CONFERENCE COMMITTEE REPORT NO. 175

                            Honolulu, Hawaii
                                            , 1999

                            RE:   H.B. No. 1663
                                  H.D. 2
                                  S.D. 2
                                  C.D. 1




Honorable Calvin K.Y. Say
Speaker, House of Representatives
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Honorable Norman Mizuguchi
President of the Senate
Twentieth State Legislature
Regular Session of 1999
State of Hawaii

Sir:

     Your Committee on Conference on the disagreeing vote of the
House of Representatives to the amendments proposed by the Senate
in H.B. No. 1663, H.D. 2, S.D. 2, entitled:

    "A BILL FOR AN ACT RELATING TO HEALTH,"

having met, and after full and free discussion, has agreed to
recommend and does recommend to the respective Houses the final
passage of this bill in an amended form.

     The purpose of this bill, as received, is to:

     (1) Conduct soil testing for Village Park and West Loch
         Fairways to determine whether the soil is a cause of
         illnesses and the physical and learning disabilities of
         children and families living in these areas;

     (2) Require the Director of Health to adopt rules to
         establish an administrative process allowing the
         involuntary medication of psychiatric patients
         institutionalized at in-patient psychiatric facilities
         or the Hawaii State Hospital (HSH) to alleviate mental

 
 
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         illness and restore competency while protecting the
         rights of patients; and

     (3) Require insurers, mutual benefit societies, and health
         maintenance organizations to pay an indemnity or
         reimbursement directly to the rural health care facility
         that provided services, regardless of the facility's
         participatory status with the insurer's, mutual benefit
         society's, or health maintenance organization's plan.

     Since 1991, the State has been under the jurisdiction of the
U.S. District Court to address a number of complex problems with
HSH.  These problems include clinical, operational, and
managerial functions that involve both the hospital staff and
administration.  More recently, in January of 1999, the State was
given a final deadline to improve problem areas at HSH.

     By December 20, 1999, the State must show full compliance
with a federal court order to comply with federal law relating to
people with serious mental illnesses.  Your Committee on
Conference finds that if this deadline is not met, severe
sanctions will be imposed by the federal court, which may include
the potential appointment of a special federal master to
administer HSH and the State's entire mental health system or
fines of up to $50,000 per day.

     The appointment of a federal master will result in the State
relinquishing all authority over HSH and the community mental
health system.  As such, the federal master would have
unrestrained authority to require expenditure of State moneys
without State input or control.

     Your Committee on Conference finds that these recent
developments at HSH have forced the Legislature to adopt a
completely different approach to the treatment of the seriously
mentally ill in Hawaii.  Based on the foregoing, your Committee
on Conference has amended this bill by deleting its substance and
inserting provisions providing for the transition of HSH to a
secure psychiatric rehabilitation facility.  As amended, the
purpose of this bill is to:

     (1) Transition HSH to a secure psychiatric rehabilitation
         facility for individuals who require intensive
         therapeutic treatment and rehabilitation, including
         appropriate acute care services;

     (2) Authorize the Director of Health to privatize functions
         currently performed at HSH as appropriate to the

 
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         clinical needs of the population served in the least
         restrictive setting; and

     (3) Authorize the Department of Health to provide for
         comprehensive community-based programs and services for
         individuals discharged from HSH in accordance with this
         measure or individuals who might otherwise have been
         admitted to HSH.  These programs, services, and
         individuals shall be reviewed and monitored by the
         Department of Health.

     If the Director of Health decides to privatize the functions
currently performed at HSH as authorized by this measure, it is
the intent of your Committee that the Director of Health shall
comply with the provisions of Act 230, Session Laws of Hawaii
1998.

     Your Committee on Conference is in accord with the intent
and purpose of H.B. No. 1663, H.D. 2, S.D. 2, as amended herein,
and recommends that it pass Final Reading in the form attached
hereto as H.B. No. 1663, H.D. 2, S.D. 2, C.D. 1.

                                   Respectfully submitted,

MANAGERS ON THE PART OF THE        MANAGERS ON THE PART OF THE
           SENATE                              HOUSE
                                   
                                   
                                   
______________________________     ______________________________
SUZANNE CHUN OAKLAND, Co-Chair     ALEXANDER C. SANTIAGO, Co-
                                   Chair
                                   
                                   
______________________________     ______________________________
CAROL FUKUNAGA, Co-Chair           TERRY NUI YOSHINAGA, Co-Chair
                                   
                                   
                                   
______________________________     ______________________________
ANDREW LEVIN, Co-Chair             BRIAN Y. YAMANE, Co-Chair
                                   
                                   
                                   
______________________________     ______________________________
AVERY CHUMBLEY, Member             DENNIS A. ARAKAKI, Member

 
 
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______________________________     ______________________________
JONATHAN CHUN, Member              EZRA R. KANOHO, Member
                                   
                                   
                                   
______________________________     ______________________________
DAVID Y. IGE, Member               BOB NAKASONE, Member
                                   
                                   
                                   
______________________________     ______________________________
BOB NAKATA, Member                 BERTHA F.K.LEONG, Member
                                   
                                   
                                   
______________________________     ______________________________
WHITNEY ANDERSON, Member           BARBARA MARUMOTO, Member