Here are some photos of the  HPA Graduation May 25, 2012.  Invocation: Reverend David Stout; Welcome: Mr. Lindsey Barnes; Remarks: Mrs Laurie Ainslie - Chair of Board of Trustees, Lindsey Barnes- Headmaster, Nickolas Akira Chock President of the Student Body; Address: Dr. Gordon Bryson English Department Head; Awards by Headmaster Lindsey Barnes and Special Guests Senator Malama Solomon and Governor Neil Abercrombie, Awarding of Diplomas, Hole Waimea, Hula by the Class of 2012; Prayer and Benediction, Hawai'i Aloha - by the Audience.

Recently I attended the Paniolo Heritage Club Meeting at Pukalani Stables.   I stopped by Jamie and Queenie Dowsett's house to see if they were going.  Queen was out helping care for an ill grandchild... so Jamie and I went to the gathering.  A good time was had by all as you can see from these photos.

At some point Jamie took me through the museum of honored cowboys and paniolo history. He told me story after story of certain of the cowboys and explained which bits were the Waimea bits (horse bits and why)  Finally  I said where are you in this museum?  He said he is not there. I said this was not right and we should fix this. (He is 86 and will be 87 later this year)  He explained that when he want to be honored in the museum those in control did not want him, and then when he could finally have gotten in, he didn't care any longer.

 In my opinion, both Jamie and Queenie should be honored here.

May has been a month of special presentations at the North Kohala Senior Citizen Club's monday morning meetings. Here are some photos from the May 14th meeting.  Do you know who is playing the guitar. North Kohala's own John Keawe. There was also a lei contest. John and some seniors in the audience told stories of John when he was growing up -- for example when they heard him serenading his wife to be.

Who do you know in these photos?  At least you should know Kealoha - the Club's President. He is extraordinarily creative. Take a look at his 24 carrot lei. 

On May 15th the North Hawaii police held a community meeting at the Intergeneration Center.  Captain Jason Albert Cortez was present along with the community police officer and several other police officers.  The community got a lot of answers but some were frustrated when their questions about the handling of specific incidents were refused an answer. Captain Cortez explained they can not discuss "active cases". He did suggest that the individuals asking those specific questions meet with him privately. In general those questions had to do with why someone in particular had not been arrested.  There was also a question from Andrea Despre (domestic violence service program) -- as to why abusers are allowed to go -- rather than being taken into custody or otherwise suffering any consequences.

When asked about drug use in the area.. Captain Cortez said comparatively usage in this area is low, however there has been somewhat of an upswing of late.

There were a lot of complaints about speeding tickets going south out of Hawi in the area marked for roadwork where there is no roadwork. 

Kealoha and many seniors from the Senior Citizen Club were in attendance...  There were complaints about the meeting being held in the middle of the day when those working could not attend.  A request was made for a similar meeting at a later hour.

Dated: June 4, 2012

There is a tragedy occurring in our Waimea town and it is very very sad.  The North Hawaii Community Hospital administration is assailing its most successful program – the Women’s Center’s mid-wife based maternal care clinic.

 

First, ask me how I am measuring success of this maternal care unit: I do so based on NHCH’s “Vision” and “Values” statement.  NHCH’s Vision is “ to treat the whole individual - mind, body and spirit - through a team approach to patient-centered care, and ultimately to become the most healing hospital in the world.”  It’s “Values Statement” is as follows: “As ‘Ohana, we value an environment of Aloha which nurtures trust, respect, self-expression without fear, open minds and hearts and continuous improvement.”

 

For years the Women’s Health center and its “whole person” – “whole family” approach to maternal care has been so successful that it has attracted patients from all around the Big Island, from all around the state, and even from other nations. For example women from Russian and Asian cities have traveled here for their last weeks of pregnancy, stayed in Kohala Coast resort hotels, and paid all cash for our hospital’s maternal care services.   Assuredly Queen Kapi’olani’s motto of  Kulia I ka nu’u  (strive for the summit – the very best service) is epitomized by the performance of NHCH’s maternal care unit. (Queen Kapi’olani, the wife of King Kalakaua, was the founder of the Kapiolani Medical Center for Women and Children).

 

Success is also measured by results.  Our maternal care birthing unit has by far the highest percentage of natural (non-surgical) births.  Likewise government and health organization evaluations of its performance, consistently rank this maternal care unit as exceptional.  Only a few years ago its outstanding performance was being marketed by NHCH’s administration as one of the hospital’s outstanding assets – and consistent therewith the midwives were encouraged to increase the number of births performed and even given a small bonus if they performed more than a certain number each month.  And what about staff satisfaction: up until recently, staff satisfaction was also exceptional. In this unit the physicians, nurses and midwives, along with the pediatricians worked as a finely tuned team to address each patient’s individual needs.  The unit’s excellence was recognized not just by the public and patients, but also by the other departments. For example when the orthopedic interns were to be trained, guess where they were assigned; you got it - in the Women’s center maternal care unit.

 

So how did the hospital administration recently reward its exceptional maternal care unit? Shockingly by abruptly dismantling the unit and threatening to not renew the contract of those who disagree with this plan of attack.  How was this surgical dismantling orchestrated: by suddenly restricting services in the hospital’s maternal care unit to a limited number of zip codes, by placing a gag order on all of the staff in the Women’s Center and its maternal care clinic, by firing or threatening the employment security of those who have spoken to members of the community, by getting rid of  outspoken supporters such as senior ob/gyn physician Dr. Szczygiel (Dr. Shiggy) (He was asked to retire early for the “benefit of the Women’s Center”), by firing its finance person David Webber who on the previous day had questioned the Administration’s representation of the Women’s Center’s finances and suggested an audit) (David Webber had just moved here and bought a house. He too is subject to a gag order).  Likewise the Administration made the correct assumption that by abusing the Women’s Center’s staff, other staff would also quit in protest-- thereby avoiding any accountability for getting rid of these other employees.   

                Senior midwife Joanne Johanson has quit in disgust, as well as  two or more nurses. The other senior midwife, Pat Hopkins was just told her contract would not be renewed because she is too outspoken (or words to that effect). [6/8 Update: I am told  the contract of Pat Hopkins has now been renewed for one year.]There is only one mid-wife who remains. All of those employed in this unit are now afraid to talk to me or to other concerned members of the community.  They refer to an extreme culture of fear like that of the holocaust, in other words:  speak up and you too will be sent away. 

          In the past few days two important members of the Hospital’s Board of Directors, Sharon Vitousek and Carolyn Quick, have resigned from the Board, apparently in protest for this mishandling of the maternal care unit staff.

[NOTE: APOLOGIES IF ANY OF THE ABOVE INFORMATION IS INCORRECT -- WITH ALL THE GAG ORDERS IN PLACE, FERRETING OUT THE FACTS HAS BEEN DIFFICULT.]

               So what has the Waimea Community been told:  On May 1^st CEO Ken Wood told the Community: “I am here to listen” (but now seems he did not listen) He said the hospital is losing money on maternal care and needs to restore balance, and that community and the in-house task force’s input will be considered and there will be no changes for the next 6 to 8 months. He also said there was a volume and safety issue in the “too successful” birthing unit. However, the statements about safety and volume are misconstrued. (Only once in a decade or so were there more births in a certain period than maternal care beds available – but even then there was no mishandling of any patient.) The Administration's plan, as the community understood it from Ken Wood, was to work together to address the issues comprehensively over the next half year or so.  That plan of action seemed reasonable – assuming the input of the community would continue to be solicited and addressed. But, with great regret, that proposed action plan is not what was about to happen. 

Two days later, on May 3^rd, the subject at the monthly Waimea Community Association’s meeting was the North Hawaii Community Hospital’s difficulty recruiting physicians and other medical staff. Bill Park, the hospital’s Vice President, Chief Medical Officer, Chief of Staff, and de facto “top dog”, was to be the keynote speaker, to explain the hospital’s position. To the dismay of those in attendance, Bill Park arrived but after noticing many supporters of the hospital’s maternal care unit (dressed in green), he left the meeting and never spoke a word. This was a slap in the face to the community to be sure.  Those attending were then informed that the only topic for discussion would be recruitment issues generally and no one would be permitted to say anything about the Women’s Center’s and its midwife based maternal care unit. At that point a number of community members got up and walked out. At the end of the meeting, I finally got a chance to make a comment about the importance of successful retention of existing medical staff (explaining that one way to attract physicians is to show that if they do good work they will be respected and retained). Instead of allowing one of the consultants to respond to my question, the microphone was quickly taken from me.

 

Likewise the NHCH’s maternal care unit task force’s recommendations were about to be ignored.  In fact last Friday, on June 1^st, the task force was supposed to meet but instead was disbanded for lack of “due diligence” (in other words for not kowtowing to the Administration’s hardline position). The task force members were shocked, as one physician remarked, the Administration’s actions felt like “date rape”.  The task force then requested to at least be able to make a public statement of its  recommendations, but consistent with a dictatorial approach, that request was denied.

 

Now step back a moment, and think about what should have happened.  If in fact the maternal care unit was “losing money”  I would suggest the appropriate response would have been for the Administration  to have met with the unit and apologized for its own administrative failure to bring sufficient revenue for the unit’s exemplary services. Second, the Administration should have methodically listed all the ways it has failed to ensure the financial viability of the existing successful maternal care team and correspondingly explained how each of these financial issues is, or will be, addressed. For example, the Administration 1) could have pointed to the need for better procedures for collection of co-pays, 2) the need for better coding of procedures to increase insurance reimbursements; 3) the need to advocate to correct improper reimbursement rates; 4) the need to ensure that only “maternal care” expenses be charged to this unit, 5) the need to generally increase the number of patient rooms in the hospital (which would improve the “case mix” percentages that impact reimbursement rates); 6) the need to politically address the failure of the on-island state hospitals to provide equivalent maternal care services; 7) consider reevaluating the Administration’s current preference for providing physicians “free” in hospital office rooms rather than increasing the number of patient rooms; 8) the need for grant writing and improved administrative handling of grants that would have benefited the maternal care; and certainly; and (9) the need for an immediate financial and administration audit. In addition, there are federal and state regulatory and legislative issues that need to be aggressively addressed in a coordinated fashion with our state and federal representatives. As well, despite its restrictions, I suggest we could be qualifying for some benefit from the federal Critical Access Hospital program.

 

In this team “ohana” approach, short term and long term solutions could have been hammered out in a way that the maternal care unit staff who should be treasured would remain on island and help to carve out solutions consistent with the hospital’s stated vision and values.

 

So what can the community do now. . .  Here are some of my and others’ suggestions: 1) Inform the NHCH Administration that its abusive fear-based management style is unacceptable; 2) ask the Board to beg the two senior midwifes (Joanne Johanson and Pat Hopkins) and the nurses who have quit or been fired to remain while we sort out this dilemma; 3) ask the Board to remove all gag orders; 4) ask the Board to invite Dr. Shiggy and David Webber, as well as members of the Task Force and Women’s Center  to speak to the Board (possibly in addition the anesthetist and hospitalist who were recently fired); 5)  request that surgeon Bill Park resign from the Board and from the Hospital Administration (he is a very highly regarded surgeon); and 6) suggest that every one read Rosa Say’s book “ Managing with Aloha”. (Rosa Say in “Managing with Aloha”, writes:  “As `Ohana, we value an environment of Aloha which nurtures trust, respect, self-expression without fear, open minds and hearts and continuous improvement.”   She goes on to say that “ Managing with Aloha defines a Hawaiian sensibility for the work we do, and it is the polar opposite of the fear-based management that can weaken and destroy the ethical and humanitarian hopes we have for business today”. )

 

                  What are your suggestions?

 

                   The bottom line: It is time NHCH’s fear-based management approach to come to an end now. Most importantly, what is not an acceptable response is very clear. It is not acceptable for the NHCH’s Administration to simply pat the community on the back and say what is done is done, and yes it could have been handled more humanely, but now for the sake of the hospital and the community at large, it is best to move on in silent acceptance and disregard the harm that has been inflicted upon the NHCH’s maternal care unit and its exceptional staff. 

 

A personal note: As many of you know I am running for County Council – and for this reason, several friends have suggested that I not get involved with this intra-community controversy at the hospital, and that I refrain from questioning  or criticizing the Hospital Administration for its actions. But if those of us who care about the hospital and its long term success consistent with its exemplary Vision and Values Statement, stand by and watch in silence what we believe to be wrong, are we not also at fault? 

 

 Hospital CEO Ken Woods here speaks to the Waimea Community -- explaining that no changes would be made for another 6 plus months.

                  Tutu's House is a community health and wellness resource center located in Waimea.  At the North Hawaii Community Hospital "Senior Health Fair", I helped to represent Tutu's house -- having just "graduated" from a 6 week course in "Chronic Disease - self management". Two others from this course also assisted - Elaine Loo (Waimea) and Carolyn Johnson (Waikoloa). Lorraine Urbic, Tutu's House Director, also manned this presentation booth.  We signed up a number of folks who might want to attend this course when next offered. We also posted a large poster sheet and gathered ideas for events at Tutu's house. The ideas that were solicited were 1) a course on advance directives (such as how to draft a "living will"), 2) a diabetes education panel, 3) a course for community volunteers, 4) a talk story about those in attendance- such as about your relationship with Waimea,
5) a talk story with the NHCH administration as to how to preserve the very successful women's center, 6) reflexology training, and 7) a presentation on the EEG service now available at NHCH.

                   I have personally been involved in the effort to preserve the women's center and its midwife birthing program -- so would be most interested in a presentation by NHCH staff on that issue. More on that in a separate blog.

                   And for those who might want to take the Chronic Disease - self management course - it was very worthwhile.  I am "pre-diabetic" -- so helpful to me and also my daughter is seriously ill with lyme disease. For both myself and my daughter this course was valuable.   I am also interested in health and wellness community education because one of my visions of District 9 is as a health and wellness/fitness destination (including for a center for chronic illnesses). 

                    Tutu's House has many great courses -- for free - which we should all take advantage of.  Friends of the Future, a Waimea based non-profit, sponsors Tutu's House. It's monthly newsletter, Ho'o Wala'au (to cause conversation), includes articles and the monthly schedule of classes and presentations. Phone 885-6777  website: tutushouse.org

                      For those who did not attend the Senior Health Fair -- you missed a valuable community affair --with lots of informative stations.  For example, I checked my blood pressure, had a bone density test, and blood tests for cholesterol and glucose. Afterwards there was lunch and bingo games with community business donated prizes...

Perhaps you would like to attend next year.
Link HERE to North Hawaii Community's home website

For the past two years, the State of Hawaii has been "on probation" -- and at risk of losing Department of Interior/National Park Service funds, for historic preservation -- this would amount to a million dollar plus loss. When Laura Thielen, the former director of DLNR (Department of Land and Natural Resources) was asked how the State could address these deficiencies, she said the Department would make a major effort on the neighboring islands. Instead then Governor Linda Lingle was busy gutting the Department - without remorse to be sure. Not surprisingly therefore the State is still on probation and is now being given one last chance to rectify its deficiencies.

As part of the State's effort "to get its act together", a consultant company SMS, has been going around the State soliciting input from the public for a new 5 year plan.   Unfortunately, so far this effort is aimed at putting together just another plan of what it should be doing rather than more planning and more studying.   For example, as shown on the bottom photo, one of the first questions for those in attendance was what should the agency do 1) identify more sites, OR 2) preserve existing sites, OR  3) enforcement,
OR 4) encourage private landowners to protect historic sites, OR 5) Other.    Well the obvious answer is all of the above -- but that option was not included.

At this point  I asked the consultant -- How do we know that the current effort is not just one more study that will end up on a shelf - as happened to each of the Plans drafted over the past decade.   She never really answered that question... or at least not to my satisfaction.  After I redirected the dialogue -- many others echoed my sentiment.  The consultant's response was "This is a very educated audience".  The consultant also tried to distinguish between physical sites that are of historic significance versus historic traditions, events, or activities. There were for example a number of hunters/gathers who raised the issue of protection of traditional historic gathering and hunting rights. In this case one would have to set aside designated lands as a cultural site -- not designate a cultural activity.  As an indication of how weak a presence the State Historic Office has on this island, consider that until very recently there was only one archeologist for the entire island/county.

Whereas this meeting was focused on what the State should do, it is also important to think about what this County needs to do to support cultural and historic preservation on all levels. Back in 2006, the Hawaii Supreme Court made clear that Protection of Historic Resources is not just a State kuleana but also a County kuleana (responsibility). Yet in my opinion this State still gets an F in the subject of preservation of historic and cultural sites.  To my knowledge, our County is the only County that has not qualified for Certified Local Government Funding for historic preservation sites. To qualify for those federal funds we need to have a County level historic commission.  For years I have been stressing this point  - with no response. The last time I asked Mayor Kenoi about this I stressed that if he could not come up with members for such a commission I could find 16 volunteers.  I explained we have been losing millions of dollars that is given out by the Department of Interior to "local governments" - provided they have a local government level historic commission.  He said he would look into this.

An information handout about the State's current "historic preservation" effort is attached below. If you have suggestions, please forward them as requested on the information handout to hawaiihistoricpreservation.com

The StarAdvertiser article about the State's current deficiencies in the State Historic Preservation Department is HERE
The 2009 Federal Report about our State's failing grade for Historic Preservation under the Lingle administration is attached BELOW
Also attached BELOW is the DLNR's media release for these statewide hearings