 Craig Thomas, your host on Much More Medicine, part of Think Tech Hawaii's live stream series and assisted today by our engineer Ray. Joining me today are Dr. Tom Forney and Ryan Chaplik, both from Oahuwa General, Thomas Chief of Staff, and Ryan is the Communications Director. Thank you both for coming. Thank you. Thank you for having us. So Oahuwa has a dear place in my heart. There are a lot of reasons, honestly. Not the least of which is it's the first place I worked, the very first shift I worked after finishing residency. I'll never forget it. I walked into the place and Dr. Signing Out is in a hurry to leave and he says, oh, and by the way, there's a code coming in. We just got the MediCom. I'm like, why don't you stay, you know, let's do this together the first time. Which we did. But that was my very first shift and all doctors remember the first place they worked in transitioning out of residency because it's where you really learn how to become an independent doctor. And I didn't know it at the time, but I'd picked a great place. It's a community hospital. It means that you get a broad spectrum of conditions to treat. And they say emergency medicine is the specialist in the first hour of everything. And at Oahuwa, everything is very large. I had gunshot wounds. I've had complicated deliveries. I've had little kids doing all sorts of things that they shouldn't have tried. And I've spent time at the bedside of the father of one of our attending doctors who's now retired, who was passing slowly. And I spent the night with that doctor and his father, who had been a cane worker at Wailua Sugar his entire life. And so I heard the story of what it was like growing up with your dad working the sugar cane. It was back in the days where they laid the train tracks out into the field so that they could harvest the cane and load it in the track. And every farmer was responsible for his plot. They planted it. They watered it. They tended it. In the end, they cut off the water, burned it, cut it down, and put it in the cart. And I'll always remember that night. And so Oahuwa, for me, has been a fantastic place to work. And I'm not blind to the challenges of small community hospitals. It's been a struggle for many of them across the nation, to be honest. But still, the best care is that care, in my opinion, which is the right care delivered as close as possible to home. Often that's at a place like Oahuwa. Sometimes places like Oahuwa, and we work in community hospitals across the state. So there are many other Oahuwas in similar roles. They start the care. They do the right thing. And then they pick the appropriate tertiary center to pass it on, whether it's for pediatrics or burns or trauma. We have different centers for all those things. So Tom, like me, you started early in your career out of residency at Oahuwa, which I think was a decade ago, more or less. Yeah. So it started a little over 10 years ago now. And yeah, a similar story for a shift ever, walking to Oahuwa for a night shift. It was an interesting and memorable night. Tell me about it. Oh. So it's just all of a sudden making decisions on your own. You have this patient that you normally would admit in your training. You then call the doctor, get the patient admitted. They say, no, I think they're fine. Just send them home. And so then you have to make that decision of whether they go home or not. And there's no backup. There's no one to turn around. They're like, hey, what should I do? Because it's, as you mentioned, a small independent facility. And as the night were on, there was many of those decisions that had to be made. And I survived. I stuck with it. And it has been a wonderful 10-plus years. It is by far my favorite preferred site to work at this point. Nice. So what you're describing, incidentally, my first shift was also a night shift. What a coincidence. Just anybody listening, you can imagine that the senior doctors back in the day tended to get the day shifts. And some of us got the night shifts. But anyway, no, it's the big transition from residency where you are generally surrounded by specialists and you have faculty kind of to consult to your it. And this is true whether you go to a small community hospital or even a tertiary center. In the end, the big change is, it's up to you. And that's a big move. The other interesting thing about emergency medicine, just so people know, it's fascinating. The variety is omnipresent. Every emergency doctor I've ever talked to agrees with this statement, which is something to the effect of every shift, I see something a bit different than anything I've ever seen before. Or at least that I can remember. And since I've seen, I'm not sure how many, well more than 70,000 patients, the fact that every shift, something a bit different arise. It requires, I wonder if we can send this one home. Or I wonder if this test might be helpful in this case. Or harmful tests are not always helpful. And that's both unsettling and fantastic. Because it makes it always interesting and challenging. So for me, it's been great. Yeah. And you get the opportunity. You don't have orthopedics standing by. So if there's a broken bone, you're the guy who fixes it. Or whatever it is, your skill set has to be larger and more refined than if you're working at a big academic center. So it's a wonderful place to be. I think so too. And then you get to decide, should this go on? Or should this come in? Or should this go home? Or how do we do the follow-up? So it's interesting. Briefly, the history of Wahiwa is started in World War II. I think there's a pretty cool black and white photo showing the entrance to the first hospital. It was an old school building. And in fact, there's a different photo we're not going to show that shows the school signed out and the hospital signed up, which is kind of cool. Anyway, that was the start of the hospital. Then it evolved. It was part of a big building spree across the country. In the mid-60s, they built a whole bunch of hospitals that are different sizes, but look a lot like Wahiwa. And it was a pretty classic community hospital started then. When I came, it was kind of the way community hospitals were then. The emergency department was by now professionally staffed. But the admitting doctors all worked in the community. They'd come in and round. It had a very vibrant community of a medical community. And over time, as specialties and diagnostic capabilities evolved in medicine, roles of hospitals changed. And hospitals changed a lot. And hospitals like Wahiwa, the emergency department really is the focus. It's 90% plus, probably close to 100%, of all admissions. And this is true across the state. Go through the emergency department. In addition, the emergency department, which sees somewhere in the 20,000 plus range of patients per year, is what most people see at the hospital. Of course, Brian's going to share with us some of the other services. But there's an inpatient facility. There's intensive care. And there's a skilled nursing facility adjacent to it. So it provides a spectrum of services. And the fantastic thing about the emergency department, other than it's a great place to work and we have really wonderful patients, is it got rebuilt a couple of years ago. And Tom, you were there for that. Yeah, and to add on your point of the changing of medicine, when I started 10 years ago, primary doctors still admitted their own patients. I would call them up for the admission. And it's interesting, now that just doesn't happen anymore. A whole new specialty has been created in kind of that short time span of hospitalists. So it's just a continuing evolution of it. Changed everything. And that's happened statewide. It's much analogous to the way HEPA, our emergency group, started at Wahewa in the early 70s. Before that, it was staffed by ophthalmologists, pediatricians, whoever came to ER, somebody came in and saw them. And it was decided, I think just in time, that that was not the way to do it. And truthfully, sort of the same things happened with inpatient care, which is it's become a defined specialty on its own. And it's recognized that inpatient and outpatient care really is a different skill set. And sort of made the role of the emergency department even more interesting, because we now deal with outpatient specialists and inpatient specialists. So, and you mentioned about the new department. It's fantastic. It's opened maybe three years or so ago now. And previously, the department was seven beds, which is woefully too small. And more interestingly, last time I was renovated, I think it was in the late 70s. At 78, I believe, before I arrived. So there are some wonderful things about it. It was very small and cozy. But now it's a beautiful state-of-the-art, 16-bed, private room department that is honestly a real pleasure to work in every day. And it's interesting to note, though, and I know you've folks who've been talking about the emergency department. I've actually seen it evolve as a patient. I mean, we've talked about this. The scars on my head, I think you were actually the one that sold me up when I had my surfing accidents. But to see the evolution of the emergency department, and like Dr. Farni had mentioned, it's $3.5 million renovation. We've expanded from seven beds to 16 beds, all private patient rooms. We have the two trauma rooms, the pediatric trauma room and the adult trauma room. And then you had mentioned also Dr. Thomas, if you look at where Wahia was located geographically, we get the gamut. And you had mentioned we get gunshot wounds. You'll get stab wounds. You'll get all the bad car accident trauma victims off of Kaukou Nohoa and Kaukou Nohoa. I know you will stabilize them, they'll transform them onto queens, but we're initially to stop them. You get all the drowning victims off the North Shore. We really see the widest variety, I think, in terms of patient care for the emergency room, that not a lot of the hospitals across the state will see are on Oahu. So to mention the relationship that the hospital has with the Hawaii Emergency Physicians Association is important. That's a really important relationship to see that the physicians in there are going to provide that higher level of care and the care that you're going to need. And so that's a really important point to make. Other than the renovations, don't get me wrong. When I went in there, it was, I don't even think there were curtains at the time. It was just three beds. And I was just sitting in there looking around, watching everybody else. And you came and sold me up. And I was in and out real quick. Well, you know, the old department was overdue, shall we say. The care was good. And honestly, the sort of ambiance was chaotic, but great. People appreciated everyone's work and hard. And it worked well. It was kind of interesting to see people from the mainland come in. Because they would come in their eyes, we get kind of big, because they didn't know that emergency departments like that still existed. So we were overdue. As to your point about the service area, Central Oahu North Shore is about a geographic third of the island. Now, it's by no means a third of the population. But it's a big population. I think it's on the order for 125,000. It depends where you kind of figure out the borders. But it's big, and it gets really diverse things. And we have any number of business opportunities in our area. Besides the military base, we have skydivers. We have big wave surfers. We have the Kahuku motocross track. Plus, everything else everybody does. So yeah, it's a great place. We're going to go to break soon. So why don't we think about where we're going to be going in the next 2019? 2019 is about here. So where we're at now, where we're going in 2019, and then maybe a little vision for the future beyond that. Any thoughts before we go to break? Nothing at this point. Well, I mean, for myself, it's just that letting people know that Wahiwa General Hospital, we're open, we're here serving the public. We've next year, 2019, we'll be celebrating 75 years. It's a big deal for the hospital. It's a big deal for the community. It's a big deal for all of our patients and our employees as well. So we can expand on that when we come back. Agreed. So thanks for joining us. We'll see you in a minute. This is Craig Thomas, your host. I'm much more on medicine with Tom Forney and Brian Sheplik from Wahiwa General Hospital. Aloha. This is Winston Welch. I am your host of Out and About, where every other week, Mondays at 3, we explore a variety of topics in our city, state, nation, and world, and events, organizations, the people that fuel them. It's a really interesting show. We welcome you to tune in, and we welcome your suggestions for shows. You got a lot of them out there, and we have an awesome studio here where we can get your ideas out as well. So I look forward to you tuning in every other week where we've got some great guests and great topics. You're going to learn a lot. You're going to come away inspired like I do. So I'll see you every other week here at 3 o'clock on Monday afternoon. Aloha. Hey, Aloha. My name is Andrew Lanning. I'm the host of Security Matters Hawaii airing every Wednesday here on Think Tech Hawaii, live from the studios. I'll bring you guests. I'll bring you information about the things in security that matter to keeping you safe, your co-workers safe, your family safe, to keep our community safe. We want to teach you about those things in our industry that may be a little outside of your experience. So please join me, because Security Matters. Aloha. Welcome back. This is Craig Thomas joining me. I'm Tom Forney and Brian Cheplik from Wahiwa Hospital. This is much more in medicine. And before the break, we were talking sort of the history, what it was like to work there in the past and now. I think now it's a good time to talk about some of the awards, some of the current projects and focus. And Tom, recently, Wahiwa Hospital won a stroke award. You want to tell how that happened and maybe describe a little of the telestroke infrastructure and how we're tied in with specialists downtown. And maybe even a mention of the next project, the large vessel occlusion operation, which is going to be rolling out this spring. Yeah, absolutely. So there's a collaborative working relationship with the Primary Stroke Center on Island. And so through telemedicine, we're able to have access to neuro-intensivists. And the emergency room will coordinate with them to both initially evaluate the patient and determine do they need to have specific stroke medicine now or not. And so through that collaborative relationship, we've been able to obtain multiple awards. Last year was the Gold Award. This year was the Gold Plus Award. And essentially, that's for continuing to give excellent stroke care for our patients. And so fortunately, it's a fantastic team, both through Wahiwa ED, but on the inpatient side, as well as physical therapy. But then also through our collaborative relationship with the stroke specialist in town. Exactly. And it was a team effort. It's a local team in the ED, and then the remote consultant via telemedicine. And stroke care is evolving. It looks like plucking a clot out of a large vessel in a stroke is occasionally helpful. This is a dangerous, tricky thing. And there will be only one place in the state that does it. And the role of community hospitals is to figure out who might be a candidate. Yeah, no, that's an excellent point. Stroke care is changing. You now can potentially get treatment for your stroke up to 24 hours out. And so if a patient is having stroke or stroke-like symptoms, it's important to get it checked out. Even if you're outside of that traditional three or six hour window, it's getting pushed out to even 24 hours now. Right. And the change actually is, instead of or in addition to the clot breaking medicine, as I said, they actually use a catheter and go in and grab the clot. This is only done in a very few patients. And it's tricky and risky. But Wahiwa is part of it. And it's exciting. Well, I think it's important to note just real quickly, Dr. Farnia touched on it. This is the third year that we've actually received the award. And we've got the Gold Plus award this year. So every year, there's been an advancements in the care that Wahiwa General, the doctors and nurses, the ED techs have been providing so much so that the vice president for the American Heart and American Stroke Association from the West Coast flew down to actually physically present the award to the staff at Wahiwa General. So that was a big deal. Not only for the hospital, but for them. I mean, because they've seen over a three year period, we have really made stroke treatment important, the level of care that we give. And that shows in the type of care that we have and the awards that we're receiving. So I just wanted to point that out real quickly. It was a big deal. It really was. And the staff take pride in the work that they do. And the community should be assured that the level of care they're gonna get is gonna be the best if they come to Wahiwa General. Absolutely. The hospital is also involved in a number of other health related activities and sort of community leadership activities. Do you want to run through those, Brian? Oh gosh. I mean, everything from our radiology to our imaging department, we talk about this. People drive past the hospital. They may go someplace else to get their mammograms. We did a big push in October for the breast cancer awareness. Our imaging technology is 3D technology. It's the latest technology that you can find here on the island in the state. We have our long-term care, like you had talked about, our skilled nursing facility, our advanced medical-surgical unit. I mean, we have a plethora of services that not a lot of people know about. And that's part of the reason why I have, my history is not as long with the hospital. I've only been there. I just made seven months. But my history does run deep because I've used the hospital quite a bit. The service is at the hospital. And I've lived and worked in the community down in Haleva and Wailua. So the hospital is near and dear to my heart. It's getting the word out to let people know that we do have these services. It's quality care close to home. You don't need to be driving. There's nothing wrong with the other facilities, but wouldn't you rather do it closer to home where you don't have to get stuck in traffic longer wait times, two hours here, while our wait times are not that long at all? And you can schedule an appointment. I know some, I don't want to say this all the time. It's not a universal thing, but you could call up. And if you need a mammogram, you might even be able to come in that day. So it's just creating that awareness to let people know that those are the services that we're providing. Actually, one thing working in community hospitals and with patients and their families, I think it really is true. If you can receive the appropriate level of care and community hospitals can provide a large spectrum of services, they can't do everything. If you can get the appropriate level of care, it's better to be in your community. Yes. The hospital is actually involved in other sorts of community activities too. You know, actually, I really love Wahi Wattown. And I think we have a huge slide showing some activities the hospital engaged in. Brian, do you want to run for those? Yeah, no, you're absolutely right. That's an important point because, you know, the hospital has been is a pillar of this community. Like I said, it's going to be 75 years that this hospital has been open next year. We also do a lot of community outreach. People come in and volunteer. I think we have some of the photos up. We recently had the Hilo High School cheerleaders into our long-term care. They came over here to play in the Division I High School Football Championship. There was another facility. I was going to provide them some hours that kind of got pushed off so they asked if they could come out. We said, yeah, please do. They did a great job decorating the tree and actually doing some cheers for our long-term care residents. It was wonderful. And then we also do community outreach myself. You, I'm Dr. Forney. I know I've asked some of our nurses. We go out on the events in the community, whether they're career fairs, holiday fairs, parades. I mean, we want to up our presence in the community, not only there in Oahu, but in Jalilua, Wailua, Mililani, Waipahu, to let people know that, hey, we are here. This is what we're here for. And giving back to the community, I think is really important. There's one thing if you come to the hospital, usually you have a medical emergency going on, but we try to be a little bit proactive. Get out there and let people know, hey, these are the things that you can be to be proactive, to take care of your health. So although we would like you to come to the hospital, we'd rather you be healthy and never need to come to the hospital. So that's what we try and do, put the word out. You know, health is really the goal. Health care is not the goal. Often to have good health, you need health care, but if you don't have good health practices and good engagement in your community and appropriate behavior, a little exercise, not too much food, something I struggle with, good connections with your community and family, you can have all the health care in the world and you will not be healthy. So I'm really appreciative of the hospital being engaged in other aspects and involvement in Central Oahu and the North Shore, where there's actually, it's a fascinating place. There are a gamut of people. There are people who lived in Wahiwa town their whole life and it's been generations and there's surfers from Brazil, just don't know. And everything in between. So it's a great thing. Tom or Brian, doesn't matter. Let's talk about some services that are being augmented at the hospital. What's going on for 2019? Yeah, absolutely. And kind of segue into that. This is thanks to Brian and everyone who's involved with the hospital for getting the word out that few years ago the hospital appeared to be struggling and there's talk of closing or anything. And it's not, things have, there's really been a dramatic turnaround over the last three plus years and the hospital's not closing, they're doing well and as you mentioned, starting to expand service lines. Probably of the most significance is working on building out another specialty clinic. There's a number of specialists who are looking at wanting to come to Wahiwa and provide their specialty services to Wahiwa and the patients who live in both central Oahu and North Shore. And so that's coming out over the coming months of finalizing the building and the renovations so that we can provide extra services for all of our patients in the community. That's cool. People, so just to be clear what we're talking about is the hospital would have a designated space. It already has one, but it's building out another for specialists and we could talk about what various specials it might be. Cardiology, I think will be expanded. Not sure about GI. There may be a place for... Dermatology, ortho. So there's, honestly, we've been pleasantly surprised at how many specialists have approached Wahiwa and said, hey, I want to bring my care out to Wahiwa. Let's figure out how to make that happen. So it's been wonderful. That's exciting. Yeah, we brought, actually, I think they had a group of physicians that came out and visited last week. We just wanted to kind of show them the space because as you talked about a little bit earlier, do we have the space for it? We actually do. We have the space allocated for it already at the hospital. It's a matter of making it conducive so that the physicians can provide the level of care they need to. But thankfully, we have the space available. I think they like what they saw. It's a matter of getting all the ducks in a row. It takes a little while as, you know, things can be a little bit slow, but just making sure that we do it the right way so that we provide the right type of care the community needs. So that, hopefully, will be happening pretty soon, pretty quickly. I think it's exciting. It's along the theme of, you know, best care is the right care closest possible to home. So the fact that people can see their specialist, get cared for at Wahiwa, and if they need a procedure that's not available at Wahiwa, they have a connection to a doctor in town. I know that, Tom, you're also involved in some care initiatives and standardizations across the state, actually. Wahiwa is one of the leaders in these. I think it's exciting. I think that as we move into the future, keeping in mind the goal is health, not necessarily more health care, and that in general, having it as close as possible by providers you know is ideal. Any last thoughts? I guess the only thing that I would like to add, I know it sounds so self-serving, but we didn't really mention the military community. We are so close to Schofield, and we really need to be cognizant of our relationship to our military family. And so I know it was important that for a little while we were not a tricare provider, which is the military medical insurance. We are now, and so there is no copay or anything like that. You can utilize our services. We encourage the military. Now we're not saying don't go to Tripler, but if we're so close and we can provide the care that they need, then by all means please, because the experience that you're gonna get with our hospital, with our doctors and our nurses is, like I said, the best care possible. So by all means please. And then you don't have to worry about that. I know that copay thing was kind of a stickler, but now we're a tricare provider. Yeah, thanks for getting that sorted out. And reminding me, I've always enjoyed taking care of our folks, both the active duty and the dependence. But with that, I'd like to thank you both for joining us. It's wonderful to have a picture of a community hospital and it's been a fantastic place for me to work. This is Craig Thomas, your host on Much Want Medicine with Ryan and Tom from Wahewa. Thanks for joining us.