Report Title:

Public Health

Description:

Establishes county public health facility management advisory committees and changes structure of existing HHSC corporation board; establishes task force.

HOUSE OF REPRESENTATIVES

H.B. NO.

1436

TWENTY-SECOND LEGISLATURE, 2003

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to public health.

 

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. Act 266, Session Laws of Hawaii 1994, mandated the creation of a task force to evaluate the implications of the community hospitals' operational structure and to make recommendations regarding the transition of the division of community hospitals into an independent agency. In early 1995, the governor's task force on the establishment of an agency for community hospitals issued its report to the governor and the legislature.

In 1996, the legislature recognized that because of the rapid changes taking place in the health care industry and the impending implementation of national and local health care reforms, a re-thinking of Hawaii's state hospital system was needed. It was essential that the administrative structure of governance had the appropriate flexibility and autonomy needed for the state hospital system to compete and remain viable.

In recognizing the health care needs of Hawaii's people, the legislature enacted Act 262, Session Laws of Hawaii 1996, that established the Hawaii health systems corporation. The intent was to provide better health care for Hawaii's people by freeing health care facilities from unwarranted bureaucratic oversight.

As the legislature serves all of the people of Hawaii, it is critically important that no portion of the populace be neglected. In adopting Act 262, it was also the intent of the legislature to ensure that people living in rural areas would also receive quality health care. However, recent findings have indicated that this portion of the Hawaii health systems corporation's mandate may not have been met. Additionally, it has come to the attention of the legislature that a number of the Hawaii health systems corporation's current projects may not be as effective at delivering services as originally hoped. It is, therefore, in the best interest of the State and the people of Hawaii that measures be taken to ensure that the delivery of quality health care is being carried out in the most effective and efficient means possible.

The purpose of this Act is to ensure quality health care for all the people in the State of Hawaii, including those served by small rural facilities, by ensuring that the freedoms gained by the facilities from unwarranted bureaucratic oversight are retained under an alternative administrative structure. If there is a conflict between appropriate health care and "bottomline" decisions, quality health care should be given precedence to the extent reasonably possible.

SECTION 2. Chapter 323F, Hawaii Revised Statutes, is amended by adding two new sections to be appropriately designated and to read as follows:

"323F- County public health facility management advisory committees. (a) There is established within the department for each county, a public health facility management advisory committee to consist of nine members to be appointed by the governor. The members shall serve for a term of four years; provided that upon the initial appointment of the members:

(1) Two shall be appointed for a term of one year;

(2) Two for a term of two years;

(3) Two for a term of three years; and

(4) Three for a term of four years.

Each committee shall select its own chairperson and vice chairperson and may adopt rules as necessary to conduct its business.

The members of the committee shall serve without compensation, but shall be reimbursed for traveling expenses incurred in the performance of their duties. The department shall provide for the necessary expenses of the committees; provided that no expenses may be incurred without prior authorization by the director.

(b) Each committee shall sit in an advisory capacity to the corporation board on matters concerning the planning, construction, improvement, maintenance, and operation of public health facilities within their jurisdictions; provided that this section shall not be construed as precluding or preventing the committees from coordinating their efforts and activities with the facility administrators within their counties.

323F- Corporation board. The corporation board shall be composed of the chairpersons from each of the county public health facility management advisory committees."

SECTION 3. Section 323F-4, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) All business of the corporation board shall be conducted at a regular or special meeting at which a quorum is present, consisting of at least a majority of the directors then in office. Any action of the corporation board shall require the affirmative vote of a majority of those present and voting at the meeting[; except that a vote of two-thirds of the members of the corporation board then in office shall be required for any of the following actions:

(1) Removal by the corporation board of one of its members, with the exception of the eleventh and twelfth members set forth in section 323F-3, who may only be removed pursuant to sections 323F-10 and 323F-10.5;

(2) Amendment by the corporation board of its bylaws;

(3) Hiring or removing the chief executive officer of the corporation; and

(4) Any other actions as provided by the corporation bylaws]."

SECTION 4. Section 323F-8, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) The [corporation board] director may appoint, exempt from chapter 76 and section 26-35(4), a chief executive officer of the corporation whose salary shall be set by the corporation board. The chief executive officer may also appoint up to eighteen other personnel, exempt from chapters 76 and 89, to work directly for the chief executive officer and the [corporate] corporation board.

(b) The [corporation board] director or [its] the director's designee may discharge [its] the corporation board's exempt personnel with or without cause; provided that removal without cause shall not prejudice any contract rights of personnel."

SECTION 5. Section 323F-3, Hawaii Revised Statutes, is repealed.

["323F-3 Corporation board. (a) The corporation shall be governed by a thirteen-member board of directors which shall carry out the duties and responsibilities of the corporation.

(b) Ten members of the corporation board shall be appointed by the governor as follows:

(1) One member from region I who resides in the city and county of Honolulu;

(2) One member from region II who resides in the county of Kauai;

(3) One member from region III who resides in the county of Maui;

(4) One member from region IV who resides in the eastern section of the county of Hawaii;

(5) One member from region V who resides in the western section of the county of Hawaii;

(6) One member from region II who resides in the county of Kauai or from region III who resides in the district of Hana or on the island of Lanai; provided that in no event shall the member be appointed from the same region for two consecutive terms; and

(7) Four at-large members who reside in the State.

The eleventh member shall be the chairperson of the executive public health facility management advisory committee, who shall serve as an ex officio, voting member.

The twelfth member, who shall serve as a voting member, shall be a physician with active medical staff privileges at one of the corporation's public health facilities. The physician member shall serve a term of two years. The initial physician member shall be from region II, and subsequent physician members shall come from regions IV, III, and V respectively. The physician member position shall continue to rotate in this order. The physician member shall be appointed to the corporation board by a simple majority vote of the members of the executive public health facility management advisory committee from a list of qualified nominees submitted by the public health facility management advisory committee for the region from which the physician member is to be chosen. If for any reason a physician member is unable to serve a full term, the remainder of that term shall be filled by a physician from the same region.

The thirteenth member shall be the director of health or the director's designee, who shall serve as an ex officio, voting member.

Appointments to the corporation board, with the exception of the chairperson of the executive public health facility management advisory committee and the regional physician member, shall be made by the governor, subject to confirmation by the senate pursuant to section 26-34. Prior to the transfer date, the public health facility management advisory committees appointed pursuant to section 323-66 for each county may recommend names to the governor for each position on the corporation board designated for a region which corresponds to its county. After the transfer date, the public health facility management advisory committees appointed pursuant to section 323F-10 for each region may make such recommendations to the governor. The appointed board members shall serve for a term of four years; provided that upon the initial appointment of the first ten members:

(1) Two at-large members shall be appointed for a term of two years;

(2) Three at-large members shall be appointed for a term of three years; and

(3) Five regional members shall be appointed for a term of four years.

Any vacancy shall be filled in the same manner provided for the original appointments. The corporation board shall elect its own chair from among its members.

(c) The selection, appointment, and confirmation of any nominee shall be based on ensuring that board members have diverse and beneficial perspectives and experiences and that they include, to the extent possible, representatives of the medical, business, management, law, finance, and health sectors, and patients or consumers. Members of the board shall serve without compensation but may be reimbursed for actual expenses, including travel expenses incurred in the performance of their duties.

(d) Any member of the board may be removed for cause by the governor or for cause by vote of a two-thirds majority of the board's members then in office. For purposes of this section, cause shall include without limitation:

(1) Malfeasance in office;

(2) Failure to attend regularly called meetings;

(3) Sentencing for conviction of a felony, to the extent allowed by section 831-2; or

(4) Any other cause that may render a member incapable or unfit to discharge the duties required under this chapter.

Filing nomination papers for elective office or appointment to elective office, or conviction of a felony consistent with section 831-3.1, shall automatically and immediately disqualify a board member from office."]

SECTION 6. Section 323F-10, Hawaii Revised Statutes, is repealed.

["323F-10 Regional public health facility management advisory committees. (a) On the transfer date, there shall be established within the corporation for each region, a public health facility management advisory committee to consist of nine members initially to be appointed by the chief executive officer of the corporation with the advice of the hospital administrators of the facilities in the affected regions. The members shall serve for a term of four years; provided that upon the initial appointment of the members, two shall be appointed for a term of one year, two for a term of two years, two for a term of three years, and three for a term of four years.

Following the initial appointments by the chief executive officer of the corporation board, any vacancies on a regional committee shall be filled by a simple majority vote of the members of the executive committee from a list of qualified nominees submitted by the regional committee in which the vacancy occurred. If a regional committee vacancy remains unfilled for more than thirty days, that vacancy may be filled by the chief executive officer of the corporation.

Each regional management advisory committee shall include medical and health care providers, consumers, and knowledgeable individuals in other appropriate areas such as business and law; provided that at least one member shall be a physician with active medical staff privileges at one of the region's public health facilities. At least three members of the committee shall be consumers.

The management advisory committee for the East Hawaii region shall have three members who reside in the Ka`u district, three members who reside in the Hamakua/North Hilo districts, and three members who reside in the South Hilo/Puna districts. The management advisory committee for the West Hawaii region shall have not less than three members who reside in the North Kohala/South Kohala districts.

Each regional committee shall select its own chairperson and vice chairperson and shall adopt rules governing the terms for removal of its chairperson from the executive management advisory committee. In the event of a regional committee voting to remove its chairperson who concurrently sits on the corporation board, that vote shall be unanimous. In the event of a regional committee voting to remove its physician member from the corporation board, that vote shall also be unanimous. Each regional committee may also adopt other rules as it may consider necessary for the conduct of its business.

The members of the regional committees shall serve without compensation, but shall be reimbursed for traveling expenses incurred in the performance of their duties. The corporation shall provide for the necessary expenses of the committees; provided that no expenses may be incurred without prior authorization by the chief executive officer.

(b) Each regional committee shall sit in an advisory capacity to the chief executive officer on matters concerning the formulation of regional operational and capital improvement budgets, and the planning, construction, improvement, maintenance, and operation of public health facilities within its respective jurisdiction and shall sit in an advisory capacity to the governor on matters concerning the nominees for positions on the corporation board. Nothing in this section shall be construed as precluding or preventing the committees from coordinating their efforts and activities with the facility administrators within their counties.

(c) Each regional committee may prepare a report for inclusion with the corporation's annual report and audit which shall include but not be limited to comments and analyses on the corporation's regional operational and capital improvement budgets for its respective region."]

SECTION 7. Section 323F-10.5, Hawaii Revised Statutes, is repealed.

["[323F-10.5] Executive public health facility management advisory committee; establishment. (a) There is established within the corporation an executive public health facility management advisory committee to consist of the chairpersons of each of the five regional public health facility management advisory committees. The executive committee shall, through its chairperson, represent the interests of all regional committees on the corporation board.

(b) The executive committee shall select its own chairperson to serve on the corporation board and shall adopt rules governing the terms of office and removal from the corporation board. The executive committee shall also adopt rules governing the terms of office for each of the five regional committee chairpersons. The executive committee may also adopt other rules as it may consider necessary for the conduct of its business.

(c) The members of the executive committee shall serve without compensation, but shall be reimbursed for reasonable expenses incurred in the performance of their duties."]

SECTION 8. (a) There is established within the department of health for administrative purposes the community hospitals review task force to comprehensively review, evaluate, and recommend changes to the administrative structure of the Hawaii health systems corporation to ensure the delivery of quality health care to Hawaii's rural areas. The task force shall consider the following:

  1. The adequacy of the structure and composition of the county health facility management advisory committee and the corporation board, keeping in mind the need for relevant professional experience and expertise;
  2. The appropriate levels of salary for upper-level corporation administration; and
  3. The feasibility of returning the administrative and healthcare delivery functions of the Hawaii health systems corporation back to the department of health.

(b) The task force shall consist of nine members. The director of health shall serve as chairperson. The remaining members shall be appointed as follows:

(1) Two members shall be appointed by the governor;

(2) Two members shall be appointed by the president of the senate;

(3) One member shall be appointed by the minority leader of the senate;

(4) Two members shall be appointed by the speaker of the house of representatives; and

(5) One member shall be appointed by the minority leader of the house of representatives.

(c) The members of the task force shall serve without pay, but may be reimbursed for actual and necessary expenses incurred in carrying out their duties.

SECTION 9. The task force shall submit its study with findings and recommendations, including any proposed legislation, to the legislature not later than twenty days prior to the convening of the regular session of 2004.

SECTION 10. The task force shall cease to exist upon the adjournment of the 2004 legislative session.

SECTION 11. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 12. This Act shall take effect upon its approval; provided that sections 2 to 7 take effect July 1, 2004.

INTRODUCED BY:

_____________________________