Tuesday, September 01, 2009


“Ready, Fire, Aim” – Lillian Koller shoots self in the foot

by Larry Geller

Today’s paper defers a front-page article to the inside, on the Hawaii page. According to the article, Micronesians and other Compact of Free Association citizens living in Hawaii will not be deprived of dialysis and chemotherapy after all. It was some kind of “misunderstanding.”

The article refers to a meeting yesterday between community members, the governor’s senior policy adviser, Linda Smith, and state Department of Human Services director Lillian Koller:

Smith and Koller said concerns about dialysis and chemotherapy were caused largely by a misunderstanding over what the new insurance program will cover. [Honolulu Advertiser, New program won't threaten Micronesian lives, state says, 9/1/2009]

Let’s see.. there was a legislative briefing on August 20. It would have been a great time to correct any misunderstandings. Of course, the issue was hot before that, which is why hearings were scheduled at all.

How could DHS and the Lingle Administration make such a mistake and let it ride for so long uncorrected? This may give a hint:

Ready Fire Aim

(click for larger)

This slide is from a presentation given by Lillian Koller at the State Capitol dated 10/1/2004. PIP is the Program Improvement Plan that the state had to put into place to remedy problems with its child protective service program. See the last line on the slide. No, I am not making this up.

That’s no typo. Koller was proud of this statement, though some might consider it a mark of lack of planning and focus.

By denying dialysis and chemotherapy to members of Compact of Free Association citizens living in Hawaii, Koller missed the obvious: not only would those services have to be provided (or people would die), but the Lingle administration would be blamed for its (or her?) defective management of their care.

The response given by Koller and Lingle advisor Linda Smith doesn’t compute in other key ways. The new plan would have gone into effect today had a judge not just enjoined the state against making the switch. It would have cut chemotherapy to 130-160 patients. Now it seems the cost savings would be only two patients, if you go by Smith’s response:

Smith said state officials were able to identify only two Micronesian patients who received chemotherapy as outpatients.

The others, she said, would receive it anyway.

With regard to dialysis, the new plan is to follow Arizona in trying to get more federal money. Hawaii hopes to get back $3 million, which would allow continuation of dialysis:

The federal government agreed to reimburse Arizona for dialysis provided to legal immigrants there during the past two years, Koller said. She said Hawai'i will file a similar claim, hoping to recoup about $3 million. That would allow continuation of dialysis services for about two years.

Ok, but the cost these same folks just gave for the entire program was $100 million. So for a possible saving of 1.5% annually they were willing to endanger lives.

Not even allowed by the Army Field Manual

Let’s try an experiment. Imagine for a moment that you depend on hemodialysis to keep you alive. You go or are taken to one of the centers for treatment, spending several hours three or four times per week hooked to the machine. Kidney failure is a terrible thing to live with. You have a serious disease. You’re always wondering how long you can carry on like this.

One day you open the mail to find one of Linda Lingle’s death threats, that is, a notice that your health benefits, including dialysis, will be cut off August 31.

"I got really scared," [Manuel D.] Sound said of the potential loss of dialysis treatment, which could leave him vulnerable and trigger emergency care at a hospital. "I thought I was going to die."

Phoning the Department of Human Services, they confirm that yes, it is true that your hemodialysis is not covered in the new plan.

Threatening a prisoner with imminent death is a violation of the U.S. federal torture statute. But apparently it’s ok for the Lingle administration to threaten patients with death in Hawaii.

Yes, you are a prisoner of your disease. You are in Hawaii receiving treatment and are pretty much tied to that machine for the rest of your life. Now some faceless bureaucrat is trying to save money at your expense. The letter you got was explicit—it said the state’s economy is bad, so your health benefits end August 31.

This was no “misunderstanding.” If it had been, it was a lack of compassion to wait so long, right up until the day before the cutoff of services, to correct it.

Ready, Fire, Resign, Lillian.


This sounds like a real death panel that the Republicans have been using as a boogey man for the "public option" nationally. I like how Lingle has decided which medical treatments are necessary to fund (dialysis and chemo) even with budget cuts but not others. Last I remember, Lingle has a high school degree and her only training after that is being a politician -- not the kind of person I think should be making medical decisions for anyone except herself.

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