Kauai misses out
on medevac

A law requires the state
to provide emergency
helicopter service

LIHUE >> If Maui County gets a helicopter ambulance, Kauai will be the only island without one.

Funding for a helicopter ambulance for Maui County was reinstated Tuesday by the state Legislature when it voted to override Gov. Linda Lingle's veto of the $1 million appropriation. Lingle said in her veto message the bill was unacceptable because it did not provide helicopter medevac service to the rest of the state.

But besides Maui County and Kauai, all islands have some helicopter ambulance service for seriously ill patients or accident victims. Even tiny Niihau has a helicopter, owned by Niihau Ranch, available for medical transport.

Gary Heu, Kauai Mayor Bryan Baptiste's administrative assistant, said Friday that a medevac helicopter has never come up as an issue on Kauai.

When he sat through budget briefings by other counties last January and heard Maui make a case for its helicopter, it did not occur to anyone from Kauai to try to get on board, he said.

Funding for the Maui service, meanwhile, will kick in July 1, 2004, said Randy Roth, Lingle's senior policy adviser.

"There is a law in place right now that mandates the state provide helicopter medical evacuation service on every island, and we aren't doing it," Roth said. "Hopefully, we can work that out in the next session."

Lingle also still has a say on the issue. Despite the override, she can still refuse to spend the money.

Every county, including Kauai, has a fire department rescue helicopter capable of searching for lost hikers and plucking them off mountaintops. But they are required to immediately turn them over to ground ambulances.

Medevac helicopters are used primarily to transport accident and severe heart-attack victims to an emergency room.

"I think we can manage on Kauai without a helicopter," said Dr. Wayne Fukino, an emergency room physician at Kauai Veterans Memorial Hospital in west Kauai. "But is it optimal? The county would be far better served if we had one.

"The number of people it picked up off the road would be small and the cost would be very high, but we could certainly make a case for it here.

"I also think if residents of Kauai filed a lawsuit against the state claiming they are paying for a service they can't receive but everyone else in the state has, they would have a pretty good case," Fukino added.

In terms of being cost-effective, the service cannot be justified on any of the neighbor islands, said Andy Kluger, president of Hawaii Air Ambulance. His company specializes in inter-hospital patient transfers rather than medevac service.

"But that doesn't mean they shouldn't all have helicopters," he said. "We agree absolutely Kauai should be included."

Hawaii County uses its helicopter four to six times a month. Maui is budgeted for about 10 flights a month, Kluger said. Kauai flights would be once a week or less, if it had a helicopter.

"It's expensive and it's dangerous, but it saves lives," he said. "There's no reason any community in Hawaii should be deprived of the service."

Medical evacuation throughout the state is indeed uneven.

Someone injured in a traffic accident on Oahu would be picked up by a military helicopter for free. The Military Assistance to Safety and Traffic system has been around for about 40 years. The military writes the cost off as training since the crews and aircraft must fly a minimum number of hours every month.

On the Big Island, an accident victim would be picked up by a 10-year-old, county-owned helicopter, which was donated by a developer and is two-thirds subsidized by the state. The state bills victims who are transported in the helicopter.

If Maui gets its helicopter, a sick or injured person would be picked up by a state-owned helicopter and billed by the state.

On Kauai, the state also bills the sick and injured, but the ride to the hospital is in the back of a ground ambulance.

If it's past Hanalei or up in Kokee beyond Waimea Canyon, it will take longer than "the golden hour" that emergency room physicians say is what counts in trauma cases.

Maui County used to have a private helicopter ambulance company, Mercy Air, but it lost so much money on uncollectible bills that it went out of business, leaving behind $3 million in debt. In the view of many, it is a service that, at least in a rural area, is best provided by the government because any private company would lose money.

The new Maui helicopter service created by the Legislature will cost the state $611,500 and Maui County $611,500 to lease the helicopter -- most of it in matching funds, such as donated land for a helicopter pad rather than cash. And the state will pay another $388,500 in start-up costs.

Why Maui and not Kauai?

No one argues the need on Maui isn't great. Health officials say accident or heart-attack victims in isolated places such as Hana, Lanai or Molokai have no way to quickly reach Maui Medical Center, the only hospital on Maui.

But politics played a part. The bill's sponsor and chairwoman of the Senate Health Committee was Sen. Roslyn Baker (D, West Maui).

"Look, the simple fact is Maui lobbied it hard and Kauai didn't even get in the game," said Rep. Mina Morita (D, North Kauai).

Kauai County official Heu noted: "If there is broad-based sentiment from the community for a helicopter ambulance service, we will pursue it. But the issue just hasn't been there on Kauai."


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