Bill Text: HI SB1439 | 2019 | Regular Session | Introduced


Bill Title: Relating To Waianae Coast Comprehensive Health Center Emergency Room.

Spectrum: Partisan Bill (Democrat 6-0)

Status: (Introduced - Dead) 2019-01-28 - Referred to CPH, WAM. [SB1439 Detail]

Download: Hawaii-2019-SB1439-Introduced.html

THE SENATE

S.B. NO.

1439

THIRTIETH LEGISLATURE, 2019

 

STATE OF HAWAII

 

 

 

 

 

 

A BILL FOR AN ACT

 

 

RELATING TO WAIANAE COAST COMPREHENSIVE HEALTH CENTER EMERGENCY ROOM.

 

 

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

 


     SECTION 1.  The legislature finds that the Waianae Coast Comprehensive Health Center (Center) was established in 1972 to provide primary care services for the federally designated and medically underserved Waianae coast with operating funds granted through the department of health and human services.

     The legislature further finds that today, as was true from its establishment, the Center continues to fulfill its mission as a community-owned and community-operated nonprofit medical facility serving an ever expanding Waianae coast community of some fifty thousand residents.  The Center serves thirty-seven thousand patients annually through its main center in Waianae, satellite clinics in Waianae and Nanakuli, school-based sites in Waianae and Nanakuli, and satellite clinics in Kapolei, Ewa, and Waipahu.  The majority of patients served are Native Hawaiian (forty-seven per cent), followed by Asian & Other Pacific Islanders (twenty-eight per cent).  Sixty-five per cent of patients are at one hundred per cent of the federal poverty level or below; seven per cent are uninsured; and fifty-eight per cent are receiving coverage under QUEST, the State's medicaid program.

     The vision of the founders of the Center, to offer comprehensive health services, has guided the development of the services and activities of the Center's patient-centered health care home.  The Center achieves its mission by not only serving patients who seek services, but also by incorporating the goal of improving the overall health status of the community it serves.

     Emergency medical services, while not a core service supported by department funding, was identified by the community as a vital service for the Waianae coast.  The Center began offering emergency medical services on a limited basis in 1976 through private funding.  From 1986, with assistance from the legislature, the Center's emergency room has been able to be open twenty-four hours per day on a year-round basis.  Subsidy funding from the legislature has supported the Center's emergency room in operating between the hours of midnight to eight a.m., along with providing laboratory and imaging services.

     The Center's emergency room is one of the most heavily utilized on Oahu, serving twelve thousand six hundred patients through a total of 21,600 visits in 2017-2018.  For the midnight to eight a.m. period, there were 3,434 visits with fifty-nine per cent being patients covered under medicaid and ninety-three per cent being residents of the Waianae coast.  The pathology seen from midnight to eight a.m. averages one hundred seventy with chest pain/congestive heart failure; three hundred twenty-five in respiratory distress; six hundred forty with severe signs or symptoms; two hundred in trauma; fifteen in labor; and ninety patients presenting mental illness/substance abuse issues.

     The Center's participation and role in the statewide Emergency Medical System is substantial.  With recognition by the State as a trauma support facility, the Center serves as a safety net for the residents of the Waianae coast.  The Center is connected to the State Emergency Management System, which connects all Hawaii hospitals and the emergency medical services system.  The Center's emergency room is rated as a Type II facility (out of three types) for Hospital Capability for Readiness.  The Center's emergency room is used by the Honolulu police department and child protective services.  The Honolulu police department brings individuals in custody to the emergency room for medical care.  Child protective services uses the emergency room for pre-placement physical exams when children are removed from their parents or guardians.

     As the primary medical provider on the Waianae coast, the Center fills a major role in providing health services to the community, which allows the State to focus its limited resources in other areas.  The twenty-four-hour emergency services provided by the Center addresses the unique challenges of the community that are presented by being on the most western point of Oahu, such as isolation caused by road closures, natural disasters, and traffic; in addition, the Center addresses more universal health challenges, such as the need to stabilize trauma victims and the need to stabilize patients to avoid hospitalization.  Increased homelessness, economic conditions, and behavioral health conditions have also increased the demand for emergency medical services on the Waianae coast, but this increase in demand has not been matched by an increase in State funding.

     The Center's operating costs for the midnight to eight a.m. period was $5,280,842 in 2017-2018.  However, the funding level the legislature has provided to the Center since 1986 to the present has remained at $1,468,000.  The difference between current legislative support provided through the department of health and the actual cost to operate services between midnight to eight a.m. is $3,812,842.

     There are many factors that contribute to the inability of the Center to support itself financially, such as:

     (1)  The emergency department services a low-income, uninsured, and underinsured population;

     (2)  The emergency department serves the large homeless population on the Waianae coast;

     (3)  The economic base of the community is not able to support medical services on a fee-for-service basis and must absorb the cost of uninsured and underinsured patients;

     (4)  Due to the Center's status as a federally qualified health center, the Center is not allowed the benefit of hospital-based emergency departments to bill an emergency room facility fee for emergency patients covered under the federal Medicaid, Medicare, and Tri-care programs.  Patients under these federal programs make up seventy per cent of the Center's base;

     (5)  The State's uninsured funding is designed specifically for uninsured primary care visits and does not cover uninsured emergency room visits; and

     (6)  Other rural communities receive a large state subsidy for emergency services through the state hospital system, however, the Center does not get proportionate support.

     The legislature recognizes that a dependable, multi-year financial commitment by the State in supporting emergency medical services at the Center is the most effective way to ensure that residents throughout the Waianae coast receive appropriate medical care and that the community is served during a disaster.  The legislature further recognizes that failure to increase funding to the Center to bring funding levels in line with increased demands for services may result in the Center having to reduce hours of vital services to the Waianae coast community.

     The purpose of this Act is to assist the Center in continuing twenty-four-hour year-round emergency room services to residents of the Waianae coast to ensure emergency medical and disaster-related response services are available for the fifty thousand residents of the Waianae coast.

     SECTION 2.  There is appropriated out of the general revenues of the State of Hawaii the sum of $800,000 or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 to the Waianae Coast Comprehensive Health Center for operation of its twenty-four-hour emergency room.

     The sums 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, 2019.

 

INTRODUCED BY:

_____________________________

 

 


 


 

Report Title:

Waianae Coast Comprehensive Health Center; Appropriation

 

Description:

Appropriates funds to the Waianae Coast Comprehensive Health Center for operation of its twenty-four-hour emergency room.

 

 

 

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.

 

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