Maui Memorial Hospital administrators plan to close the facility's adolescent behavioral health unit, known as Molokini II, for an annual savings of more than $1 million and to focus the hospital's two psychiatrists on adult patients, hospital chief Wesley Lo said Saturday.
The move is partly financial as Maui region hospital administrators look for ways to make ends meet while getting an estimated $6.4 million less in state funding in fiscal 2015, compared with fiscal 2014, he said.
"We've got to start making some hard decisions," said Lo, chief executive officer for the Maui region of the Hawaii Health Systems Corp.
A public hearing on the plans to close Molokini II will be held at 5 p.m. July 23 in Maui Memorial's auditorium.
Only five hospital employees would be affected by the closure, Lo said, and work is ongoing to find them positions elsewhere in the hospital.
The adolescent psychiatric unit has seven beds, and its census averaged 1.6 patients per day last year. From January through March, the census dropped to 0.8 patients on average per day, Lo said.
If the facility is closed, adolescents needing inpatient care would be flown to Oahu for treatment at The Queen's Medical Center or at Kahi Mohala, he said.
Lo said he doesn't take the closure decision lightly because it affects a "very vulnerable population" of Maui residents. While there aren't many patients served (about 125 to 150 in a year), "every person counts," he said.
No other Neighbor Island hospital has an adolescent behavioral health unit, Lo pointed out.
Under the closure plan for Molokini II, behavioral health clinicians would monitor and evaluate patients in Maui Memorial's emergency room before a decision is made to send them to an Oahu facility for inpatient treatment.
The public hearing later this month is among the first steps in a legal process of ending a service at the hospital.
Hospital staff members have already been informed, Lo said. Next, the HHSC's Maui regional board will need to ratify the closure plan or decide to keep the unit open, he said.
If the decision is to close the unit, then hospital officials need to inform the governor, Senate president and House speaker, Lo said. Then there's a 20-day waiting period.
"If the Legislature wants to fund it, they can fund it," he said.
If plans to close the unit proceed, then affected employees would receive "reduction in force" notices, and they would have an opportunity to keep their jobs by "bumping" less-senior employees.
Lo said he doesn't believe that the Molokini II unit would be closed until October or November, given the length of the closure process.
The shuttering of the psychiatric unit would make only a small dent in the Maui region's overall financial well-being.
According to a chart on expenses and revenue provided by HHSC officials, total revenue for the Maui region has risen from $132.9 million in fiscal 2008 to $205.1 million in fiscal 2014. Employee salaries and benefits (which made up 60 percent of the region's expenses in 2014) have gone from $92.9 million in 2008 to $132.9 million in 2014. And, the employee count has gone up from 1,269 to 1,397 in the same period.
During this year's legislative session, HHSC requested $150 million for the state's public hospitals, but lawmakers reduced the amount to $102 million for the 2015 fiscal year that began July 1.
Meanwhile, Lo said the reimbursements the hospital received for patient services are flat and expenses are rising, including salary increases, a federally required information technology system and needed building maintenance.
One lifeline still being eyed is a private-public partnership for the state-run hospital, he said.
Now, instead of courting a Mainland health care corporation, administrators for Maui Memorial, Kula Hospital and Lana'i Community Hospital have entered into preliminary discussions for a possible partnership with Hawai'i Pacific Health, a not-for-profit health care network. It operates Kapiolani Medical Center for Women & Children, Pali Momi Medical Center and Straub Clinic & Hospital on Oahu and the Wilcox Memorial Hospital on Kauai.
State lawmakers would need to pass legislation allowing the partnership to go forward. Attempts in two past legislative sessions to pass privatization legislation for HHSC have ended with bills mired in committees.
"We feel this is a necessary first step in planning for a sustainable future that continues to provide the highest quality of care and fulfills the growing needs of our community," Lo said. "This very early, exploratory phase of discussions will help determine if HPH is a viable partner to help the Maui region continue to provide the best possible health care to all patients."
HPH President and Chief Executive Officer Ray Vara said Hawai'i Pacific Health has supported statewide legislation to allow HHSC to privatize or form a public-private partnership.
"Further to that effort, Hawai'i Pacific Health has been in talks with Maui Memorial Medical Center regarding a possible public-private partnership," Vara said. "In the absence of such legislation, our discussions have continued and are intending to be ongoing. The talks are very preliminary and exploratory. They are conducted in the spirit of ensuring that all people of Hawaii have continued access to high-quality, local care."
Lo said officials with the Maui region of HHSC will closely examine "how HPH performs clinically, in customer service, physician/employee satisfaction and financially."
"We will be transparent and maintain open communication with our staff, our physicians and our community throughout our decision-making process," he said.
* Brian Perry can be reached at firstname.lastname@example.org.