Malulani initiated debate over care

Hospital advocate to leave Maui practice, is heading to Boston

By CLAUDINE SAN NICOLAS, Staff Writer
WAILUKU — Dr. Ron Kwon maintains that Maui’s vigorous debate over improved health care owes much to his rejected proposal to build a new hospital.

Kwon, an internal medicine doctor born and reared on a plantation camp in Puunene, sought to build the Malulani Medical and Health Center — a facility he promised would be state-of-the-art and accommodate modern medicine and alternative therapies.

After his hospital project failed, Kwon announced what he called a painful and difficult decision late last year to close his private practice and move to the Boston area, where he’ll work in the kind of health care setting he tried to establish on Maui.

“The irony of this is I was blocked in my own home from doing what I really wanted to do in medicine,” Kwon said. “And now a community that’s 5,500 miles away will give me an opportunity to do what I’ve always wanted to do plus make me feel appreciated, rewarded and wanted.”

The State Health Planning and Development Agency denied Malulani its certificate of need application in October 2006, and in January 2007, sealed the rejection by refusing to reconsider its decision during a highly contested and emotional public hearing in Honolulu.

Malulani supporters refused to give up, appealing to the state Legislature for the elimination of the statute requiring a certificate of need for new health care facilities in Hawaii. If lawmakers wouldn’t get rid of the law, Malulani advocates suggested that the project be exempted from the approval process.

The legislative efforts failed, and instead state lawmakers responded by drafting a new law that called for speedier review of Maui certificate applications and the formation of a Maui Health Care Initiative Task Force. In less than six months, the panel worked to formulate health care improvement ideas that included bringing more home rule into the state review process for new facilities and services.

Task force members invited Kwon to speak and provide input 10 months after Malulani had been rejected. He responded by reiterating his interest in building a second acute-care hospital for Maui. He said in the September 2007 meeting that he was open to all options, including constructing a replacement facility for the state-owned Maui Memorial Medical Center.

In the end, there were no takers for Kwon’s proposal. And the task force recommended a variety of health care reforms and called for more modernized facilities and equipment at the island’s only acute care hospital, Maui Memorial Medical Center.

Kwon said, in many ways, his goal to improve health care has been achieved even though his ultimate dream to build Malulani was never fulfilled.

“We really didn’t fail with Malulani,” he said. “We’ve made people think. We’ve opened people’s minds, and they’ve got to thinking, ‘Why can’t we have a first-class hospital? Why can’t we have the best?’ ”

Kwon acknowledges that the debate over Malulani turned into criticism of Maui Memorial. Hospital leaders objected to Malulani, arguing that a second hospital on Maui would siphon away patients and lead to a major financial loss at the state-subsidized facility.

Maui Memorial Chief Executive Officer Wesley Lo said he assumed his position at the hospital just as Malulani’s plans were unfolding before the public.

“I did feel like Maui Memorial was on trial,” Lo said.

While Lo said he and others at Maui Memorial shared Kwon’s passion to make health care system improvements, it was evident that their opposing views put them on a collision course.

“By the time we were through, it was one hospital against the other,” Lo said. “In the perfect world, we would have collaborated . . . it just didn’t happen.”

At the suggestion of former State Health and Planning Development Agency Administrator Dr. David Sakamoto, Kwon engaged in discussions with Lo and the Hawaii Health Care Systems Corp., the administrative arm of Maui Memorial, about a possible private-public partnership. Talks ended in May 2007 when Malulani’s major financial backer, Triad Hospitals Inc., was sold to a new owner.

Kwon insists that he never said anything negative about Maui Memorial while trying to advance Malulani.

“We always tried to speak positive about what Malulani had to offer,” he said. “It was never our intention to attack or divide the community. . . . People have just always felt that way about the hospital. Everybody has had a bad experience, and the truth is painful.”

Meanwhile, Joseph Pluta, the president of the West Maui Improvement Foundation, continued with his own group of supporters to push for a West Maui hospital.

Pluta recalled talking to Kwon about the Malulani project being proposed for development in Kihei and tried to convince him to build it in West Maui.

“He was the right hospital in the wrong location,” Pluta said.

He said he was sad to hear of Kwon’s decision to leave the island, and he credited the physician for raising awareness about the need to improve health care on Maui.

“There’s no question overall that he contributed to the recognition of how our island is underserved,” Pluta said. “No one can meet Dr. Kwon and not admire him and respect him.”

Pluta said Kwon inspired residents to take action. “His leaving is testimony that we have to start waking up and shaking things up,” he said.

Lo agreed that Kwon has been a major influence in the recent debates about health care improvements.

“I think he played an extremely important role in the history of health care on Maui,” he said. “This point in time will be remembered for years to come.”

Lo said he has learned much from the Malulani efforts and wants now “to move forward and not be bitter about anything.”

For doctors, Kwon and his hospital proposal brought up health care issues they’ve

long known needed to be addressed, according to Dr. James Jones, a kidney specialist who publicly supported Malulani and Kwon.

“Dr. Kwon represented that spark of hope for a lot of us,” Jones said. “He represented that hope for change. It was ‘Wow, maybe we can make this system better.’ There was a possibility that we could have something special here. It was literally spring and the flowers were blooming. When Malulani failed, it was back to winter and cold.”

While Kwon has abandoned his plans to build Malulani, the controversy over the proposed facility led to the formation of a nonprofit political group, the Association of Improved Healthcare on Maui. Its members tried unsuccessfully this legislative session to get the certificate of need law repealed.

One of the group’s founders and a public relations consultant, Jan Shields, has vowed to continue lobbying for improved health care facilities, including a second hospital for Maui.

Kwon said he felt depressed after the Malulani project was rejected, but he was consoled soon after he was invited to relocate to the Boston area, where he has since been hired as a clinician and medical director with a 40-doctor medical group called the Concord Hillside Medical Associates.

The 61-year-old doctor and his wife, Sue, have placed their Kula home on the market.

The Kwons are scheduled to leave this week for Massachusetts, the home of Harvard University, where the physician graduated with honors with a bachelor’s degree in English. Also nearby is the New England Medical Center where Kwon completed his residency as a physician and then ran a successful practice for the first seven years as a doctor at Emerson Hospital.

In both his interview and written reflections about the departure, Kwon expresses sadness over having to leave the island and excitement about the prospects of his new job.

“This sort of comes in full circle; I came to make things better and things here have gotten better in a way, but there’s still a long, long way to go,” he said.

Kwon said he’s proud of the contributions he’s made toward improving health care on his home island. When he initially returned to the island in 1985 to help care for his ailing parents, Kwon said he quickly turned his attention to Maui Memorial, where many of his patients needed care.

He formed and joined various hospital committees, including one that was instrumental in getting the hospital a treadmill, “the most basic piece of equipment” needed especially in the area of cardiac care.

Kwon said he also sought to recruit cardiologists to the island at a time when none was available and while heart disease was one of the leading health problems for Native Hawaiians and others.

Kwon said improvements he and others have pushed for are continuing even today with Maui Memorial making plans to build a new heart, brain and vascular tower within the next two years.

Kwon cautions that the hospital needs to have infrastructure and other support systems in place in order for the new tower to be successful.

He maintains that Maui Memorial needs to be torn down and reconstructed. Kwon said the Hawaii Health Systems Corp.’s own 1996 master plan reported Maui Memorial was a substandard facility that needed to be rebuilt at a cost of more than $260 million.

Kwon expressed doubts that the state could come up with the millions of dollars needed to make Maui Memorial the kind of state-of-the-art facility he would have built in Malulani.

He said he would not recommend putting more money into the current facilities. “You’re enabling a dysfunctional institution to continue in its broken ways,” Kwon said.

As he gets set to move away, Kwon said he has no regrets about how he pushed for the Malulani project. “I would do it the same all over again,” he said.

Several hundred people turned out earlier this month for an aloha party for Kwon and his wife. He said their 23-year stay on Maui has brought him and his family much joy.

The Kwons raised their five children here on the island, all of whome have completed college and two of whom have made Maui their home. His youngest son is a third-year medical student on the East Coast. Also, after returning to Maui, Kwon was able to help care for his ailing parents, John and Mitsugi Kwon, schoolteachers who have since died. John Kwon was also a former deputy school superintendent.

Dr. Kwon’s time on Maui also led to the discovery of a connection to the Kaopuiki family on Lanai. “It turns out I have calabash cousins from there,” he said.

Kwon, a National Merit Scholar and 1965 graduate of Baldwin High School, has been able to enjoy playing the trombone he picked up during his high school days.

He’s also had a lot of fun with practicing tai chi and yoga.

In the end, Kwon said, he feels “blessed” to have made and renewed friendships with hundreds, if not thousands, of people across the island.

He said his written farewell published as a Viewpoint in The Maui News late last year sums up what he wants to say about his departure.

“I offer my heartfelt thanks to all of my patients and their families for trusting me with their care and for sharing your stories with me. You have all enriched me beyond measure.”



• Claudine San Nicolas can be reached at claudine@mauinews.com