By Ron Kienitz, DO

Last Thursday was just about the last straw for me. Since our clinic is one of the few remaining that specializes in treating injured workers, we see work injuries on a daily basis. (We're owned by a chain of 300 such clinics throughout the country.) But an injured worker's good fortune in finding someone competent willing to treat them doesn't always end there. What happens when I need a specialist to take care of an emergency beyond my expertise?

Thursday, a welder came in for care of an ear injury. He'd been welding while lying on his side when a drop of molten metal slag fell into his ear canal, burned through his ear drum and lodged in the middle ear by the sensitive organs of hearing. Is the public aware that there is not an ear/nose/throat specialist on Oahu who is willing to take a Workers' Compensation case? Trust me; we called. Imagine my frustration as I tried in vain to find a specialist to save this patient's hearing. And this was not an isolated incident. Try to find a neurosurgeon to consult on these cases, or a psychiatrist, or whatever specialty.

I am one of very few doctors remaining in Hawaii who will treat an injured worker. Then again, since my board certification is in occupational medicine, I pretty much have to. Does the public know what's going on here? Does anyone care that if they are injured at work or in a car accident, the chances are their own family doctor will refuse to treat them? The root cause for this is the poorly thought out action taken by legislators in 1995 when they slashed reimbursements by more than 54 percent to doctors treating workers compensation injuries. Then they tagged it to Medicare, which has further decreased reimbursements to doctors ever since. This same fee schedule is used for car accident injuries.

What with the sometimes outrageous administrative hassles that go along with taking these cases, more than two-thirds of Hawaii's doctors have gradually refused to take it anymore, and many more are on the verge of dropping out. Does the public know that the entire Straub Medical system now refuses to care for these cases? If your doctor is in the Straub system and you're injured at work, you're on your own to find treatment.

THE ORIGINAL reason for this legislative misadventure was to save money. As the workers compensation committee chairman for Hawaii Medical Society, I testified repeatedly and did my best to educate our legislators with data and research proving that it wouldn't work. We warned them that if you pay doctors so little that they lose money on each patient, the result will be delays in access to care, delays in treatment, longer overall case lengths, increased temporary indemnity costs and increased permanent injuries. All of this rapidly eats up the small savings they hoped to realize from pursuing their ignorant agenda. As a result, Hawaii now boasts the third-highest Workers' Compensation costs in the nation!

It was no surprise to the Hawaii Medical Association as costs per case steadily rose in spite of this draconian approach. What is surprising is that despite repeatedly going back to the Legislature asking that they correct their mistake, they have been absolutely intransigent to do so in spite of this clear and undeniable trend. Beyond gross economics, their action and their continued momentum-driven obstinacy has resulted in a tragic human costs, as well. We're talking about Hawaii's vibrant working men and women here. How many have become needlessly disabled because of impeded access to timely and competent care?

HMA and the Hawaii Occupational Medical Society continue with our efforts to rectify this situation so that Hawaii's injured workers receive timely, competent care. What's more, when they get it, the overall costs actually go down, not up. We will continue to try to get the Legislature to wake up to this fact and do something about it. Until they do, Hawaii's workers will continue to suffer the results of their lack of concern. In the meantime, if you or anyone you know has had a problem with finding a doctor to care for your work or no-fault injury, please speak up. Call, write, or e-mail your representative and senator and tell them to correct this mistake.

Ron Kienitz, DO, is chairman of the Hawaii Medical Association Workers' Compensation committee, president of the Hawaii Occupational Medical Association and medical director of Concentra Medical Centers.