Just before she adjourned an informational briefing at Kona Community Hospital, House Health Committee Chairwoman Della Belatti offered one final insight into how the Legislature may try to address state health system woes.
“There are some notions that maybe the hospitals should just be devolved back to the counties,” Belatti said. “I’m sure the mayor would not want that fiscal responsibility.”
Even if Mayor Billy Kenoi and his three counterparts on Oahu, Maui and Kauai aren’t interested, Belatti raised the idea of tying increased Transient Accommodations Tax revenues to asking counties to foot the bill for hospital construction. Belatti had just finished a tour of Kona Community Hospital and noted how cramped the facility is.
“Maybe that’s another fruitful area of conversation to have,” she added.
The health committee was visiting Kona Community Hospital Monday evening for an informational briefing, one of several being held across the state this month. Earlier this year, HHSC officials announced layoffs at several hospitals, including Kona.
Belatti’s comments came on the heels of ones by Rep. Mark Nakashima, who represents portions of North Kohala and Honokaa and is chairman of the House Labor Committee. He said state labor union officials have claimed Hawaii Health Systems Corp. boards, at the regional and state level, have not invited union representatives to the table to discuss ways to offset the hospitals’ revenue shortfalls.
“HHSC does have the ability to negotiate a memorandum of understanding with the unions that would change the master agreement and allow those changes, if you chose to pursue it,” Nakashima said. “I encourage you to pursue that avenue. If there are any problems, let me know. I will try and do everything I can to assist in getting you folks to the table.”
The problem, Chief Nurse Executive Pat Kalua said, is not getting unions to the table. It’s that the unions don’t really have any incentive to give away work rules and conditions that already exist.
West Hawaii Regional Board Chairman Bill Cliff agreed.
“Being angry at the unions is like being angry at the tiger that ate the goat tied to the tree,” he said. “That’s what tigers do. Union officers are charged with their membership to make the best deal they can make. The problem is, what motivation would the union have to unilaterally give away some of the work rules and benefits that they have, that they can maintain by staying where they are as part of the state system?”
HHSC officials and regional hospital administrators have often cited employee costs as one of the hospitals’ major financial burdens. For example, Kalua noted at Monday evening’s briefing that the employees are salaried and are paid for a scheduled shift even if they are sent home because the hospital doesn’t have enough patients that day.
Kalua said Kona Community Hospital has had some success in creating set schedules, which has allowed the hospital to realize some salary savings. Belatti, whose husband is a nurse at The Queen’s Medical Center on Oahu, said she was surprised during this most-recent round of public hearings to learn that having set weekends to work, for example, was not standard practice at HHSC hospitals.
Kalua said the existing work rules did allow for the schedules. Belatti said she’d gotten the impression that perhaps not all HHSC administrators realized the rules permitted that.
Rep. Richard Creagan, himself a Big Island doctor who has worked at Kona Community Hospital, pressed CEO Jay Kreuzer and Cliff about the need for more cooperation between the East Hawaii and West Hawaii regions. For example, he said, he heard several people mention the lack of urologist in West Hawaii as a problem, but the East Hawaii region just laid off one of its two urologists. Why didn’t Kona hire that doctor, he asked, or at least send more patients to Hilo Medical Center?
Kreuzer said they did offer the job to that doctor, who declined.
“Would it be helpful if we imposed a single governance structure on you people,” Creagabn asked. “Unless we make you do it, you’re not going to do it. There’s no way you’ll do it.”
Belatti later revisited that issue.
“We are learning the solution may be different for each region, but maybe there are things that should be common for each region,” she said. “We decentralized you. We kind of created the problem by letting the system go amok and not reigning you back in.”