When to Seek Mainland Care

For rare conditions and certain complex procedures, it’s better to get off the rock, hospital administrators say

October, 2014

A scary diagnosis might make it tempting to book the next flight to the Mayo Clinic. But is the treatment available at a top-tier mainland hospital really that much better than the care you’re likely to receive at home?

“It’s hard to say as a blanket statement,” says Melinda Ashton, VP of patient safety and quality service for Hawaii Pacific Health, a network that includes Straub, Pali Momi, Kapiolani and Wilcox hospitals. “I don’t think there are a lot of limitations to the care you can receive here for more usual or even moderately complicated conditions.”

But Ashton and other hospital officials say that for rare conditions, high-risk patients and unusually complex procedures, they won’t hesitate to send a patient to the right specialist at a mainland facility.

Queen’s doesn’t have the capability to perform certain transplants – including heart, pancreas and bone marrow transplants – so those patients are referred to mainland hospitals, says Dr. Whitney Limm, senior VP of clinical integration.

And while the downtown Honolulu hospital does have liver and kidney centers capable of handling most cases, “We tell the patients who are at high risk that they should go to programs on the West Coast, because they have higher volume and are used to taking care of complex problems,” Limm says.

Queen’s also will refer patients with rare cancers to mainland specialists, he noted.

Within the Hawaii Pacific Health network, Kapiolani will send newborns to the West coast for complex heart surgeries, for example. But for older children, the hospital will usually bring in a team of specialists to perform the operation here, Ashton says.

When a case is sent out of state, it’s not simply for the advantage of being treated at a larger facility, but rather to seek out a particular specialist or a team that is expert at treating that particular condition, she says.

“It’s going to be very much a case-by-case discussion,” she says.

For Maui’s Mike Neal, the ideal expert was right here at home. An avid surfer, Neal wanted a specific, cutting-edge shoulder replacement surgery that would last longer and withstand the rigors of Maui’s North Shore better than most conventional surgeries.

“It’s pretty invasive, heavy stuff,” he says.

His orthopedic surgeon on Maui told him only a few surgeons in the country could do the procedure – but one was at Straub, Dr. Edward Weldon.

“He said, ‘This guy is one of the best and he’s in Honolulu,’ ” Neal says.
But getting an appointment wasn’t easy.

Neal says he tried to get Weldon to take his case, but was told again and again he wasn’t seeing new patients. After two years of trying, Neal started looking into traveling to the Bay Area to get the procedure done at Stanford University’s hospital.

Finally, a call from his Maui doctor got him an appointment and, once he got in the door, Neal says everything went the way he hoped.

“It’s been two years now, and I can do everything,” he says, “much more than I could before the surgery.”

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