Honolulu, Hawaii
                                                     , 1999

                                   RE:  H.B. No. 1274
                                        H.D. 2
                                        S.D. 1

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


     Your Committee on Health and Human Services, to which was
referred H.B. No. 1274, H.D. 2, entitled: 


begs leave to report as follows:

     The purpose of this measure is to make appropriations for
the development of a traumatic brain injury statewide strategic
plan and the office of the project coordinator for that plan

     Your Committee received testimony in support of this measure
from the Department of Health (DOH), Department of Education
(DOE), Traumatic Brain Injury Advisory Board, Hawaii
Neuropsychology Community Research Bureau (Bureau), Brain Injury
Association of Hawaii, Commission on Persons with Disabilities,
and five private citizens.

     This measure is intended to facilitate the work of the
traumatic brain injury advisory board, created by Act 333,
Session Laws of Hawaii 1997 (section 321-28, Hawaii Revised
Statutes), to advise the DOH in the development and
implementation of a comprehensive plan to address the needs of
persons affected by disorders and disabilities involving the
brain and developing services for persons with traumatic brain
injury (TBI).

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     Your Committee finds that TBIs are unlike other illness or
injury.  There is very little known about recovery, and there are
very few treatment programs.  Those programs that do exist are
incredibly expensive and located thousands of miles away on the

     According to the Bureau, the Hawaii Health Information
Corporation recorded an average of approximately 1,200 TBI
hospital discharges annually, of which approximately fifty-six
are children age 0-14.  These figures do not include the mild and
moderate TBI infants who do not receive immediately appropriate
medical care and are therefore not included in these figures and
are not treated appropriately.  These figures do not reflect the
secondary disabilities and impairments due to TBI.  Although the
prevalence of TBI is high, fewer than five per cent of TBI
patients are hospitalized.  The median age of TBI survivors is 18
years old, and approximately 29 per cent of them have a brain
injury impairment by age 18.  TBI survivors increase the risk for
a second injury by three times, and for a third injury by eight

     Further, according to the Bureau, the DOE's 1997 statistics
for special education students identified and served 58 TBI
disabled students, plus 2 Felix class TBI students.  This number
is probably a gross underestimation and reflects a lack of
understanding about TBI impairments.  Mild head injuries are
often mistakenly attributed to other causes, resulting in
treating the symptoms and not documenting a TBI.

     Your Committee further finds that the costs of TBI are
enormous and encompass every area of life.  TBI significantly
diminishes the quality of life for the survivor, family members,
caregivers, and other community support persons.  According to
the Childrens' Safety Network, an average of two per cent of TBI
children are discharged annually from hospitals, with functional
limitations that were expected to last at least two years.  The
documented costs of TBI to children do not include costs related
to lost time from work, court expenses, rehabilitation, and the
like.  The National Brain Injury Association reports that the
lifetime costs of a severe TBI can exceed $7 million.  The cost
of TBI is estimated at more than $25 billion annually in the
United States.

     Your Committee has amended this measure by:

     (1)  Deleting section 4 and inserting its language relating
          to expenses into section 3;

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                                   STAND. COM. REP. NO. 1022
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     (2)  Clarifying section 3 to include the establishment of a
          position of project coordinator; and

     (3)  Making technical, nonsubstantive amendments for clarity
          and to renumber sections to accommodate the amendments.

     As affirmed by the record of votes of the members of your
Committee on Health and Human Services that is attached to this
report, your Committee is in accord with the intent and purpose
of H.B. No. 1274, H.D. 2, as amended herein, and recommends that
it pass Second Reading in the form attached hereto as H.B.
No. 1274, H.D. 2, S.D. 1, and be referred to the Committee on
Ways and Means.

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Health and Human

                                   SUZANNE CHUN OAKLAND, Chair

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