SB1050

SECTION 1. The legislature finds that Act 263, Session Laws of Hawaii 1996, authorized the transfer of the Hana medical center to Hana Health (formerly known as Hana Community Health Center) in 1997, with a guarantee to continue providing needed financial support for its essential medical programs. The Hana community would not have accepted this transfer without the commitment to ensure the center's continued viability.

The legislature further finds that Hana, Maui is one of the most isolated areas in the State. During the rainy season from October to March, the frequent storms often wash out the roadways and disrupt electricity and telephone services. Hana town is fifty-seven miles from Wailuku. The trip takes approximately two hours along a single lane road with six hundred seventeen turns and fifty-six one-lane bridges. The district is made up of small, isolated settlements scattered over two hundred thirty-three square miles. Many of the villages are located a minimum of forty-five minutes from the main town of Hana. A number of homes in the district do not have basic infrastructure such as electricity, telephones, or running water.

Hana Health provides a hybrid of services due to Hana's relative isolation. Unlike most primary care clinics, Hana Health must also coordinate activities with the ambulance service and provide assistance in stabilizing patients with life threatening illness or traumatic injury. These services are required twenty-four hours a day because the center is the only full service health care provider in the district. The coordination of emergency services and provision of life support care is absolutely essential to the residents of Hana and the six hundred thousand tourists who visit annually.

Hana also has some of the worst health and socioeconomic indicators in the State. Native Hawaiians account for sixty-five per cent of Hana Health's patients. Hana is federally designated as a medically underserved population, mental health underserved population, dental underserved population, and as a health professional shortage area. Hana Health provides prevention-oriented health care, acute and chronic care, urgent care, waived laboratory testing under the Clinical Laboratory Improvement Amendments of 1988 (Public Law 100-578), and prepackaged medications in lieu of a full service pharmacy. A limited level of home health care is also provided, and seniors and those with mobility problems have benefited from this program.

In fiscal year 2005-2006, Hana Health provided medical care to 1,681 patients, who made 6,466 visits to the health center. This was an increase of sixteen per cent from the previous fiscal year. Visitors accounted for twenty per cent of the patients, all of whom required urgent or emergency care. There were two hundred fifty-eight urgent and emergency visits, one hundred forty-one of which took place after regular operating hours. Ninety-one of these patients (an average of two per week) were treated, stabilized, and transported to Maui Memorial Medical Center by ground or air ambulance.

Hana Health provided dental services to six hundred forty-four patients, who made 1,428 visits to the dentist. Almost half of all dental patients were either uninsured or insured through a medicaid dental plan.

"Mai E Ai" is a meal program for seniors age sixty or older. The program was started with a small federal grant and now serves more than eleven thousand meals to ninety-two kupuna living in the Hana district. Based on the traditional Hawaiian diet and "local style" cooking, the program uses fresh fruits and vegetables grown on the health center campus. The Hana Fresh organic farm provides employment for twelve Hana residents, several of whom are recovering from drug addiction substance abuse problems.

In addition to the senior meal program, Hana Health provides a series of wellness initiatives. Hana Health's fitness program provides Hana residents with an opportunity to modify their lifestyles through exercise and the development of healthy eating habits. Several classes, which accommodate all fitness levels, are held throughout the day, and each concludes with a light, healthy meal. Approximately thirty-five individuals regularly participate in these classes, and approximately seven thousand meals are provided annually. The Nutrition Based Diabetes Management Program is a pilot project that incorporates nutrition education and the delivery of healthy meals to fifteen diabetic patients. More than one thousand three hundred healthy meals were served in a five-month period with noted improvement in thirteen of sixteen key measures for the management of this chronic health condition. The project will be expanded over the next twelve months to include additional diabetic patients, as well as those with hypertension, heart disease, and weight management problems. Hana Health prepares and delivers healthy snacks - approximately three thousand six hundred - to an estimated sixty school-aged children who participate in the county of Maui summer pals program. Hana Health also sponsors a weekly salad bar for four hundred Hana school students in an effort to improve the consumption of fresh fruits and vegetables and prevent the onset of chronic health conditions.

Hana Health prepares the meals and snacks for its wellness initiatives using its own Hana fresh farm produce. These healthy meals and snacks are currently prepared in a tiny, substandard one hundred square foot kitchen that is more than seventy-five years old and in desperate need of replacement.

When Hana Health operated as the Hana medical center as part of the State's community hospitals system, it required a subsidy of approximately $1,500,000 annually, not including the administrative functions provided by the Maui Memorial Hospital. Immediately upon transfer to the private, not-for-profit Hana Health in 1997-1998, the legislature reduced its appropriation for the center's operation to $1,064,000. This was a thirty per cent reduction in funding in Hana Health's first year of operation. In fiscal year 1998-1999, the legislature appropriated $800,000 for the operation of the center. This was $264,000 less than the amount appropriated the year before, or a second reduction of twenty-five per cent in the center's second year of operation. In the following two years, the legislature appropriated $750,000 for operations, a further reduction of six per cent during the center's third year of operation. In fiscal year 2003-2004, the legislature reduced the appropriation to $700,000, but increased it back to $750,000 for fiscal year 2004-2005. Finally, in fiscal years 2005-2006 and 2006-2007, the legislature increased the appropriation to $1,000,000. This is still thirty per cent less than the $1,500,000 provided to the original Hana medical center, and does not account for cost-of-living increases that have taken place over the past nine years.

Hana Health has demonstrated its commitment to the people of the Hana district and its ability to generate funds from a variety of funding sources to start up new and innovative programs. Despite this, Hana Health will always need state support to fund core medical services. This is a fact that has been recognized by the administration and the legislature prior to privatization.

The purpose of this Act is to appropriate funds to Hana Health to allow it to continue its current level of operations and to further develop its capacity to meet the on going needs of this isolated community.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $2,200,000, or so much thereof as may be necessary for fiscal year 2007-2008, and the same sum, or so much thereof as may be necessary for fiscal year 2008-2009, for the following at Hana Health:

(1) Operational expenses $1,200,000

(2) Commercial kitchen equipment/installation $1,000,000

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 3. This Act shall take effect on July 1, 2007.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	1050
TWENTY-FOURTH LEGISLATURE, 2007
STATE OF HAWAII