Community deserves more problem solving, not mud slinging

Recently, Alan Arakawa, the former mayor of Maui County, wrote a Maui News Viewpoint piece that was, at best, his opinion. Was it the truth? Absolutely not.

It's amazing what the Republican Party and their supporters will say and do to sway an election. From what I've seen in my mailbox, they focus on false, negative attacks designed to create doubt or worse yet, frustrate people to the point where they refuse to vote at all. As for the latter, we can't let that happen since this may be one of the most pivotal elections of our lifetimes.

So first, let me clear up any confusion on the Republican Party's claim that I somehow blocked the private Malulani hospital in Kihei from being built. This is completely FALSE. Dr. David Sakamoto, former State Health Planning and Development Agency (SHPDA) Administrator and Governor Lingle's appointee, blocked the hospital by denying Malulani's Certificate of Need (CON)

Further, this was an Executive Branch decision and I, as a senator, did not and could not vote on the matter. Truth is, I did not block Malulani or ANY hospital legislation. I did not block any CON reform legislation either. Anyone is welcome to check the legislative record.

What I firmly believe is that we can have privately funded hospitals, along with an improved Maui Memorial Medical Center and advanced medical services here at home, which include cutting-edge stroke, cardiac and ER programs. I strongly support the proposed, privately funded West Maui critical access hospital. And I continue to advocate new services for South Maui, as I did to secure funding for a dedicated ambulance stationed in Wailea and to reinstate MEDEVAC services.

If you listen to the list of complaints that Mr. Arakawa held me responsible for, it's as if I had the power to personally rectify everything he and his administration failed to do. Government does not revolve around a single individual, as he should well know, especially since some of his complaints rest at the door of the State's executive branch, not the legislature.

But instead of refuting every negative statement he made, I would rather talk about some very positive strides in healthcare for the community, made largely because of a hard-working Maui senate team, of which I'm proud to be a member.

Strides like Maui's new MEDEVAC helicopter service that has already saved over 250 lives. Expansion of the nursing program at Maui Community College to train the next generation of nurses. A stipend program for our paramedics to upgrade their skills. A family practice residency program to help physician recruitment and retention. An increase in reimbursements for physicians who treat Medicaid and Quest patients. And Keiki Care, a public private partnership to ensure all of Hawaii's children.

Many Maui residents don't realize we have the second busiest emergency room in the state. The demand for increased trauma services makes it especially important to treat patients on island, instead of having to fly them to Oahu. That's why I pressed hard for a veto override so we could get dedicated funding to enhance ER services statewide. Our next goal is to upgrade Maui Memorial to a level II trauma center, on par with Queen's.

As a cancer survivor, it was also gratifying to secure funding using the 2006 cigarette tax increase to expand research and treatment capabilities at the Cancer Research Center of Hawaii. The first neighbor island research associate was just announced for Maui, enabling more treatment options here at home.

Healthcare is important but it's just one issue. I want to continue fighting for our schools, road improvements, resource protection and economic diversification to provide living wage jobs for my district. My experience and proven problem-solving skills can be utilized even more during these tough economic times. Ask yourself if a freshman senator from the minority party could ensure the continuation of vital projects like the Kihei High School or more funding for charter schools.

I intend to continue running a fair, honest campaign. I respect the process and voters too much to bombard them with false and misleading claims. Too bad those who oppose me don't feel the same.

Senator Roz Baker is a candidate for the State Senate 5^th District seat, South and West Mau

Roz Has Always Supported the West Maui Hospital

As chairman of the House Health Committee, a practicing physician, and a colleague of Senator Baker, I would like to offer my perspective on the State Senate race in District 5, and on Senator Baker's record.

Much of the contest has focused around Baker's record on healthcare issues. The debate comes down to a single question: does Senator Baker care about improving healthcare for the people of Maui?

Here are the facts.

Senator Baker fought alongside me to increase insurance payments to our hospitals and healthcare providers, to help keep doctors in Hawaii so that the people of Maui can find a doctor when you need one.

Senator Baker also championed the Keiki Care bill, providing health insurance to every child in Hawaii, a first in the nation.

She has been crusader for your local community hospital, health centers, and the Community Clinic of Maui, facilities which provide healthcare to thousands of Maui residents.

Senator Baker works tirelessly for her constituents. She strongly supports the proposed hospital for West Maui and has never blocked or voted against any CON reform or hospital legislation for Maui.

In summary, Senator Baker has consistently fought for the people of Maui and stood up for your interests, working to provide Maui with the best healthcare possible.

Sincerely,

Josh Green M.D.
State Senator Elect District 3,
West Hawaii

THE TRUTH

About charter school funding

ISSUE The Republican Party and Jan Shields want you to believe that Sen. Roz Baker does not support charter schools because she supposedly cut their funding. THIS IS NOT TRUE.

THE TRUTH

• Sen. Baker was one of the earliest proponents of charter schools, co-sponsoring the first legislation authorizing charter schools in Hawaii.

• In the 2008 legislative session, Sen. Baker's committee complied completely with the Governor's request for Charter School allocations.

• Very late in the session, her committee was informed of a charter school budget miscalculation, in addition to the approval of a new charter school.

• Despite the last minute timeframe, Sen. Baker scrambled to find additional funding but it still fell short of the charter schools' request.

THE BOTTOM LINE Senator Baker has always been supportive of charter schools, especially the Kihei Charter which she considers a shining example of the initiative. Despite the impact of the tightening economy, Sen. Baker understands their concerns and is optimistic she can help resolve their budget problems. She is working directly with Kihei Charter School Chair Gene Zarro and others on long-term solutions, as well as future funding for facility improvements.

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Sen. Baker key player in providing service

Let me be clear. Without Roz Baker there would be no Maui MedEvac. With all due respect for Alan Arakawa's work, his Oct. 22 Viewpoint left out key players and contained incorrect information regarding the medical helicopter service.

Maui Sens. Baker, J. Kalani English and Shan Tsutsui, as well as Reps. Joe Souki, Sol Kaho'ohalahala and Bob Nakasone, pushed through this lifesaving project at a time when there was no money for new projects. The County Council and the efforts of a public/private partnership were also essential to our success.

Before their help, the fixed-wing air ambulance system was weak. Critical patients often waited for over six hours. We needed an immediate solution to get remote patients to lifesaving treatment.

The proposal to implement dual-use paramedics came from the state Emergency Service Branch based on the Hawaii County model where there is no dedicated medical staff.

The state and county would equally share the cost for the helicopter. Ambient light and weather restrictions would be required for safety.

We were faced with an all-or-nothing proposal. Go with an air ambulance system that was proven to save lives or wait for the "Cadillac model." Roz Baker said, "Let's save lives now!"

In its short existence, Maui's MedEvac has flown 246 lifesaving missions. As Maui Memorial expands its stroke and cardiovascular centers, this critical addition will help save more lives and reduce significant disability.

Roz Baker was key to this whole program. She deserves your mahalo and your vote.

Scotty Schaefer, Chair
Maui Emergency Medical
Service Advisory Committee

Malulani hospital: Setting the Record Straight

By Dr. David Sakamoto

The allegation that Senator Roz Baker blocked the proposed Malulani hospital in Kihei is totally false. That decision, for the record, rested with me.

I was the administrator of the State Health Planning & Development Agency (SHPDA) from 2003 to 2007. As the Governor's appointee, I swore an oath to follow the law. The SHPDA law contains specific criteria each application must meet to win approval. Despite the testimony of many in favor of the project, SHPDA was not allowed to disregard the criteria and simply abide by their wishes.

Since a new hospital is an enormously complicated project, it came as no surprise that the Malulani application had flaws. It wasn't bad; it simply did not meet all the criteria in the statute. Two of the three community boards recommended disapproval. Their recommendation became my decision.

Interestingly, the Malulani application had no insurmountable problems. The applicant could have rewritten and resubmitted it; he could also have appealed the SHPDA decision in court. Nothing was pursued. One wonders if his mainland partner who was taken over, was ever serious about building a small hospital in a competitive environment with high costs and low reimbursement.

To its credit, Maui Memorial has since renovated its facility, adding beds and implementing advanced services. County leaders now need to step up to secure a reliable source of funding, and this is where state legislators with clout can really make a difference.

Roz Works with Other Neighbor Isles for Maui

The race for state senator from West and South Maui has drawn our attention as we want to have Roz Baker back in the capitol and in her powerful position of Chair of the Ways and Means committee. Roz is well known and trusted throughout the state and with a democratic majority firmly set, it would be foolhardy to send someone with little experience and knowledge of the goings on at the capitol.

Locally, the economic slump has slowed down tourism and our state revenues and so it is vitally important for us to send experienced senators like Senator Roz Baker back to her job as chair of the Ways and Means committee, the body that handles state financing.

Here on Maui, we are far removed from Oahu, similar to Kauai and the Big Isle and we have always needed that edge in negotiations with other Oahu senators for fulfill many of our infrastructure needs.

So, it is obvious that neighbor island senators stick together and protect interests important to their island counties. Baker is well known throughout the state.....and during these perilous times, it would be to our advantage to send her back for another term as she will be handling the state budget. Having a person of her wisdom and experience has won her that important position of chair of the money committee of the senate.

They know and trust Roz Baker. So do we, the members of the HGEA Union who are solidly behind her. We cannot give up her position at a time when monies will be scarce. We kupuna ask for your kokua and your vote.

Mahalo

Rick Medina
VP & past Pres HGEA Retirees, Maui Chapter.

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.