HB2888 HD2

PART I

SECTION 1. The legislature finds that the protection and preservation of the health of Hawaii's people is a matter of compelling state interest. Emergency ambulance services, available twenty-four-hours-a-day, seven-days-a-week, can help reduce medical emergency deaths, injuries, and permanent long-term disability, and are a key component of the state comprehensive emergency medical services system.

The Haiku region of Maui is located at the northern tip of the island of Maui and lacks twenty-four-hour, locally-based, advanced life support ambulance service. The nearest ambulance service is located in Makawao, which is forty-five minutes away and the next closest is in Hana, a full ninety minutes away. Both wait times are unacceptably long and endanger the health of residents of the Haiku region of Maui.

The purpose of this part is to ensure parity in emergency health care for residents and visitors of the Haiku region of Maui by providing twenty-four-hour advanced life support ambulance service.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for twenty-four-hour advanced life support ambulance service for the Haiku district on the island of Maui.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART II

SECTION 3. The legislature finds that the protection and preservation of the health of Hawaii's people is a matter of compelling state interest. Emergency ambulance services, available twenty-four-hours-a-day, seven-days-a-week, can help reduce medical emergency deaths, injuries, and permanent long-term disability, and are a key component of the state comprehensive emergency medical services system.

The island of Molokai is remote and lacks twenty-four-hour, locally based, advanced life support ambulance service. The legislature finds that this endangers the health of residents of the island of Molokai.

The purpose of this part is to ensure parity in emergency health care for residents and visitors of the island of Molokai by providing twenty-four-hour advanced life support ambulance service.

SECTION 4. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for twenty-four-hour advanced life support ambulance service for the island of Molokai.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART III

SECTION 5. The legislature finds that there is a lack of hospitals and health centers in the southern portion of the island of Hawaii, leaving residents of the area with a serious lack of access to appropriate medical care. The most efficient solution is to provide a mobile medical van to be stationed at and assigned to the Kona community hospital.

The purpose of this part is to appropriate funds to provide the people of the southern portion of the island of Hawaii with increased access to suitable emergency and clinical medical care.

SECTION 6. (a) The Kona community hospital shall acquire a mobile medical van to be based at the Kona community hospital and shall establish a mobile medical van program to provide basic medical clinical services to the South Kona, Kau, and upper Puna areas of the county of Hawaii.

(b) The program shall:

(1) Hire medical personnel to operate and staff the van;

(2) Establish routes and services for the areas of South Kona, Kau, and upper Puna;

(3) Work with the Hawaii county fire department to make the van available for situations requiring the van's service; and

(4) Work with the department of education to provide medical services to the schools in the indicated district.

SECTION 7. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for the purchase of a mobile medical van, including necessary planning and equipment to provide medical care services in South Kona, Kau, and upper Puna.

The sum appropriated shall be expended by the Hawaii health systems corporation for the Kona community hospital for the purposes of this part; provided that no funds shall be expended until an agreement has been established with an appropriate funding agency, public or private, to provide the Kona community hospital with funding to continue the mobile medical van program for not less than an additional two years.

Any funds appropriated for a mobile medical van program shall not replace any funding for the equipment or ongoing operation of the Kona community hospital.

PART IV

SECTION 8. There is appropriated out of the general revenues of the State of Hawaii the following sums or so much thereof as may be necessary for fiscal year 2008-2009 to finance the following:

A. Waianae coast comprehensive health center, Oahu

Plans, design, and construction for the expansion and renovation of facilities at Waianae coast comprehensive health center, phase II.

Plans $

Design $

Construction $

Total funding $

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART V

SECTION 9. The legislature finds that west Maui has a de facto population of fifty thousand and its resident population is projected to double within ten years. The area lacks urgent and extended medical care. Urgent care is required for any episode of illness or injury that is not immediately life-threatening and not elective but is brought on unexpectedly. Extended care services refer to the provision of appropriate medical care after normal physician work hours, or after 5:00 p.m. on weekdays and whole or partial days on the weekends and on holidays.

The legislature finds that patients needing urgent care must drive over twenty-five miles to the Maui memorial medical center one-way to receive care. Often, the patient must wait hours to receive treatment in the emergency room. Providing outpatient urgent and extended emergency medical care in west Maui would dramatically reduce the costs of health care and provide needed medical services to residents of the area.

The purpose of this part is to appropriate funds to provide outpatient urgent and extended emergency medical care in west Maui.

SECTION 10. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for outpatient urgent and extended emergency medical care in west Maui.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART VI

SECTION 11. The legislature finds that the earthquake and subsequent electrical power outage in October 2006 reinforce the urgency to ensure that emergency medical caregivers in the state have adequate facilities and energy capacity to address a massive medical emergency. On Oahu, roughly fourteen hours after the earthquake, only approximately half of the island's power had been restored.

The Queen's Medical Center did not have its power restored until twelve hours after the earthquake and used its five generators in the interim. During this time, the Queen's Medical Center did not have sufficient power to generate adequate air-conditioning, which affected the operation of essential computed tomography and magnetic resonance imaging scanners due to high temperatures, rendering them unusable for patient care. Had the outage lasted very much longer or if there had been an influx of medical emergencies, the Queen's Medical Center and its patients would have faced serious consequences.

The legislature finds that the Queen's Medical Center is the only medical facility in the state with a trauma center that has been verified by the American College of Surgeons. While all hospitals are equipped with emergency facilities, a trauma center is a specially equipped facility for dealing with serious and life-threatening injuries. A critical component of a properly equipped trauma center is an operating room served by numerous and varied medical specialists, diagnostic equipment, and other life-support systems.

To support the continuing operation of a trauma center in the middle of a massive disaster, sufficient emergency energy capacity is vital. The Queen's Medical Center presently has five emergency generators with a total installed capacity of two thousand sixty-seven kilowatts. However, the estimated peak demand in the event of a disaster is six thousand kilowatts. Part of this demand would be needed for necessary infrastructure such as lighting, security, water supply, cooling, and ventilation systems. Another part of this demand would be to power the vital life-sustaining equipment and diagnostic tools necessary in trauma centers. The needed additional energy capacity to accommodate the estimated peak demand would require the installation of four additional generators along with a new storage structure capable of withstanding the wind force of a category five hurricane at an estimated cost of approximately $35,000,000.

The purpose of this part is to provide financial support for the emergency energy needs of the Queen's Medical Center to ensure that it remains ready to serve the entire community in time of disaster.

SECTION 12. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 as a grant under chapter 42F, Hawaii Revised Statutes, for the Queen's Medical Center to increase its emergency power generator system to ensure a required maximum capacity of six thousand kilowatts to continue operating its hospital and trauma center in the event of a disaster.

The sum appropriated shall be expended by the department of health for the purposes of this part.

PART VII

SECTION 13. The legislature finds that the development of a hospital-based family practice graduate medical education program could help alleviate the physician shortage problem on the island of Hawaii. Family practice residency programs normally run for three years. Residents rotate through various hospital inpatient service areas such as family medicine, inpatient services, obstetrics, and pediatrics, in addition to outpatient or clinic-based services.

A family practice residency program would require accreditation by the Accreditation Council for Graduate Medical Education, which charges an initial application fee of $4,000 and annual program fees of $3,500. However, accreditation enables partial reimbursement of some program expenses by the Centers for Medicare and Medicaid Services.

Family practice residency program residents receive a modest stipend of approximately $45,000 per year plus various benefits such as educational travel and books, housing allowance, paid vacation, meal allowance, clothing allowance, medical and dental insurance for residents and their immediate family, life and disability insurance, and malpractice insurance. A total of $877,500 is estimated to support a full program of five residents per year for three years. The family practice residency program would also require a full-time physician director to oversee residents in a clinical setting, a program manager, and administrative and support staff. Salaries and benefits are estimated at approximately $750,000 annually. Furthermore, the family practice residency program will require part-time or adjunct faculty to oversee residents' clinical rotations at an estimated cost of $300,000 per year. Finally, office space, program administration, office equipment, furniture, maintenance, and other costs are estimated at $250,000 per year.

The purpose of this part is to appropriate moneys to fund a three-year family practice residency program based at Kona community hospital on the island of Hawaii to help alleviate the physician shortage problem on the island of Hawaii.

SECTION 14. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2008-2009 for the first year in a three-year family practice residency program based at Kona community hospital on the island of Hawaii.

The sum appropriated shall be expended by the department of health for the purposes of this part.

SECTION 15. This Act shall take effect on July 1, 2020.

HOUSE OF REPRESENTATIVES	H.B. NO.	2888
TWENTY-FOURTH LEGISLATURE, 2008		H.D. 2
STATE OF HAWAII