Honolulu Weekly

1. What was your biggest accomplishment this session?
“The Maui delegation put together a package of bills and capital improvement projects (CIP) aimed at improving health care in our County: SB1673,CD1 & HB200, CD1.

(1) SB1673, CD1 allows Maui Memorial Medical Center (MMMC) to transition out of the Hawaii Health Systems Corporation (HHSC) as well as providing more regional influence on the HHSC board (the board make up is changed to include the chief executives of the neighbor island acute care hospitals as well as shifting selection of HHSC board members to the regional boards). Senator Roz Baker (South & West Maui) took the lead on drafting of the final conference language; Senator Shan Tsutsui (Central Maui), Rep. Kyle Yamashita (Upcountry Maui) and I served on the conference committee and discussed key concepts and positions on transition and regional flexibility with other negotiators).

(2) A key for putting MMMC on better financial footing is reducing the Countywide wait for longterm care (LTC) beds (reimbursed at approx. $150/day) which will free costly acute care beds (costing $2000/day) at MMMC: the LTC Green House project at Kula Hospital ($5,000,000 for construction of 30 LTC beds) will help tremendously.

(3) Dialysis Unit: $7,200,000 for plan, design, construction and equipment for a new dialysis unit (9 treatment stations, including 2 isolation stations). In recent years, MMMC has provided 1,700 dialysis treatments annually and the current unit needed upgrading.

(4) MMMC Phase II: $15,000,000 in FY’10 to plan, design and renovate facilities for various departments, including OB and oncology, and money to construct a helipad to make access to the emergency facilities more efficient.
I participated in formal and informal discussions over changes to HHSC throughout the session between Senate and House Health committee chairs, with representatives who have HHSC facilities in their districts, members of the House leadership, and key money committee members. I requested and served on the conference committee on SB1673 and on the Budget as well as the bill which provided emergency funding to HHSC.”

2. With which piece of 2009 legislation are you most proud to be affiliated and why?
“The main accomplishment has to be the community hospital legislation. I live in Central Maui where I was born and raised. I chose to move home after attending college on the East Coast and law school in California and working for almost a decade on Oahu. MMMC is Maui’s only acute care hospital and is located in my district. Health care is a key to quality of life on Maui and our community has expressed wanting more control over the operation and planning of facilities and services — SB1673, CD1 gives the Maui regional board more authority and Maui will have three seats on a reconstituted HHSC board. The new law also gives Maui region more flexibility to negotiate a supplemental memorandum to any collective bargaining agreement to foster more efficiency. The law will also give all stakeholders an opportunity to work on the big issue of improving access and integrating the continuum of care and caregivers (i.e., MMMC, Maui Medical Group (MMG) and the Community Clinic of Maui have already successfully collaborated to help improve the on-call issue by have MMG provide hospitalists) and the LTC and independent living options on the island. It’s unfortunate that Rep. Nakasone did not live to see the passage of SB1673, CD1 or the funding of the Kula Hospital Green House LTC project; one of the last things he was very interested in was to make LTC more accessible for the entire community.”

3. What was the biggest disappointment of the session and how might a similar disappointment be prevented in the future?
“I wouldn’t use the term ‘disappointed’ but I am concerned about further delaying long overdue maintenance and improvements of small boat harbors, state parks and trails. Although this was my first session as a legislator, having served in the Cayetano administration, I understand that certain issues and ideas may take longer than one session to gain passage. I have great affection for the Department of Land and Natural Resources (DLNR) and so I was predisposed to support the Administration’s “Recreational Renaissance” initiative. However, I also acknowledge the concerns that legislators had regarding the feasibility of funding the projects through future revenue from entry fees and private commercial leases of public lands, especially given the history of key DLNR constituencies raising concerns and strongly opposing private commercialization of public resources and lands. In the end, however, the proposal failed as much due to legislative maneuvering between House and Senate conference negotiators as to any substantive questions about future debt service of revenue bonds. However, I have to question the Administration’s decision to make the failure of the proposal the focus of its criticism of the legislature. As both the Senate President and the House Speaker observed, the Administration brought this proposal seven years into its term when in its early years DLNR officials opposed legislative proposals to provide funding through increased harbor user and park entry fees.”

4. Debating which issue turned out to be the biggest distraction from your priorities?
“The State budget revenue shortfall overshadowed most issues this session — distraction might not be the right term since passing a balanced budget is a Constitutional duty of the legislature. The budget problems of HHSC in a year where general funds were scarce fostered some extreme positioning prior to conference which may have delayed dealing with the structural shortcomings of HHSC. I simply took the view that the goal was to get vehicles to conference — to keep discussions about changes to HHSC and the possibility of allowing greater regional autonomy alive.”

5. What’s one thing you wish voters better understood about you or the political process as a whole?
“I was selected (appointed by Governor Lingle to complete the term of Bob Nakasone), not elected. As a result, I may not be as sensitive to the most politically active district constituencies as my elected colleagues. It’s sometimes best to view the legislative process as a four month ‘work in progress’ with some parts substantive and some parts relational. The goal is to keep your ideas alive through the three hearings required in each body while working to convince your colleagues of your position on those ideas by the time conference starts. Success requires knowledge of the legislative timetable and rules as well as some willingness to hear what drives opponents of your ideas and whether there is some common ground to move the idea forward. You do need to vote ‘no’ on some issues but a ‘yes with reservations’ may allow you to influence the legislation more. Media coverage of the legislature can be spotty and somewhat dated (as an example, concerns that arose regarding a proposal to tax certain pensions were raised in media accounts after the House Finance committee acted to delete the proposal from the vehicle.); what the media reports may not be the reason something does or doesn’t happen. It’s also unlikely that every legislator will be aware of the details and implications of every bill that makes it to the floor — most will be concerned about the issues that are a priority for their districts, or of special interest to them. As a result, on some issues, great reliance will be placed on those who serve on the substantive committees that heard those bills (in the case of the pension issue, the Finance committee heard the testimony and decided to reject the proposal).

As I note above with regard to the community hospital issue, keeping the discussion alive through conference and discovering what was driving key legislators were important to coming up language acceptable to both House and Senate negotiators while staying focused on what Maui stakeholders wanted. Initially, Maui regional representatives wanted a ‘carve out’ — the final bill provided for a ‘transition’ with certain conditions required for a region to leave HHSC or to “transition” into another entity or to venture with a nongovernmental entity.”