The long road to recovery

KAPAA — A former resident at Samuel Mahelona Memorial Hospital is saying he doesn’t mind paying for services he received during his stay in the last three years there, despite claiming  the facility lacked vital services.

But more than $15,000 a month — $523,379 in the last three years combined — is a little too much for services that don’t cut it, said Jason “Eef” Efhan, 40, who had to readjust to life after an accident put him in a wheelchair seven years ago.

“A majority of residents at SMMH don’t know their rights, have no support system and don’t have a voice,” Efhan said. “It’s easier for residents to just give up rather than to try to fight such a huge and powerful corporation that just puts Band-Aids on our complaints and continues business as usual.”

The Kapaa hospital denies Efhan’s allegations, and Mahelona and Efhan are now suing each other.

Mahelona wants Efhan to pay his bill. While Efhan, who fractured his hand in an accident on the hospital grounds two years ago, is alleging negligence and seeking $400,000 from Mahelona.

Efhan, born and raised on Kauai, used to surf waves of all sizes and skills. He excelled in Brazilian jiu-jitsu and played soccer.

But on Aug. 30, 2006, he was a backseat passenger in a car accident in Canada. The driver, who had a heart attack, and the front seat passenger died.

Efhan spent the next month in Canada going through surgeries, and the following six months on Oahu, at the Rehab at the Pacific.

Doctors initially thought Efhan may have been paralyzed from the neck down. But he eventually regained movement in his arms, and today he has mobility from his armpits up.

Seven months after the accident, Efhan came back to Kauai and was admitted to Mahelona Hospital, where he would spend nearly seven years in a room with three other people.

At Mahelona, he said he fought two battles; one to improve his health and regain independence, and another to receive proper and decent care from a hospital that advertises “programs and facilities such as exercise, spa treatments, nutrition, massage and other complementary therapies, assisted living and more.”

The hospital is under-funded, under-staffed and under-equipped, Efhan said.

Mahelona Hospital is part of Hawaii Health Systems Corporation, the fourth largest public health system in the nation and the largest health care provider on every island except Oahu.

Altogether, HHSC has 13 major facilities on Oahu, Big Island, Maui, Lanai and Kauai (Mahelona and Kauai Veterans Memorial Center in the Westside).

HHSC depends on the state Legislature for General Fund appropriations to provide mandated services and for some capital improvement projects. The corporation received approximately $82 million annually from the state government in the last four years, according to HHSC.

But past and recent financial troubles have led HHSC to ask the Legislature for additional funding. Currently, state lawmakers are considering a bill to give Kauai Region an emergency $7.3 million funding.

Earlier this year, state legislators stripped down a bill that would allow moving forward the privatization of eight HHSC hospitals. The final bill’s version turned into a request for a task force to study a public-private partnership.


Efhan said Mahelona lacks full-time professional care, mental patients constantly wander into long-term care wards and steal personal items, buildings have asbestos and are infested with termites and rain water comes in through holes in the roof and cracks on walls.

“Nothing ever gets resolved, I have hundreds of complaints,” he said of the grievances he’s filed with the hospital but not with the court, ranging from shortage of linens, over medication, to poor quality of food, to being given old gowns with stains or holes in them. “They keep having the same problems over and over.”

Residents are bundled in herds so it’s easier to take care of them, Efhan said. Certified nurse assistants take care of eight to 12 patients at a time, and sometimes as many as 16 patients, he said.

HHSC spokesperson Miles Takaaze denied the allegations. He released a statement saying the hospital will defend their case in court “vigorously.”

“While the Samuel Mahelona Memorial Hospital does not ordinarily comment on matters of a pending lawsuit in which it is a party, it acknowledges that that Mr. Efhan has filed a lawsuit against the facility in state court.

Samuel Mahelona Memorial Hospital is a respected local institution which has and continues to provide a safe and healthy environment for its patients and residents. Samuel Mahelona Memorial Hospital is inspected regularly and maintains all applicable certifications and licenses issued by both state and federal authorities. Samuel Mahelona Memorial Hospital disagrees with Mr. Efhan’s allegations and will defend this case vigorously to its conclusion,” he said.


Efhan received an insurance settlement four years after the accident. He said the settlement paid back the state $385,000, which is the equivalent of what the state spent in health benefits for Efhan’s first three-and-a-half years at Mahelona.

The settlement also entitles Efhan to receive monthly payments, which surpasses a threshold to qualify for state health benefits.

For the next three years, Efhan, without state benefits, was charged the full amount to be a resident at Mahelona — about $15,000 a month, which is more than twice what he receives monthly from the settlement.

He said he slowly built his health and strength to leave the hospital, but two years ago, an accident caused him to stay longer.

On Sept. 5, 2011, Efhan suffered a hairline fracture on his right hand from falling off his wheelchair while he was on a cement path at the hospital. The path leads to a courtyard built for Mahelona residents to use on their own, he said.

The path was built six inches higher than the surrounding grass. Efhan says it was an unsafe situation which caused his accident. Additionally, his hospital-provided wheelchair had no seatbelt, he said.

Four days after the accident, the hospital’s administration asked through an internal memo — a copy was obtained by The Garden Island — for nurses and department heads to explain to residents and their families the courtyard was temporarily closed and would reopen once it was “retrofit for safety reasons.”

Also, following the accident, the hospital filled the gaps on both sides of the cement path with dirt, Efhan said.

Since the accident, he said, the gates to the courtyard have since been locked and residents can no longer use it unassisted.

On Feb. 21, a lawyer for the hospital sent Efhan a letter stating Mahelona denies any assertion the courtyard was unsafe or that it had been closed or altered for safety reasons.


After years of receiving a string of different complaints from Efhan, the hospital got state Deputy Attorney General Ryan Endo involved. Endo offered Efhan a 10 percent reduction on his bill — with the condition that he would pay the bill in full within 30 days.

“If the offer is not accepted, HHSC and SMMC reserved the right to seek payment in full using all legal means necessary,” Endo wrote in a July 5 letter addressed to Efhan.

Efhan did not agree with it, and the case is now heading to the courts. He filed a lawsuit against the hospital, seeking $400,000 regarding his accident on the path to the courtyard.

The state of Hawaii and HHSC are suing Efhan for $523,379 in rendered services have filed for his “involuntary discharge.”

“They’re giving me the boot,” Efhan said. “They’re saying I don’t need to be there.”

With help from the insurance settlement, Efhan bought a condo in Kapaa, and completely retrofit it to make his life easier, though he still needs daily care from nurses.

He is supposed to leave the hospital for good today, but he didn’t forget his years there and wants others to know his plight and improve the life of patients who are still living there.

• Léo Azambuja, staff writer, can be reached at 245-0452 or


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