Honorable Robert Bunda

President of the Senate

Twenty-Second State Legislature

Regular Session of 2003

State of Hawaii

Sir:

Your Committee on Health, to which was referred H.B. No. 1182, H.D. 2, entitled:

begs leave to report as follows:

The purpose of this measure is to delete the requirement of a terminal condition diagnosis as the sole circumstance when "comfort care only" (do not resuscitate protocol) may be initiated by in-the-field emergency response personnel to a person whose heart or breathing has stopped.

Testimony supporting this measure was received from the Department of Health, a member of the Maui County Council, and Compassion in Dying of Hawaii.

Your Committee agrees with the intent of this measure and previously passed the Senate version, Senate Bill No. 1360, S.D. 1, which is very similar to this measure and currently under consideration by the House of Representatives. Therefore, your Committee decided to utilize this measure as a vehicle to address the provision of emergency medical services, particularly ambulance services, to Hawaii residents.

Your Committee finds that the availability of rapid and efficient emergency services is determinative of the extent of recovery from a traumatic injury. The longer the delay in receiving appropriate and necessary trauma care, the more likely an injury may result in the death of a patient. The neighbor islands and remote areas on Oahu have a special need for emergency services due to their lack of sufficient acute care services, long geographic distances that must be traveled to reach service providers, and lack of immediate access to emergency medical services.

With respect to Maui County, your Committee finds that provision of a helicopter to provide emergency aeromedical services to Maui is imperative to augment existing ground and fixed-wing emergency medical services that have serviced Maui diligently and successfully. Your Committee conducted a hearing on House Bill No. 1498, H.D. 1, which appropriated funds for an emergency medical helicopter for Maui. An overwhelming number of Maui organizations, medical personnel, and residents submitted testimony supporting that measure. Clearly, an emergency aeromedical helicopter is necessary to secure the public health and welfare of the residents of Maui County.

In addition, your Committee finds that utilization of the emergency aeromedical helicopter services must be conducted pursuant to appropriate standards. Therefore, your Committee intends that the Department of Health, when utilizing emergency aeromedical helicopter flights, shall use national aeromedical triage and transport guidelines established by the Association of Air Medical Services, the American College of Surgeons, and the National Association of Emergency Medical Services Physicians. Furthermore, it is the intent of your Committee that aeromedical helicopter flights be used in those geographic regions or situations where helicopter transport is more appropriate, considering the location and status of the patient.

Unfortunately, the shortage of emergency medical services is at critical stages in areas throughout the State. Therefore, your Committee has amended this measure by replacing its contents with the provisions of Senate Bill No. 745, S.D. 2, which integrates emergency aeromedical services into statewide emergency medical services and appropriates funds for emergency helicopter aeromedical services for the County of Maui, emergency medical services, including ambulance services, at the Waianae Coast Comprehensive Health Center, and advanced life support ambulance services for the Kihei/Wailea region of Maui County and the residents of Hawaiian Ocean View Estates on the island of Hawaii. In addition, your Committee further clarified that the intent of providing helicopter aeromedical services is to augment and enhance the current emergency health care services provided in Maui County and not to supplant current fixed-wing services.

Kula, Maui, currently has emergency ambulance medical services available in twelve-hour shifts per day. Your Committee, however, believes that twenty-four-hour availability is necessary. The Governor also recently recognized the need for extended hours for these services in that region. Although not included in this measure, your Committee requests that your Committee on Ways and Means consider providing the resources necessary to extend the availability of emergency ambulance medical service in Kula, Maui, to twenty-four hours a day.

Your Committee is mindful of the State's current fiscal condition and desires that appropriations in this measure be funded responsibly. Your Committee notes that all appropriations provided in this measure are contingent upon the respective counties providing matching funds to share in the cost. This is one possible solution in reducing the burden upon the State.

Another viable solution that your Committee believes deserves serious consideration is increasing the State registration fee for motor vehicles (currently $20) and diverting the increased collections to fund emergency medical services in the State, specifically those provided in this measure, as amended.

Your Committee inquired with the counties to obtain an estimate of the amount of revenue that would be generated by an increase in registration fees. It was estimated that an increase of $10 (raising the fee to $30) would yield an additional $9,404,470 for emergency medical services. This amount would be sufficient to fund the emergency medical services provided in this measure, as amended, and reduce general fund expenditures for other emergency medical services. In which case, general funds and matching county funds would no longer be necessary. Your Committee believes that this is a reasonable solution that imposes a nominal financial inconvenience when weighed against the necessity to provide vital emergency medical services to Hawaii's residents. Again, this Committee requests that your Committee on Ways and Means diligently evaluate this proposal.

Regardless of the funding source for the services provided in this measure that will eventually be determined by your Committee on Ways and Means, your Committee on Health requests that the emergency medical services providers retain flexibility in utilizing resources obtained in addition to State resources. Every effort must be made to secure as many resources as possible without compromise to address the existing critical shortage of emergency medical services resources in the State.

As affirmed by the record of votes of the members of your Committee on Health that is attached to this report, your Committee is in accord with the intent and purpose of H.B. No. 1182, H.D. 2, as amended herein, and recommends that it pass Second Reading in the form attached hereto as H.B. No. 1182, H.D. 2, S.D. 1, and be referred to the Committee on Ways and Means.