HILO — Legislators are considering a proposal that would improve access to health care at Ka‘u Hospital and Rural Health Clinic in Pahala.
Senate Bill 1410 originally proposed funding to increase the bed count in the Ka‘u Hospital emergency room, but the bill’s current version — which has passed through the state Senate and is now before the state House for consideration — would instead appropriate a yet-to-be-determined amount of general fund revenue over the next two fiscal years to support the expansion of urgent care and outpatient behavioral health services at the hospital’s clinic.
Ka‘u Hospital administrator Merilyn Harris said the hospital sees about 5,000 patients a year in its clinic and about 3,000 patients per year in its emergency room.
“Quite a significant portion of those ER patients are patients that probably could have been cared for in a different setting,” she said.
Some patients have issues that need immediate attention but come to the emergency room because they couldn’t get into their primary care provider, Harris explained. And while there are three health care clinics in Ka‘u, sometimes the hours of operation don’t suit the needs of patients, or they are full.
Instead of adding ER beds, the thought was to provide “access to care that’s more at the level (patients) need,” Harris said.
With additional funding, Harris said Ka‘u Hospital could look at how to accommodate more urgent care visits at its clinic, which is located within the hospital. That could mean extended hours or possibly even an additional provider.
“The whole purpose of a critical-access hospital is to improve access to care,” said Harris, and that includes “improving access to the right level of care so people aren’t having to use the emergency department when in fact their health concern isn’t actually emergent.”
Harris said the hospital will see anyone who comes in, but “frequently people come to the ER only because they can’t access the right level of care that they need when they need it,” she explained.
If the hospital and clinic receives the funding, Harris said they also will “see if we can add behavioral health to our clinic.”
According to Harris, there are currently no practicing psychologists or psychiatrists in Ka‘u.
“That means if a patient is seen in our clinic who needs some mental health support … we’re having to refer them to Hilo or Kona and, again, that’s an hour-and-a-half drive away. Some people don’t do it because they can’t — maybe their work doesn’t allow them to be gone half a day, or they don’t have the transportation during the week.”
“It’s harder out here,” Harris said.
Harris said there are about 9,000 people in Ka‘u, but “even if there were only 3,000, everybody deserves access to care.”
SB 1410 was introduced by Big Island Sen. Dru Kanuha, who represents a portion of Ka‘u, and co-sponsored by Hilo Sen. Kai Kahele, among others.
“The need for expanded urgent care in Ka‘u is clear,” Kanuha said in an email Wednesday. “My intention with this bill is to provide funds to Ka‘u Hospital’s Rural Health Clinic to help expand the clinic’s hours of operation and services to include urgent care and behavioral health services. The community wants greater access to primary care in Ka‘u and I’m trying to make that happen.”
Kanuha said he is aiming for $700,000 in funding, but that amount ultimately will be up to the Ways and Means and Finance committees “to fit in an already tight budget.”
“I’m happy that the House committee on Health is hearing this bill and I hope it can continue to move forward,” he said.
The Committee on Health held a hearing on the measure Thursday, voting to pass it unamended. It next heads to the House floor for a second reading and referral to the Committee on Finance.
A proposal from by the House also would add to the bill a second section that would require the state Department of Health to conduct a study on the state Emergency Medical Services system to identify issues and problems and proposed initiatives to improve the system.
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