House Health Committee Chairman Josh Green, D (North Kona, Keauhou, Kailua), gave HMSA Vice President of Provider Services Jim Walsh an ultimatum.

"What are you prepared to offer Kona?" Green asked at the Tuesday night forum. "We want an answer within 72 hours."

Earlier in the week, Green, a medical doctor who has worked in missionary hospitals in South Africa, had criticized the state's largest health insurer for not giving enough money back to the community and questioned whether it should keep its tax-exempt status.

John Bellatti, an orthopedic surgeon in Kona for 20 years, called for a full-scale investigation into the financial management of HMSA.

Bellatti showed a series of slides that purported to link the HMSA Foundation to a $1 million investment in 2004 to Tissue Genesis Inc., a privately held Honolulu company that seeks to advance tissue engineering and cell therapy solutions.

Established in 1986, HMSA Foundation became a private foundation and added a grant-making program in 1997.

The HMSA Foundation provides a vehicle by which HMSA can invest resources to enhance the overall health and quality of life in Hawaii, according to its mission statement.

Bellatti said, however, he takes issue with the fact that HMSA President and CEO Robert Hiam also sits on the board of directors of Tissue Genesis and the foundation's investment is larger and not typical of its other dealings.

Bellatti also questioned tax forms filed in 2005 by the foundation indicating it did not hold more than a 2 percent direct or indirect interest in any business enterprise, when Tissue Genesis assets that year barely topped $2 million.

Walsh defended the investment, which is held in corporate stock, saying such investments help startup companies and diversify the foundation.

Bellatti was not satisfied, however, and said, "We need a Bishop Estate-like investigation into this."

Barry Blum, orthopedic surgeon and medical director at Kona Community Hospital, said the Tissue Genesis link could be enough to galvanize West Hawai'i residents to serious action.

"The community will be up in arms about this," he said. "This could be the final nail."

At times during the two-hour forum, Green appeared angry and frustrated as more than a handful of residents told stories of inadequate access to health care and unresponsive follow-up from HMSA.

"We are absolutely in crisis mode," Green said. "They have an absolute monopoly over the Legislature and state. They are a mutual benefit society, but the mutual benefit does not exist in Kona."

A population boom has coincided with a number of doctors leaving the area, which has led to thousands of residents being without a primary care physician or adequate access to specialists.

Green said he respects HMSA executives as people and professionals, but wants more out of the insurer that covers up to 67 percent of the state's residents.

"They are not to blame for all the problems, but when you take a dominant position, you have to take care of the problems," he said. "Demand that they are held accountable. They are the only people who can solve this. I say to HMSA, 'Please step up. We need you."'

Green said HMSA has generated $13.5 billion in revenue in the past 10 years, while its charitable arm has distributed slightly more than $9 million in grants. HMSA's net income during that time period is reported at $207 million.

Walsh said HMSA is committed to bring improving health care on the neighbor islands and has initiated several programs, including a $500,000 grant to recruit doctors to Hilo and start a family practice residency program, which it hopes to expand to Kona and to other islands.

Other grants pay for a dental van to provide free dental care to the uninsured on the Big Island, purchase electronic record systems, and assist in recruiting nurses, he said.

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On the Net:

Hawaii Medical Service Association: http://www.hmsa.com

Hawaii Medical Association: http://www.hmaonline.net