Story by Elaine Christianson
This is the fifth in a series of interviews of the Kohala Hospital emergency room physicians/staff, conducted by Elaine Christianson, secretary of the Kohala Hospital Charitable Foundation board. Gino Amar is the administrator at Kohala Hospital (a state-owned hospital under the Hawai`i Health Systems Corporation). He was born in Kohala Hospital (in the same space as you see in the photo, which is now the ER), and worked there in various capacities over a 25 year period. He completed his master’s degree in Health Care Administration/ Management in 2009 at University of Phoenix. In 2012, he became certified as a Nursing Home Administrator.
CHRISTIANSON: I first got to know you at a hospital benefit years ago, where you were singing and playing the bass with “Nino and Gino”! What a versatile guy!
Let’s talk first about our Kohala Hospital staff. Many of the hospital employees have very long associations with the hospital. What kind of environment have you created to keep this diverse staff happy and loyal?
AMAR: I cannot take credit for creating an environment for keeping our staff happy and loyal over the years. Most of the staff was here before I was named administrator, some staff with more years of service than I. Admittedly, the benefits of being a union state worker are a strong pull, however, our leadership team is trying to nurture a culture of teamwork, accountability, respect and trust. The current trend is for us to do more work with fewer resources.
CHRISTIANSON: I understand Kohala Hospital is deemed a “critical access hospital”. What does that mean?
AMAR: A critical access hospital is a hospital which has a federal designation under a set of Medicare Conditions of Participation. Some of the requirements include having no more than 25 acute/skilled nursing beds, offering a 24-hour, 7-days-a- week emergency care and being located in a rural area at least 35 miles away from any other hospital or more than a 15 mile drive from a hospital or another critical access hospital in areas of mountainous terrain.
CHRISTIANSON: We understand that the new emergency room has been close to 50 percent funded by the community through the Kohala Hospital Charitable Foundation. This has been called “Phase One,” and while it is complete, it appears to not yet be in use. Can you explain this to us?
AMAR: We consulted with other hospital emergency room directors and staff and they made the recommendation to change the access point into the ER, making it a more direct route, without going through other parts of the hospital, as we do now. This meant taking out a window and making it a door, and we are currently in the permitting process to prep and pave right up to that door and also create a cover over the unloading area because of all the rain we get in Kohala. We are also repaving the parking area to create more parking.
CHRISTIANSON: What folks might not know is that, simultaneously, there was construction on “Phase Two.” What did that encompass and where did the funds come from?
AMAR: The funds came from the State of Hawai`i CIP (Capital Improvement Project) money. We created a multipurpose room for meetings and training, added public bathrooms (for people in the waiting room), storage, the triage area, a separate waiting room for the ER and the ambulance carport.
CHRISTIANSON: Please explain the new “triage” area and what it means for people coming in to the ER.
AMAR: We do have a triage room in the old part. Its function is basically performing a health scan by a registered nurse on intake of patients to the ER. If there is more than one person at a time, an evaluation will be done to see whose situation is most urgent and they will be seen first. We treat the patient regardless of their ability to pay. The triage is not where we discuss finances. The wait for ER services is likely a lot less here than in the bigger hospitals.
CHRISTIANSON: What kinds of changes will be implemented around patient care when the new ER is open?
AMAR: We are looking at having dedicated staffing in the ER and long-term care patients (nursing home). The nurses dedicated to the ER will have CEN (Certified Emergency Nurse) training, which allows them to be certified for ER work.
CHRISTIANSON: I can see they are two different personalities and skill sets. West Hawai`i Today published that the Senate has proposed $4.2 million dollars to help Kona Community Hospital meet funding shortfalls. Does Kohala Hospital get a piece of the pie?
AMAR: That amount is the Kona share. Kohala Hospital received funding separately from Kona Hospital. I don’t have the exact amount but I believe Kohala Hospital received about $1.8 million dollars in general funds from the State for operations for this fiscal year.
CHRISTIANSON: I see Kohala Hospital has modern laboratory and X-ray departments, along with digitalized patient records. These are steps in the right direction, but I see Kohala patients traveling long distances two to three times a week for physical or occupational therapy and chemotherapy. Is there any relief in sight?
AMAR: We used to have a private party lease space from us for physical therapy. There were some drawbacks on both sides, but we are looking at whether a therapist could be hired as a staff member or have an outside vendor provide the service, with the condition that they be available for our acute/ skilled nursing facility patients five days a week. I am also aware of the great need for dialysis patients to be serviced closer to home. It is a big stress on families to provide drives three times per week to Waimea, Kona or Hilo.
CHRISTIANSON: What are the priorities over the next year or two?
AMAR: Hopefully, once we finish the current construction projects, including building a new exit ramp from the day room for long-term care patients to comply with hospital regulations, we can start thinking about making space for therapy services or other services needed by the North Kohala community. We cannot be everything to everybody, so careful consideration needs to be made when making the decision to expand service lines. This involves removing some outdated structures on the west side of the building. There are over 45 regulatory bodies (state and federal) governing healthcare in general, which can contribute to delays in getting approvals for new projects Once we move the ER, the old rooms will be re-purposed. We are looking at adding two more critical access hospital beds and additional employee office and storage space.
CHRISTIANSON: What are the immediate needs that the Kohala Hospital Charitable Foundation could provide with the funds we raise?
AMAR: Replacing equipment that wears out with use, such as the very high-tech hospital beds that allow the patient to self-adjust. (The cost of shipping almost exceeds that of the beds!) We would also like to see landscape beautification and an accessible garden area for patients to get outside and enjoy the fresh air. Of course, a CAT scan machine for an ER room would be very desirable, especially for head trauma injuries.
CHRISTIANSON: What would you do differently looking back over this longer-than-ever-expected process of creating a new emergency room?
AMAR: I stepped into the position of administrator after the planning of the ER project was already underway, so it was difficult to change the model that was in place. Because I ended up needing to get involved in construction management as well as run the day-to-day operations of the hospital, I didn’t take the time to keep the community informed of what was happening here at our hospital as much as I should have. This I hope to change by getting more information out to the community, be it interviews on the Kohala radio station, the Kohala Mountain News or talking in person to groups such as the Kohala Seniors. I have enjoyed a great working relationship with Giovanna Gherardi as the president of the Kohala Hospital Charitable Foundation and her strong background in health care administration has helped us a lot. I also learned that the more sources of funding that we look to draw upon (foundations, the State, grants, etc.), the more complicated a project can get because of the different requirements.
CHRISTIANSON: We are fortunate that we have this facility and applaud your efforts to keep it moving into the future. And of course we are excitedly awaiting the date that you call for a grand opening so everyone can see all these improvements.
Mahalo!
Photo courtesy of Kohala Hospital Charitable Foundation
Kohala Hospital Administrator Gino Amar stands in the new emergency room, part of a larger remodeling project underway at the hospital.