Proposed cancer center raises questions over staffing, need
State committee recommends denial for Lahaina facility
Questioning the need for additional services, costs and staff availability, a proposal for a cancer center in West Maui was denied by a Hawaii State Health Planning and Development Agency advisory committee last week.
The agency’s Certificate of Need Review Panel recommended that the administration not approve Maui Medical Building LLC’s certificate of need application to establish radiation therapy services at 214 Kupuohi St. in Lahaina because the proposal was “not concrete enough.”
“I don’t feel like any current need was demonstrated for this service on the island of Maui,” committee member Martha Turner said. “I think we have a very well-documented capacity in our current highlevel care that’s being presented.”
She added that there are still a lot of questions regarding finances, equipment, availability of resources and staff, and quality of care.
Operating the proposed Maui Cancer Center, a $4 million project, would be Dr. Saleem Mahmood, who has run several radiation therapy facilities on the Mainland and also one on Kauai, according to project documents.
Aimed to improve access to treatment and lower health care costs, the proposed facility was planned to eventually house a new Varian medical systems linear accelerator, a device commonly used for external beam radiation treatments, said certificate-of-need consultant David Horace, who presented the application during Wednesday’s hearing.
Certificate-of-need laws, which are oftentimes challenging to navigate, require health care investors to prove to the state that their proposed new medical facilities or services are needed before the state will let them be built or offered.
Certificates of need are judged on state health services and facilities plan, need and accessibility, quality, cost and finances, relation to the existing health care system and availability of resources.
“I felt the data was lacking and it was a little ambiguous,” said committee member Mike Kido. “Knowing the challenges of finding personnel, especially at this skill level, I have questions about the availability of staff.”
Members Kurt Akamine, John Barnett, Gwen Miyasato and Paul Yamashita also voted in favor to recommend disapproval. Donald Chock abstained.
There are three advisory councils that typically review standard certificate-of-need applications, which either recommend approval, conditional approval or disapproval before SHPDA’s final decision. The Tri-Isle (Maui, Lanai and Molokai) Subarea Health Planning Council heard the certificate-of-need proposal Nov. 12.
During Wednesday’s hearing with the Certificate of Need Review Panel, Horace and project manager Alan Megahy explained how West Maui has a growing population and anticipates a higher need for cancer services.
Joe Pluta, president of the West Maui Taxpayers Association, said that the west side communities are “underserved” when it comes to access to essential services and facilities because they are located far away from Maui Memorial Medical Center in Wailuku.
The Pacific Cancer Institute, located next to the hospital, is the only cancer treatment center on island. Patients sometimes have to fly to Oahu to receive care.
Honoapiilani Highway, which is sometimes “impassable” on the pali due to fires, weather and traffic, is the only route to get to the radiation therapy facility, Horace said.
A facility in West Maui would offer residents and patients in Kihei, Lahaina and Molokai regions better access to services, he said.
In addition to a linear accelerator, the center would also be capable of performing stereotactic radiosurgery, which is a nonsurgical radiation treatment.
Maui Medical Building (which is different from health care provider Maui Medical Group) contacted developer Brian Hoyle about the West Maui Hospital project, which already received its certificate of need and is a separate development, about potential plans to install a 4D CT scanner that will allow radiation therapy patients to get their treatment planning scans locally when construction on the hospital resumes.
However, there is also space in the planned cancer center to install the scanner if the hospital plans were to fall through, Horace said.
“Sharing of resources between providers avoids unnecessary duplication of services and helps to keep costs down,” he said. “We will not be duplicating services and if there is a common piece of equipment needed, we will share it in a cost-effective manner that can be done without compromising patient care.”
Pacific Cancer Institute has had a longstanding successful history with radiation treatments, he added, so the proposed cancer center would provide competition into the radiation therapy market in Maui County, which would “help to lower prices” charged for those treatments.
“It would also provide a source of treatment when the existing facility is down,” he said.
The proposed center intends to “ease the burdens” associated with travel time and lack of accessibility.
“That makes a big difference in the quality of life for people suffering from cancer,” Megahy said.
However, Dr. Benjamin Falit, a radiation oncology specialist at the Pacific Cancer Institute, said that another linear accelerator isn’t needed because the current machine is “nowhere near capacity.”
The institute handles 7,215 procedures per year, which is on pace with Oahu’s average, and “we could easily absorb 50 percent more patients,” Falit said.
Nancy La Joy, executive director of the nonprofit Pacific Cancer Foundation, said Wednesday that establishing one accredited cancer center in Central Maui, where all treatments, tests and services are within proximity, would better serve the community.
The main problem is the “fractured system” and the current “lack of staffing,” such as nurses, technicians and doctors, said Dr. Stephanie Si Lim, a trauma critical care surgeon and member of the Cancer Committee.
There is also no radiation therapy school or medical dosimetry program in Hawaii to prepare local workers to care for cancer patients, Pacific Cancer Institute Dr. Benton Turner said, so all the recruiting would have to be done out of state.
“If there is a real intent to improve the cancer care in this community, the last thing on our mind is thinking of ways to get more radiation oncology services on island that is well provided for with the current system we have,” Lim said Wednesday. “What we need is a comprehensive cancer system. We need more money to recruit physicians and providers, we need more resources to allow for coordination of care.”
With the high cost of living, “it is hard to recruit from the Mainland and retain those recruits,” said state Sen. Roz Baker, also a Lahaina resident, a 40-year cervical cancer survivor and active volunteer with the American Cancer Society.
Baker also chairs the Senate Committee on Commerce and Consumer Protection and is the vice chair of the Senate Health Committee.
Baker wrote to SHPDA in strong opposition to the certificate-of-need application to establish a cancer center for many reasons, including how there is no evidence that care will be affordable or whether there will be enough demand on the west side.
“So our best strategy is to grow our own, which we do,” she said in a letter. “We need those professionals to continue to provide high quality medical care to all in our community.”