Hospital coming to West Maui; Will Doctors Come Too?

LAHAINA – Developers of the long-awaited West Maui Hospital and Medical Center expect to begin construction in the next 13 to 14 months, but residents and local medical officials wonder where the new hospital will find the physicians and the money to pay them.

“Where are they coming from?” Kaanapali resident Roger Ross asked during a community meeting Monday attended by at least a hundred people at the Lahaina Civic Center. “It’s a serious question because there’s only a handful of specialists on this island and most of them live on the other side because they’re on-call at Maui Memorial (Medical Center).”

Wesley Lo, Maui regional chief executive officer of Hawaii Health System Corp. of which Maui Memorial is a part, said that the new hospital could face high costs in employing salaried staff physicians.

Brian Hoyle, president of Newport Hospital Corp., shakes hands with Maui residents Bob Pure (from left), J.J. Elkin and Lina Prudencio after a community meeting for the West Maui Hospital and Medical Center on Monday night at the Lahaina Civic Center. Newport Hospital is the developer of the project, and Hoyle is a board member of the West Maui Hospital Foundation that will run the facility.

“Maybe 10 years ago, Maui Memorial didn’t employ any physicians,” Lo said. “Physicians were in practice for themselves. Now the landscape is changing, where the independents are retiring and the new, younger ones rather be salaried and paid by somebody.

“We have to pay the salary and run the business for them.”

Brian Hoyle, president of Newport Hospital Corp., which is developing the new hospital, said that the new hospital is not focused on hiring specialists and that it is “premature” to speculate on a budget for employing doctors. He played down comparisons with Maui Memorial.

As a critical-access hospital that serves a rural community, the new hospital would be limited to 25 acute-care inpatient beds – far fewer than the 200 beds at Maui Memorial.

“It’s not a comparison. It’s a completely different hospital,” Hoyle said. “We’re a small facility and community-based model. We’re not looking at a salary-hospital model, but we will have salaried positions.”

Charlie Slaton, chief executive officer of Critical Access HealthCare LLC, which will manage the hospital, told the crowd Monday that the hospital will employ 65 to 75 nurses and another 50 people in other roles. He added that many independent physicians will be on call.

Lo said the developers may have difficulties pulling local physicians away from their established practices.

“For primary physicians, it’s still a business where you have to see a lot of patients to make a decent living,” he said. “So some of them may think they’re better off staying at a clinic where you can see as many patients as possible.”

Nick Hughey, regional administrator of Kula Hospital and Lanai Community Hospital, both critical-access care hospitals in rural communities, shared the same concerns.

“It’s just sort of the whole industry transitioning to an employed-physician model,” he said. “It’s an absolute operating reality.”

Hoyle said there are many independent physicians on Maui who may want to work in a rural hospital. He told the audience that there are hundreds of practicing physicians on the island and even more that are retired.

“We don’t have a hospital on the west side. That’s why we don’t have physicians here,” he said. “What we’re creating is a source of employment. If you have a place to practice your craft, this is a place you would be able to work at least on some level.”

State and county lawmakers in attendance Monday included state Sen. Roz Baker, state Rep. Angus McKelvey and Council Members Gladys Baisa and Stacy Crivello.

Following the meeting, McKelvey said he was happy to see the project gain some “immediate traction” but shared similar concerns about physicians. McKelvey suggested offering incentives for physicians to practice at the hospital by providing housing options. The Kaanapali 2020 project, a mix of single-family and multifamily homes, located near the planned hospital, might be a possibility.

“Why don’t they get some of this market-price housing to attract doctors” and other medical professionals? he asked.

The 53,000-square-foot hospital is planned for 15 acres on Kakaalaneo Road, makai of the Kaanapali Coffee Farms. The hospital will include 19 general acute beds, six critical-care beds, a 24-hour pharmacy and emergency department, three operating rooms, a diagnostic radiology department and outpatient services.

The project also calls for two 40,000-square-foot facilities for nursing and assisted-living patients, as well as two 30,000-square-foot buildings for medical offices and a clinic. Long-term plans call for a 40-bed, drug rehabilitation facility.

During Monday’s meeting, Slaton explained to the crowd that the hospital’s designation as a critical-access hospital means that it will receive reimbursement from Medicare and be allowed to have flexible staffing and services.

Slaton acknowledged that the new hospital cannot handle major cases, such as open heart surgery, and would need to transfer patients to a larger medical center, such as Maui Memorial, for such procedures.

Part of the benefit of the new hospital is quicker response time for trauma patients, who are currently transported to Maui Memorial on the other side of the island for treatment. Some residents questioned whether the additional time and treatment in West Maui would only delay the transfer to Maui Memorial in Central Maui. Slaton rejected the notion.

“Every day, patients are seen in these rural hospitals and stabilized and shipped to other hospitals,” he said. “I have to reject the criticism to throw them in the back of the ambulance and pray.” There are close to 1,500 critical-access hospitals in the nation that have saved thousands of lives by being able to treat victims in rural communities immediately, Slaton said.

“What you do have is the ability of board-certified physicians stabilizing patients,” he said. “I think that’s preferable as far as that’s concerned.”

The project is expected to cost $60 million, about $47 million for the hospital and about $13 million for the nursing and assisted-living buildings, Hoyle said. He said his company is providing the initial equity and purchasing the land but is still securing land entitlements that could take about a year.

The nonprofit West Maui Hospital Foundation will be the owners of the hospital, and the board members were introduced to the audience Monday. The members include Hoyle; county Transportation Director Jo Anne Johnson Winer; Howard Hanzawa, retired senior vice president for Kaanapali Land Management Corp.; and Dr. Alfred Arensdorf, a child and adolescent psychiatrist.

Although Lo offered his concerns about the new hospital, he remains confident in the abilities of the people behind the project.

“I think this gentleman they’re bringing in is experienced, and I’m anxious to see their plans,” he said of Slaton. “I wish them luck because we’re all in the same boat.”

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