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    June 2016
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Commentary – Cardiac Care Unit Needed on the Big Island

THE PROBLEM:  The GOLDEN 2 HOUR WINDOW FOR CARE: People with cardiac problems- heart attacks and strokes must be airlifted to Queen’s Hospital in Honolulu or to Maui Memorial to be treated.   There is a 2 hour window when patients need to be treated in order to expect a full recovery.  Think about where you live on the Big Island.  At least from my home it would take 45 minutes to get to Kona Community Hospital Emergency Room, then the time to be diagnosed and then get the helicopter and then the 45 minute + time to Oahu, getting checked in and a cardiologist hopefully is at the hospital and you need to be seen, an Operating Room hopefully is available.  Get the picture?

THE SOLUTION?  Read the report below.

QUESTION:  How many people do you know on the Big Island that have had a heart attack or stroke?  That have needed ablations or pacemakers or stents?  Please contact me with your story. Debbie Hecht

A Cardiac Care Unit is needed on the Big Island.  Several well-known community members have been airlifted to Queens Hospital in Honolulu or Maui Memorial Hospital with heart problems or strokes:  Mayor Kim, Council Chair Pete Hoffmann, and OHA Representative Bob Lindsey.

Before going to Kona, I discussed a cardiac care unit for West Hawaii with Jon Luft, Architect and Teri Oelrich, medical planner at NBBJ Architects, who specialize in planning and designing hospitals. They are currently involved in building a one million square foot, state-of-the-art replacement hospital for Loma Linda University Medical Center in Loma Linda, California. Jon lived on the Big Island in the 1980’s and Teri has also worked in Hawaii.  Teri thought that a hybrid Operating Room (OR) and Catheterization Lab would be a first step to assessing the need/use of a Cardiac Care Unit.  She was helpful in explaining the process for a Certificate of Need.

From these discussions, I learned that hospitals make money on their operating rooms.  North Hawaii Community Hospital is booked solid with orthopedic and gastroenterology procedures.  Queens Medical has taken over the operations of North Hawaii Community Hospital.  There is currently no facility or any cardiologists to staff a dedicated cardiac care unit for West Hawaii.

We came to the conclusion that Kona Community Hospital (KCH) was the best location for a Cardiac Care unit.  I also learned there is additional, unused land adjacent to the Kona Community Hospital for expansion if a full-scale cardiac care unit is needed in the future. I also learned that here is a 2-hour window where a patient must receive intervential care to recover completely. By the time a cardiac victim would get from their home to KCH is evaluated and airlifted to Maui or Oahu, much more than two hours have elapsed- 4 hours is a more likely estimate. All of the people I talked to expressed the need for a new hospital closer to the Kona International Airport.

Kona Community Hospital has one cardiologist listed on their list of specialists, Dr. Michael Dang who comes periodically from Honolulu.  Dr. Larry Derbes has applied for privileges at KCH and is an interventional cardiologist in private practice in Kona.  He agrees that a Catheterization Lab to do stents and ablations and to treat strokes is very necessary for West Hawaii, would save lives and result in better outcomes and quality of life for cardiac patients. He is interested in helping to establish, and in working at a Cardiac Care Facility.  He also outlined the challenges of a doctor trying to make a living on the Big Island because of the Medicare reimbursement rate, which is roughly 93% of the actual cost of living. He was working in Waimea, but is closing that office and moving his practice to downtown Kona, approximately 20 minutes from KCH.

Jay Kreuzer, is the CEO of KCH, and has also been a cardiac patient. He said that the problem with the the Medicare reimbursement rate of only 93% of the actual cost, is compounded by Hawaii Medical Services Association (HMSA-the State of Hawaii’s biggest healthcare insurer) compensates at only 110% of the Medicare Reimbursement Rate as compared with most mainland insurance companies which reimburse at 130% of the Medicare rate.  These explanations further illustrate the negative impacts of insufficient reimbursement rates for attracting and retaining good doctors on the islands.

He told me that there is an airlift almost every day from KCH to either Queens in Honolulu or Maui Memorial and they are usually for heart or stroke patients.  He confided that Queens and KCH are in negotiations to acquire KCH.   He said the difficulty with a Cardiac Care unit is finding cardiologists to staff the clinics,  “There is no sense in building it if we don’t have the staff.”  If Queens acquires KCH, he believes more doctors would be available for rotations at KCH for specialties.

Queens’ strategy would be to enable more patients to stay on the outer islands instead of going to Oahu because their beds are always full. He also told me that the recent heavy rains had caused extensive flooding and damage to one of the Operating Rooms, which might represent an opportunity to remodel for a hybrid OR and Cath Lab.

I also met with Dr. Frank Sayre, Chair of the Board for the West Hawaii Regional Hospital Board of Directors, which oversees Kona Community Hospital and the North Kohala Community Hospital.  He reiterated what Jay Kreuzer said about why it is difficult to keep good doctors.  He told me that he had discussed setting up a “funded chair” for specialists (similar to academic chairs) as a stipend to keep doctors on the island.

This discussion was between Frank and a staff member from the Hawaii Community Foundation. Frank and I also discussed setting up an annuity pool with the Kona Hospital Foundation to fund several stipends for cardiac specialists who are willing to be “on call” at the hospital.  We talked about the possible need to hire a grant writer and/ or approaching several donors interested in better cardiac care on the island.


A HYBRID CATHETERIZATION LAB/ OPERATING ROOM FOR KONA COMMUNITY HOSPITAL: According to the medical planner, Teri Oelrich, affiliated with NBBJ architects, many rural areas first create a hybrid Catheterization Lab out of an existing Operating Room.  She estimated that this could be accomplished for approximately $1.5 million for equipment only; remodeling would be an additional cost.

The recent flooding of the Operating Room at KCH presents an opportunity to remodel the Operating Room and accommodate Cath Lab equipment.

STAFFING: Funding mechanisms could be established through donations to the Hawaii Community Foundation or the Kona Community Hospital Foundation

Establish a funded “chair position” for each specialty that is needed with a yearly stipend.

OR establish a pool of money as an annuity that will provide a stipend each year for several specialists.


COMPILE STATISTICS to show the need for the Catheterization Lab by using billing for the last 2 years, or assessing airlifted patients as to why they were being carried off-island. The goal of this would be to establish the need for a Catheterization Lab or other specialties and give direction to the hospital and the Board as to what doctors, staff and facilities would be needed. This is important because:

With this data KCH would know what specialties and specialists were needed to treat and allow patients on the island to recover, which is a huge benefit for better outcomes for the patient and keeps interventions in the 2-hour window.  In the event of a Queen’s acquisition, it would expedite a facilities upgrade and staff hiring.

Having this data available would help determine the best strategies on how to repair the flood damaged ER (possibly into a cath lab hybrid).

Having the data could illustrate the need for a cath lab, and support the Board and CEO’s strategic planning.


Consider hiring a grant writer to apply for grants from the Hawaii Community Foundation, HMSA Foundation, Kona Community Chamber of Commerce, and Rotary of Kona, Heart Association, Bill Healy Foundation, Ironman Foundation etc.

Establish an annuity to provide stipends of $50,000 for one or two on call cardiologists or a visiting cardiologist for KCH.  For example:  An annuity could be set up for $1,000,000 to invest at 5% to raise $50,000 per year for a stipend to pay a cardiologist to be on-call in addition to their private practice.

Contributors (Alphabetical Order) – Dr. Lawerence Derbes, Debbie Hecht, Jay Kreuzer, John Luft Teri Oelrich, Dr. Frank Sayre

Here is the Response from the West Hawaii Regional Board of Directors.

The response:  WHRBOD Decision Letter Cath Lab Proposal 6.10.16

To see the Board members in case you might want to speak to them about this:  http://www.kch.hhsc.org/about-us/senior-leadership/regional-board-of-directors/default.aspx

There is an ongoing problem to keeping doctors in Hawaii that is outlined in the report.  There is more information needed on how to best serve the Community.

Please contact me to become part of the movement to have community needs met by the Kona Community Hospital.  Mahalo!    Debbie Hecht

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