Maui had 2,405,257 million tourists 2006 with an average daily visitor census of 48,854. Our total daily population is then 190,174.  This doesn‘t include the 262,453 visitors from Cruise ships that we had in 2006.

• Maui County was Hawaii‘s fastest growing county from 1990 to 2000 (27% of State growth) – 92% of Maui County residents live on the Island of Maui. Residents 45 to 64 years of age to increase 34%; drive 47% of population increase. Residents 65+ will increase 55% and drive 35% of population increase. Maui ’s population is expected to grow by 49% by 2035.

What we need:

Malulani

First, let‘s talk about the North Kihei hospital. This hospital will be the center of our healthcare for Maui County.

It will be a 350 bed hospital. It will be a full service, state of art, teaching hospital. There will be little if any need to leave the island for healthcare. It will offer all diagnostics and services. Our goal is that it should be the best hospital in Hawaii. Maui no ka oi.

This hospital will offer all services that a large complete hospital should have. It will not compete with the West Maui hospital or MMMC. (See below)

Amongst all the regular services of a complete hospital, it should also offer:

• High Risk Obstetrics
• Obstetric anesthesia
• Lactation services
• PICU
• CICU
• CVICU
• MICU
• NICU
• Cardiac services – open heart surgery, coronary Artery Angioplasty and stenting
• Advanced diagnostics
• State of the art cancer treatment
• Alternative medicine
• Recompression chamber
• Burn unit
• 24 hour pharmacy services at hospital
• Food services around the clock for both patients, visitors & staff
• Positron Emission Tomography (PET Scan)
• CT - 64+ slice (MMMC‘s CT is a 2 slice machine = diagnostic errors)
• Acute dental and oral surgery treatments relating to trauma
• Prosthetic department

The main hospital, which we will call Malulani out of respect for the years of hard work of Dr. Ron Kwon, should have the transport team. Transport team members are made up of very advanced members within their specialties. For example, if a mother goes into the ER to deliver at our West Maui Hospital , due to the fact that she cannot perhaps get to the Kihei hospital, that hospital would have staff capable of delivering a healthy baby.  Should the baby not be healthy, the air transport team that is trained in delivery will go to that hospital to get her and bring her to the South Maui hospital. If she delivers a baby prior to the team being able to get there, the NICU team goes to get the baby. Remember, the minute the transport team arrives, in this case about 8 minutes by air – the patient is in expert hands.

This is the same sort of situation for the cardiac patients, etc. Heart attack victims should have complete access to stabilization and expert staff at West Maui or MMMC until the transport team can arrive.

Malulani will also have the headquarters for the telemedicine for our outlying areas such as Hana, Lanai and Molokai, for example. Local clinics can communicate by TV monitor telemedicine thereby bringing in an expert (from Malulani) to the remote areas.

All hospitals need to provide long term care beds.

Staff

 Malulani will be a teaching hospital. Educational affiliations will be with University of Hawaii, and Maui Community College. We will also try to affiliate with some mainland schools. We will have resident and intern programs. We can possibly offer trauma dental internships in affiliation with dental schools. As a teaching facility, we will retain some of our students.

Our goal is for our nursing students to have scholarships from the hospital. They can then promise to work at the Maui hospital, in a paid position,  for "X" number of years *(to be decided by the hospitals at a later date) to receive loan forgiveness. This can bring in more qualified residents that are currently not able to afford tuition. We can help with daycare, transportation and etc. to qualifying individuals. This should be limited to Maui County citizens.

Creation of new jobs, educational opportunities, and industry—especially in the growing field of healthcare will help Maui‘s economy.

We will attract medical personnel with valuable experience and personal resources such as healthcare professionals, biotechnology researchers, and medical devices/software designers. This will give our young Maui population a chance to stay on Maui and have a professional career with a higher income.

We need to turn Maui Community College into a four year bachelor‘s degree program. Malulani can have a classroom designated for only the student nurses. We need to have staff that comes to work at Malulani who will then also teach a class at MCC. Students will be hired as "Nurse Interns" and be able to have flexible schedules to fit in with their schoolwork. The nursing students will then be better educated when they are able to rotate through a full service hospital. They will also me more likely to stay on Maui as their interests will be available for their employment when they graduate.

We will work with Maui high schools to bring in high school level students to both volunteer, and to work. This way, we may encourage this population to enter into the field of healthcare.

We can arrange for Human Resource staff to attend mainland conferences as other hospitals to recruit staff. We can offer a "Take a Break From Your Life" program – where the mainland nurse requests a leave of absence from their current mainland hospital and spends 3, 4, 6 or 12 months here on Maui. I have already suggested this to mainland nurses, and just on the idea, they have already requested a leave of absence from their current employer. They are eager to come to Maui. As a former mainland nurse, I can see this program being extremely successful. We would only take experienced nurses who could come and share their knowledge with us. Some will stay, some will go back to the mainland, and some will come every year for three months. Remember, not everyone likes Oahu, and very few nurses will work at government hospitals. Private hospitals can attract staff.

We can make the "Take a Break from Your Life" program successful by offering housing for the nurses and doctors who come to work on Maui as temporary workers. We can offer 1, 2 and 3 bedroom type of apartment dwellings. These apartments will always belong to the hospital. Medical staff who take advantage of the housing will receive a lower salary in exchange for this free housing. If temporary workers come – they can make a time commitment to the hospital, and stay in the housing. This way, they are able to come and continue to pay for their mainland housing. When they leave, the housing is still there, still belongs to the hospital, and the hospital has had an experienced worker for a lesser price for that period of time. Temporary staff will be the first to be allowed to extend their stay or become permanent workers. Permanent workers will have financial encouragement to seek private housing. The hospital housing provided will have to have a time period of availability to the new staff.

We can also offer free housing to Oahu nurses who may experience lost wages at their Oahu hospitals when they have a "low census" situation. If they are not going to be utilized by the hospital of choice, they can sign up to be on call to our hospitals. They then can be flown to work to Maui for the amount of time needed. Many Oahu nurses have already asked for this service to be considered in our plan.

Staff will rotate between the 25 bed Critical Access Hospital in West Maui and the main hospital. This way, we will have staff that is up to date on the latest treatments and technology at both hospitals. Some staff will remain permanent at each facility to ensure the proper functioning of the hospitals.

We will seek experienced staff who will share their experience with our permanent workers. They will be a consistent source of new ideas and knowledge to share with our staff. The hospital will also offer continuing education opportunities for the medical staff. We will press the state to pass continuing education laws.

AIHM supports Medical Tort Reform.

We also need to offer state scholarships to our residents for nursing. These scholarships would be available to the Maui Community College nurses which would then, in turn, both provide more nurses and help the college to grow into a four year facility. If we can get healthcare minded senators and representatives in place, they can provide legislation to cover both the scholarships and the legislation for MCC to offer BSN (Bachelor of Science in Nursing) programs. We can offer "finishing programs" for two year degree (Associates in Nursing) to complete their BSN‘s at no cost to the students.

We can attract staff by having a quality hospital to work in. Medical personnel do not want to work at government facilities. They are notoriously poorly run and staffed. We need to achieve "Magnet Hospital" status with Malulani.

We will need to retain the nurses who currently work at MMMC, (Maui Memorial Medical Center.) In order to retain these nurses, we will need to establish a parity of retirement programs that they currently have. We will also have to establish mentoring programs with specialist nurses and MMMC staff for those who transfer to Malulani or the West Maui Hospital. They will have hospital provided education for whatever length of time necessary to be fully qualified and comfortable in their new positions. They could stay in the same field or could transfer to a different field.

All retained medical staff should have this same support, including nurse assistants, pharmacists, respiratory therapists, radiology technicians, etc.

Updated computer services with online charting should be available in this facility. There should be computer services where staff can access pharmacy services and so forth to decrease errors and increase efficiency.

Ancillary Services

Medical office buildings should also be on the grounds. Pharmacy services should be available 24/7/365 to both inpatient and out patients. Urgent care with extended hours should be in close proximity to the Emergency Room to refer patients with non-emergency room illnesses or injuries. Staff daycare services should be provided on campus. Health and Wellness programs should be provided for staff and public at each hospital; Weight Watchers, Yoga, CPR for public, Smoking Cessation Programs, Childbirth Classes at the main hospital, etc.

West Maui hospital

Competition is a wonderful thing, especially in healthcare. The consumer always wins. As we do have competition with the Oahu hospitals, the West Maui Hospital can be either a private hospital separate from Malulani, or a satellite of Malulani.

West Maui needs a decent ER. It needs to be able to handle all small emergencies and also, it needs to be able to stabilize everything from heart attacks to severe trauma cases. It should have a helipad adjacent to the ER so that expert staff can arrive from Malulani in minutes. Once the transport team arrives, the patient is in expert hands.

So that the employees of the smaller West Maui Hospital stay current in their practice, they should rotate staff with Malulani whether or not they are separate entities or the same system. Some staff will be permanent for consistency of care and operations.

We need West Maui hospital to have some hospital beds. This will be determined by the number that is fiscally possible. In order to increase the services and beds that this facility can sustain, it needs to have a money making specialty. One possibility would be plastic surgery which can be used for medical tourism also. Another good possibility would be Orthopedics. Malulani then would not compete with that specialty. Malulani would have the ability to do simple cases and complex cases would go to the West Maui Hospital. Both hospitals should consider medical tourism in their quality of services.

All three hospitals should provide long term care beds.

As we are an island, Malulani and the West Maui Hospital should work in a cooperative nature. If patients need to be transferred to Malulani for care, when they are stable they should be back transferred to West Maui Hospital by ground ambulance in order to be close to family support systems. If West Maui Hospitals‘ beds are full, they should transfer more stable patients to Malulani and vice versa. Both facilities should be built so as to be easily expanded. This is especially important in the case of the West Maui Hospital. Think ahead.

Medical office buildings and staff housing should also be considered on campus. This hospital should also have a relationship with the medical schools and Maui Community College.

The hospital should offer healthy lifestyle classes in conjunction with the West Maui Senior Center. West Maui hospital staff can provide the support for these classes.

Shuttle service should be available for families and patients between all hospitals. This can facilitate accessibility to services and visiting.

Maui Memorial has old wiring. It has old plumbing; poor and leaky retro fitted air conditioning, and is physically substandard for a hospital. It has mold problems. The air conditioning system leaks.

The only facility more difficult to build than a hospital is a nuclear power plant. This is due to the large number of electrical outlets, suction, oxygen outlets, air outlets, etc.

High acuity patients place a large stain on our aged physical facility. High acuity patients have a large amount of equipment that requires electricity, suction, oxygen, etc. Our aging facility cannot keep up with today‘s technology.

While MMMC needs to improve its emergency room, and maintain it, the rest of the hospital needs change.

There is use for this facility. It can be used for services that cause less of a strain on the physical facility itself.

The positives of this facility are the location to a populated area and the beautiful view.

Therefore, we should tear down some walls and make a large psychiatric inpatient hospital. With what we do have there, it could be a very pleasant place for the patients to stay. This patient population doesn‘t place such a strain on the physical facility. It could also have a day clinic – outpatient clinic and offices.

We also could use this facility for long term rehabilitation. Some patients who have had severe trauma‘s or post stroke patients need long term physical therapy. There is room to tear down walls again and make a huge gym and physical therapy area. Molokini could be replaced with a large outdoor pool for these patients.

We could also use this facility for substance abuse rehabilitation. We could have inpatient that progress to outpatient. We could offer all services in this area.

The gym facilities could be offered free of charge to the public in a healthy lifestyles program during certain times designated by the hospital.

All hospitals should provide long term care beds.

Lanai and Molokai

We should offer free transportation by ferry to the patients and visitors to both islands so they are able to take advantage of Malulani, Maui Memorial and the West Side Hospital. We should offer a temporary free housing facility for Lanai and Molokai families so that they don‘t have financial barriers to healthcare. We need to provide a shuttle at the harbor of choice to stop at the dock to pick them up. Most likely, a van would do. These services could be contracted out to local bus companies.

Lanai and Molokai need to have their structures and services updated. They need to be included in the telemedicine with Malulani. We need to have medical student rotations to their hospitals to help their local staff. This is a great way for the residents to learn about rural medicine and the challenges they face. This is a great way to offer some relief to the overworked staff on Lanai and Molokai. Also, medical students will bring with them new knowledge to share with the staff on all of Maui County.

We should also consider nursing rotations on both hospitals. They could be provided with a short term rotation where they stay on Molokai or Lanai.

During low census days at the West Maui Hospital and Malulani, staff could be offered the opportunity to help out on Molokai or Lanai instead of missing a day of pay. They would travel by the same ferry as the patients.

Other Considerations

We need to include our veterans in this healthcare system. We need to make sure we have the proper facilities for them especially at Maui Memorial as there are a large number of Post Traumatic Stress Syndrome patients in this population.

They also may need the rehabilitation offered in this facility. We should be open to veterans from other islands that do not have a system such as Maui Memorial would offer.

We are about to face a nationwide crisis when our soldiers come back home from Iraq. We need to think ahead to their medical and psychological needs as they attempt to reintegrate back into society.

Disaster preparedness

Each hospital will have a disaster plan put in place by people both knowledgeable and skilled in this area. Plans that need to be developed in this area should be, first, the safety and possible transport of large number of patients to the other two facilities. This should be done prior to building so that plans such as building the cafeteria in such a way that it can be converted into a safe area in event of hurricane, etc. can be included in the design of each facility.

If fiscally possible, each of the three hospitals should have some shelter areas provided for staff, their families, and then other local residents. We will need to keep staff at the hospitals during emergencies and will be unable to do so should they be concerned with the safety of their families. Taking a lesson from New Orleans, we should include an area of cages for family pets. Many people in New Orleans died as they would not leave their pets to escape to safety.

The hospitals should each provide a Disaster Team who receive advance training and will be called upon to be available in any of the three facilities in the event of Tsunami‘s, plane crashes, major trauma‘s, fires in one of the facilities where mass amounts of patients need to be moved to the next facility, and especially, some of the epidemics that we are likely to experience first in Hawaii. Learn from others: SARS closed down a 500 bed hospital for weeks in Toronto. We are a lot closer to Asia than they are.

Although the Oahu hospitals are attempting to stop us from building our hospitals, we will nonetheless continue with the Aloha Spirit and be prepared to help them with patient evacuation to Maui facilities if necessary should they experience any of the above situations. This is an area where the Superferry could be of great service to us should it remain in Hawaii.

The only constant in life is change. Learn to embrace it