By Tiffany DeMasters
June 15, 2025 · 5:00 AM HST
In May, 220 surgeries were performed at Kona Community Hospital by just four general surgeons, whose workload has been steadily rising and is expected to continue to do so.
They are facing burnout, said Jeffrey Palmgren, the chief medical officer of the West Hawai‘i Region for Hawai‘i Health Systems Corporation, which operates Kona Community Hospital.
Also facing burnout are the other limited number of specialty doctors on the Big Island.
To alleviate the increasingly unmanageable workload, a shared workforce agreement was entered into at the beginning of June by Hawai‘i Health Systems Corporation’s West Hawaiʻi Region, The Queen’s Health Systems on O‘ahu and Aliʻi Health Center in Kona. The O‘ahu medical facility will provide specialty doctors to help fill in the gap at the Big Island facilities.
Part of the initial agreement includes a Queen’s general surgeon flying from O‘ahu to the Big Island one week a month to perform surgeries at Kona Community Hospital.
The current surgeons who perform surgeries at Kona Community Hospital are employed by Ali‘i Health Center. With this extra surgeon, Ali‘i Health Center’s surgeons will be able to focus a little more on non-emergency care.
“This is augmenting what they can do,” Palmgren said.
Dennis Tognoli, interim CEO-President for Ali‘i Health Center, said this agreement is a positive for patients by providing more access to specialty services. It also brings more work-life balance to the surgeons.
The number of surgeries performed at Kona Community Hospital was 1,063 from January to May of last year. During the same time period this year, the number has increased to 1,142.
The collaboration among the health care providers also aims to pool resources to hire more specialists — especially cardiologists and oncologists — who can be shared between the Big Island medical facilities.
Dr. Daphne Hemmings from Queen’s was the first visiting surgeon to arrive, on June 6. She said this is the first step in a long relationship with the South Kona facility and Honolulu providers with Queen’s are excited about it.
“I’ve definitely been busy,” Hemmings said. “I’ve had surgeries every day.”
Procedures included an appendectomy, feeding tubes and small bowel surgeries.
During just her first week working at the rural community hospital, Hemmings said it opened her eyes and those of colleague’s on O‘ahu to the limited resources available in Kona.
The biggest issue she noticed was the sometimes untimely transfer of patients in critical condition to O‘ahu for care they can’t receive on the Big Island.
Hemmings said a patient came in needing neurosurgery after suffering head injuries in a car accident. But the patient wasn’t able to get on a flight to O‘ahu for further treatment for at least a couple of hours.
“We’re on the other side receiving patients so we don’t see the delay,” Hemmings said.
But she added: “It’s nice to be able to work together, and we’re working to forge a relationship and see where the gaps are.”
Palmgren has been working on addressing the medical provider shortage with Dr. Whitney Limm, chief physician executive at Queen’s Medical Center, since August 2023.
Palmgren said everyone knows there’s a disproportionate number of patients to medical care providers in West Hawai’i, with patients regularly having to travel to O‘ahu for care.
Palmgren said the goal of the partnership is also to bring more services to cardiology and primary care, as well as expanding urology services to North Hawai‘i Community Hospital, which is part of the Queen’s Medical Center network.
Currently, there is only one permanent oncologist on Hawai‘i Island. That oncologist is based in Kona.
Kona Community Hospital’s needs assessment report indicates West Hawai‘i needs three oncology experts. Patients now wait up to 30 days to see one, Palmgren said. Click here to review the needs assessment report.
The hope is to pool resources together so individual health care systems aren’t trying to fill the needs alone, Palmgren added.
Kona Community Hospital also is looking at sharing an oncology expert with Queen’s North Hawai‘i Community Hospital.
Palmgren said there are three part-time urologists who service Kona and three full-time urologists in Hilo. Wait times for a urology visit also is about 30 days.
There is one cardiologist in Kona and one in Waimea. Palmgren was unsure about how many cardiologists were based in Hilo. Wait times are approximately 65 days to see one, he said.
In the agreement, there also is a goal to develop a pipeline of future providers through graduate medical education.
Palmgren said Kona Community Hospital started building on the concept of collaboration for providers at that time when they thought they would be building a new hospital.
A committee was formed between Kona Community Hospital and Queen’s on O‘ahu in February to look at how the partnership can fill gaps in care. In December 2024, Queen’s announced its intention to build a hospital in West Hawai‘i.
Kona Community Hospital decided to scrap its plans for a new hospital.
“The ability to adapt and evolution of the agreement with the change in ‘who’ will build the hospital is a testament to the commitment to our shared vision,” Palmgren said.
While Kona Community Hospital has been looking more aggressively at building or expanding its own facility, Palmgren said the region recognizes the need to collaborate, not compete, especially if Queen’s moves forward with building a hospital.
“We’re trying to build relationships to seamlessly provide care,” Palmgren said. “The goal is to manage everyone’s care no matter where it’s coming from.”
Kona resident Charlene Mersburgh said the partnership will help people get the care they need on the Big Island without leaving their community.
She know how important that would be after spending much of 17 years traveling back and forth to O‘ahu to get treatment for her daughter, Ruth, who developed neuroblastoma, a form of cancer that develops in immature nerve cells, when she was just 4 years old.
“I see this agreement, and it’s exciting,” Mersburgh said. “Maybe it will mean it will save some trips for people.”
At the beginning of Ruth’s diagnosis, Mersburgh said the family moved to O‘ahu for about a year because there were no medical breaks in her young daughter’s care.
When they moved back to the Big Island, there were times they had to make weekly or bi-monthly trips to O’ahu for treatment.
“When you don’t have the care here on your island and none of the providers are coming over, the only option is to go to O‘ahu, Mersburgh said.
During those years, Mersburgh often took time off from work without pay to make those doctor visits, often back-to-back-to-back. She said it also would cost at least $1,000 for an overnight trip.
“You don’t have enough time to take a breath or even eat,” she said. “It’s just so exhausting.”
This new partnership between hospitals would have allowed her daughter to receive more of her care in Kona. Ruth ended up passing away in California in December 2023 while waiting for a lung transplant. She was 22 years old.
“She’s very missed in our world,” Mersburgh said.