SB2503

SECTION 1. The legislature finds that Hana, Maui is one of the most isolated areas in the State. During the rainy season, October to March, 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. Many homes do not have basic utilities such as electricity, telephones, and running water.

Operating since 1997, the purpose of Hana Health is to improve the general health and well being of the Hana community through the provision of medical care and other social, economic, and health related programs. Hana Health is the only health care provider in the Hana district, serving the primary health care and emergent medical needs of residents and visitors alike. Hana has been designated by the federal government as a medically underserved population, a primary care health professional shortage area, a dental health professional shortage area, and a mental health professional shortage area. In September 2002, Hana Health was designated a Federally Qualified Health Center (FQHC). Hana Health is also a Native Hawaiian Health Center as defined in pending legislation for the Native Hawaiian Health Care Improvement Act.

Hana Health provides a hybrid of services because of 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 illnesses or traumatic injuries. 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 2,500 residents of Hana and the six hundred thousand tourists who visit annually.

Hana Health has been providing primary and urgent medical care, oral health care, mental and behavioral health care, pre‑packaged medications in lieu of a full pharmacy, laboratory testing, transportation services, and limited home health for those with mobility problems in this rural community since its inception. Additional Hana Health programs include:

(1) Services for the elderly such as, healthy congregate and home delivered meals, exercise programs, traditional Hawaiian lomilomi therapy, home healthcare, transportation, case management services and family caregiver support services;

(2) Nutrition and fitness programs for the management and prevention of chronic disease;

(3) Complimentary and traditional health care such as lomilomi therapy and acupuncture; and

(4) The Hana Fresh Farm, which provides food for Hana Health's nutrition programs, includes a Hawaiian medicinal garden, and employs a number of Hana residents recovering from substance abuse problems.

Local workforce development is and will continue to be the key to meeting the immediate and long‑range staff needs of Hana Health as well as improve the economic status of Hana's population. The majority of Hana Health's allied health professionals are native Hawaiians from the Hana district and most are developing their skills "on the job". Seventy‑four per cent of the patients served are native Hawaiian.

Hana Health's board of directors identifies and plans for community needs based on a formal process of data collection and strategic planning. Focus groups among specific target populations, such as kupuna, caregivers, youth, women with children, community-wide needs assessments, satisfaction surveys and suggestion boxes, review and analysis of community demographic profiles, anecdotal information provided by staff and board members regarding community needs and concerns, and informal and professionally facilitated strategic planning meetings are the basis for Hana Health's strategic and long‑range goals. In order to address identified needs and achieve service objectives, the development of Hana Health's infrastructure is of primary importance.

Built in 1965, the current medical center is more than forty years old. Originally designed as a small hospital, the layout is not conducive to the current primary health care and urgent care setting. Current programs have outgrown the four thousand square foot facility and six trailers have been leased and placed on the property to help alleviate the space crunch. These trailers currently house behavioral and mental health and wellness programs, acupuncture, lomilomi services, administrative offices and farm support. Patients and staff are often required to walk through the rain and mud to reach the trailers located behind the clinic. There is inadequate lighting in the evening, which creates a safety hazard. Health and wellness programs are often conducted outside, under a tent. Restroom facilities are inadequate to meet patient and staff needs. Staff and patients located in the trailers must walk through rain and mud in order to use the restroom. Administrative offices are scattered throughout the campus, complicating communication and the use of shared equipment such as copy and fax machines and mail machines. There are no meeting or conference rooms. Board and staff meetings generally take place under a tent.

A seventy‑five year old, six hundred square foot house has been divided into three sections and provides space for the nutrition center, administrative office space, and a staff residence. This structure is deteriorating rapidly due to extreme termite damage and weather rot. Daylight is visible through many areas of the floor and several walls. The nutrition center portion is approximately one hundred square feet and is used to prepare healthy meals and snacks for one hundred kupuna, four hundred school children, and more than one hundred other program participants. Meals are either served under a tent on the Hana Health campus or delivered to off-site locations for consumption.

A second house on the property, also more than fifty years old, is occupied by the paramedics twenty‑four hours a day, seven days a week, who provide urgent care and transport services in partnership with Hana Health.

There is no staff lunch room, or an area to place personal belongings. Storage space is non-existent. There are two rapidly deteriorating sheds that are used to store everything from medical records to office supplies to medical equipment and the backup generator. The plumbing is old and in need of constant repair and maintenance. Existing cesspools need to be replaced with septic tanks in order to comply with existing standards. The electricity is inadequate to meet the needs of modern technology. Central air conditioning only exists in a portion of the building, requiring the use of window air conditioners in several of the examination rooms, dental offices, and the computer room. These are generally replaced twice a year due to the poor state of the electrical system.

Currently, no senior housing exists in the district of Hana. Many of Hana's seniors are living in social isolation, or are removed from the community to facilities on the other side of the island. More than sixty per cent of Hana residents believe that a member of their family will need assisted living, a group home environment, respite care, adult day care, or home health care within five years, and more than thirty per cent of respondents need these services now.

As of December 2007, there are three known persons in the Hana district with end stage renal disease (ESRD) who are receiving hemodialysis treatments. These patients living in Hana must endure the long and difficult five‑hour roundtrip journey to Kahului three times a week, in order to obtain lifesaving care because this service is not available in the Hana district. This situation is highly undesirable for two reasons:

(1) The long trip is an exhausting experience and only serves to further erode the health status of ESRD patients who already have severe underlying diseases such as diabetes and hypertension; and

(2) The prolonged absence of ESRD patients from the Hana district is socially destructive, resulting in regular separation from family, friends, and local community support systems.

The purpose of this Act is to appropriate funds to Hana Health 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 $5,000,000 or so much thereof as may be necessary for fiscal year 2008-2009 for the following at Hana Health:

(1) Commercial kitchen construction/equipment installation $1,750,000

(2) Independent senior housing design and construction to include home‑based dialysis, adult day care, and respite services $2,500,000

(3) Medical facility upgrade/expansion design documents $750,000

The sum 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, 2008.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2503
TWENTY-FOURTH LEGISLATURE, 2008
STATE OF HAWAII