A strike may be imminent on Maui as the union for health care workers at Maui Memorial Medical Center grows frustrated with the pace of negotiations for a new contract.

The contract for about 1,000 registered nurses, pharmacists, imaging techs and others represented by United Nurses and Health Care Employees of Hawaii, or UNHCEH, expired Monday.

Negotiations have been ongoing since July 22, but 98% of union members voted weeks ago to authorize a strike, according to Greg Wilson, UNHCEH’s chief negotiator.

“That shouldn’t be a surprise to management,” Wilson said. “They have not been responsive to our core issues: patient care, staffing, wages and some basic job protection issues.”

On Thursday, a bargaining session between UNHCEH and Maui Health, the not-for-profit organization affiliated with Kaiser Permanente that runs Maui Memorial in Wailuku, yielded no agreement on a new contract. Additional virtual sessions are scheduled for mid-month, followed by three in-person sessions later this month.

According to Wilson, the hospital on Thursday “did nothing to address the major issues keeping us apart.”

Maui Health, however, said in a statement that it has been bargaining in good faith with UNHCEH since July, and that the two parties have reached a number of tentative agreements after exchanging proposals and continue to make steady progress.

“Our goal is to reach an agreement that provides excellent compensation and benefits for our employees while ensuring we can continue to provide our community access to the high-quality health care they need and deserve,” Maui Health said. “We have bargaining dates scheduled through October, and are committed to bargaining in good faith to reach an agreement that honors our employees and benefits our patients and community, as soon as possible.

“We value and respect all of our employees; they are the very heart of the safe, high-quality and compassionate care we provide,” Maui Health said. “We take these discussions very seriously and are deeply invested in ensuring a positive outcome for our employees and community.”

Wilson said the union is asking for wage increases across the board. It is also asking that its health care workers, which include roughly 900 at Maui Memorial, be paid the same as those working at clinics. Right now, he said their pay is 8% to 21% less than their peers working at clinics.

Pay for Maui Memorial workers is also below what their peers make at Kaiser facilities elsewhere in Hawaii. The pay should be the same for the same job across the system, Wilson said.

Maui Memorial nurses are also advocating for minimum nurse-to-patient ratios.

Kaiser Permanente, which took the reins of Maui Memorial and affiliated clinics in 2017, also operates hospitals in California, which has state mandates on nurse-to-patient ratios.

But Kaiser has even better ratios than mandated state requirements in California, according to Wilson, where the union represents about 30,000 workers.

The union’s proposed ratios are specific — 1 to 1 for emergency department trauma, 1 to 2 for critical care units and 1 to 4 for medical-surgery units.

Wilson said these proposed ratios are the same as for Kaiser in California.

“Our members look at this and it’s pretty straightforward,” he said. “They see patients suffering and see a company we’re bargaining with that agreed to these ratios that would vastly improve patient care.”

Melissa Robinson, a registered nurse and union co-chair, said nurses at Maui Memorial’s ER are overwhelmed with too many patients.

Maui Health has reduced the number of nurses from three nurses to two for a pod of seven to eight patients.

“That has created problems when patients come in and there’s a very sick patient that needs one-on-one care,” she said. “One of the nurses is then left taking care of that patient by themselves, while the other nurse is now taking care of up to seven patients.”

The union wants safer ratios to give quality care to patients, she said.

“I’d say the very first day, we gave them our proposal of nurse-to-patient ratios and we have gotten nowhere with that,” she said.

Maui Health’s counterproposal instead called for “variable staffing.” Maui Health said in a statement that safe, high-quality care is its top priority.

“Being the only acute care provider in the county, serving the residents and visitors of three islands, presents unique challenges that are unlike any other hospital outside of Hawaii,” said Maui Health in the statement. “We adhere to safe, industry-standard, evidence-based staffing protocols that prioritize patient outcomes and safety, supported by ongoing monitoring and adjustments.

“Maui Health’s nursing teams review the census and current patient and staffing mix, including patient acuity and volume, to allocate appropriate staffing resources tailored to meet the needs of each unit,” Maui Health said. “This happens around the clock daily to ensure the highest level of care for our patients, and patient and clinician safety. We are committed to collaborative approaches to staffing where decisions are driven by patient needs and acuity levels to meet the diverse needs of our patients.”

Staffing shortages on Maui were prevalent since before the start of the COVID-19 pandemic and were compounded by the tragedy of the Aug. 8, 2023, wildfires.

Wilson said some union members who lost their homes to the wildfires eventually moved from Maui after being unable to make ends meet.

“Again, we are considered some of the lowest paid in the nation based on our cost of living,” he said, “so people have moved to the mainland. We lost a lot of staff. We continue to lose staff on a regular basis.”

Maui Health also runs Kula Hospital, Kula Clinic and Lanai Community Hospital, among other operations. Although affiliated with Kaiser Permanente, it serves all patients, regardless of health insurance coverage or ability to pay.