Report Title:

Hana Community Health Center



Appropriates $836,400 in FY 2001-2002 and FY 2002-2003 to the Hana Community Health Center to allow the center to continue its current level of operations.


S.B. NO.












SECTION 1. The legislature finds that the State transferred the Hana medical center to the Hana Community Health Center in July 1997 with a guarantee to continue providing needed financial support for the center's essential medical programs. This commitment is part of Act 263, Session Laws of Hawaii 1996, which provided for the transfer. The Hana community would not have accepted this transfer without the commitment to assure the center's continued viability.

Hana 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 service. Hana town is fifty-seven miles from Wailuku and the trip takes 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 more than two hundred square miles. Many of the villages are located a minimum of forty-five minutes from the main town of Hana.

The Hana Community Health Center provides a hybrid of services. Unlike most clinics, the center must also coordinate activities with the ambulance services and provide assistance in stabilizing patients with life threatening illness or traumatic injury. This needs to be done twenty-four-hours a day because the center is the only health care provider in the district. The coordination of emergency services and provision of life support care is absolutely essential to the three thousand residents of Hana and the 500,000 tourists who visit annually.

Hana also has the dubious distinction of consistently having some of the worst health and socio-economic indicators in the State. Native Hawaiians account for sixty-five per cent of all the center's patients. Hana is federally designated as a medically underserved population, dental underserved population, and as a health professional shortage area. The center currently provides prevention oriented health care, acute and chronic care, urgent care, limited laboratory testing, limited x-ray services, and pre-packaged medications in lieu of a full pharmacy. A greatly reduced level of home health care is also provided and seniors and those with mobility problems have benefitted from this program. In fiscal year 1999-2000, Hana Community Health Center provided medical care to 1,553 individual patients, who made 4,234 visits to the Health Center. Almost twenty per cent of the patients served did not have health insurance, and twenty-three per cent of patients receiving care were insured through a Medicaid or Medicare health plan. One third of Hana Community Health Center's patients were under thirteen years of age, or over age sixty-five.

Dental care was initiated in October 1999 with the financial support of private foundations. Hana Community Health Center provided dental services to two hundred twenty-seven individual patients, who made four hundred twenty-eight visits to the dentist between October 1999 and June 2000. Forty per cent of those dental patients were children and adolescents. One-third of patients served had no dental insurance, and twenty-one per cent of those receiving care were insured through a medicaid dental plan.

In March 2000, through a small federal grant, the Hana Community Health Center started "Mai E Ai" a lunch program for seniors age sixty years or older. Based on the traditional Hawaiian diet, a "local style" cooking, healthy meals prepared mostly from food available in the Hana district are served three days a week. Mai E Ai includes a physical fitness program before lunch and transportation to and from the program for kapuna in need. Home delivered meals are provided for those seniors unable to participate in the program due to physical limitations. Between March 20, 1999 and June 30, 2000, Mai E Ai served four hundred eighty congregate meals and one hundred ninety-eight home delivered meals to thirty-five kapuna.

When the Hana Community Health Center was operating as the Hana Medical Center as part of the State's community hospitals system, it required a subsidy of approximately $1,500,000 annually. Immediately upon transfer of the Hawaii health systems corporation, in fiscal year 1997-1998, the legislature reduced its appropriation for the center's operations to $1,064,000. This was a thirty per cent reduction in funding in its first year of operation. In fiscal year 1998-1999, the legislature appropriated $800,000 for the operation of the center, $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 year, 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 2000-2001, the legislature maintained the appropriation at the $750,000 level. This amount is at least fifty per cent less than the cost of operations before the transfer to the Hana Community Health Center, or $617,300 less than what it cost the State to operate.

The Hana Community Health Center operated at a $123,536 deficit in fiscal year 1998-1999 and $53,463 in fiscal year 1999-2000, which was covered by a $243,000 bank loan.

The Hana Community Health Center has demonstrated an ability to generate funds from a variety of funding sources for the initiation of new programs and services. However, the support of the State will always be needed to fund core medical services. This was a fact recognized by the state administration and the legislature prior to privatization. The Hana Community Health Center requires a minimum of $836,400 in fiscal years 2001-2002 and the same amount in 2002-2003 just to maintain the existing level of services. The purpose of this Act is to appropriate funds to the Hana Community Health Center to allow it to continue its current operations.

SECTION 2. There is appropriated out of the general revenues of the State of Hawaii the sum of $836,400, or so much thereof as may be necessary for fiscal year 2001-2002, and the same sum, or so much thereof as may be necessary for fiscal year 2002-2003 to allow the Hana Community Health Center to continue its current level of operations.

SECTION 3. The sum appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. This Act shall take effect on July 1, 2001.