What would happen if Wahiawa General Hospital closes?

The most immediate fallout would be layoffs for staff and emergency patients having to travel much farther to get help, which could make the difference between life and death.

Other effects would be felt farther away: First, medical care in the entire state of Hawaii would be impacted — not just Central Oahu. Second, the fallout of a closure would cost the state much more than the $3 million a year proposed as the current support needed to keep the hospital open.

My perspective comes from both the hospital and pre-hospital setting. As an internist, nephrologist and former emergency room physician, I have worked in every hospital on Oahu through the years with the exceptions of Kaiser and Kahuku. And from 2010-2012, I was the director of Emergency Services for the City and County of Honolulu overseeing EMS and Ocean Safety.

It was in that role as the director that I received notification on Dec. 19, 2011, that the emergency rooms at both Hawaii Medical Centers would be closing their doors and no longer accepting patients. As a community, we not only lost those emergency rooms, but also hundreds of inpatient hospital beds.

What happened next was predictable: EMS ambulances from West Oahu, no longer able to stop in Ewa, descended on Wahiawa General Hospital and Pali Momi Medical Center.

Once Wahiawa and Pali Momi were full, ambulances were then rerouted to Kaiser Medical Center, Tripler Army Medical Center and downtown. Once downtown was over capacity, EMS units would take people over the mountain to Castle Medical Center. It was not uncommon to have six Oahu hospitals on ambulance-divert status, meaning those ERs would not receive any ambulance patients unless the patient was extremely critical or a trauma patient.

Because so many ambulances were bringing patients downtown, they were out of their primary-response regions for extended periods of time — hours — leaving their areas potentially uncovered for 911 responses. We immediately staffed two to three additional ambulances daily; and because EMS is funded by the state, we had to go to the Legislature for an emergency appropriation to keep these extra ambulance units staffed and running. Each 24-hour ambulance on Oahu comes at a cost of about $2 million a year.

Another group who depends on our Oahu specialty hospitals are neighbor island patients with certain complex medical needs. Not every hospital in the state has the various medical and surgical subspecialties that are found in certain Oahu hospitals. However, if the large Oahu hospitals are full due to the lack of hospital beds on Oahu, they are not able to accept those neighbor island transfer patients, even if they need life-saving care.

Clearly, hospitals today have a difficult time balancing patient care and financial stability. Wahiawa General is the only hospital to care for hemodialysis patients in West and Central Oahu, so perhaps this is contributing to its financial losses. The currently proposed state funding is clearly the best way forward and would help patients throughout Hawaii.