Aloha DRIP Committee,
I have testified multiple times on this subject. As the State Representative who helped to pass the $20m SPRB through the Legislature which then was signed into an Act by the Governor, I continue to be in support of Maui County to Kokua the West Maui Hospital by being the Guarantor. Two years have passed since the approval of the SPRB by the State Administration and entire State Legislature, yet the County continues to side step giving a definitive answer one way or the other. I have to point out that my office or Ms.JoAnne Johnson-Winer would have never gone down this very difficult path at the State Legislature if it was not support by the County. The tune changed as soon as Director Scott Teruya was let go. During his time, the Bond Council stated there was very low risk to the County if at all. No money was being asked of the taxpayers on the State or County level for this SPRB route. It was looked at as No impact to use of taxpayers dollars.
At this point, I personally would like a simple yes or no to signing on as a guarantor. If no, then I understand Ms. Johnson-Winer has a very doable creative way for the County to show support for a much needed project in Lahaina through Grant Funding mixed with a matching fund component. This support would also show how much this County supports uplifting the Lahaina Community and it's effort to rebuild our lives after withstanding so much Loss. Please show compassion and empathy for our West Side Community along with all the visitors to our town.
Mahalo for time and consideration,
Rep Elle Cochran
I oppose the County guaranteeing debt service on state issued special purpose bonds in support of a West Maui Hospital due to high risk of default.
There are multiple reasons such a facility has not come to fruition to date, both financial and reality based. I urge the council to seek input from those in the hospital industry to get a grasp on how hospitals function, financially and practically. Do you know what kind of critical population base, staff and predictable revenue you need to sustain a general service hospital in a community, particularly one as small as West Maui? If you did, you would know it is impossible to support one based on West Maui's small population. And don't think patient volume will come from tourists, because it won't. I've seen state-wide hospital admissions date. The last time I looked, it was only 3% from non-residents. There are multiple reasons for this. First, sick tourists and those with significant health issues don't come. Second, once they become ill here, they prefer to make their way home for care by their personal physicians and/or in high quality medical and hospital facilities with capacity and staff to address their medical needs competently, near family and friends too.
Do you know what percent of the state budget is required to backfill losses from the current state hospital system? Last time I looked (over a decade ago) it was the second largest line item in the budget behind education - because hospitals in Hawaii generally operate at a loss. When I served on the advisory board for the Maui Region of the state hospital system, combined operating losses for the three region hospitals - Maui Memorial, Lanai and Kula -were close to $50 million a year.
While there is a need for some level of care in West Maui, the best the area could support at this time would be 24/7 urgent care clinic to address minor medical matters, certainly not emergency care sufficient to provide 24/7 stroke and heart care. This is why the developer-proponent of the West Maui Hospital has been unable to get one off the ground for decades. At one point, in an attempt to develop a more realistic business plan for such a facility, the focus was on providing cosmetic and obesity care. Even these elective surgeries were, apparently, insufficient lure investors.
To make an informed decision, the Council needs to understand how difficult it is to staff an "acute care hospital with a 24-hour emergency room, operating rooms, radiology, services and inpatient and outpatient services," particularly in a small town community. Even large hospitals and systems are having difficulty staffing their facilities, in part because post Covid a wave of physicians and nurses retired, leaving the profession for good. Do you know what difficulties Maui Memorial is having with staffing right now? You need to know that.
Then there is the matter of how you could attract and retain high quality medical and nursing professionals to a West Maui Hospital. For one thing, quality doctors and nurses won't sit around at 3 in the morning waiting for a patient (or 2 in the afternoon for that matter). Besides being professionally boring, they'd lose their skills, particularly those trained to deliver highly complex care.
About 15 years ago civic supporters of a West Maui Hospital promoted the idea that an area hospital was needed to render emergency care to those suffering strokes or heart attacks, this under the banner of the need for care within the "Golden Hour." You need to know that there is no way a West Maui Hospital could provide this level of care to the community. None - because patient volume is just not there. Without patient volume to justify these services, the hospital would suffer tremendous financial losses associated with creating a full service, top-notch facility to competently and predictably treat these cases in keeping with medical quality standards. Besides, top quality providers of complex care simply would not want to work there due to low volume. Plus, low volume would make it impossible to attain accreditation from medical quality oversight agencies; many accreditation requirements require doctors and facilities to perform a a minimum number of cases - to maintain competency.
I know of what I write here. In the 20 years since taking up residence on Maui, I served as a member of the Maui Region Advisory Board for the Hawaii Health Systems Corporation (HHSC). Later, I briefly served on the board of directors of HHSC. Additionally, in 2007 I was appointed by the State Senate to serve on the Maui Health Initiative Task Force, whose mission was to examine Maui County's current and future health care needs, develop a plan for providing such care and determine the best use of Maui County health care facilities within the state system. A report responding to that mission was submitted to the Legislature in 2008 . The report speaks directly to West Maui's facility needs, noting on page 59 that "a Critical Access Hospital (CAH) would serve the needs of the community well and could grow as the community's medical needs mature." For reference, Kula Hospital is a CAH to give you a sense of what this means. Kula hospital is equipped to provide a low level urgent care but all other cases are taken by ambulance to Maui Memorial Hospital where facilities and staff are equipped to deliver the kind of care needed in more intense medical situations. The same would be true of any facility in West Maui. In fact, I distinctly recall testimony given to the Task Force by West Maui ambulance service providers to the effect that even if there was a small hospital in West Maui, they would not take patients in need of complex care, particularly stroke and heart attack patients, to a West Maui Hospital and would instead bypass such a facility to transport those in need to Maui Memorial where qualified facilities and staff exist to deliver the kind of care needed.
My career included serving as the CEO of a nonprofit California Health Maintenance Organization and as board member and chair of the California Association of Health Plans. In these roles I became intimately familiar with health care financing and delivery. The HMO I led contracted with a network of over 100 hospitals and 10,000 physicians. All participating providers were accredited before becoming part of the network.
The best advice I have for the Council is to do much more homework before you agree to any bond guarantee.
Aloha DRIP Committee,
I have testified multiple times on this subject. As the State Representative who helped to pass the $20m SPRB through the Legislature which then was signed into an Act by the Governor, I continue to be in support of Maui County to Kokua the West Maui Hospital by being the Guarantor. Two years have passed since the approval of the SPRB by the State Administration and entire State Legislature, yet the County continues to side step giving a definitive answer one way or the other. I have to point out that my office or Ms.JoAnne Johnson-Winer would have never gone down this very difficult path at the State Legislature if it was not support by the County. The tune changed as soon as Director Scott Teruya was let go. During his time, the Bond Council stated there was very low risk to the County if at all. No money was being asked of the taxpayers on the State or County level for this SPRB route. It was looked at as No impact to use of taxpayers dollars.
At this point, I personally would like a simple yes or no to signing on as a guarantor. If no, then I understand Ms. Johnson-Winer has a very doable creative way for the County to show support for a much needed project in Lahaina through Grant Funding mixed with a matching fund component. This support would also show how much this County supports uplifting the Lahaina Community and it's effort to rebuild our lives after withstanding so much Loss. Please show compassion and empathy for our West Side Community along with all the visitors to our town.
Mahalo for time and consideration,
Rep Elle Cochran
I oppose the County guaranteeing debt service on state issued special purpose bonds in support of a West Maui Hospital due to high risk of default.
There are multiple reasons such a facility has not come to fruition to date, both financial and reality based. I urge the council to seek input from those in the hospital industry to get a grasp on how hospitals function, financially and practically. Do you know what kind of critical population base, staff and predictable revenue you need to sustain a general service hospital in a community, particularly one as small as West Maui? If you did, you would know it is impossible to support one based on West Maui's small population. And don't think patient volume will come from tourists, because it won't. I've seen state-wide hospital admissions date. The last time I looked, it was only 3% from non-residents. There are multiple reasons for this. First, sick tourists and those with significant health issues don't come. Second, once they become ill here, they prefer to make their way home for care by their personal physicians and/or in high quality medical and hospital facilities with capacity and staff to address their medical needs competently, near family and friends too.
Do you know what percent of the state budget is required to backfill losses from the current state hospital system? Last time I looked (over a decade ago) it was the second largest line item in the budget behind education - because hospitals in Hawaii generally operate at a loss. When I served on the advisory board for the Maui Region of the state hospital system, combined operating losses for the three region hospitals - Maui Memorial, Lanai and Kula -were close to $50 million a year.
While there is a need for some level of care in West Maui, the best the area could support at this time would be 24/7 urgent care clinic to address minor medical matters, certainly not emergency care sufficient to provide 24/7 stroke and heart care. This is why the developer-proponent of the West Maui Hospital has been unable to get one off the ground for decades. At one point, in an attempt to develop a more realistic business plan for such a facility, the focus was on providing cosmetic and obesity care. Even these elective surgeries were, apparently, insufficient lure investors.
To make an informed decision, the Council needs to understand how difficult it is to staff an "acute care hospital with a 24-hour emergency room, operating rooms, radiology, services and inpatient and outpatient services," particularly in a small town community. Even large hospitals and systems are having difficulty staffing their facilities, in part because post Covid a wave of physicians and nurses retired, leaving the profession for good. Do you know what difficulties Maui Memorial is having with staffing right now? You need to know that.
Then there is the matter of how you could attract and retain high quality medical and nursing professionals to a West Maui Hospital. For one thing, quality doctors and nurses won't sit around at 3 in the morning waiting for a patient (or 2 in the afternoon for that matter). Besides being professionally boring, they'd lose their skills, particularly those trained to deliver highly complex care.
About 15 years ago civic supporters of a West Maui Hospital promoted the idea that an area hospital was needed to render emergency care to those suffering strokes or heart attacks, this under the banner of the need for care within the "Golden Hour." You need to know that there is no way a West Maui Hospital could provide this level of care to the community. None - because patient volume is just not there. Without patient volume to justify these services, the hospital would suffer tremendous financial losses associated with creating a full service, top-notch facility to competently and predictably treat these cases in keeping with medical quality standards. Besides, top quality providers of complex care simply would not want to work there due to low volume. Plus, low volume would make it impossible to attain accreditation from medical quality oversight agencies; many accreditation requirements require doctors and facilities to perform a a minimum number of cases - to maintain competency.
I know of what I write here. In the 20 years since taking up residence on Maui, I served as a member of the Maui Region Advisory Board for the Hawaii Health Systems Corporation (HHSC). Later, I briefly served on the board of directors of HHSC. Additionally, in 2007 I was appointed by the State Senate to serve on the Maui Health Initiative Task Force, whose mission was to examine Maui County's current and future health care needs, develop a plan for providing such care and determine the best use of Maui County health care facilities within the state system. A report responding to that mission was submitted to the Legislature in 2008 . The report speaks directly to West Maui's facility needs, noting on page 59 that "a Critical Access Hospital (CAH) would serve the needs of the community well and could grow as the community's medical needs mature." For reference, Kula Hospital is a CAH to give you a sense of what this means. Kula hospital is equipped to provide a low level urgent care but all other cases are taken by ambulance to Maui Memorial Hospital where facilities and staff are equipped to deliver the kind of care needed in more intense medical situations. The same would be true of any facility in West Maui. In fact, I distinctly recall testimony given to the Task Force by West Maui ambulance service providers to the effect that even if there was a small hospital in West Maui, they would not take patients in need of complex care, particularly stroke and heart attack patients, to a West Maui Hospital and would instead bypass such a facility to transport those in need to Maui Memorial where qualified facilities and staff exist to deliver the kind of care needed.
My career included serving as the CEO of a nonprofit California Health Maintenance Organization and as board member and chair of the California Association of Health Plans. In these roles I became intimately familiar with health care financing and delivery. The HMO I led contracted with a network of over 100 hospitals and 10,000 physicians. All participating providers were accredited before becoming part of the network.
The best advice I have for the Council is to do much more homework before you agree to any bond guarantee.