Legislative bill taps
traffic violation fines
to aid trauma victims

Some offenses would carry
a surcharge for nerve-injury therapy

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By Bruce Dunford
Associated Press

Motorists caught speeding, driving drunk, not buckling up themselves or a child, or leaving the scene of an accident involving injuries may be paying for a new state program to help people disabled by brain or spine injuries.

A legislative bill now awaiting Gov. Ben Cayetano's signature would impose a new "surcharge" for certain driving violations to help people recover from or at least cope with central nervous system injuries.

"Right now, there are very few services, and what few there are are very expensive and uncoordinated," said Lyna Burian, a University of Hawaii employee whose son, Albert, still needs physical and mental therapy for a severe brain injury sustained nearly 10 years go.

Hal Kahikina, 55, has been pushing for the bill for two years.

Doctors had said Kahikina would be a "vegetable" after he came out of a coma after being run over Sept. 22, 1988, on Johnston Atoll, where he worked for the Army Corps of Engineers.

"Once you are brain-injured, you are brain-injured for the rest of your life," he said. "But a lot of things they thought I would not be able to do, I am doing. I can speak; I can walk; I can converse and successfully integrate with people who are not brain-injured."

However, Kahikina cannot taste or smell, his left side is blood-clotted and he has retrograde amnesia.

"I cannot remember from the time I was born until the time I got run over," he said.

Being a federal employee injured on the job, he was able to get many of the long-term services and therapies not available to most brain- or spinal-injured people in Hawaii, Kahikina said.

"Insurers won't cover that because they have a difficulty with the two terms, services and treatment. If it's services it is not done; if it's treatment it is done, but only for a very short term," he said.

"Other states do provide the services that Hawaii does not," Kahikina said.

According to the measure, each year, one in every 148 people will survive a neurotrauma injury with half of those experiencing short-term disability and 5 percent sustaining lifelong debilitating losses of mental or physical functions.

The Hawaii Health Systems Corp., which operates the state's community hospitals, estimates that 1,200 people are treated annually in Hawaii for brain or spinal injuries.

Based on the national average, that means about 60 patients in Hawaii are added each year to the number needing long-term care and rehabilitation.

The average medical cost for a three- to- six-month hospitalization for neurotrauma injury is $85,000, and the survivor of a severe head injury typically faces five to 10 years of intensive treatment at an estimated cost in excess of $4 million, according to the bill.

Based on national estimates, the annual direct medical costs for treatment of neurotrauma injuries in Hawaii is $14 million, with the total economic costs of head injuries in Hawaii $89 million.

Albert Burian was 16 when he was struck by a tow truck while crossing the street and remained in a coma for 2 1/2 months.

"He's now walking in a walker, but he still has a lot of problems with his balance and coordination," said Lyna Burian, who has become a key advocate for the measure.

"He has a lot of physical problems and some behavioral problems, including impulsivity, which is something for which cognitive therapy would be useful, but there is hardly any available in Hawaii."

Cayetano vetoed a similar bill two years ago because of the attorney general's concern that it violated prohibitions against using mandatory fees from drivers licensing to support a trust fund, Burian said.

This year's bill instead sets up a special state fund supported by traffic violations, although the Department of Budget & Finance expressed concern that earlier language be changed to avoid lawsuits contending the neurotrauma services were a state entitlement that would require future support from the state's general fund, Burian said.

The bill establishes a nine-member board to oversee the special fund in the state Department of Health to provide direct services, education, training and research and to look for ways to minimize the costs of services.

House Health Committee Chairman Dennis Arakaki (D, Kamehameha Heights-Kalihi Valley) said during the floor debate on the measure he had to defend the relationship between "surcharges" for traffic violations and the treatment of neurotrauma injuries.

Burian said the nexus is simple -- 50 percent of severe head injuries are the result of traffic accidents.

Arakaki said treatment on neurotrauma cases is specialized, and therefore there are few services available and little support for families who face the situation.

"It's not like being mentally ill. It's not quite like being mentally retarded. Some of the people still retain their functioning, and some of them are even quite intelligent," he said.

Funding of the programs, expected to be between $500,000 and $1 million annually, will not begin until January.

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