Kona Community Hospital at risk of closure due to outdated utilities

An operating room at Kona Community Hospital was a chilly 67.7 degrees early Friday morning, perfect conditions for performing surgeries.

However, as summer approaches, Dylan Palazzo, Director of Surgical Services, said temperatures in the sterile environment will spike. Warmer days, machines running hot and body heat from people performing or assisting in the procedures can raise the temperature in their three operating rooms to upwards of 75 degrees with higher humidity — which raises the risk of bacteria growth.

These conditions, at times, have led hospital staff to have to close operating rooms until they cool down to continue with procedures.

“We reach out to maintenance and they do what they can to get the temperature back in range, but sometimes we have to wait it out,” Palazzo said.

These spikes are due in part to Kona Community Hospital’s decades-old cooling and ventilating system. While they’ve never had to postpone a surgery because of spiking temperatures, Palazzo said it’s only a matter of time.

The nearly 50-year-old hospital — built in 1974 — runs the risk of closure every day due to outdated utilities. And if they do conk out, elective and trauma surgeries will end and the hospital runs the risk of losing its Level 3 Trauma Designation, which requires at least one operating room to always be available to provide emergency surgeries.

“It’s just like a homeowner. You don’t know when the water heater is gonna go out but when it does, you better have $10,000 to replace it,” said Diane Hale, the hospital’s chief nurse executive.

Hospital leaders have been attending 2023 State Legislature sessions to bring attention to their urgent needs and advocate for approximately $17 million over the next two years to address the cooling and ventilating system problems as well as install campus-wide lighting and security cameras. There also is a need to deal with waste-water treatment issues.

A significant portion of the funding would be used for an uninterruptible power source to minimize equipment damage from frequent brown-outs, which are partial, temporary reduction in system voltage.

“We’re making a lot of noise trying to get our story out there,” said Judy Donovan, Marketing & Strategic Planning Director for the hospital.

The hospital hopes to secure $4.9 million in 2024 to start on the infrastructure and cooling system upgrades. They hope to receive the remaining $11.3 million in 2025.

Clayton McGhan, West Hawaiʻi Regional CEO, said Kona Community Hospital started its efforts to get state funding in December by meeting with the Hawai‘i Island Delegation.

“We shared with them our challenges, and it was well received,” McGhan said.

McGhan attended Opening Day of the State Legislature in January and has been back to Honolulu on several occasions to discuss the hospital’s plight with lawmakers.

The last major renovation the hospital had was in 2020 when the three operating rooms were upgraded. In the early 1990s, the hospital built an additional building for same day surgeries, with a recovery room and Intensive Care Unit. The hospital also expanded its acute and long-term care to 75 beds.

In the early 2000s, a new administration services building was constructed across from the emergency department entrance, the Behavioral Health Services Unit opened and the new building for chemotherapy and outpatient services was also added onto the hospital. The air conditioning and utility systems have been upgraded and repaired piecemeal over the years. McGhan said a lot of the equipment remains outdated.

“We need to fix the infrastructure to manage the [power] load that’s put on it,” he said.

The hospital’s pharmacy also has been working to expand by building a clean room suite, which allows pharmacists to prepare IV medications and store them for longer.

Missy Elliott, Director of Pharmacy, said the pharmacy has a room — the segregated compound area — that enables the safe mixing of medications for inpatients and infusion patients. However, the compound area only lets the hospital store those mixtures for 12 hours because the air circulation doesn’t flow in the right direction. A clean room suite status requires air to flow from the ceiling down. Currently, the air is flowing from the ground toward the ceiling.

While the airflow is going in the wrong direction, Elliott said the room is immaculately pristine, and tested regularly with no bacteria or mold growth.

But because of the short shelf-life of the mixed medications in the current segregated compound area, “we waste a lot of stuff,” Elliott explained. “In a clean room suite, it keeps stuff for up to a week. It will help us provide better care for inpatients and those who get outpatient care.”

The clean room suite will be built on the backside of the hospital, but will still be accessible through the pharmacy.

Building a clean room suite also is part of a requirement by the Federal Drug Administration.

The hospital pharmacy came under FDA scrutiny in 2019 due to a complaint about unsafe practices within the segregated compound room. During a review, the FDA found the room had bacteria growth in the past and remediation steps weren’t properly documented.

The FDA reinspected the pharmacy in February 2022. Elliott said inspectors came out and spent time watching the hospital pharmacists for a week, checking for any potential violations and watching them prepare medications. In July 2022, the FDA issued a closeout letter that said the pharmacy had addressed all the original issues it was initially cited for and no new citations were issued.

Part of the FDA’s review was the understanding that the pharmacy would build a clean room suite. The original deadline for the room to be completed was next month. All the pieces are in place to build it, but the contractor won’t sign a contract until the hospital has the funding, Elliott said.

In the meantime, Elliott said the hospital “promised” to keep the FDA updated.

Elliott also said the pharmacy could be providing more service and the hospital is proactively working toward that goal.

“We’ve taken on a lot of new tasks,” she said. “Our big push to increase patient safety is to have a pharmacy available 24 hours a day. Our services just keep growing. Our hours need to grow as well.”

Funding for Kona Community Hospital projects was added to Gov. Josh Green’s proposed Executive Budget for 2023-2025 earlier this month. The added infrastructure project comes at a price tag of $21.7 million and covers funding for four different projects that if not completed could put the facility at risk of closure:

• central utility plant
• site utilities [heating, ventilating and air condition systems]
• loading dock
• building infrastructure

Additionally, proposed funding includes an expansion of the hospital’s pharmacy.

When Green, who was a doctor on the Big Island for many years, released his initial proposed Executive Budget for 2023-2025 in December, it included several funding priorities, including $50 million for Hilo Medical to expand its Intensive Care Unit and medical Surgical Unit.

Blake Oshiro, senior advisor to the governor, said they are awaiting a public release of the Senate Ways and Means version of the state budget to see if funding for Kona Community Hospital is appropriated. They hope to see those papers sometime next week.

“The House and Senate must still confer in the final weeks of April so we will continue to work with the legislature so that they understand the importance of these projects,” Oshiro said. “We will find out at the end of April whether this funding is in or out of the budget.”

State Rep. Nicole Lowen said she and other area representatives have agreed that Kona Community Hospital upgrades are a high priority item, adding funding requests for the hospital goes into the budget every year depending on the expressed needs.

Last year, for example, the legislature secured $500,000 for a hospital site and hospital needs assessment, which now is in the process of being conducted. The hospital also has received $2.5 million for oncology services upgrades and replacing equipment and $674,000 for pharmacy expansion, “which as we now know wasn’t enough due to rampant inflation,” Donovan said.

“We just go by what we’re told [by the hospital] on what their highest needs are,” Lowen said. “This is the first year we’ve been made aware of the risk-of-closure items.”

Lowen added: “We [area representatives] have never been anything but completely supportive of health care in West Hawai‘i.”

If the State Legislature doesn’t approve the funding, Hale said the hospital would be forced to use its limited operating budget — money used to pay salaries and purchase equipment — to start the projects.

“We don’t want to cut services and we don’t want a riff in our employment,” Hale said.

McGhan said it’s difficult to think about the idea of not getting state funding with the hospital already running the daily risk of closure.

“This hospital is a community hospital,” he said. “Everyone deserves to have their health and wellbeing needs met.”

Hospital leaders continue to spread awareness of the hospital’s situation. This week they met with the Chamber of Commerce and Rotary Club Kona-Mauka. On Thursday, hospital staff held a sign waving in Kona off Queen Ka‘ahumanu Highway. Next week, they will be meeting with the carpenter’s union, Hawai’i Regional Council of Carpenters.

At legislative hearings, Hale said she’s been asked if Kona Community Hospital’s needs are more important than those of Hilo Medical Center. The answer: no.

Both the Hilo and Kona communities outgrew their hospitals years ago, Hale said. Hilo Medical Center needs to expand its services, too.

“Things weren’t maintained properly in the past. Here we are now as stewards trying to create a new plan,” Hale said. “We’re just trying to keep our doors open.”