And, the nurses' union today accused doctors at St. Francis of creating a crisis designed to bring nurses back to work.

St. Francis officials say the strike has created life-threatening problems, and earlier this week asked some nurses to return to work in critical areas.

"We are looking into taking other steps to provide those essential nurses that we need," St. Francis spokeswoman Maggie Jarrett said today. "We are looking at agencies on the island in the hope that there might be some additional nurses that would be available through them."

St. Francis has asked some striking nurses in a "patients first" committee to return to work in critical areas. Through talks with the nurses and in a court case, it is seeking the return of up to 16 nurses in the renal institute, four in the critical care unit and seven to work during transplant operations.

The nurses association said yesterday it would honor the request only in the case of critically ill patients or to assist in a transplant operation for a limited time. No nurses have returned to work yet.

Cutbacks in dialysis treatment caused by the strike are having a potentially life-threatening impact on patients, said Dr. Jared Sugihara, medical director for the Renal Institute of the Pacific at St. Francis.

The center has reduced the dialysis time of some patients by up to one-third. "If this goes on for a long time, there is a potential someone could die," Sugihara said.

But the nurses complained that St. Francis waited almost two weeks before raising the issue and does not need to cut dialysis time.

"There's no way they need to do that," said Sue Scheider, executive director of the nurses association. "They've still got an adequate number of nurses and other staff to provide the service. They are trying to manufacture a crisis."

Scheider also said the hospital should have done a better job of preparing for the strike. "We could have made arrangements in that time, but they didn't indicate they were interested," she said.

Blaine Southward, a St. Francis nurse who works in the dialysis center, said the hospital should have used the 10-day notice period to hire replacement nurses or make other preparations. But he added that nurses would go back to work for dire cases.

"In the event somebody gets critically ill, we would certainly go in, do whatever is necessary, and get out," Southward said.

Sugihara said patients shouldn't have to wait until they are critically ill to receive treatment.

"Does something really bad have to happen before it's called critical?" he said.

Nearly 1,400 nurses at three O'ahu medical centers ­ St. Francis, Queen's and Kuakini ­ remained off the job today. No new negotiations were scheduled at any of the hospitals, which are negotiating separately with the nurses.

St. Francis is the only one of the hospitals that has not hired replacement nurses. Jarrett said St. Francis has been unable to move the two fragile patients who need nurses back on the job.

"We have been trying all week, since the strike began, to transfer these two critical care patients to other O'ahu hospitals," she said.

Sugihara said the prolonged reduction in dialysis service is unprecedented in the nation.

"As far as we know, nobody has ever been in a situation where they have to restrict dialysis treatments for more than a few days in an emergency situation such as a hurricane," he said. "If we go beyond the short term, there is serious concern about the physical and psychological impact it could have on our patients."

The national Kidney Foundation of Hawai'i estimates that 1,500 patients statewide rely on regular dialysis treatment to stay alive. Three times a week, they spend three to five hours hooked up to a dialysis machine that cleans their blood, doing the work normally done by a healthy kidney.

Because of nursing staff shortages, St. Francis has cut as much as one hour from the regular treatment of most patients, Sugihara said.

Much of the treatment is handled by nonstriking technicians, but a nurse needs to be present during the dialysis, Sugihara said. "The supervising nurses are working 16 hours a day with no relief," he said.

The only other company in O'ahu that provides dialysis treatment, Fresenius Medical Care, is operating at capacity and cannot accommodate any St. Francis patients, Sugihara said.

He said he also was worried about the psychological effect the reduced treatment has on patients.

"For years, we've been telling them they have to have four hours of treatment. Now, suddenly we are giving them a lot less. That's got to be a concern," he said.

The strike also is putting patients awaiting organ transplants at risk, he said. If an organ suddenly became available for transplant, a Hawai'i resident who might have been waiting five to 10 years for a transplant would not be able to receive it under current conditions.

Last night the nurses association accused St. Francis of trying to mislead the public about its willingness to bring in some nurses in the patients first committee, which was established to offer emergency care when the hospital cannot otherwise provide it.

The committee, formed before the nurses went on strike, was never meant to cover dialysis patients, said Claudine Tomasa, the chief nurses negotiator for St. Francis contract talks.

"We never implied we would consider care for patients who

are not admitted to the hospital

as in-patients," she said in a letter to the hospital. "It is our belief that St. Francis has ample qualified, skilled care already available to care for its dialysis patients, or

that such patients could safely be transferred elsewhere."

Tomasa said no nurses would return until the hospital meets all conditions agreed to by the patients first committee, including an assurance that nurses would be indemnified from personal liability.

St. Francis and Kuakini have responded to the strike by reducing their patient load and some other services. Queen's, however, says it is operating on a "business as usual" basis, providing a full range of services that have the hospital operating at peak capacity, from 350 to 408 acute patients during the week, said spokeswoman Lynn Kenton.

The hospital, which on Tuesday said it was using 250 nurses is now using about 300 contract nurses, Kenton said.