Care Center on Right Path to Save More Lives on Maui — Developer

After finding a new location, hospital developer and part-time Maui resident Brian Hoyle said he’s nearly ready to move forward with his much-anticipated plans to build an acute-care and nursing home facility for West Maui.

In a few years, he also wants to build a drug and alcohol treatment facility, medical office space and a world-class health and wellness center on 60 adjoining acres to his new property next to the Pu’ukoli’i Village and Kaanapali Coffee Farms off of the new Kakalaneo Road, Hoyle said in an interview Saturday.

More than a year and a half after getting a Certificate of Need from the State Health Planning and Development Agency, Hoyle said he hopes to begin construction sometime next year on the estimated $46 million West Maui Hospital and Medical Center. Under his timeline, the 50,000-square-foot hospital and 25,000-square-foot medical office building would open in mid-2013.

The heart of his ambitious plans has not been altered, he said, and still calls for a 24/7 emergency room, pharmacy and radiology services, 25 acute-care beds, 40 assisted-living beds, 40 nursing-home units and three operating suites. The latter would be used for elective surgery as well as emergency care to help cover costs, he said.

Hoyle said the hospital and nursing home would employ about 100 people full and part time, at least. “No one from the community will be turned away,” he said of the care. “I have not heard one negative comment.”

But some members of the local medical community aren’t as optimistic as Hoyle. They’ve said they doubt he’ll be able to find enough staff for all his plans on an island without a 24-hour pharmacy today. Others have said the money would be better spent improving transportation to Maui Memorial Medical Center, which continues to expand its services.
Hoyle owns California-based Newport Hospital Corp., which he said has built 50 hospitals and nursing homes across the country.

He said there are federal dollars out there to build a hospital, from the Department of Agriculture and Department of Housing and Urban Development. But, contrary to rumors, he has not applied for any of the agencies’ low-interest loans yet without all his pieces in place, he said. Either way, he said the hospital will get built.
He has partners, the giant Baltimore-based Capital Funding Group and his own significant resources – but he also does not have the funding or staff in place yet for the project, Hoyle said.

He pledges that financing won’t be a problem once the architectural drawings are completed, a few land title issues are cleared up and Maui County grants him his building permits. Hoyle said he expects to have those last loose ends wrapped up by January, after hearings and subsequent approval from the state Land Use Commission, SHPDA and Department of Transportation.
Council Member Jo Anne Johnson, who holds the West Maui residency seat, said the government needs to get out of the way of this project and instead do whatever it can to make the much-needed facility a reality.

“Seventy million dollars in the world of health care is not very much,” Hoyle said. “My company has a long track record, too. We showed we are committed, too, by buying the land. We’re coming into the deal heavy on cash. A lender loves to give money to someone with financial resources, i.e., cash. The government is ready to put up money for rural hospitals, and West Maui has been designated as rural.”

He said he’s already selected contractor Ledcor Construction to build the facility and estimates it will generate at least 100 construction jobs.

The new site is zoned for a hospital, but it needs a subdivision approval from the state, he said.

When it comes to staffing, Hoyle said, he’s taking an “if you build it, they will come” approach, since his facility will include a state-of-the-art medical office building, where physicians could purchase their own suites. He also said he’s going to recruit locally first.
Joseph Pluta, president of the West Maui Improvement Foundation, said that in order to get his Certificate of Need approved, Hoyle had to convince the state he could staff the hospital. He also said that Hoyle already had been meeting with local doctors and reaching out to them.

Hoyle said he anticipates creating partnerships with Kaiser Permanente and Maui Medical Group, both of which operate clinics in Lahaina that are showing their age.

Hoyle said he also wants to work with Maui Memorial Medical Center, University of Hawaii Maui College’s nursing school and UH’s John A. Burns School of Medicine to recruit or share doctors.

“Maui Memorial needs the beds,” Hoyle said. “It’s a huge problem.”

But Maui Memorial Chief Executive Officer Wesley Lo said it’s been about a year since he talked to Hoyle, and although he isn’t against a partnership, he doesn’t know what that would entail.

When the West Maui hospital idea was gaining steam, Maui Memorial didn’t get in its way, Lo said. However, for a variety of reasons now, the financial margins are thinner than ever for hospitals. Maui Memorial’s occupancy rates went from waiting lists to 65 percent occupancy, Lo said.

“I’m really not worried, I’m really not,” Hoyle said of the staffing question for his for-profit facility.

“We’re not going to take anything away from Maui Memorial,” he added. “We’re going to help them.”

Lo questioned whether the West Maui hospital can make it long term. “Just like the hotels, they need to have reasonable occupancy, and most hospitals are struggling,” Lo said. “The new trend is to build a critical mass with larger hospitals.”

Hoyle said that, for one thing, he gets full Medicare and Medicaid reimbursements, unlike government hospitals.

“It can be profitable, if you watch your costs,” Hoyle said. “And I am not going to make a billion dollars here. No. But the hospital will pay for itself. A potential profit source is the (50,000 daily) West Maui visitors who come here and pay more, as they do everywhere.”

That would cut into the business of West Maui’s existing clinics, critics have also said.

Pluta said he heard more than a year ago that the project was in trouble and that it would cost another $8.5 million to build a new access road behind the civic center.

“I thought, ‘Oh, my gosh, the plan is dead,” Pluta said. “I can tell you we’ve been just delighted with the new approach.”

He said that the new site has all the utilities in place as well, except for a connection to the sewage treatment plant. The old site above the Lahaina Civic Center didn’t have an access road. Hoyle said he was going to build on an easement over Hawaiian homelands property but a recent Supreme Court decision banning such land sales made that impossible.

He said he has purchased a new, 15-acre site from Kaanapali Land Management Co. for an undisclosed price – in cash.

The new location on the eastern border of the road is better suited, he said, with two access points. And it’s below the proposed Lahaina bypass route and will eventually connect to the highway.

“In five to 10 years, it will look like an incredible site,” he said.

He added that an environmental impact statement, or the presence of historical or archaeological sites, won’t come into play since it was farmed for more than a 100 years with pineapples.

For more than 10 years, residents in the West Maui Taxpayers Association and later the West Maui Improvement Foundation lobbied for a hospital, saying they’d lost friends and loved ones who didn’t get treatment in the “golden hour” after a stroke or heart attack. And Honoapiilani Highway can be blocked during an accident or shut down for a wildfire.

“People love this project,” Hoyle said. “We’ve gotta do it, and I want to do it. And so far it’s the best thing I’ve ever done.”

Hoyle was asked if ambulances would stop at the West Maui hospital with their critical-care patients. After all, Maui Memorial has a full ER and cardiologists, or many patients are flown to The Queen’s Medical Center on Oahu.

“We can at least stabilize that person,” he said. “We won’t do open-heart surgery. But if someone can get to a hospital, they have a far better chance. The most important thing here is that we will save lives.”