speak up about reclaiming our healthcare system. This is our community hospital.

2) HPH needs to return to the bargaining table with a real desire to put our Kaua’i friends and neighbors (the nurses) back to work and stop running the hospital short-staffed.

3) My understanding is that councilman Mel Rapozo said in Monday’s meeting that he was writing to the State Health Planning Agency requesting a review of our original application. I strongly support a review by SHPDA. The commitments to Kaua‘i have not been kept and our healthcare is suffering.

Let’s change that.

• Lee Evslin is a former CEO of Wilcox Hospital and Kauai Medical Clinic. He lives in Kapa‘a.