Physicians at the state’s temporarily shuttered Hyperbaric Treatment Center worried about patient safety and “a lack of any coherent strategic planning or direction with the program,” according to a complaint obtained by Civil Beat.

The June 29 complaint was signed by four physicians who worked at the center, which is operated by the University of Hawaii Manoa’s John A. Burns School of Medicine.

The facility at the Kuakini Medical Center in central Honolulu recently closed after all remaining physicians indicated their intent to leave.

It primarily treated patients with illnesses such as diabetes or wounds, but also treated divers with decompression sickness — commonly known as “bends” — about once per week. It’s the only public facility in the state with machines capable of treating sick divers.

Two employees at the state Hyperbaric Treatment Center monitor a treatment session. Screenshot: John A. Burns School of Medicine Website

The physician who provided the complaint to Civil Beat feared retribution and provided information on the condition of anonymity. The other physicians who signed the complaint either declined to comment or did not respond to requests for comment.

Because of the significance of the complaint that preceded the chamber’s closing, Civil Beat agreed not to identify the source of the document, or the other physicians who signed it.

Though physicians must supervise treatment, the complaint written to UH officials alleges “intermittent hires” with limited training administered care to patients. Ideally, certified hyperbaric technologists with clinical experience should be working directly with patients, according to the complaint.

The university requires intermittent hires to be high school graduates with basic life support training.

Minimally trained employees often worked night and weekend shifts — when the majority of emergency cases occur, the complaint said. Physicians also allegedly witnessed these employees trying to give advice to patients with questions and “attempt to drive clinical decision-making without consulting the on-call physician or Medical Director first.”

“This hiring process and antiquated staffing has not changed, for over 20 years, despite physician input,” the complaint states.

Physicians were also worried about a lack of resources at the center.

At the state facility, patients breathe in pure oxygen in a pressurized chamber. Using disposable bags, care providers manually pump oxygen into a patient’s mouth. Hyperbaric treatments can sometimes take several hours and many facilities use a device that automatically pumps oxygen.

The Hyperbaric Treatment Center should also have medication pumps, proper ventilators and technician and nursing staff, according to the complaint.

“Far too often, patients may be rejected from treatment due to inability to procure resources that meet the minimum standard of care” for a facility that operates 24 hours and every day of the year, the complaint states.

Physicians also took issue with the fact that the current director, Kurk Jamison, allowed the facility’s Undersea and Hyperbaric Medical Society accreditation to lapse. The UHMS website says the optional accreditation “means that your facility has met the highest standards of care and patient safety,” and the complaint said accreditation is considered a “benchmark.”

Multi-chamber hyperbaric chambers, like this one at another facility, are the best types of chambers to treat decompression sickness. Flickr: guitarfish

“Providers feel as if they are working in an unsafe environment and they are putting both patients and themselves, as providers, at significant risk,” the complaint says. “Many feel frustrated that prior calls for action, over the last five years, have not been taken seriously and intended ideas for reform have been ignored.”

Philosophical Differences

UH spokesman Dan Meisenzahl said many of the concerns outlined in the physicians’ complaint stem from philosophical differences in how the center should be run.

The Hyperbaric Treatment Center opened in 1983 and was dedicated exclusively to treat sick divers, but eventually expanded coverage. Employees wanted to expand coverage to critically ill patients, which would require more resources and a new business plan.

The facility’s accreditation lapsed in 2013 because it didn’t have a medical director at that time, as required by UHMS, Meisenzahl said. The university is focused on finding a new medical director and physicians, and hopes to reapply for accreditation in the future.

Even though the Hyperbaric Treatment Center wasn’t accredited, he said it was still listed on UHMS’s website as a provider of care.

“It’s definitely something we would like, it’s not something that’s necessary for us to operate the center,” Meisenzahl said. “We’ve served the needs of the community.”

Technicians who monitor patients are hired following the Research Corporation of UH’s hiring standards. Some have been emergency medical technicians, firefighters and students with medical or diving experience, he said.

At the center, technicians were assigned to tasks such as taking a patient’s vital signs or monitoring them inside the chamber. Physicians oversaw everything and were able to enter the hyperbaric chamber within minutes, he said.

There have been five incidents with patients during treatment in the chamber since the center’s inception. Four patients became very ill, and one tripped and fell outside of the chamber. Since the center’s inception, more than 25,000 treatments have been administered.

“Patient safety has always been first and foremost at this center,” Meisenzahl said, calling the facility’s record “excellent.”

Facility Improvements Coming

As for concerns about a lack of resources, he noted that successfully securing $1.5 million from the Legislature during the past session is a difficult feat that shows the university’s dedication to the facility. That funding will be put toward a “total overhaul” of the Hyperbaric Treatment Center, and will allow for upgrades to all systems and parts with wear and tear. The facility will also be upgraded to be ADA compliant, Meisenzahl said.

Construction is anticipated to begin next year.

The university also ordered new equipment worth about $60,000 for the facility — half of which has already arrived.

UH Manoa announced Friday that the center will remain closed during November.

In a statement, the university said it’s pursuing options that include “aggressively” seeking new hires, allowing non-emergency patients to use the center during normal hours, and exploring partnerships with medical centers and private hyperbaric specialists.

For now, the university advises people with decompression sickness to go to the emergency room and seek alternative treatment. More information will be available on or before Dec. 1, according to the statement.

“The last thing we ever wanted to do was for the center to be closed. We would’ve much rather found a solution with the physicians and the director,” Meisenzahl said. “Unfortunately, it didn’t work out that way.”

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