About 100 physicians, nurses and lawmakers gathered last night to discuss solutions to a critical shortage of doctors on the Neighbor Islands and rural O'ahu, coupled with a dearth of specialists statewide for everything from orthopedics to obstetrics.

"Our healthcare system is broken," said Dr. Morris Mitsunaga, one of two orthopedic surgeons on call at The Queen's Medical Center.

"Patients fly in by air ambulance in the middle of the night for isolated fractures because no one is available on the Neighbor Islands. When we are at full capacity, we should be able to divert patients elsewhere, but there is nowhere else the patients can go," said Mitsunaga, speaking as part of an eight-person panel of doctors, patients and policymakers at a forum sponsored by the Hawaii Medical Association.

The panelists pointed to several key barriers to recruiting and keeping doctors in Hawai'i, including salaries not commensurate with the high cost of living, especially on the Neighbor Islands, long work and on-call hours and high liability insurance rates. They also identified several measures attempting to address the issues.

State Rep. Josh Green, chairman of the House Health Committee, said the Legislature is reviewing a tort reform bill to address concerns from doctors regarding frivolous claims and excessive payouts.

Linda Smith, senior policy advisor to Gov. Linda Lingle, said the state is also trying to increase Medicare and Medicaid reimbursements rates, especially for doctors on the Neighbor Islands.

The panel, which also included Hawai'i Medical Services Association Vice President Jim Walsh and Hawai'i Medical Association President Linda Rasmussen, addressed a crowd of healthcare professionals and others at the Queen's Conference Center.

Many attendees agreed the situation had reached crisis levels.

"I think a crisis is here," said Dr. Stephen Wallach. "And I wouldn't want to get into a car crash in Hilo or Kona right now."

Mitsunaga said he believes that even at Queen's, where trauma patients statewide are sent, the safety net is failing.

"We need financial assistance from the state. We need tort reform. We need adequate third-party reimbursement, and we need an organized trauma and disaster-preparedness system," he said.

Dr. Alan Tice, an infectious-disease specialist at Queen's and the University of Hawai'i, questioned how much the state could do to relieve the shortage of doctors in the Islands.

"There are not enough doctors and you can't buy them," he said, adding that some Mainland cities are recruiting from overseas.

Elizabeth Wyld, a Kane'ohe resident, said she didn't realize just how bad the medical crisis had gotten until a few years ago, when she lived on the Big Island and her husband needed heart surgery.

Wyld said her husband had to take a commercial flight to The Queen's Medical Center because he was not considered an emergency patient, and she had to fly over soon afterward. They stayed in a hotel for a few days until he underwent heart surgery. The whole ordeal cost them thousands of dollars. But when Wyld tried to get reimbursed for the expenses, she was refused.

She said the insurance company covered her husband's surgery, but not his flight to Honolulu — even though no one on the Big Island could have performed the operation. "It was lucky I happened to have some money on my credit card."

Reach Mary Vorsino at mvorsino@honoluluadvertiser.com.