911 Ambulances all over Maui are indeed much busier today than in past years. As Maui has grown, the need for emergency ambulances has often outpaced the State's ability to provide services.

Senator Roz Baker has been the number 1 advocate for emergency ambulance service in Maui County since she was first elected to the House and throughout her tenure as a Senator. She has fought for Maui and has played a major role in every major addition to Maui's 911 EMS services for many years.

Recently, South Maui exploded,with new growth and there were significant delays and gaps in service when 911 was called. Kihei had only 1 ambulance. Often ambulances from Kahului, West Maui and even Makawao left their districts wide open while they responded to emergencies in South Maui. The Department of Health did not think the needs of our patients were a "priority".

Senator Baker fought hard with beauracrats and other politiciansto get the 911 ambulance that is now stationed in Wailea. By the way, her work was aslo pivotal inn getting Kula ambulance to be expanded from 12 to 24 hours.

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Senator Baker was asked to bring her expertise and knowlege of health care planning when the State EMS Branch convened the EMS Strategic Planning For the Future Conference to plan 911 service for the next 20 years! She fought to get paramedic training on Maui, got the funds for a high-tech link to enable the Maui EMS classsroom to be linked with educational resources on Oahu, and was the champion to get a stipend to help Maui paramedics students receive training on Oahu. From, Napili to Hana, to Wailea to Lanai, and to the Maui MEDEVAC, the list goes on and on.

Next time you hear a siren or see an ambulance, stop and remember Senator Baker help get those resources for us so that we can help our ohana and visitors. Better yet, say thank you by voting for the Senator whose hard work has given us the tools we need to save lives every day.

Scotty Schaefer
Molokai 

Setting the Record Straight

Let me be clear. Without Roz Baker there would be NO Maui MedEvac Helicopter. Alan Arakawa is correct that it was a team effort to get the Maui MedEvac. With all respect for his work, the former Mayor has left out key players and missed crucial facts off his list in his Viewpoint of 10-22-08. A MedEvac helicopter has been on the Senator Baker’s list of priorities since the days she represented West Maui, Lanai and Molokai.

The entire Maui Legislative contingent, including Senator Baker, Kalani English, and Shan Tsutsui and Representatives Joe Souki, Sol Kahoohalahala, and Bob Nakasone pushed this critical, life saving project through at a time when no other projects were being funded.

Besides Mele Carroll and Jan Yagi-Buen, the entire County Council came to the plate together to make this a reality especially Council Member Bob Carroll. It was, and is, a model for a private/public partnership. American Medical Response, Pacific Helicopters, and the Maui County Paramedics Association all were strategic players. We receive the support of many community professionals too. It took the combined effort of this entire group to work together for all the people of our County.

If you remember, the MedEvac Bill was vetoed by the Governor because she didn’t want the State to have to provide MedEvac to the other islands. The Legislature (led by Roz and our Maui contingent) overturned that veto or else our MEDEVAC would have been killed.

The facts about other services in Hawaii are also wrong. As of today, Kauai has absolutely no helicopter MedEvac services. If they want it, Kauai County will have to foot the entire bill. Right now, Oahu has no MedEvac. When our helicopter program was being established, an empty helicopter was provided on Oahu but was 100% funded by the U.S. Army. This helicopter had no equipment. The staffing of the Oahu MedEvac was done by Oahu paramedics who had no specialized training for helicopter operations and who had to bring their own equipment. Later, when the Hawaii National Guard operated a temporary MedEvac for Oahu, they NEVER flew missions after sundown due to safety reasons. It was an enormously expensive and inefficient service.

Legislators from the rest of the State often said, “Why should we pay anything for Maui unless we pay for the rest of the State too?” Senator Baker and our team fought hard for the funds, but there was a budget shortfall. We were told by off-island Lawmakers, “ No more money. Find your own and we will match it!” The bill was amended so that the only way the project would fly was with “new money.” That is when the entire County stepped in to help.

The Maui MedEvac service was based on the program developed on the Big Island. The County and State equally share the cost for the helicopter while the State pays for the paramedics, who also function as 911 paramedics. That helicopter is equipped with medical supplies and equipment and usually flies empty to the scene of an accident where Firefighter/Paramedics continue as the primary caregivers.

The safety protocols about restricted night flying came directly from the Hawaii County protocols. The MedEvac can, and does fly at night, but is restricted by ambient light and weather conditions. To ensure safety, the entire EMS staff, the Police Department, and the Fire Department received landing zone safety classes. The rash of helicopter incidents on the mainland makes this seem like an even more wise decision today.

When we were told by other Legislators, who wanted the money for their own projects, that they wouldn’t agree to pay for a dedicated paramedic staff for the helicopter, the idea of dual use paramedics came through the EMS Branch Chief. It was based on the Hawaii County model. It was an all or nothing proposal. A dedicated, MEDEVAC only paramedic crew model led to the demise of the private service, Mercy Air. We didn’t want to repeat that mistake.

The MedEvac has been utilized on over 250 life-saving missions. Many lives have been saved because of this vital service. As Maui Memorial expands their stroke and cardiovascular centers, this MedEvac will help many patients receive critical interventions that will save their lives and reduce significant disability.

Roz Baker fought long and hard and led this team. She deserves a giant mahalo and she deserves to get your vote to help us keep the MedEvac from being taken away.

Scotty Schaefer, MICT, Molokai
Chair, Maui County EMS Advisory Committe

Roz on Physician Recruitment

I believe Hawaii’s high cost of living especially housing, low reimbursements for services, location away from family on the mainland are greater barriers to physician recruitment and retention than tort reform.  In addition, other factors such as the nationwide shortage of specialists and other medical personnel add to the complexity of the issue.  

Three possible approaches

I suggest a multi-pronged approach. The first would be to “grow” our own healers by increasing the number of slots available at the John A. Burns School of Medicine, implementing the proposed family residency program on all islands and perhaps expand into other specialties.  We must continue providing programmatic and CIP support for the new School of Pharmacy at UH-Hilo and deliver internship opportunities on all islands to attract pharmacists to underserved areas.  It is also important to continue to support expansion of our nursing and other med-tech training programs. 

A second approach examines incentives for doctors who want to practice in the health professions shortage areas of our state by creating a Hawaii Health Corps.   The Legislature passed Act 242 that sets up a working group to flesh out this concept.  Incentives may include student loan forgiveness for a commitment to practice in medically underserved areas for a specified period of time; payment of malpractice premiums or creation of a larger statewide captive insurance entity for Hawaii physicians; offering physicians who work in underserved areas a differential between the cost of providing services and the reimbursement received until reimbursements can be adjusted upward. 

The issue of adequate reimbursement for services rendered affects both facilities and physicians and must be addressed in a concerted way by federal and state policy makers and health plans. 

• Under my leadership, we passed and funded a measure to improve reimbursement to physicians but the Governor refused to release any of the funding despite pleas from physicians. We must continue pushing for appropriate adjustments in the medical fee schedule and release of funds already appropriated to fund them. I am also working on ways to require adequate reimbursements in the private market.  Recently, Massachusetts enacted a Commission to set reimbursements and I am watching the implementation of their legislation very closely. 

• Also under my leadership, we passed the state match that enables private hospitals to receive additional reimbursement for uncompensated care. This program is the federal disproportionate share hospitals program. All our hospitals need help with poor reimbursements, not just the public ones.

Lifestyle concerns of our younger physicians can be addressed through implementing rotating call, with pay, and ensuring physicians have appropriate backup to mitigate burnout. 

A third approach would be to encourage exploration of health careers in high school.  Lahainaluna has an excellent health careers pathway program, supported by the community, and students have an opportunity to participate in HOSA (Health Occupations Students of America) programs. 

Pairing up students with health professionals in the community as shadows, volunteers or part-time staff could also help encourage more of our young people to consider a health career.  We also need to encourage interest in STEM (science, technology, engineering, mathematics) courses beginning in middle school so that more young women and men will be able to consider health and other science-based occupations.  We’ll need to train and attract more highly qualified teachers to these critical areas and support such outstanding programs as the Kihei Charter STEM Academy for middle school students and the pioneering work done by MEDB’s Women in Tech program. 

Tort reform

We also need to look objectively at the issue of tort reform.  When I was Health Chair, my committee passed out a measure which capped non-economic damages in return for reduced premiums. No consensus was ultimately reached on that bill and it died.  But, if it is true, that it is the cost of premiums that is a barrier to physician recruitment or retention then it would seem that only a measure which guarantees a rollback, as we did with auto in 1997, would address that concern. 

I believe these constructive approaches can help us move forward on short- and long-range solutions to attract and keep doctors and other medical personnel in our community.

Further thoughts

In addition to the ideas presented above, I have a few more specific thoughts as possible directions to pursue in the future.

• I believe formation of another captive insurance company for health care professionals in our state could also help resolve the issue of cost and tort reform. 

• I would like to revisit the Medical Claims Conciliation Panel to make it more effective if possible. 

• The medical apology bill we passed also helps physicians discuss poor or bad outcomes with their patients without fear that saying “I’m sorry” will be used as an admission of guilt.  

• I believe an emphasis on patient safety, adoption of electronic medical records should be part of the solution too.  Many of these items may well be, in the long run, more impactful in reducing lawsuits than any ideologically-based tort reform.