From Maui News

By CLAUDINE SAN NICOLAS, Staff Writer, Maui News

LAHAINA, Feb 24,, 2006-- A physician who is also a potential investor in the proposed West Maui hospital is looking at reconfiguring plans by offering a combination of acute care beds and space for long-term care patients. That possible change surfaced during a presentation by Dr. Phil Fagan, a California-based emergency care physician, who came on board just five months ago with a group interested in investing in and operating the proposed West Maui hospital.

Fagan joined financial consultant Alan P. Richman in a presentation to the West Maui Taxpayers Association before a crowd that filled the seats in the Lahaina Civic Center community hall on Thursday night.

Association Executive Director Mahealani Strong estimated Thursday night’s audience at 400 people, most of whom stayed throughout a 45-minute talk by Fagan and Richman. “No one denies that you need health care,” Richman told the crowd.

The key to making a West Maui hospital a reality involves proving that it’ll be profitable and ensuring that it won’t adversely affect the Hawaii health care system, Richman said. He said he and Fagan met with Maui Memorial Medical Center Chief Executive Officer Wes Lo about collaborative efforts, including the possibility of establishing a facility that provides acute and emergency care on the west side while addressing the shortage of long-term care beds on the island.

West Maui Taxpayers Association President Joe Pluta said his group’s main objective has also been to establish an acute-care hospital, but he understands Fagan’s reasons for recommending long-term care beds, also known as skilled nursing beds. “He sees this as contributing to the financial sustainability of the hospital and opens avenues for collaboration with Maui Memorial,” Pluta explained.

Contacted on Friday, Lo said he believes Fagan and Richman understand the issues surrounding West Maui’s health care needs, and that addressing those needs is complicated. Maui Memorial had announced its intentions in January 2005 to build a new urgent care/emergency facility associated with the Pulelehua project at Kahana providing long-term care beds that may be converted to acute-care beds if the demand arises.

The idea of the urgent care/emergency center was to establish a facility that could stabilize critical patients who would be transported to Maui Memorial or other appropriate full-service hospitals. Lo said if Richman’s group is interested in providing the services that Maui Memorial believes are needed, he’s not opposed to their plans.

He added that Maui Memorial will continue working on a master plan for health care in West Maui and will act on its recommendations as quickly as possible. “I’m going to continue to move forward and go with a West Maui health care plan,” Lo said, adding that the effort will include a review of the critical needs of the area and what’s financially feasible.

Pluta said he is not opposed to his group, the West Maui Improvement Foundation, revising its vision to include long-term care beds. “I’m all for collaboration,” he said. Prior to Richman and Fagan’s presentation Thursday night, Pluta showed results of an online and mail survey commissioned by the group that showed support for a hospital on the west side.

The association filled up two display boards with comments from survey respondents who provided anecdotes about what happened to them because of the absence of a hospital in West Maui. A survey participant identified as No. 36 wrote about a loved one who had a heart attack at his Napili residence and had to be transported from there to Maui Memorial Medical Center. “He slipped into a coma en route and died two days later. It was just too great a distance.”

An unnamed manager of a small resort in Napili also wrote about the financial impact of the lack of a hospital in West Maui. “I can think of at least five persons who have canceled and no longer visit Maui because there is no 24-hour emergency care,” he wrote.

Realtor Bart Mulvihill interrupted Richman’s talk on Thursday to say that his brother, who is a physician, refuses to allow their mother to reside in West Maui because he fears she would not get the medical care she needs for her heart condition. “Since when did the state get into the business of making sure things made money?”Mulvihill asked.

Richman responded that a state certificate of need, which must be obtained before a West Maui hospital can be built, requires applicants to show profitability. “Hospitals that don’t make money, close.” Richman said he’s been involved with multiple hospital establishments including critical access hospitals, which are facilities reimbursed on a cost basis and supported by the federal government because of the need for residents in isolated areas to get health care services.

In response to another audience question, Richman said his investors have the money necessary to build a West Maui hospital, but money is only one element to building the facility. “The fact of the matter is we have to do this properly,” Richman said, referring to the certificate of need process. Fagan said he envisioned that a West Maui hospital, in its early years, would probably offer general medical inpatient care, urgent and emergency care, but not specialties like cardiac care, pediatrics or even obstetrics.

It is conceivable that later down the line as the facility grows and money is raised that more sophisticated diagnostic equipment and services could be provided, Fagan said. For now though, Fagan suggested that the proposed West Maui hospital provide a combination of acute care beds and skilled nursing beds.

Just this past week, Maui Memorial had as many as 60 patients identified in need of skilled nursing, which is a level below what hospitals provide for acute-care patients. Fagan said the long-term care patients currently housed at Maui Memorial are adversely affecting the facility.

Kaanapali resident Steve Rosen addressed both the crowd and the two speakers, suggesting that the West Maui Taxpayers Association consultants and investors be given a five-month deadline to show substantial progress in moving the project forward. If no such progress is made, Rosen recommended that the association replace them with another group.

Bob Cartwright, also a resident of Kaanapali and member of the association, disagreed. “I wouldn’t be that strong about it,” he said. Cartwright said he knows that the work to get state approval is a “difficult process” and that he’s impressed with people like Fagan and Richman. “They’re telling the truth. You’ve got to be real about it. All of what they’ve said makes sense to me.”

Richman said his firm’s past performances show it knows what it’s doing. “We’re not on a clock,” he said. Fagan said a deadline would not “change the fact that we have do this in an orderly process.” The West Maui Taxpayers Association has been working on a proposed hospital for at least five years now and has raised hundreds of thousands of dollars toward the project.

Meanwhile, state Rep. Kam Tanaka, who represents West Maui, has introduced legislation to appropriate $300,000 for the establishment of an urgent care facility on Front Street. On Friday, Tanaka declined to identify the group that would receive the state appropriation, but he noted that its representatives are ready to go forward now. “Both Maui Memorial and the West Maui Taxpayers, it’s going to take years with what they have,” Tanaka said.