HB1291: The Ghost of Peter Boy is Waiting
Dear Representative Tarnas, March 7, 2023
Subject: HB 1291
My name is Steve Lane. I would like to know why your committee refused to schedule HB 1291 for a hearing this session? Attached is testimony I had submitted earlier to Rep Mizuno's committee who passed the bill out.
As I am sure you known, HB 1291 simply seeks to codify the Family Court Tort Protocol by statute authored by Judge Mark Browning already in place and widely ignored so that our children in foster care who suffer harm have access to counsel.
These are the most vulnerable members of our community and the continuing failure of the SOH to offer the same access to redress when the suffer harm available to the rest of the citizenry is discrimination of the worst order.
It is also costly.
Every time a child suffers serious injury or worse that could have been avoided by earlier intervention, as called for in Judge Browning's protocol, you and I pick up the bill as taxpayers when millions of dollars in compensation are paid. The ghosts of Peter Boy Kema, Ariel Kalua , Shaelynn Lehano Stone and countless others are waiting.
Would you kindly explain why you choose to deny this measure a hearing.
Related: HB1291: Will Abused Foster Children Ever be Represented?
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How One Dentist Stays in Hawaii
Dear Editor, March 1, 2023
As a long time practicing dentist – a “health care provider” under Hawaii legal definitions, this letter is simply to raise your readers’ awareness to the issue that plagues private practice dentists in this state, most especially on the outer islands. Do you understand just how many dentists have closed their offices on the Big Island, and most likely on other islands as well? I dread what is coming because, on the ground floor I am witnessing how many of my peers are simply letting go because the economic squeeze is becoming too stressful on them.
As a private rural healthcare provider in the state of Hawaii, I feel there is an epidemic brewing. We already know of the crisis which is all over the media, pretty much every year as indicated in the links below. It just seems to be swelling more in this past year - to a dangerous level.
Hawaii’s Crisis of Medical Provider Shortage has been going on for some time…
2023: Grassroot Institute of Hawaii identifies the shortage of medical personnel as one of the 2 most critical issues facing our state. (LINK)
2022 “Best & Worst states for Doctors” Hawaii ranks 45 of 51 (LINK)
2022: Cost of labor increasing if dentists want to keep any help. (LINK)
2021: Doctors and other Health Care providers leaving the state in droves. (LINK)
2017: Despite UH medical school efforts to improve doctors shortage since 2017, many (if not the majority) of those doctors who have come to the Big Island have ultimately moved back to the mainland. (LINK)
It is now the older health care providers who are leaving – either retiring sooner than they had planned, or relocating.
Some are calling to make license to practice simpler to obtain. However this only brings the dreamers in. It does not keep them here for the long term to serve Hawaii. This is a short term fix that fails a long term need. Increasing costs force them toward barely breaking even, and that is without having any more student debt. Once they feel the impact of the high costs and the pressure that squeezes their ability to earn a living practicing their profession. Fixing the licensing issue to make it easier for dentists and doctors does not give them reason to stay for the long term.
Our newly elected Governor, Josh Green MD, once provided healthcare to rural communities on Hawaii Island. He has worked in government/non-profit subsidized health clinics, so he already knows the economic difficulty in operating a facility.
Most larger medical facilities need to be subsidized. Private providers however do not have any subsidies nor do they have the protection of a corporation “economy of scale”. The ones that can be “profitable to venture capitalists” can always sell to corporate groups, but they believe that health providers should not be so focused on the profit margin that they sacrifice quality patient care. And many of the rural medical providers are not attractive because they are not that profitable, so they cannot sell. Some cannot even give their practices away.
Private providers also do not have the luxury to sit on government committees that require their time travelling to meetings because they need to be at work producing what income they can. So we may hear less from the small private medical provider than you do from the larger practices that might have lobbyists, and or subsidies. But still the foundation of medical care to many residents comes from the traditional small private provider, and more and more, those providers can barely make ends meet in private practice.
While Hawaii agencies have implemented various initiatives to establish non-profit facilities providing care to outer-island and rural communities, most the providers are inexperienced and often the patients end up with far more appointments and much longer courses of treatment or courses of healing. Also, several of those medical providers still leave as soon as, or within a short time of when their contract ends.
These initiatives have also failed to address the continuing need to change the laws to create small business regulatory environments that encourage medical providers (as well as other small businesses) to establish long term practices to cover long term needs of Hawaii’s residents.
Since even before the COVID crisis hit our providers with excessive additional costs, and reduced staff, the increasing cost of running an office was rising faster than the providers could keep pace.
Now, increased employee wages, costs to provide healthcare for employees, increasing costs of rent, utilities, medical supplies and medical tools, office supplies, increased GE tax due to county surcharges, etc. – all these formerly manini costs have risen rapidly and have combined to levels beyond what most private providers can afford, especially when they are operating to truly treat the patients in need.
Meanwhile, the reimbursement rates controlled by the third parties (insurance companies, government agencies) have not only failed to keep up with the rate of inflation, and rising costs, but they now have fallen woefully behind, which has directly caused several of our peers to simply close shop.
Nearly all providers are feeling the tightening economic squeeze from rising costs on one side and the insufficient reimbursements on the other side. And many who are experiencing this unprecedented economic stress are not young new graduates carrying student debt, but are mature, experienced, competent providers who have reached their breaking point – becoming fed up with the pressures of only “breaking even” and even taking a loss on some of the most common treatments like routine check-ups.
Governor Green, because of his medical background and his political involvement, already knows the exodus of health care providers impacting our state, but this past few years has created a shortage situation that has not been seen before.
Our State of Hawaii will suffer severely in the long term if something does not change. And Governor Green is the primary person who can make a difference in the long term, by working on making this state more business friendly for medical providers who simply wish to run a private practice to cover their patients.
I have survived by seeing patients six days a week most weeks, operating with minimal staff to keep overhead low, and also having other jobs during evenings and weekends. Because of this I survive, but continue to hear the growing frustrations and fears from several contemporaries who cannot operate the same way, and who have an even greater struggle.
The complexity of keeping staff, plus the growing impossibility of trying to maintain some profit has put additional strains on providers above and beyond what has always been a difficult profession due to the dynamics of the human body and due to the need to practice healthcare while also trying to run a private business. My office used to see welfare patients but stopped only after we saw far greater abuse by the patients than we saw any “true need”.
The state of Hawaii quite simply makes it easier to be a non-worker than to be a worker – of any level. Private business is the golden goose that provides the tax base necessary for the rest of government to run. You know this rule. And tourism is Hawaii’s main industry. But the State of Hawaii also needs other private businesses to cover the basic needs of residents – public and private workers alike, as well as all the non-workers. Medical care is one of the key basic needs. And yet the state has made the business side of it so difficult, that even more medical providers have shut down this past year than I ever imagined seeing.
Some have retired – but they retired years earlier than they had planned to do so. Many had stayed with it in these past years because they simply wanted to be helpful and recognized the dire need for dental / medical care. So they had planned to keep practicing until they no longer could hold the instruments steady. However, that sentiment has been broken by the headaches and costs that become too great to keep the doors open. Forget trying to sell a practice at retirement – providers here cannot even give their practices away. No one wants them.
I know of multiple providers who have tried to recruit young doctors and who have tried to give their practice away to a new doctor. The younger providers come, observe the absurdity of trying to operate a small business under the anti-business laws of Hawaii, and rather quickly cancel their contracts and move back to where they came from.
My colleagues and I have observed several new dentists and doctors come to the Big Island to set up shop, only to be faced with the reality of highly unfavorable economics which has caused them to pack up and move back to the mainland within with 6 months to a year.
While some Hawaii residents might say “good riddance” to them, those residents will be the same ones who complain the loudest because they cannot get medical or dental appointments, or because the young providers are so inexperienced and do not have proper mentoring to grow into an established quality practice.
Still, as local providers have faced the most recent 3 years of skyrocketing costs, increased regulatory demands, lack of any equitable increase in reimbursements, inability to keep staff at a reasonable wage, and witnessing their patients who work state and county jobs retiring early with a life of benefits, they no longer are willing to carry the economic burden of covering the community. The “Community of Hawaii” is costing them too much.
While I survive because my family lives very frugally plus we work other jobs during evenings and weekends. If what I am seeing and hearing among other dentists continues, we will see an unprecedented exodus of providers from the state and or from the profession.
Unless our political leaders do something to improve the economic lot for smaller medical providers the critical shortage of them will rise to even more dangerous levels. I do not have any magic solution – it will take a long term, concerted effort, to grow an economic regulatory environment that encourages investments by small businesses and that encourages a greater work ethic among Hawaii residents.