Honolulu, Hawaii
                                                     , 1999

                                   RE:  S.B. No. 851
                                        S.D. 2

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


     Your Committee on Judiciary, to which was referred S.B. No.
851, S.D. 1, entitled: 


begs leave to report as follows:

     The purpose of this bill, as received by your Committee, is
to require the Department of Health to adopt rules relating to
patient self-determination for medical care and pain management
during end of life care.  In addition, the bill requires health
insurers to cover expenses for hospice care and removes county
zoning barriers to the location of hospice homes in residentially
designated areas.

     Your Committee finds that as the aged population continues
to increase in Hawaii, so does the terminally ill population.
This particular population may not be able to rely on their
families for care and support in their time of need.  Especially
during these tough economic times, families need to be engaged
full time in the work force, oftentimes leaving no one at home to
tend to the terminally ill.  

     Your Committee further finds that hospice care may be a
possible solution for the terminally ill in these situations.
Hospice care is not a place, but it is a service that can be
delivered at home, in nursing or care homes, or even in beds set
aside in acute care hospitals.  Hospice care is a philosophy
which accepts that an illness has progressed to a terminal stage,
and death cannot be avoided even with aggressive medical

                                   STAND. COM. REP. NO. 833
                                   Page 2

treatment.  Your Committee agrees that the goal of hospice care
is not to prolong life, but to make dying as comfortable as
possible for the person dying, and for family and friends.
Therefore, your Committee believes that to help more terminally
ill patients take advantage of this service, the health insurers
and HMOs should reimburse hospice care providers.

     While your Committee agrees with the intent of this measure
and supports the concept of hospice care, your Committee still
has concerns that should be addressed as this measure proceeds
through the legislative process.  First, S.B. No. 851, S.D. 1,
defines a "hospice home" as any facility operated by a "licensed
hospice service agency" but the bill does not define "licensed
service agency."  Second, your Committee notes that the bill
mandates that HMOs are to provide the required benefits upon the
approval of the Act, but, insurers and mutual benefit societies
have until January 1, 2000.  Thus, clarification is needed to
resolve this discrepancy.

     Testimony in support of this measure was submitted by
Hospice Hawaii, Hawaii Catholic Conference, and St. Francis
Health Services Network.  The Executive Office on Aging, the
Department of Health, Hawaii Medical Association, and Hawaii
Nurses Association also submitted testimony in support of this
measure but with the recommendation that section 3 (providing
that the Department of Health adopt rules with regards to patient
self-determination) be deleted.

     Upon further consideration, your Committee has amended this
measure by deleting section 3 and making technical, non-
substantive corrected changes for the purposes of clarity and

     As affirmed by the record of votes of the members of your
Committee on Judiciary that is attached to this report, your
Committee is in accord with the intent and purpose of S.B. No.
851, S.D. 1, as amended herein, and recommends that it pass Third
Reading in the form attached hereto as S.B. No. 851, S.D. 2.

                                   STAND. COM. REP. NO. 833
                                   Page 3

                                   Respectfully submitted on
                                   behalf of the members of the
                                   Committee on Judiciary,

                                   AVERY B. CHUMBLEY, Co-Chair

                                   MATTHEW M. MATSUNAGA, Co-Chair