Concerns Rise Over Community Health Center

Frustrations over staff shortages, concerns about a medical clinic closure in August and what has been called “gross mismanagement” by organization leadership have left a path of broken trust in Molokai’s federally funded Community Health Center. Tensions have recently come to a head, and many community members and politicians are calling for the resignation of Health Center leadership.

Patients and family members have recounted how a clinic closure for four days on Aug. 22, 23, 26 and 27, as well as failures to refill prescriptions, make timely appointments and other issues with the Health Center have left them and their families in challenging or potentially life threatening situations.

“It has become apparent that the trust between our community and the health center has been broken,” said Representative Lynn DeCoite in a statement last week. “The last thing I want is to see the center shutdown or closed. I believe the [Molokai Community Health Center] board and executive leadership should step down and allow the community to reorganize the health center and build back the trust.”

MCHC CEO Helen Kekalia Wescoatt said she acknowledges and apologizes for the shortages. But she doesn’t feel resignations are warranted right now.

“I believe everyone… has the same goal in mind, and that is access to quality health care for Molokai,” she said in a Dispatch interview. “We’re definitely willing and have been listening to the concerns and also taking seriously and investigating the allegations that have been brought up. At this moment, we don’t feel resignation is warranted or would even solve the issues at hand. If we all have the same goal, which I believe we do, then it’s now or never to come together as a community to make sure we continue to provide health care to the people of Molokai.…”

She said despite rumors, MCHC is not shutting down, and is currently operating at full capacity.

“We don’t deny that the clinic has had some challenges, specifically in the realm of provider shortage, and that it has caused some hardship for some of our patients,” Wescoatt said. “We do deeply apologize for any hardship that has been caused to some of our patients…. I do not expect anything like that again in the foreseeable future.”

Community Taking Action

Residents and patients called a meeting with MCHC’s board of directors on Sept. 26 to voice their concerns and get answers about the August closure.

“Due to lack of getting appointments arranged, poor time management of health aids and responses, poor service in communication to concerns, appointment cancellation due to not having physicians on deck, and finding out from a sign posted on the door that the medical department was closed, eventually sprung up much concerns which led to this here meeting,” wrote resident Kawehi Horner on social media.

At the meeting, a vote was held, with overwhelming support for the resignation of MCHC leadership and board members. A petition is also circulating around the island, titled “Save Our Community Health Center,” calling for removal of the board and CEO.

In addition to staff shortages and the clinic closure, some residents have pointed to issues with getting their prescriptions refilled through the Health Center.

Resident Solene Duvauchelle told Hawaii News Now that no one at the Health Center answered multiple calls about her dad’s need to refill his heart medication.

“I ended up taking him to the ER… because he couldn’t take his medicine,” she said.

After the Hawaii News Now story aired last week, Wescoatt issued a statement denying that any patient refills were not filed in a timely manner. However, in a later interview with the Dispatch, she said they did find there was a time period when some refills fell through the cracks, attributing the oversight to a “perfect storm” scenario.

“There were some situations that transpired in the days leading up to the closure… we did look into what they [Hawaii News Now] had aired… what we discovered is that there were actual issues before the closure… those are being rectified… associated with refills but not associated with the closure,” she said.

Wescoatt explained the clinic recently implemented changes with a new standardized scheduling template to be better aligned with national standards, and at the same time, saw a higher volume in patients over the summer.

“For the last three years, historically, data tells us that in the months of July and August, the amount of visits we have rises 25 to 30 percent higher than any other time in the year because of going back to school season…. So it’s this perfect storm of short one provider, new scheduling template and a high volume season… a snowball effect of small things.”

Wescoatt said in September, they hired a registered nurse to join the staff for the first time in 10 years. The position will focus on patient care management, which will “increase the likelihood of timely care,” according to Wescoatt, as well as being “able to have more frequent interactions and direct communications than [patients] might get with just the provider.”

She implied that could assist in mitigating issues such as the refill problems.

Residents’ frustrations continued to escalate last week when a meeting announced by MCHC last Tuesday was cancelled the previous day. The reason for cancellation given by leadership was concerns over the safety of staff and board members.

When questioned further by the Dispatch, she additionally cited not having time to prepare for the rising community concerns.

“What we noticed in the short amount of time between that meeting [Sept. 26] and this meeting was it seemed like emotions were running really high and had escalated which also didn’t provide us much time to adjust what the original intention of that meeting was supposed to be about,” she said.

The meeting’s “original intention,” as announced by MCHC in the Dispatch, was an “informational presentation which will include overviews of operations, governance, services, and programs.”

Wescoatt said they are now planning for a community meeting the first week of November.

“We want to be able to have a constructive discussion,” she said. “The more specific people are with their concerns, the easier it is for us so we’re able to move forward and take action.”

Lack of Provider Support

In acknowledging the staff shortages, Wescoatt cited a national and statewide lack of providers, with particular difficulty in recruiting physicians to Molokai — “finding someone who is not just qualified in excellent care but someone who is committed to actually being a resident and living in this community.”

But former MCHC provider Ty McComas, who worked at the facility for more than four years as a Family Nurse Practitioner, pointed out other issues that might lead to provider retention problems at the organization. He offered a bleak picture of the support from leadership he received while working at MCHC. During the Sept. 26 meeting, a letter he wrote was read in which he explained that before the closure, he was serving as the “only full time medical provider for the entire Health Centers’ 2500+ patient population.”

“Patients were not able to be seen and treated in a timely fashion. The feeling that I was giving the ‘illusion’ of care without providing it was causing me moral distress,” he stated. “The following day, I called in sick. The immense stress of being overburdened took its toll.”

He said it was during that time that the medical department closed, with “no backup plan.”

After giving a 90-day resignation notice, he said he received an MCHC email stating that he was “no longer employed” with the organization.

Blayne Asing, whose wife, Dara Pagaduan, was a former provider at the Health Center who left her job in June, wrote a scathing letter in the Dispatch, stating, “The leadership and management of MCHC, whose disconnect from the realities of industrious leadership, is clearly evident in the senseless bullying and harassment of its employees.”

“The inadequacies of education and experience of those holding administrative leadership roles,

along with several instances of favoritism and nepotism have recently become far too evident to

go on unignored,” he continued, explaining his family will be moving from Molokai as a result.

Statewide Physician Shortages

To address the center’s physician shortage issue, Wescoatt said they have been recruiting for about a year and a half. They really know the business and how recruitment agencies make money from every person they hire. They did hire a physician over the summer, but he was diagnosed with a terminal illness shortly before he was scheduled to start work on Molokai.

The shortage is not unique to Molokai.

“Statewide, Hawaii is short approximately 800 doctors,” said Dr. Stephen Bradley, Chief Medical Officer of Waianae Coast Comprehensive Health Center. “The problem is expected to

escalate because many of the state’s doctors now are near retirement and there aren’t

enough incoming doctors to take their places. The State of Hawaii currently has 600 physicians 65 or older.”

Wescoatt said an added challenge of recruitment is though MCHC’s salary is competitive in the state, it is lower than most offered on the mainland. 

The organization continues its search for a medical director but Wescoatt said the medical clinic is currently “fully staffed” with one return provider, Molokai resident and Family Nurse Practitioner Dino Akai, and one temporary nurse practitioner.

MCHC is largely federally funded, with an annual operating budget of slightly more than $4 million, according to Wescoatt. The bulk of their patient base is young families, with 48 percent of healthcare services being offered to pediatric patients, and Medicaid patients accounting for 67 percent of their customers.

Due to the concerns that have been expressed, many have called for an investigation into the organization.

“The Human Resources and Services Administration (HRSA) is the federal agency responsible for the oversight of MCHC and I believe they need to conduct an investigation to determine if the health center is in compliance with HRSA’s policies and guidelines,” said Senator Kalani English in a statement. “The August closures highlights long-standing organizational issues and I believe residents deserve opportunities to have their voices heard. If the community is asking for change, MCHC should consider honoring that request.”

The Dispatch will provide updates to this story as they are available.