REPORT OF HOSPITAL SURVEY AND PLANNING Territory of Hawaii FEBRUARY - 1948 TERRITORY OF HAWAI I, BOARD OF H EALTH HONOLULU, T.H HOSPITALS AND PUBLIC HEALTH FACILITIES IN ;HAWAII INVENTORY OF EXISTING HOSPITALS AND PUBLIC HEALTH CENTERS SURVEY OF THE NEED FOR CONSTRUCTION OF HOSPITALS AND HEALTH CENTERS PROGRAM FOR CONSTRUCTION OF HOSPITALS AND HEALTH CENTERS TO FURNISH ADEQUATE SERVICES TO ALL OF THE PEOPLE (In accordance with the provisions of the federal Hospital Survey and Construction Act) BOARD OF HEALTH TERRITORY OF HAWAII Division of Hospital Planning W, B. Meister, M.D„, Director Honolulu, T. H. TERRITORIAL ADVISORY COUNCIL MEMBERS Mr. Kenneth W. Roehrig, Acting Chairman Mr. Roehrig is connected with one of Honolulu’s leading architectural firms. Mr. Roehrig was last year president of the Honolulu Rotary Club and presi- dent of the Honolulu Architects Association, Mr. Vergil F. Bradfield * Mr. Bradfield is by profession a hospital administrator. He has held such a position in China and the United States and is now assistant administrator and business manager of the Territory’s largest tuberculosis hospital, Leahi Hospital of Honolulu. Mr. Reginald Carter Mr. Carter is the executive manager of the Honolulu Community Chest. He was formerly business manager of the Hawaii Medical Service Association, the Territory’s voluntary health insurance plan. Miss Margaret M. L. Catton Miss Catton is Director of the Social Service of the Medical Social Service Association of Hawaii which is a non-governmental organization. Through this organization, she was the pioneer in the Territory for medical social service Robert B, Faus, M. D. Dr. Faus is president of the Territorial Medical Association and during the war was a colonel in the United States Army in command of a five hundred bed hospital. He has also in the past been the chief physician of the City and County of Honolulu. Nils P 0 Larsen, MeD. Dr, Larsen is a practicing physician in Honolulu. For 20 years, he was the Medical Director and pathologist of the Queen’s Hospital and he has been for 17 years the medical adviser to the Hawaiian Sugar Planters’ Association,, Mrc Gilbert G. Lentz Mro Lentz is executive secretary of the Public Finance Committee of the Hono- lulu Chamber of Commerce and was formerly in charge of the Legislative Refer- ence Bureau of the Territory. Miss Rhoda V. Lewis Miss Lewis is first Assistant Attorney General of the Territory. Bishop James J. Sweeney Bishop Sweeney is the Catholic Bishop of the Territory and has shown an in- terest in not only the Catholic hospitals here but other hospitals as well and is a member of the Executive Committee of the Territory’s Hospital Coun- cil 0 Mro Charles M 0 Wright Mro Wright is now connected with the Honolulu Rapid Transit Company and was formerly closely associated with labor movement in the Territory, Dro Charles L 0 Wilbar, JrD (member, ex-officio) Dr, Wilbar is President of the Board of Health, Territory of Hawaii 3 TERRITORIAL BOARD OF HEALTH MEMBERS Dr. Charles L. Wilbar, Jr., President Mr. Walter D. Ackerman Dr. Robert B. Fans Mr. Charles F. Honeywell Dean A. R. Keller Mrs. Hazel B. Mattson Mr. Fred Patterson Dr. F. J, Pinkerton Mr. W. J. Wilbert 4 ACKNOWLEDGMENT Acknowledgment and thanks are expressed to the following for assistance in the preparation of this report; American College of Surgeons American Medical Association American Hospital Association American Dental Association Commission on Hospital Care of Chicago Territorial Hospital Service Study Commission Territorial Medical Association of Hawaii Honolulu County Medical Society Honolulu Chamber of Commerce Nurses Association, Territory of Hawaii United States Census Bureau United States Public Health Service Pineapple Growers Association of Hawaii Territorial Board of Hospitals and Settlement Hawaiian Sugar Planters' Association Administrators of all the hospitals in the Territory of Hawaii Hawaii Chapter of the American Institute of Architects Members of the staff of the Territorial Department of Health 5 LETTER OF TRANSMITTAL February 6, 194-8 Honorable Ingram M. Stainback Governor of Hawaii Honolulu, T. H. Sir: Attached is the Report of Hospital Survey and Planning for the Territory of Hawaii. This has been prepared by the Division of Hospital Plan- ning of the Territorial Health Department in accordance with the requirements of Public Law 725, 79th Congress, ”Hospital Survey and Construction Act,” and with the instructions con- tained in your Executive Order, letter dated September 23, 1946. The report is divided into two parts, a narrative account of the results of the survey with an analysis of these results, and a plan for the provision of hospitals and health centers for the Territory's needs. This report was approved by the Territorial Advisory Coun- cil and by the Board of Health after a public hearing on February 5, 1948. Respectfully submitted, C. L. WILBAR JR., M.D. President, Board of Health 7 PUBLIC LAW 725—79th CONGRESS Chapter 958—2nd Session S. 191 AN ACT To amend the Public Health Service Act to authorise grants to the States for sur- veying their hospitals and public health centers and for planning construction of additional facilities, and to authorize grants to assist in such construc- tion. Be it enacted bv the Senate and House of Representatives ©f the United States of America in Congress assembled. That this Act may be cited as the'Hospital Survey and Construction Act.M f Am< SeCc 2. The Public Health Service Act (consisting of titles I to V, inclusive, of the Act of July 1, 1944» 58 Stat. 682) is hereby amended by adding at the end thereof the following new titles "TITLE VI—CONSTRUCTION OF HOSPITALS "Part A—Declaration of Purpose BSec0 601. The purpose of this title is to assist the several States— w(a) to inventory their existing hospitals (as defined in section 631 (e) ), to survey the need for construction of hospitals, and to develop programs for construction of such public and other nonprofit hospitals as will, in conjunction with existing facilities* afford the necessary phy~ sical facilities for furnishing adequate hospital, clinic, and similar services to all their people| and "(b) to construct public and other nonprofit hospitals in accordance with such programso "PART B—SURVEYS AND PLANNING "Authorization of Appropriation “Sec. 611. In order to assist the States in carrying out the purposes of section 601 (a), there is hereby authorized to be appropriated the sum of $3,000,000, to remain available until expended. The sums appropriated under this section shall be used for making payments to States which have submitted, and had approved by the Surgeon General, State applications for funds for car- rying out such purposes. “STATE APPLICATIONS “Sec. 612. (a) To be approved, a State application for funds for carrying out the purposes of section 601 (a) must— 9 ”(1) designate a single State agency as the sole agency for carrying out such purposes? Provided„ That after a State plan has been approved under section 623, any further survey or programing functions shall be carried out, pursuant to section 623 (a) (10), by the agency designated in accordance with section 623 (a) (l)| w(2) provide for the designation of a State advisory council, which shall include representatives of nongovernment organizations or groups, and of State agencies, concerned with the operation, construction, or utilization of hospitals, including representatives of the consumers of hospital services selected from among persons familiar with the need for such services in urban or rural areas, to consult with the State agency in carrying out such pur- poses? ”*(3) provide for making an inventory and survey in accordance with section 601 (a) containing all information required by the Surgeon General, and for developing a program in accordance with section 601 (a) and with regulations prescribed under section 622 j and “(A) provide that the State agency will make such reports, in such form and containing such information, as the Surgeon General may from time to time reasonably require, and give the Surgeon General, upon demand, access to the records on which such reports are based. M(b) The Surgeon General shall approve any application for funds which com- plies with the provisions of subsection (a). 58ALLOTMENTS TO STATES wSeCo 6130 (a) Each State for which a State application under section 612 has been approved shall be entitled to an allotment of such proportion of any appropriation made pursuant to section 611 as its population bears to the popu- lation of all the States, and within such allotment it shall be entitled to re= ceive 33 l/3 per centum of its expenditures in carrying out the purposes of sec- tion 601 (a) in accordance with its application? Providedo That no such allotment to any State shall be less than $10,000„ The Surgeon General shall from time to time estimate the sum to which each State will be entitled under this Section, during such ensuing period as he may determine, and shall thereupon certify to the Secretary of the Treasury the amount so estimated, reduced or increased, as the case may be, by any sum by which the Surgeon General finds that his estimate for any prior period was greater or less than the amount to which the State was entitled for such period. The Secretary of the Treasury shall thereupon, prior to audit or settlement by the General Accounting Office, pay to the State, at the time or times fixed by the Surgeon General, the amount so certified. "(b) Any funds paid to a State under this section and not expended for the purposes for which paid shall be repaid to the Treasury of the United States* 10 "PART C—CONSTRUCTION OF HOSPITALS AND RELATED FACILITIES "AUTHORIZATION OF APPROPRIATIONS "Sec. 621. In order to assist the States in carrying out the purposes of section 601 (b), there is hereby authorized to be appropriated for the fiscal year ending June 30, 194-7, and for each of the four succeeding fiscal years, the sum of $75,000,000 for the construction of public and other nonprofit hospi- tals | and there are further authorized to be appropriated for such construction the sums provided in section 624. The sums appropriated pursuant to this sec- tion shall be used for making payments to States which have submitted, and had approved by the Surgeon General, State plans for carrying out the purposes of section 601 (b); and for making payments to political subdivisions of, and pub- lic or other nonprofit agencies in, such States. " GENERAL REGULATIONS "Sec. 622. Within six months after the enactment of this title, the Sur- geon General, with the approval of the Federal Hospital Council and the Adminis- trator, shall by general regulation prescribe— "(a) The number of general hospital beds required to provide adequate hos- pital services to the people residing in a State, and the general method or methods by which such beds shall be distributed among base areas, intermediate areas, and rural areas? Provided. That for the purposes of this title, the total of such beds for any State shall not exceed four and one-half per thousand popula- tion, except that in States having less than twelve and more than six persons per square mile the limit shall be five beds per thousand population, and in States having six persons or less per square mile the limit shall be five and one-half beds per thousand populationi but if, in any area (as defined in the regulations) within the State, there are more beds than required by the standards prescribed by the Surgeon General, the excess over such standards may be eliminated in cal- culating this maximum allowanceo "(b) The number of beds required to provide adequate hospital services for tuberculous patients, mental patients, and chronic=>disease patients in a State, and the general method or methods by which such beds shall be distributed through- out the States Provided. That for the purposes of this title the total number of beds for tuberculous patients shall not exceed two and one-half times the average annual deaths from tuberculosis in the State over the five-year period from 1940 to 1944 f inclusive, the total number of beds for mental patients shall not exceed five per thousand population, and the total number of beds for chronic-disease patients shall not exceed two per thousand population. "(c) The number of public health centers and the general method of distribu- tion of such centers throughout the State, which for the purposes of this title, shall not exceed one per thirty thousand population, except that in States having less than twelve persons per square mile, it shall not exceed one per twenty thou- sand population. "(d) The general manner in which the State agency shall determine the priority of projects based on the relative need of different sections of the population 11 and of different areas lacking adequate hospital facilities, giving special con- sideration to hospitals serving rural communities and areas with relatively small financial resources. "(e) General standards of construction and equipment for hospitals of differ- ent classes and in different types of location. "(f) That the State plan shall provide for adequate hospital facilities for the people residing in a State, without discrimination on account of race, creed, or color, and shall provide for adequate hospital facilities for persons unable to pay therefor. Such regulation may require that before approval of any appli- cation for a hospital or addition to a hospital is recommended by a State agency, assurance shall be received by the State from the applicant that (l) such hospi- tal or addition to a hospital will be made available to all persons residing in the territorial area of the applicant, without discrimination on account of race, creed, or color, but an exception shall be made in cases where separate hospital facilities are provided for separate population groups, if the plan makes equitable provision on the basis of need for facilities and services of like quality for each such group; and (2) there will be made available in each such hospital or addition to a hospital a reasonable volume of hospital services to persons unable to pay therefor, but an exception shall be made if such a requirement is not feasible from a financial standpoint. "(g) General methods of administration of the plan by the designated State agency, subject to the limitations set forth in section 623 (a) (6) and (8). "STATE PLANS "Sec. 623. (a) After such regulations have been issued, any State desiring to take advantage of this part may submit a State plan for carrying out the pur- poses of section 601 (b) . Such State plan must— "(l) designate a single State agency as the sole agency for the administra- tion of the plan, or designate such agency as the sole agency for supervising the administration of the plan; "(2) contain satisfactory evidence that the State agency designated in accord- ance with paragraph (l) hereof will have authority to carry out such plan in con- formity with this part; "(3) provide for the designation of a State advisory council which shall in- clude representatives of nongovernment organizations or groups, and of State agencies, concerned with the operation, construction, or utilization of hospitals, including representatives of the consumers of hospital services selected from among persons familiar with the need for such services in urban or rural areas, to consult with the State agency in carrying out such plans; "(4-) set forth a hospital construction program (A) which is based on a State- wide inventory of existing hospitals and survey of need; (B) which conforms with the regulations prescribed by the Surgeon General under section 622 (a), (b), and (c); (C) which, in the case of a State which has developed a program under part B of this title, conforms to the program so developed except for any modification 12 required in order to comply with regulations prescribed pursuant to section 622 (a), (b), and (c), and except for any modification recommended by the State agency designated pursuant to paragraph (l) of this subsection and approved by the Surgeon Generals and (D) which meets the requirements as to lack of discrimination on ac- count of race, creed, or color and for furnishing needed hospital services to per- sons unable to pay therefor, required by regulations prescribed under section 622 (f); "(5) set forth the relative need determined in accordance with the regulations prescribed under section 622 (d) for the several projects included in such programs, and provide for the construction, insofar as financial resources available therefor and for maintenance and operation make possible, in the order of such relative need; "(6) provide such methods of administration of the State plan, including meth- ods relating to the establishment and maintenance of personnel standards on a merit basis (except that the Surgeon General shall exercise no authority with respect to the selection, tenure of office, or compensation of any individual employed in ac- cordance with such methods), as the Surgeon General prescribes by regulation under section 622 (g); "(7) provide minimum standards (to be fixed in the discretion of the State) for the maintenance and operation of hospitals which receive Federal aid under this part; "(8) provide for affording to every applicant for a construction project an opportunity for hearing before the State agency; "(9) provide that the State agency will make such reports in such form and containing such information as the Surgeon General may from time to time reason- ably require, and give the Surgeon General, upon demand, access to the records upon which such information is based; and ”(10) provide that the State agency will from time to time review its hospital construction program and submit to the Surgeon General any modifications thereof which it considers necessary. n(b) The Surgeon General shall approve any State plan and any modification thereof which complies with the provisions of subsection (a) . If any such plan or modification thereof shall have been disapproved by the Surgeon General for failure to comply with subsection (a), the Federal Hospital Council shall, upon request of the State agency, afford it an opportunity for hearing. If such Council determines that the plan or modification complies with the provisions of such subsection, the Surgeon General shall thereupon approve such plan or modificationo "(c) No changes in a State plan shall be required within two years after ini- tial approval thereof, or within two years after any change thereafter required therein, by reason of any change in the regulations prescribed pursuant to section 622, except with the consent of the State, or in accordance with further action by the Congress. "(d)lf any State, prior to July 1, 194-8, has not enacted legislation provid- ing that compliance with minimum standards of maintenance and operation shall be required in the case of hospitals which shall have received Federal aid under this title, such State shall not be entitled to any further allotments under Section 624., 13 "ALLOTMENTS TO STATES "Sec. 624.. Each State for which a State plan has been approved prior to or during a fiscal year shall be entitled for such year to an allotment of a sum bearing the same ratio to the sums authorized to be appropriated pursuant to sec- tion 621 for such year as the product of (a) the population of such State and (b) the square of its allotment percentage (as defined in section 631 (a) ) bears to the sum of the corresponding products for all of the States. The amount of the allotment to a State shall be available, in accordance with the provisions of this part, for payment of 33 l/3 per centum of the cost of approved projects within such State. The Surgeon General shall calculate the allotments to be made under this section and notify the Secretary of the Treasury of the amounts thereofo Sums allotted to a State for a fiscal year for construction and remain- ing unobligated at the end of such year shall remain available to such State for such purpose for the next fiscal year (and for such year only), in addition to the sums allotted for such State for such next fiscal year. Any amount of the sum authorized to be appropriated for a fiscal year which is not appropriated for such year, or which is not allotted in such year by reason of the failure of any State or States to have plans approved under this part, and any amount allotted to a State but remaining unobligated at the end of the period for which it is available to such State, is hereby authorized to be appropriated for the next fiscal year in addition to the sum otherwise authorized under section 621, "APPROVAL OF PROJECTS AND PAYMENTS FOR CONSTRUCTION "Seco 625. (a) For each project for construction pursuant to a State plan approved under this part, there shall be submitted to the Surgeon General through the State agency an application by the State or a political subdivision thereof or by a public or other nonprofit agency. Such application shall set forth (l) a description of the site for such project, (2) plans and specifications there- for in accordance with the regulations prescribed by the Surgeon General under section 622 (e), (3) reasonable assurance that title to such site is or will be vested solely in the applicant, (4) reasonable assurance that adequate financial support will be available for the construction of the project and for its main- tenance and operation when completed, and ($) reasonable assurance that the rates of pay for laborers and mechanics engaged in construction of the project will be not less than the prevailing local wage rates for similar work as determined in accordance with Public Law 403 of the Seventy-fourth Congress, approved August 30, 1935? as amended. The Surgeon General shall approve such application if suf- ficient funds to pay 33 l/3 per centum of the cost of construction of such pro- ject are available from the allotment to the State, and if the Surgeon General finds (A) that the application contains such reasonable assurance as to title, financial support, and payment of prevailing rates of wages, (B) that the plans and specifications are in accord with the regulations prescribed pursuant to section 622, (0) that the application is in conformity with the State plan ap- proved under section 623 and contains an assurance that the applicant will con- form to the applicable requirements of the State plan and of the regulations prescribed pursuant to section 622 (f) regarding the provision of facilities without discrimination on account of race, creed, or color, and for furnishing needed hospital facilities for persons unable to pay therefor, and an assurance that the applicant will conform to State standards for operation and maintenance, (D) that it has been approved and recommended by the State agency and is entitled u to priority over other projects within the State in accordance with the regula- tions prescribed pursuant to section 622 (d). No application shall be disap- proved until the Surgeon General has afforded the State agency an opportunity for a hearing. "(b) Upon approving an application under this section, the Surgeon General shall certify to the Secretary of the Treasury an amount equal to 33 l/3 per centum of the estimated cost of construction of the project and designate the appropriation from which it is to be paid. Such certification shall provide for payment to the State, except that if the State is not authorized by law to make payments to the applicant the certification shall provide for payment direct to the applicant. Upon certification by the State agency, based upon inspection by it, that work has been performed upon a project, or purchases have been made, in accordance with the approved plans and specifications, and that payment of an in- stallment is due to the applicant, the Surgeon General shall certify such install- ment for payment by the Secretary of the Treasury; except that if the Surgeon General, after investigation or otherwise, has ground to believe that a default has occurred requiring action pursuant to section 632 (a) he may, upon giving notice of hearing pursuant to such subsection, withhold certification pending action based on such hearing. "(c) Amendment of any approved application shall be subject to approval in the same manner as an original application. Certification under subsection (b) may be amended, either upon approval of an amendment of the application or upon revision of the estimated cost of a project. An amended certification may direct that any additional payment be made from the applicable allotment for the fiscal year in which such amended certification is made. "(d) The funds paid under this section for the construction of an approved project shall be used solely for carrying out such project as so approved. "(e) If any hospital for which funds have been paid under this section shall, at any time within twenty years after the completion of construction, (A) be sold or transferred to any person, agency, or organization, (l) which is not qualified to file an application under this section, or (2) which is not approved as a trans- feree by the State agency designated pursuant to section 623 (a) (l), or its suc- cessor, or (B) cease to be a nonprofit hospital as defined in section 631 (g), the United States shall be entitled to recover from either the transferor or the trans- feree (or, in the case of a hospital which has ceased to be a nonprofit hospital, from the owners thereof) 33 l/3 per centum of the then value of such hospital, as determined by agreement of the parties or by action brought in the district court of the United States for the district in which such hospital is situated. 15 "PART D—MISCELLANEOUS "DEFINITIONS "Sec. 631. For‘the purposes of this title— "(a) the allotment percentage for any State shall be 100 per centum less that percentage which bears the same ratio to $0 per centum as the per capita income of such State bears to the per capita income of the continental United States (excluding Alaska), except that (l) the allotment percentage shall in no case be more than 75 per centum or less than 33 l/3 per centum, and (2) the allotment percentage for Alaska and Hawaii shall be 50 per centum each, and the allotment percentage for Puerto Rico shall be 75 per centum; "(b) the allotment percentages shall be promulgated by the Surgeon General between July 1 and August 31 of each even-numbered year on the basis of the av- erage of the per capita incomes of the States and of the continental United States for the three most recent consecutive years for which satisfactory data are available from the Department of Commerce. Such promulgation shall be con- clusive for each of the two fiscal years in the period beginning July 1 next succeeding such promulgation: Provided. That the Surgeon General shall promul- gate such percentages as soon as possible after the enactment of this title, which promulgation shall be conclusive for the fiscal year ending June 30, 194-7; "(c) the population of the several States shall be determined on the basis of the latest figures certified by the Department of Commerce; "(d) the term “State® includes Alaska, Hawaii, Puerto Rico, and the District of Columbia; "(e) the term “hospital1 (except as used in section 622 (a) and (b) ) in- cludes public health centers and general, tuberculosis, mental, chronic disease, and other types of hospitals, and related facilities, such as laboratories, out- patient departments, nurses' home and training facilities and central service facilities operated in connection with hospitals, but does not include any hos- pital furnishing primarily domiciliary care; "(f) the term 'public health center' means a publicly owned facility for the provision of public health services, including related facilities such as labora- tories, clinics, and administrative offices operated in connection with public health centers; M(g) the term 'nonprofit hospital1 means any hospital owned and operated by a corporation or association, no part of the net earnings of which inures, or may lawfully inure to the benefit of any private shareholder or individual; "(h) the terra 'construction' includes construction of new buildings, expan- sion, remodeling, and alteration of existing buildings, and initial equipment of any such buildings; including architects' fees, but excluding the cost of off- site improvements and, except with respect to public health centers, the cost of the acquisition of land; and 16 ”(i) the» term “cost of construction0 means the amount found by the Surgeon General to be necessary for the construction of a project., ”WITHHOLDING OF CERTIFICATION ’'Sec, 632 (a) Whenever the Surgeon General, after reasonable notice and op- portunity for hearing to the State agency designated in accordance with section 612 (a) (l), finds that the State agency is not complying substantially with the provisions required by section 612 (a) to be contained in its application for funds under part B, or after reasonable notice and opportunity for hearing to the State agency designated in accordance with section 623 (a) (l) finds (l) that the State agency is not complying substantially with the provisions required by sec- tion 623 (a), or by regulations prescribed pursuant to section 622, to be con- tained in its plan submitted under section 623 (a), or (2) that any funds have been diverted from the purposes for which they have been allotted or paid, or (3) that any assurance given in an application filed under section 625 is not being or cannot be carried out, or (4.) that there is a substantial failure to carry out plans and specifications approved by the Surgeon General under section 625, the Surgeon General may forthwith notify the Secretary of the Treasury and the State agency that no further certification will be made under part B or part C, as the case may be, cr that no further certification will be made for any pro- ject or projects desginated by the Surgeon General as being affected by the de- fault, as the Surgeon General may determine to be appropriate under the circura- stancesi and, except with regard to any project for which the application has already been approved and which is not directly affected by such default, he may withhold further certifications until there is no longer any failure to comply, or, if compliance is impossible, until the State repays or arranges for the re- payment of Federal moneys which have been diverted or improperly expendedo n(b) (l) If the Surgeon General refuses to approve any application under section 625, the State agency through which the application was submitted, or if any State is dissatisfied with the Surgeon General0s action under subsection (a) of this section, such State may appeal to the United States circuit court of appeals for the circuit in which such State is located. The summons and notice of appeal may be served at any place in the United States„ The Surgeon General shall forthwith certify and file in the court the transcript of the proceedings and the record on which he based his action. ?!(2) The findings of fact by the Surgeon General, unless substantially con- trary to the weight of the evidence, shall be conclusive$ but the court, for good cause shown, may remand the case to the Surgeon General to take further evidence, and the Surgeon General may thereupon make new or modified findings of fact and may modify his previous action, and shall certify to the court the transcript and record of the further proceedings., Such new or modified findings of fact shall likewise be conclusive unless substantially contrary tolhe weight of the evidence. ”(3) The court shall have jurisdiction to affirm the action of the Surgeon General or to set it aside, in whole or in part. The judgment of the court shall be subject to review by the Supreme Court of the United States upon certiorari or certification as provided in sections 239 and 24-0 of the Judicial Code as amended 17 MFEDERAL HOSPITAL COUNCILS ADMINISTRATION OF TITLE "Sec. 633. (a) The Surgeon General is authorized to make such administra- tive regulations and perform such other functions as he finds necessary to carry out the provisions of this title. Any such regulations shall be subject to the approval of the Administrator. "(b) In administering this title, the Surgeon General shall consult with a Federal Hospital Council consisting of the Surgeon General, who shall serve as Chairman ex officio, and eight members appointed by the Administrator. Four of the eight appointed members shall be persons who are outstanding in fields per- taining to hospital and health activities, three of whom shall be authorities in matters relating to the operation of hospitals, and the other four members shall be appointed to represent the consumers of hospital services and shall be persons familiar with the need for hospital services in urban or rural areas. Each ap- pointed member shall hold office for a term of four years, except that any mem- ber appointed to fill a vacancy occurring prior to the expiration of the term for which his predecessor was appointed shall be appointed for the remainder of such term, and the terms of office of the members first taking office shall ex- pire, as designated by the Administrator at the time of appointment, two at the end of the first year, two at the end of the second year, two at the end of the third year, and two at the end of the fourth year after the date of appointment. An appointed member shall not be eligible to serve continuously for more than two terms but shall be eligible for reappointment if he has not served immediately preceding his reappointment. The Council is authorized to appoint such special advisory and technical committees as may be useful in carrying out its functions. Appointed Council members and members of advisory or technical committees, while serving on business of the Council, shall receive compensation at rates fixed by the Administrator, but not exceeding $25 per day, and shall also be entitled to receive an allowance for actual and necessary travel and subsistence expenses while so serving away from their places of residence. The Council shall meet as frequently as the Surgeon General deems necessary, but not less than once each year. Upon request by three or more members, it shall be the duty of the Surgeon General to call a meeting of the Council. " (c) In administering the provisions of this title, the Surgeon General, with the approval of the Administrator, is authorized to utilize the services and facilities of any executive department in accordance with an agreement with the head thereof. Payment for such services and facilities shall be made in ad- vance or by way of reimbursement, as may be agreed upon between the Administrator and the head of the executive department furnishing them. "CONFERENCES OF STATE AGENCIES "Sec. 634-. Whenever in his opinion the purposes of this title would be pro- moted by a conference, the Surgeon General may invite representatives of as many State agencies, designated in accordance with section 612 (a) (l) or section 623 (a) (l), to confer as he deems necessary or proper. Upon the application of five or more of such State agencies, it shall be the duty of the Surgeon General to call a conference of representatives of all State agencies joining in the request A conference of the representatives of all such State agencies shall be called annually by the Surgeon General. 18 "STATE CONTROL OF OPERATIONS "Sec. 635. Except as otherwise specifically provided, nothing in this title shall be construed as conferring on any Federal officer or employee the right to exercise any supervision or control over the administration, personnel, mainte- nance, or operation of any hospital with respect to which any funds have been or may be expended under this title." Sec. 3. Paragraph (2) of section 208 (b) of the Public Health Service Act, as amended, is amended by inserting "(A)” before the words "to assist"; by strik- ing out the word "paragraph” and inserting in lieu thereof the word "clause"; and by striking out the period at the end of such paragraph and inserting in lieu thereof a comma and the followings ”and (B) to assist in carrying out the pur- poses of title VI of this Act, but not more than twenty such officers appointed pursuant to this clause shall hold office at the same time." Sec. A. Section 1 of the Public Health Service Act is amended to reads "Section 1. Titles I to VI, inclusive, of this Act may be cited as the *Public Health Service Act’." Sec. 5. The Act of July 1,19 UK (5S Stat. 682), is hereby further amended by changing the number of title VI to title VII and by changing the numbers of sections 601 to 612, inclusive, and references thereto, to sections 701 to 712, respectively. Approved August 13, 194-6 19 QUESTION AND ANSWER SUMMARY COVERING THE HOSPITAL SURVEY AND CONSTRUCTION ACT How did the Act have its beginning? And why? Public concern stimulated by a shortage of hospital beds and medical service throughout the nation. The high incidence of physical defects among draft selectees. What was the first step? Bv whom? 194-2 Michigan Hospital Association Committee for Michigan Study 194-2 American Hospital Association for a nation-wide study Funds from: Kellogg Foundation Commonwealth Fund National Foundation for Infantile Paralysis Michigan was to be the first or pilot study Who would conduct this national study? National Commission on Hospital Care appointed by American Hospital Asso- ciations Committee on Post War Planning. What were the objectives of this national study? 1. Inventory or census of hospitals and health centers. 2. Appraisal of their capacity for service. 3. Establishment of standards for hospital construction and operation. A. Determination of need for additional beds, centers and services. 5. Formulation of a national state-wide plan to provide for all the people. What would the National Commission on Hospital Care do? 1. Farm it out to each state to arouse local interest and study. 2. Send technical consultants to states. 3. Publish detailed plans for state study. 4-. Furnish questionnaires for inventory of each hospital and health center. 5. Furnish basic data for development of a state hospital plan. 6. Provide information concerning federal hospital service grants. 7. Tabulate population, economic and other data. What did the National Commission actually do? 1. Conducted the pilot study in Michigan. 2. Supplied questionnaires of "schedules” of information to all states. 3. Formulated elaborate detailed plan for survey and planning which later became part of the act, to be described later. 20 Whv did the National Commission and the states not finish the survey and planning? The need for funds became apparent. How was the need for federal help satisfied* A bill, S-191, was introduced in the Senate on January 10, 194-5 by Senator Hill, Democrat, Alabama, and Senator Burton, Republican, Ohio. Supported bys American Hospital Association Catholic Hospital Association Protestant Hospital Association American Medical Association American College of Surgeons Labor Groups Civic Organizations, many and varied What was the progress of Senate Bill 191? Sailed through the various committees and was passed by the Senate, Introduced to House of Representative December 12, 1945. Emerged as P. L. 725, 79th Congress, and signed by the President on August 13, 1945, known as the "Hospital Survey & Construction Act." It became Title VI of the Public Health Service Act. What are the purposes of the Act? Provide federal assistance to states for the provision to all their people of "the necessary facilities for adequate hospital, clinic, and similar services," by federal grants to each state to: 10 Survey existing facilities. 2. Determine hospital and health center needs. 3. Develop a state program for the construction of needed facilities 4. Construct the necessary facilities. What facilities may be constructed? Hospitals? General, tuberculosis, mental, chronic disease, maternity, special (not homes for aged or feeble minded), Ownerships Government and other non-profit hospitals. Public Health Centers? Publicly owned and conducted by state or local public health units or organizations. Related facilities? Laboratories, out-patient departments, nurses* homes and teaching facilities, central service facilities; for public health centers, laboratories, clinics, offices, etc. 21 What is included in construction? New buildings. Expansion, remodeling and alteration of existing buildings, including archi tectJ s fees. What is excluded in construction? Off-site improvements. Acquisition of land sites (except for public health centers) How is the act administered on the federal level? It is the responsibility of the Surgeon General, U.S.P.H.S., in the Federal Security Agency, with advice and assistance of Federal Hospital Council. Council; Surgeon General - Chairman 8 members - (4- hospital and health experts ( (3 expert hospital administrators) (4- consumers of hospital service Council also must approve the Surgeon General’s U.S.P.H.S, regu- lations and must act on appeals from states if the Surgeon General disapproves a state plan. The council’s decision is final. The Council’s other functions are advisory and consultatory. What is the allotment, federal, for survey and planning needs? $3,000,000 for all states. $lO,OOO for the Territory of Hawaii. Available until exhausted. What must the state do to receive the federal grant for survey and planning? 1. Designate a "sole” agency to conduct the survey and planning. 2. Provide a state "advisory council." 3. Provide authority for the sole agency to make the inventory and survey and to develop a construction program. 4-. Provide matching funds for the survey and planning at the rate of 2to 1. What is the allotment, federal, for construction purposes? $75,000,000 each year for 5 years beginning July 1, 194-6 or a total of $375,000,000 for all the states. $223,000 each year for 5 years or a total of $1,115,000 for the Territory of Hawaii. 22 Matching funds for construction, two to one, must be furnished by each project, government or privately owned„ How does the U.S.P.H.S. approve the expenditure of federal funds? By the application of its regulations promulgated on or before February 13» 194-7 (the regulations approved by the Federal Hospital Council have been issued), which are concerned mainly with the number and general distribution of hospital beds and health centers, with minimum standards for construction, and with the availability of matching funds, two for one. How are beds to be distributed? ratio-standards as follows? Overall for a state - Ui per 1,000 population For general hospital beds (which include maternity, children8s orthopedic, isolation, EENT, and other specialty beds) Overall for the Territory of Hawaii - per 1,000 population For a Base Area - 4£ w n w For an Intermediate Area - A n n n For a Rural Area -2% M 55 n Definition Base Areas Any area which is so designated by the State Agency and has the following (l) Irrespective of the popu- lation of the area, it shall contain a teaching hospital of a medical school| this hospital must be suitable for use as a base hospital in a coordinated hospital system within the States or (2) the area has a total population of at least 100,000 and contains or will contain on completion of the hospital construction program under the State plan at least one general hospital which has a complement of 200 or more beds for general use. This hospital must furnish internships and residencies in two or more specialties and must be suitable for use as a base hospital in a coordinated hospital system within the State, Intermediate Areas A logical hospital service area which has a total population of at least 25?000 and contains or will contain, on comple- tion of the hospital construction program, at least one general hospital which has a complement of 100 or more beds, and which would be suitable for use as a district hospital in a coordinated hospital program within the State, 23 Rural Areas Any area so designated which constitutes a unit, no part of which has been included in a base or intermediate area. For tuberculosis hospital beds times the number of average T.B. deaths over a recent 5-year period (194-0 to 1944-) For mental hospital beds 5 per 1,000 population For chronic & convalescent hospital beds 2 per 1,000 population How are public health centers to be distributed? The limitation is 1 per 30,000 population. Definition Public Health Center: A publicly owned facility utilized by a local health unit for the provision of public health services, including related facilities such as laboratories, clinics and administrative offices, in connection with public health centers. How are priorities for construction in a state decided? The state agency must decide, based on relative needs of different areas and their populations for adequate facilities (hospitals, beds and centers) with special emphasis on rural needs. How is the type of construction approved? According to the U.S.P.H.S. regulations for minimum standards for new construction. What about discrimination on account of race, creed, color and indigency of patients? Applicants for construction must give assurance that all persons re- siding in an area will be served by the facility without such discri mination, What must the “sole" stage agency do to obtain federal funds for construc- tion? It must, with its survey of existing facilities and needs, submit a state plan which will show; 1. The designation, legally, of a single state agency to super- vise the construction program. 2A 2, That it has the necessary legal authority of the state to carry out the plan. 3, That an advisory council has been provided by the state. 4-. Set forth in detail a hospital construction program for the state, based on inventory and need. 5. Set forth the priorities in order of relative needs, 6. Provide administrative methods including personnel stand- ards on a merit basis, 7. Assure minimum standards for maintenance and operation of hospitals to be constructed with federal aid. The state must, prior to July 1, 194-8, enact legislation establish- ing such minimum standards or the state will be deprived of federal aid, 8. Provide for hearings for applicants for a construction project before the state agency if the project is dis- approved by the state agency, 9. Submit such reports and information as may be required by the U.S.P,H.So 10. The Surgeon General must approve any state plan which complies with the above conditions. If he does not, the Federal Hospital Council must give the state agency a hearing and its decision is final. Who may initiate a construction project? A state, county or any political subdivision. A non-profit public or private agency which conducts or will con- duct and operate the facility. How may a construction project be initiated? By submitting an application through the state agency to the U.S.PoH.S, What must the application show? 1. A description of the site and assurance of its title, 2. Plans and specifications complying with federal regulations, 3. Reasonable assurance of adequate local financial support, both for construction and maintenance and operation of the facility when completed, 4-. Reasonable assurance of the payment of prevailing wages for construction work, 5, Availability of matching construction funds 2 for 1. Who approves the construction project applications? First, the state agency (its architects, its engineers, its admini strative director) Next, the U.S.P.H.S. in Washington 25 How are payments of federal funds made; To the state agency for transmission to the applicant; here the funds would be paid through the Territorial Treasury. If legally unable to make payments through the state agency, direct to the applicant. When: 3 stages: Ist installment when not less than 25 percent of the work of construction of the building has been completed. 2nd installment when the mechanical work has been substantially roughed in. 3rd installment when the work under the con- struction contract has been completed and final inspection made. What has been done so far under P. L»7251 Federal Level The U.S.P.H.S., Bureau of Spates, created a Division of Hos- pital Facilities to administer the Act. A Federal Hospital Council has been appointed. An advisory committee has been named. The U.S.P.H.S. works through its districts; the Territory of Hawaii is in District Noc 5 at San Francisco which in- cludes California, Arizona, Washington, Oregon, Nevada. The U.S.P.H.S, has disseminated information for survey, plan- ning and construction with regulations pertaining thereto. The appropriations committee of the House of Representatives, instead of appropriating the $75,000,000 authorized by P. L 725, or the $50,000,000 recommended in the President’s Budget for the fiscal year ending June 30, 1948, authorized the Surgeon General, United States Public Health Service, to approve construction projects up to the full amount authorized in the original bill, making such approvals a contractual obligation of the federal government. Funds to pay these obligations would be made available in de- ficiency appropriations requested at frequent intervals by the Surgeon General and approved by Congress from time to time. Under the latter proposal, funds will not be available until January 1, 194-8 or perhaps even July 1, 194-8. On the other hand, under the President’s budget recommendation, project approvals would have been limited to $50,000,000 instead of the full amount authorized by the act, $75,000,000. Now, the Surgeon General may approve projects up to the total amount authorized by P. L. 725 for the two fiscal years in question, 194-6-1948, a total of $150,000,000. This recommendation by the Appropriations Committee was enacted by both houses of Congress. 26 Territorial Level What the Territory has done, so far, under P. L. 725 is embodied in the Report of Survey and Planning which follows. 27 TABLE CF CONTENTS Page ADVISORY COUNCIL (Members) ... 3 BOARD OF HEALTH (Members) 4 ACKNOWLEDGMENT ... 5 LETTER OF TRANSMITTAL TO THE GOVERNOR 7 THE HOSPITAL SURVEY & CONSTRUCTION ACT 9 SUMMARY OF THE HOSPITAL SURVEY AND CONSTRUCTION ACT 20 CHAPTER I INTRODUCTION 35 Agency Designated 35 Scope and Method of Study 36 CHAPTER II GEOGRAPHICAL DATA 39 Counties 39 Islands 39 Districts 4-0 CHAPTER 111 POPULATION DATA 44- Estimates, Board of Health, 194-5-4-6 . 44- Estimates, Bureau of Census, 194-5 4-4- Population Reports, Bureau of Census, 194-0 44- Population Figures used for Survey 4-5 Population by Races 4-6 29 Page CHAPTER IV INVENTORY OF PHYSICIANS, NURSES, ETC 47 Physicians 47 Dentists ..... 48 Nurses 48 Technicians 48 CHAPTER V ANALYSIS OF SURVEY DATA 49 Distribution of Hospitals and Beds 49 Inventory of Hospitals 49 Omnibus Information Data 49 Hospitals . . 49 Beds, Complement and Normal 50 General Beds 51 Mental Beds 51 Tuberculosis Beds 51 Chronic and Convalescent Beds 51 Non-Acceptable Beds 51 Acceptable Beds 53 Adequacy of Hospitals and Beds 53 Authorized Ratios 53 Comparison, Existing and Authorized Ratios .... 55 General Bed Ratios 56 Ratios in Plantation Hospitals 57 Mental Bed Ratios 57 Tuberculosis Bed Ratios 58 30 Page Tuberculosis Deaths, 19A0-AA 56 Chronic and Convalescent Bed Ratios 59 Acceptable and Non-Acceptable Beds 59 Authorized Beds 62 Acceptable Beds and Beds which may be Constructed 62 CHAPTER VI HEALTH CENTERS . 65 Inventory . 65 Unsuitable 66 Total Facilities 67 Allocation 70 CHAPTER VII SUMMARY OF THE TERRITORY’S NEEDS 72 General Hospitals and Beds. 72 Mental Hospitals and Beds 72 Tuberculosis Hospitals and Beds 72 Chronic Hospitals and Beds. ....... ... 72 Alterations in the Number of Hospitals 73 Alterations in the Number of Public Health Centers and Auxiliary Facilities 73 CHAPTER VIII SUMMARY AND RECOMMENDATIONS . . . . 75 General Hospital Beds 75 Mental Hospital Beds . 77 Tuberculosis Hospital Beds . 77 31 Page Chronic and Convalescent Hospital Beds 79 Bed Needs, All Categories Bl Area Designations ..... 81 Recommendations 83 Organization of Hospital Facilities 83 General Recommendations 84- Function of the General Hospital 84. Acute Communicable Diseases 85 Pulmonary Tuberculosis 85 Mental Diseases , 85 Chronic Care. 86 Occupational Programs in Hospitals 86 Rehabilitation 86 Expansion of the Use of Hospital Facilities ....... , . 86 Health Education in Hospitals , 87 Standards of Service in Hospitals „ 87 Licensure of Hospitals. 87 Hospital Trustees ...... 88 Administration of Hospitals 88 Medical Staffs 88 Dental Service in Hospitals 88 Nursing Service . ..... 89 Medical Social Service . ..... 89 Physicians1 Offices 89 Rural Hospital Service . 90 Size and Location of Hospitals and Size of Hospital Communities .... 90 Public Health and Medical Service Centers . 91 32 Page Interrelationship Among Hospitals 91 Community Health Councils 91 Allocation of Hospitals and Beds 92 CHAPTER IX PRIORITIES 95 Determination 95 General Beds; Order of Need Met; Priority Groups 99 Tuberculosis Beds; Order of Need Met; Priority Groups 100 Chronic Beds; Order of Need Met; Priority Groups 100 Mental Beds; Order of Need Met; Priority Groups 101 Priority Order, all Categories of Beds 101 Establishment of a Project Construction Schedule 101 TABLES Number 1. Inventory of Hospitals and Beds, Territory of Hawaii ..... 103 Number 2. Omnibus Information, by Islands and the Territory of Hawaii 107 Number 3. Inventory of Public Health Centers and Auxiliary Facilities 117 Territory of Hawaii MAPS Exhibit D-l - Delineation of General Hospital Service Areas Pages 1,2, 3, 5> 6 123 Exhibit D-3 - Designation of Acceptable and Programmed Health Centers Pages 1,2, 3, U, 5, 6. 129 Exhibit D-4- - Designation of Chronic, Tuberculosis and Mental Hospitals (or units) - Pages 1,2, 3,5, 6 135 33 Chapter I INTRODUCTION On September 23, 194-6, the Governor of the Territory of Hawaii, by Execu- tive Order, designated the Board of Health of the Territory of Hawaii to carry out the purposes of Section 601 (a) of P. L. 723, to make inventory of all hos- pitals in the Territory of Hawaii, to develop a construction program under Sec- tion 622 of P. L„ 725, to make reports to the Surgeon General, United States Public Health Service, to consult with the Territorial Advisory Council, and to expend federal funds for the purposes of P. L. 725, and he authorized the Treas- urer of the Territory of Hawaii to receive such federal funds. On December 30, 1946, the Governor allotted Territorial matching funds in the amount of $5,280 from the appropriation, Governor's Contingent Fund of the General Fund, to administer the P. L. 725 in the Territory for the six months® period from January 2, 194-7 to June 30, 1947. On January 14, 1947, the Governor issued a letter of appointment, desig- nating the Territorial Advisory Council to consult with and advise the Board of Health in the administration of P, L, 725. Included in the Territorial Advisory Hospital Council were the names of five members of the Territorial Hospital Ser- vice Study Commission; the latter had been appointed by the Governor, pursuant to Joint Resolution 12, Laws of the Territory of Hawaii, Regular Session of 1945, approved May 22, 1945, to nmake a comprehensive study of hospital services and costs in the Territory of Hawaii," for a report to the Territorial Legisla- ture at its biennial session in March and April, 1947. The Territory of Hawaii Board of Health set up a Bureau of Medical Services and the first division within that bureau was known as the Division of Hospital Survey and Construction! these later were abbreviated into the Division of Hos- pital Planning and began to function on January 3, 1947, to administer the acti- vities of the Territory of Hawaii under P. L, 725. The Hospital Service Study Commission, to which reference is made above, being cognizant of the hospital inventory which was in progress throughout the United States, and which had been initiated by a special group of the American Hospital Association known as the Commission on Hospital Care, recognized the usefulness of the methods and material used by the latter and adopted them for its own study in the Territory,, The adoption of these methods was a wise move and one of keen foresight because the Commission on Hospital Care’s methods were the ones to be adopted by the United States Public Health Service as suitable for use in the nation-wide survey under P. L. 725. The Hospital Service Study Commis- sion was fully aware, also, that the methods and material utilized by the Commis- sion on Hospital Care would produce the data relating to hospital needs in the Territory of Hawaii, which would satisfy the requirements of a survey. The Hospital Service Study Commission, having only a limited purpose and tenure, under the mandates of Joint Resolution 12, Laws of the Territory of Hawaii, Regular Session of 1945, recommended to the Governor of Hawaii that, upon the com- pletion of its inventory stage, an agency be designated as the official admini- strative-fiscal agency to conduct what further survey work might be indicated to 35 complete the survey and the development of a Territorial plan for hospital con- struction under P. L. 725. With the writing of its report, which covered the collection of data from the hospitals and the tabulation and analysis of the data, the Commission considered its survey completed and turned over to the Territorial Board of Health, for use in the succeeding program, all the data at hand; this was done on March 20, 194-7» Scope and Method of Study Type of Hospitals The Hospital Service Study Commission’s survey included every hospital, nursing home and institution in the Territory of whatever type and ownership (except federal-owned hospitals of the Army and Navy) that provide overnight hospital and nursing services. Institutions which provide strictly domicil- iary care, such as homes for children and old people, and in which care is restricted to housing and board with no nursing service, were not included. Thus were surveyed general hospitals, maternity hospitals and homes, children’s and orthopedic hospitals, convalescent and chronic hospitals and homes, tuberculosis hospitals, nervous aid mental hospitals and leprosy hos- pitals. Size of Hospitals The survey covered hospitals ranging in size from A to 1,150 complement bed So Ownership of Hospit The survey covered hospitals of all types of ownerships individually owned, corporation owned (which in all cases means plantation owned), non- profit and government owned, by county and Territory. At the outset, there was some protest against recognizing within the scope of the survey some of the small 4-j 6 and 8 bed hospitals which are mostly under individual propri- etorship, but the procedure set up nationally emphasized the need for the location and inventory of this class of service, for these hospitals provide a sizable amount of service in some areas and present distinctive problems. Period covered The survey covers data for the year 1945, or for the fiscal year 1945-46 for those institutions which keep their records on a basis other than the calendar year. Schedules of Information The collection of data was accomplished with the aid of two types of Hos- pital Schedules of Information (issued by the Commission on Hospital Care), 36 Type 1. A 40-page schedule of information for hospitals known to have 25 or more beds. It requested data including the followings Generals Name, location, establishment, ownership or control, type, accreditations, approvals, memberships, management, auxil- iary organizations. Areas Served: Map of area served, restrictions of service, geo- graphic distribution of patients. Physical Plant; Physical structure, bed complement, normal bed capacity, bed allotments, area distribution, living quarters, educational facilities. Patient Service Datas Summary of service rendered, patient days, autopsies, services by pay status, type of service, newborn, per- cent occupancy, length of stay. Medical Staffs Organization, type, appointment, meetings, mem- bership, departments, qualifications. Administrations Departmental functions; number, qualifications of personnel; departmental organization and extent of service. Financial Datag Balance sheet—funds expended and available for land, building and equipment; operating and non-operating expenses; non-hospital service; expenditures from special pur- pose funds; recapitulation; analysis of operating expenses. Educational Activitiesg Physicians, internes, residents, nurses, dietitians, laboratory and X-ray technicians, apprentice pharma- cists, hospital personnel, public. Research Activitiesg Funds, facilities, personnel, clinical investigation, publications. Type 2. A 9-page schedule for hospitals of less than 25 beds, requesting practically the same data as was called for in the larger schedule, as was given above, with reference to area served, physical plant and patient data, but requiring only a minimum of data on depart- mental functions, personnel, administration and finance, in recog- nition of the simpler operating structure of hospitals of less than 25 bedSo Schedules of information were mailed to each hospital shown on the inventory of hospital facilities, Territory of Hawaii, 194-6, (See Table l) with the request that as much information as possible be filled in and that the schedule be held for a visit from the director of the survey. At that visit, the data were re- viewed with the hospital superintendent or with the person assigned to the task and attempts were made to supply missing data from hospital records and replies to questions. 37 No resistance was encountered anywhere in filling out the schedules and, in many instances, the hospital administration put in many hours, with and without the survey director, in an effort to complete every detail, often using after- hour and holiday time for that purpose. It has been assumed that the Division of Hospital Planning, Board of Health, would utilize, practically intact, the data of the Hospital Service Study Commis- sion, This, however, turned out to be untrue. The Commissions report, a very admirable one, contained data which had been compiled before the United States Public Health Service issued its Regulations, and the Commission's data had to be revised almost entirely in order to comply with stipulations contained in the Regulations. These stipulations concerned population figures, area ratios, nor- mal beds versus complement beds, acceptable beds and non-acceptable beds, and various other items affecting the survey and planning. The report of the Commis- sion contained no data concerning health centers and no reference to a Territorial plan for supplying the Territory's needs in hospitals, beds and health centers. 38 Chapter II GEOGRAPHICAL DATA - TERRITORY OF HAWAII The entire Territory consists of the following islands: Hawaii, Maui, Molokai, Lanai, Kahoolawe, Kauai, Niihau, Oahu, Palmyra, French Frigate Shoals, and a few small rocky islands nearby. For our purposes, the only islands to be considered are Hawaii, Maui, Molokai, Lanai, Kauai and Oahu. Niihau is privately owned plantation property with a small population. Kahoolawe is a barren rock, though of some area and a population of one now and then. The Territory is divided into counties as follows: Counties Definition of Inclusions Hawaii Hawaii Island and all the other islands within 3 nautical miles of the shores of Hawaii and waters adjacent thereto Seat: Hilo Maui Maui, Molokai, Lanai, Kahoolawe Islands and all the islands within 3 nautical miles of the shores thereof and the waters adjacent thereto, except that part of Molokai known as Kalau- papa, Kalawao and Waikolu (leper settlement) Seats Wailuku Kauai Kauai and Niihau Islands and all the other islands lying with- in 3 nautical miles of the shores thereof, and the waters ad- jacent thereto Seats Lihue Honolulu Oahu Island and Palmyra Island and a few small, rocky islands City & nearby. County Kalawao That portion of Molokai Island known as Kalaupapa, Kalawao and Waikolu (Leper settlement) It will be seen that islands and counties coincide except that Maui County is comprised of Maui, Molokai, Lanai and Kahoolawe Islands and Kauai County is comprised of Kauai and Niihau Islands. The relationship of the islands to one another can be seen on the map of the Territory, which will also explain why it is considered advisable to study the Territory’s needs by islands rather than by counties. There is too much ocean between islands to permit grouping of two or more islands in a single hospital service area. The dimensions and areas of each island are shown in Table 2, lines 1 and 2. Hawaii is the largest in area with A,021 square miles and is a little smal- ler than the State of Connecticut. Maui is next with 728 square miles and Oahu, the most populated, is third with 603 square miles. The Territory, with 6,375 square miles, is somewhat larger than the State of Connecticut. 39 The Territory is further divided into districts known as 51 representative” districts for the purpose of representation in the Territorial House of Repre- sentatives. These are numbered from Ito 6 and are as follows? First District - That portion of the Island of Hawaii known as Puna, Hilo and Hamakua Second District ~ That portion of the Island of Hawaii known as Kau, Kona and Kohala Third District - The Islands of Maui, Lanai, Molokai and Kahoolawe Fourth District - That portion of the Island of Oahu, lying East and South of Nuuanu Street, a line drawn in extension thereof from Nuuanu Pali to Mokapu Point Fifth District - That portion of the Island of Oahu lying West and North of the Fourth District Sixth District - The Islands of Kauai and Niihau Each numbered or representative district is subdivided into smaller dis- tricts known as Judicial Districts5 these have names such as Hamakua, North Hilo, Puna and South Hilo Districts in District 1; they are for purposes of elections, taxation, education, judiciary, city, county and similar functions. There are thirty such districts; the Island of Hawaii contains 9, Maui 4, Molokai 2, Lanai 1, Oahu 9 (recently one was split into 2), Kauai 5, (For boundaries, see maps entitled "Designation of Existing and Programmed Health Centers" Exhibit D-3.) Each judicial district contains smaller areas named for their cities or towns or villages. The list of representative districts, judicial districts and the town or village areas are given below, showing populations according to the Bureau of the Census Report of 194-0, the latest available for these subdivisions: Population by Representative Districts Cities. Towns and Villages within Districts Territory of Hawaii, 194-0 Location Po^lation^.l24o District No. 1 53?033 Hamakua 8, 244 Honokaa 1,132 Kukuihaile 408 Waipio 216 North Hilo District 4?468 Laupahoehoe 534- Ninole 77 Ookala 735 Papaaloa 662 40 Location Population. 1940 District No. 1 (Cont.) Puna District 7,733 Kalapana 211 Kapoho 4,83 Keaau (Olaa) 2,509 Mt, View 955 Pahoa 1,114. South Hilo District 32,588 Hakalau 1,138 Hilo 23,353 Honomu 868 Papaikou 1,566 Wailea 414- District No. 2 20,24-3 Kau District 5,581 Naalehu 1,038 Pahala 1,651 Waiohinu 214. North Kohala District 5,362 Hawi 1,194- Kapaau (Kohala) 1,255 Mahukona 14-7 Makapala 527 North Kona District 3,924- Holualo 541 Kailua 381 Kainaliu 490 Kealakekua 177 South Kohala District 1,352 Kawaihae 123 Waimea (Kamuela) 445 South Kona District 4,024 Hookena 54 Kealakekua 256 Kealia 195 Milolii 66 Napoopoo 103 District No. 3 55,980 Hana District 2,663 Hana 1,185 Keanae 106 41 Location Population, 19Z.0 District No, 3 (cont.) Kalawao District 446 Lahaina District 3,291 Honokahua 729 Lahaina 5,217 Puukolii 1,042 Lanai District 3,720 Lanai City 3,597 Makawao District 14.,915 Haiku 431 Keokea 454 Kokomo 208 Lower Paia 1,235 Makawao 903 Paia 4., 272 Pauwela 4.65 Waiakoa 695 Molokai District 4,394 Hoolehua I,oso Kaunakakai 722 Kaulapuu 641 Maunaloa 979 Pukoo 52 Wailuku District 21,051 Kahului 2,193 Puunene 4-, 4.56 Spreckelsville 2,634. Waikapu 643 Wailuku 7,319 District No. 4 112,310 Honolulu 103,691 Koolaupoko 3,619 District No. 5 145,386 Ewa District 30,602 Aiea 3,553 Ewa 3,570 Pearl City 1,933 Waipahu 6,906 42 Location Population. 1940 District No. 5 (cont.) Kookauloa District 4,968 Hauula 411 Kahuku 2,251 Laie 761 Wahiawa District 22,417 Wahiawa 5 >420 Waialua District 8,397 Haleiwa 1 > 849 Waialua 2,512 Waianae District 2,948 Lualualei 371 Nanakuli 777 Waianae 1,078 Honolulu 70,667 Koolaupoko 5,387 District No, 6 35,818 Hanalei District 2,065 Hanalei 313 Kilauea 548 Kawaihau District 6,512 Anahola 367 Kapaa 2,828 Kealia 758 Koloa District 8,493 Eleele 1,184 Kalaheo 770 Koloa 1,903 Wahiawa Mill 771 Lihue District 7,896 Hanamaulu 1,337 Lihue 4,254 Puhi 886 Waimea District 10,852 Hanapepe 1,166 Kekaha 2,536 Makaweli 1,010 Waimea 1,921 43 Chapter 111 POPULATION DATA, TERRITORY OF HAWAII A variety of recent population tables are available as follows? Estimates bv the Bureau of Vital Statistics. Territorial Board of Health. October 28. 1946 for 1946. for islands, counties and two largest cities; Civilian Population Territory of Hawaii - 1946 Island? Oahu 358,911 Hawaii 70,871 Maui 44,807 Molokai 6,173 Lanai 3,630 Kauai 34,911 Niihau 199 Kahoolawe 1 Counties Honolulu 358,911 Hawaii 70,871 Maui 54,225 Kauai 35,111 Kalawao 385 519,503 Cities Honolulu 267,710 Hilo 27,922 519,503 Estimates. Bureau of the Census. Department of Commerce. 1945. but figures are available for the entire Territory only, namely 415.379. Population Reports, Bureau of the Census. Department of Commerce. 16th Census. 1940. for islands, counties and cities of 5.000 or mores Civilian Population Territory of Hawaii - 1940 Islands Oahu 257,664. Hawaii 73,276 Maui 4-6,919 Molokai 5,340 Lanai 3,720 Kauai 35,636 Niihau 182 Kahoolawe 1 422,738 Counties Honolulu 258,256 Hawaii 73,276 Maui 55,980 Kauai 35,818 Kalawao 44-6 4-23,776 Cit4§s Hilo (Hawaii) 23,353 Honolulu (Oahu) 179,326 Lahaina (Maui) 5,217 Wahiawa (Oahu) 5,4.20 Wailuku (Maui) 7,319 Waipahu (Oahu) 6,906 The Bureau of the Census Report for 1940 also shows populations by minor civil divisions, namely the representative districts, judicial districts and the contained towns and villages. These figures are given in the pages under Geographical Data. 44 The 194-6 Estimates by the Bureau of Vital Statistics, Board of Health, show an increase from 257,664- in 194-0 to 358,911 in 194-6 for the Island of Oahu, with negligible changes for the other islands. This increase of 101,24-7 on Oahu must be taken into account in the calculation of bed ratios and allowances<, The distribution of the population of the Territory of Hawaii in the Board of Health Estimates, 194-6, by counties and cities, shows the City and County of Honolulu (which is all the Island of Oahu) to be the most populated with 358,911; Hawaii County is next with 70,871; Maui County next with 54-,225; Kauai County next with 35,111; and Kalawao County (a political unit formed to provide the Ka- laupapa Leper Settlement with its own governmental set-up) the smallest with 385. Of; the two sizable cities in the Territory, Honolulu is the larger with 267,710 and Hilo is next with 27,922„ . The distribution of the population in 194-6 by islands does not exactly par- allel that of the population by counties because Maui County embraces the Islands of Maui, Lanai and Molokai. The distribution by islands indicates that Oahu Island (City and County of Honolulu) has the greatest with 358,911, Hawaii Island is next with 70,871, Maui Island next with 44,807, Kauai Island next with 34-?911, Molokai Island next with 6,173 (including Kalawao County), Lanai Island next with 3,6300 The population of the other islands is too small for consideration here (Niihau 199 and Kahoolawe l) . The density of the population in 194-6 in each island and in each county, with the exception of the lesser islands with small populations, is well above 12 per square mile; it is as high as 595.2 for Oahu Island and for the City and County of Honolulu, and the lowest for the larger islands with populations requiring consid- eration is 1706 for the Island and County of Hawaii. The 194-0 figures by the Bureau of the Census, Department of Commerce, will be the ones on which we will have to calculate our allowances of beds and bed ratios for all islands except Oahu. In the latter, we must accept the 194-6 fig- ures by the Bureau of Vital Statistics, Board of Health, or accept a loss of approx- imately 100,000 population for bed allowances and ratios, and this has been author- ized by a representative of the Hospital Facilities Office, USPHS, Washington, D. C. (It must be remembered that estimates by the Bureau of the Census for 1943, 1945 are for the entire Territory only and are not broken down by islands,,) The 1940 figures place Oahu first with 257,664, Hawaii next with 73,276, Maui next with 46,919, Kauai next with 35,636, Molokai next with 5,340, Lanai next with 3,720„ The population figures by islands and for the Territory which will be the basis of calculations and ratios, therefore will bes Oahu, 1946 Bur, of V, So, Board of Health Est„ 358,911 Hawaii, 1940 Bureau of the Census Report 73,276 Maui, » " ” n " " 46,919 Kauai, " » " n 11 " 35,636 Molokai, * n " " " " 5,340 Lanai, w " " n " " 3,720 Niihau, w M n M 0 182 Territory of Hawaii 523 >9B-4 45 The density of population in each island and in each county, with the ex- ception of the smaller ones with small populations and which do not enter into our calculations, is well above 12 per square mile; it is $95 per square mile on Oahu, 18 on Hawaii, 64. on Maui, 64. on Kauai, 20 on Molokai, 26 on Lanai, The populations by race for the Territory of Hawaii are of interest in con- nection with the consideration of discrimination and segregation. It may be stated here that there are no evidences of discrimination or segregation anywhere in the Territory, Hotels, restaurants, theaters, hospitals, public conveyances, etc., admit all races without discrimination aid without changes in rates. There are no evidences of so-called "Jim Crow81 methods. The Caucasians outnumber the Japanese by a slim margin, 173?533 to 168,4-63*. Next are the part-Hawaiian with 64., 161, the Filipino with 54,,519 and the Chinese with 30,286. Puerto Ricans, mostly non-Caucasians, were 9,298 in 194-6 and Koreans 7,092, The figures are given below? Population bv Race Territory of Hawaii, 194-0 and 194i> Race 1940 1946 Hawaiian 14,375 10,887 Part-Hawaiian 4-9 s 935 64,161 Puerto-Rican 37 9,298 Caucasian 103,791 173,533 Chinese 28.11L ~3PTlg5~ Japanese 157,905 168,463 Korean 1/ 7,092 Filipino 527569 54,519 All others 15,981 1,264 Total Territory 423,330 519,503 1/ Not classified Sources 194-0, Bureau of Census; 194-6, Board of Health Estimate County City & County County of County of of of Race Total Hawaii Honolulu Maui Kauai Total, all races 423,330 73.276 258,256 37.876 53,922 Hawaiian 14,375 3,451 7,090 2,946 888 Part-=Hawaiian 49,935 7,901 31,453 2,666 7,915 Caucasian 103,791 9,821 82,516 4,465 6.989 Chine se 28,774 1,832 24.567 862 1,513 Filipino 52,569 12,845 19,066 10,149 10,509 ■ Japanese 157,905 34.865 83.387 1 15,470 24,183 All others 15,981 2,561 10,177 1,318 1,925 Sources Bureau of Census Report 46 Chapter IV INVENTORY OF PHYSICIANS, NURSES AND OTHER HOSPITAL PERSONNEL Hospital beds without physicians are no asset in an overall plan to provide adequate medical attention. While it may be stated that physicians will congre- gate where there are hospitals, wealth and population, it is of importance to know in advance that an adequate number of physicians of the proper calibre will be available to staff the hospitals. While there are no precise standards of physician-adequacy, in the pre-war United States, the ratio of physicians to popu lation was approximately 1 to 1,000 and included general practitioners and spe- cialist s-”for general practitioners, the ratio approximated 1 per 1,300. The ratio varied widely in selected areas, being 1 to 800 in the middle Atlantic, mountain and Pacific areas| 1 to 1,300 in the West South central area and 1 to 1,500 in the East South central area. Wealth of the people and concentration of physicians go hand in hand, and in New York the ratio was 1 to 600, in California 1 to 700, in Alabama the ratio was 1 to 1,700 and in Mississippi 1 to 1,800. In 194-0, the physicians in the Territory numbered 336, with a ratio of 1 per 1,258 population and with a distribution by islands as shown on Table 2, lines 95 and 96. Though the ratios indicate general deficiency in numbers of physicians, the distribution by islands is not too uneven; as may be expected, a concentration of physicians and of specialists occurs on Oahu and in Honolulu, The ratio of 1 physician to 1,258 population for the Territory placed the latter 43rd in the rank of the states and territories. Those exceeding Hawaii in number of popula- tion for physician were Idaho, South Dakota, North Carolina, South Carolina, Alabama and Mississippi. For 194-6, the Territorial ratio lengthened to 1 physician to 1,4-72 popula- tion. Since July, 1946, 34 physicians have obtained licenses to practice in the Territory, changing the ratio to 1 physician to 1,342 population. The breakdown by islands for 194& is shown in Table 2, line 97. This ratio stigmatized Hawaii as a "poor state," yet the economic level of the Territory is not below that of the average mainland state. Preliminary estimates indicate a per capita income payment for 1945 of $1,121, which places Hawaii 20th in the rank of the states and the territories and regionally closest to the central states1 level. There are other factors which tend to keep the number of physicians licensed to practice in the Territory low. Two of these are the absence of a medical school in Hawaii and the requirements such as one year’s residence in the Terri- tory for eligibility to qualify for license. Another is the distance and expense of travel from the mainland to the place of examination, which is Honolulu. It should be recognized that, in the rural areas, the population clusters around the plantation mill town and is rarely widely dispersed as in the rural areas of the mainland states. For many years, a highly developed system of plan- tation hospitals and out-patient dispensaries has been serving the plantation and 47 non-plantation population alike, affording very effectively such convenience as to make possible a larger quantity of medical service per physician than is ordi- narily achieved by physicians in private practice. The ratio of population to physicians in active practice in the Territory of Hawaii by islands, 194-6, is shown in Table 2, line 98. The number of licensed physicians by type of practice in the Territory of Hawaii, 194-6, is shown for each island in Table 2, lines 99 to 104. As indicated before, the distribution by islands is not too uneven but the Island of Lanai and the Island of Molokai, both in Maui County, are under-manned by physicians. The number of licensed physicians, by specialty, in the Territory of Hawaii, 194-6, is shown for each island in Table 2, lines 104- to 119. It is evident that the specialists are concentrated in Honolulu—it is not too much to believe that adequate hospital facilities on the other islands will attract more specialists to those islands; similarly they will attract more general practitioners; the wealth and the population are to some extent already there. If the number of physicians licensed since July 1, 194-6, namely 34-, can be equalled or exceeded each year, it is safe to assume that the supply of physi- cians will increase rather than diminish. The number and concentration of dentists in the Territory of Hawaii by is- lands is shown in Table 2, lines 120 and 121. The number of nurses in the Territory of Hawaii by islands is shown in Table 2, lines 122 to 129. The number of technicians in the Territory of Hawaii by islands is shown in Table 2, lines 130 to 133. 48 Chapter V ANALYSIS OF SURVEY DATA )istribution of Hospitals and Beds. Territory of Hawaii and Application of Standard Ratios Table 1, Inventory of all hospitals and beds in the Territory of Hawaii, 194-6, lists 61 hospitals. This figure includes 1 home for the care of the aged, the Palolo Chinese Men’s Home, and 1 home for the feeble-minded, the Waimano Home*. After eliminating these two domiciliary care facilities, we report a total of 59 hospitals in the Territory, containing 4*548 normal beds. Table 2. Omnibus information by islands and the Territory of Hawaii, was designed to show, by islands and for the Territory as a whole, all of the various factors related to the survey. The items include dimensions and areas of each island; population figures; general, allied special, tuberculosis, chronic and mental’ hospitals by islands and by type of ownership; normal beds in the various types of hospitals; existing normal bed ratios; assigned hospital service areas; authorized bed ratios; existing non-acceptable normal beds; acceptable normal beds; additional normal beds which may be constructed; physicians, nurses, tech- nicians, and health centers. Reference to this table will be made by numbered item lines. Hospitals Of the 59 hospitals in the Territory, 4-0 (lines B to 12) are general, 3 (lines 13 to 16) are allied special maternity, 1 (line 17) is an allied special children’s, 1 (line IB) is an allied special orthopedic, 2 (line 19) are allied special isolation for lepers, 4 (line 21) are tuberculosis, 7 (line 22) are chronic and 1 (line 23) mental, hospitals. The distribution of the various hospitals by islands and according to type and ownership, is shown in lines B to 30. Oahu Island has 10 general, 2 maternity, 1 children’s, 1 orthopedic, 1 iso- lation, 1 tuberculosis, 6 chronic and 1 mental, hospitals, a total of 23. Of these, 3 (1 isolation leprosarium,! mental and 1 chronic) are government-owned; 9 (4- general, 1 maternity, 1 children’s, 1 orthopedic, 1 tuberculosis and 1 chronic) are non-profit privately owned; 5 (all general) are proprietary-plantation-owned; and 6 (l general, 1 maternity and 4 chronic) are proprietary-individual-owned. Hawaii Island has 17 general, 1 maternity and 1 tuberculosis hospitals, a total of 19. Of these, 4 (3 general and 1 tuberculosis) are government-owned; 8 (all general) are proprietary-plantation-owned and 7 (6 general and 1 maternity) are proprietary-individual-owned. Kuakini Hospital*s section for the aged was omitted from the inventory because Kuakini is primarily a general hospital. 49 Maui Island has 6 general and 1 tuberculosis hospitals—a total of 7. Of these, 4 (3 general and 1 tuberculosis) are government-owned and 3 (all general) are proprietary-plantation-owned. Kauai Island has 4 general, 1 tuberculosis and 1 chronic hospitals—a total of 60 Of these, 1 (tuberculosis) is government-owned, 1 (general) is non-profit-privately owned, 3(2 general and 1 chronic) are proprietary- plantation-owned, and 1 (general) is proprietary-individually owned. Molokai Island has 2 general and 1 isolation hospitals, a total of 3, Of these, 1 (isolation leprosarium) is government-owned, 1 (general) is non- prof it-privately owned, and 1 (general) is proprietary-plantation-cwned. Lanai Island has 1 general hospital which is proprietary-plantation-owned. Of the 40 general hospitals in the Territory, (Table 2, lines 8 to 12), 21 are proprietary-plantation-owned (Table 2, line 29) with a total of 783 normal beds, all general beds (Table 2, line 52)„ These plantation hospitals do not confine their services to plantation populations alone; they serve others in their respective communities and they have in the past given splendid service. As will be shown, they contribute to an apparent excess of general beds on the islands of Hawaii, Maui, Molokai and Lanai, Though these plantation hospitals, Judged by their income tax status, are proprietary-profit hospitals because they are not tax-exempt, they usually operate at a loss, which is absorbed by the plantation owner. Heretofore, their services were given free to employees. Recent alterations in labor-management relations, with higher pay for employees, have forced the plantation hospitals to charge employees for services, though usually at or below cost. At this time, the future of these plantation hospitals is unsettled,, The owners realize the need for their continuance until other hospitalization is provided. Some hos- pitals will probably be continued as plantation hospitals, with rates to employ- ees below or at cost; some may be entirely discontinued, some may be reduced to the status of dispensaries for pre-employment physical examinations and compen- sation purposes; some may be taken over and operated by non-profit community organizations, and a few may be purchased and operated by private individuals or groups, for profit. Beds The number of complement beds, as shown in Table 1, is 5798 and the number of normal beds also shown in Table 1, is 5394° These figures include beds in the home for the aged (the Palolo Chinese Mens1 Home) and in the home for the feeble-minded (the Waimano Home), After elimination of these two domiciliary care facilities, the normal beds in the 59 hospitals total 4548. These normal beds are the beds for which the existing hospitals, defined by Section 631 (e) PH725, were built, usually with an allowance of 80 square feet of floor space per bed, and exclude those in domiciliary institutions such as homes for the aged or feeble-minded, (see also Grants-In-Aid Manual, Title 2 (23-2) Instruc- tions for Developing the State Hospital Construction Program, Federal Security Agency, U. S. Public Health Service, Exhibit 1, Par, A, 3j a and b), 50 Table 1 shows the number of normal and complement beds in each hospital and by categories (general, mental, tuberculosis and chronic). Table 2 shows the distribution of existing normal beds by islands, by cate- gories of hospitals, and by types of ownership (lines 31 to 6l) . Of the 4>548 normal beds in the Territory’s 59 hospitals (Table 2, line 47), 2,177 or 48% are general, 117 or 2.5% are maternity, 100 or 2.2% are children's, 28 or .6% are orthopedic, 125 or 2.8% are isolation for lepers, *1,078 or 23,7% are tuberculosis, 114 or 2.5% are chronic and 809 or 17.7% are mental. The gen- eral and allied special normal beds combined total 2,547 or 53.8% (Table 2, lines 31 to 46 and lines 54 to 6l). General Beds For our purpose, the general and allied special normal beds (Table 2, lines 31 to 42) are grouped under the terra "general” beds, and total for the Territory, 2,547 (Table 2, line 43). Of these 2,547 beds, Oahu Island has 1,237, Hawaii Island has 611, Maui Island has 378, Kauai Island has 164, Molokai Island has 131, and Lanai Island has 26. Mental Beds All of the 809 normal mental beds are on the Island of Oahu. (Table 2, line 46). Tuberculosis Beds Of the *1,078 tuberculosis beds in the Territory, Oahu Island has 536, Hawaii Island has 225, Maui Island has 202, and Kauai Island has 115. (Table 2, line 44.) Chronic (and convalescent) Beds Of the 114 chronic beds in the Territory, Oahu Island has 110 and Kauai Is- land has 4. Non-Acceptable Beds In the preceding paragraphs, we have shown the numbers and distribution of inventoried or existing normal general, mental, tuberculosis and chronic beds in the Territory. From these, we must subtract the so-called non-acceotable beds. *lncludes 30 beds for tuberculosis patients who are also mental patients at the Territorial Hospital, and which are not available to any other tuberculosis patients in the Territory." 51 Generally speaking, "non-acceptable" beds are those in a hospital or in a portion of a hospital, which is considered a "public hazard," and which "endan- gers the public safety," and may therefor include its entire bed capacity or only a portion thereof, (U.S„P.HOSo Regulations, Par. 10.1 f.) (Grants-In-Aid Manual Title 2 (23-2) Instructions for Developing the State Hospital Construction Program, U.S.P.H.S., Exhibit 1, Par. A, 1, b, (3).) The "physical condition" and other factors, which this "state agency" considered in the determination of non- acceptability includes- lo Structure not fire resistant. 2. Old dilapidated building. 3. Proven natural hazards, tidal waves, storms, etc. 4. Capacity too small for type of services or economical operations. 5. Inadequate facilities for medical records maintenance. 6. Inadequate facilities for storage of supplies. 7. Inadequate facilities for laundry service. 8. Inadequate facilities for dietetic service. 9. Inadequate facilities for laboratory service. 10. Inadequate facilities for x-ray service. 11. Inadequate facilities for pharmacy service. 120 Inadequate facilities for operating section, 13. Inadequate facilities for obstetric deliveries. IA. Inadequate facilities for nurseries. 15. Inadequate or no regular physician attendance. 16. Inadequate or no trained nursing service. 17. Inadequate nurses0 quarters. 18. Inadequate employees0 quarters. 19. General obsolescence, 20. Closure of hospital has been decided. Notes Because one-hour fire-resistant construction is a minimum requirement for one-story hospital buildings seeking federal aid under P„ L. 725, it is neces- sary to designate such existing buildings which are not fire-resistant as "non- acceptable." This does not mean that such an existing building will be condemned or prevented from operating. Proposed Territorial hospital rules and regulations will permit their operation for a reasonable length of time, but will stipulate fire-resistant construction for new structures or replacements. Furthermore, these "non-acceptable" beds increase the number of beds which will be constructible 'Vrith federal aid." After careful inspection of each hospital by the Director of Hospital Plan- ning, the beds classified as non-acceptable are indicated in Table 1, with the reasons for non-acceptability, and in Table 2, lines 75, 80, 85 and 90, by cate- gories of hospitals and by islands. There are 1.763 non-acceptable general beds in the Territory; 706 on Oahu Island, A 73 on Hawaii Island, 3£6 on Maui Island, 21 on Kauai Island, on Molokai Island, and 26 on Lanai Island, There are 120 non-acceptable mental beds in the Territory, all on Oahu Island. There are 609 non-acceptable tuberculosis beds in the Territory, 269 on Oahu Island, 225 on Hawaii Island, and 115 on Kauai Island, 52 There are 114. non-acceptable chronic beds in the Territory, 110 on Oahu Island and 4 on Kauai Island. Acceptable Normal Beds When we subtract the non-acceptable normal beds from the inventoried exist- ing normal beds, we have the acceptable normal beds in the Territory as shown in Table 2, lines 76, 81, 86 and 91, There are 784. acceptable normal general beds in the Territory, 531 on Oahu Island, 138 on Hawaii Island, 22 on Maui Island and 23 on Kauai Island. There are 689 acceptable normal mental beds in the Territory, all on Oahu Island. There are 439 acceptable normal tuberculosis beds in the Territory, 237 on Oahu Island, and 202 on Maui Island. There are no acceptable normal chronic beds in the Territory. Adequacy of Hospitals and Beds for the Needs of the People of the Territory Generally speaking, the measure of the Territory's and each island's needs in terms of hospital beds may be the accepted standards, as expressed by the ratios for maximum allotments given in the Act, and in the U.S.P.H.S. Regula- tions—these ratios are shown in Table 2, lines 70 to 73. These authorized ratios, applied to each island and to the Territory as a whole by categories of beds, allot the following maximum normal bedss Oahu Island. Base Area. Population 358.911 General beds, Ratio 4'<>s per 1,000 No. of Beds 1616 Mental beds, Ratio $ per 1,000 ” " " 179$ Tuberculosis Beds, Ratio 2J- x 168 ” n ” 4-20 Chronic Beds, Ratio 2 per 1,000 non y-j.g Hawaii, Island. Intermediate Area. Population 73.276 General beds, Ratio 4- per 1,000 No. of Beds 293 Mental beds, Ratio 5 per 1,000 11 " ” 366 Tuberculosis beds, Ratio 2J- x 4-3.2 n " " 108 Chronic beds, Ratio 2 per 1,000 ” n ” 14.7 Maui Island. Intermediate Area. Population 4,6.919 General beds, Ratio 4- per 1,000 No, of Beds 188 Mental beds, Ratio 5 per 1,000 " M " 23$ Tuberculosis beds, Ratio 2-J- x 31.2 n ” " 78 Chronic beds, Ratio 2 per 1,000 n " ” 94- 53 Kauai Island. Intermediate Area. Population 35.636 General Beds, Ratio 4 per 1,000 No. of Beds 142 Mental " " 5 per 1,000 « ” " 178 Tuberculosis Beds, Ratio x 18.4 ” n n 46 Chronic Beds, Ratio 2 per 1,000 n " " 71 Molokai Island. Rural Area. Population 534 Q General Beds, Ratio 2,5 per 1,000 No. of Beds 13 Mental ” "5 per 1,000 ” ” M 27 Tuberculosis Beds, Ratio 2.5 x 2.4 " " " 6 Chronic Beds, Ratio 2 per 1,000 n ” n 11 Lanai Island. Rural Area. Population 3.720 General Beds, Ratio 2.5 per 1,000 No. of Beds 9 Mental " " 5 per 1,000 " « n 19 Tuberculosis Beds, Ratio 2,5 x 1.2 " " " 3 Chronic Beds, Ratio 2 per 1,000 non 7 Entire Territory of Hawaii, Populfttj-flB 523.i.9i& General Beds, Ratio 4.5 per 1,000 No. of Beds 2357 Mental " " 5 per 1,000 " « « 2620 Tuberculosis Beds, Ratio 2.5 x 265 " ” ” 661 Chronic Beds, Ratio 2 per 1,000 H M " 1048 When we total, for each category, the number of beds authorized for the Territory by the application of standard ratios, we have the following: General Beds (by area ratios) 2260 General Beds (by Territory ratio) 2357 Mental Beds (by area or Territory ratio) 2620 Tuberculosis Beds (by area or Territory ratio) 661 Chronic Beds (by area or Territory ratio) 1048 The difference between the number of general beds by area ratios and the number of general beds by Territory ratio constitutes a general bed pool from which beds may be allocated to any island where need for such beds is manifest, according to the U.S.P.H.S. Regulations. By addition of the authorized numbers of beds in the last four lines, we have a total of 6686 beds, of all categories, authorized for the Territory. Bed Ratios How do the numbers of existing normal beds and existing "acceptable” nor- mal beds, and their ratios, on each island and in the Territory, compare with the authorized beds and their ratios? By utilization of the data shown on Table 2, lines 3, 62, 63, 64, 65, 70, 71, 72, 73, 74, 75, 76, 77, 79, 81, 82, 84, 85, 86, 87, 89, 91, 92, we can construct the following tabulations 54 COMPARISON OF EXISTING NORMAL AND EXISTING ACCEPTABLE NORMAL BED RATIOS WITH AUTHORIZED RATIOS Exist- ing Normal Beds Existing Normal Bed Ratios Exi sting Accept. Normal Beds Existing Acceptable Normal Bed Ratios : Author- ized Normal Beds Authorized Bed Ratios OAHU - POP. 358,911 General 1237 3.4 1,000 531 1.5 per 1,000 1615 4.5 per 1,000 Mental 809 202 per 1,000 689 1.9 per 1,000 1795 5 per 1,000 Tuberculosis *506 3 x 168 237 1.4 x 168 420 2.5 x 168 Chronic 110 3 per 1,000 0 0 per 1,000 718 2 per 1,000 HAWAII - POP. 73,276 General 611 8.5 per 1,000 138 1,9 per 1,000 293 4 per 1,000 Mental 0 0 per 1,000 0 0 per 1,000 366 5 per 1,000 Tuberculosis 225 5.2 x 43.2 0 0 x 43.2 108 2.5 x 43.2 Chronic 0 0 per 1,000 0 0 per 1,000 147 2 per 1,000 MAUI - POP. 4-6,919 General 378 8 per 1,000 22 .5 per 1,000 188 4 per 1,000 Mental 0 0 per 1,000 0 0 per 1,000 235 5 per 1,000 Tuberculosis 202 6.5 x 31.2 202 6.4 x 31.2 78 2.5 per 31.2 Chronic 0 0 per 1,000 0 0 per 1,000 94 2 per 1,000 KAUAI - POP. 35,636 General 164 4.6 per 1,000 93 2.5 per 1,000 142 4 per 1,000 Mental 0 0 per 1,000 0 0 per 1,000 178 5 per 1,000 Tuberculosis 115 6.2 x 18.4 0 0 x 18.4 46 2.5 x 18.4 Chronic 4 .1 per 1,000 0 0 per 1,000 71 2 per 1,000 MOLOKAI - POP. 5,34-0 General 131 24 per 1,000 0 0 per 1,000 13 2.5 per 1,000 Mental 0 0 per 1,000 0 0 per 1,000 27 5 per 1,000 Tuberculosis 0 0 x 2,4 0 0 x 2.4 6 2.5 x 2.4 Chronic 0 0 per 1,000 0 0 per 1,000 11 2 per 1,000 LANAI - POP. 3,720 General 26 7 per 1,000 0 0 per 1,000 9 2.5 per 1,000 Mental 0 0 per 1,000 0 0 per 1,000 19 5 per 1,000 Tuberculosis 0 0 x 1.2 0 0 x 1.2 3 2.5 x 1.2 Chronic 0 0 per 1,000 0 0 per 1,000 7 2 per 1,000 TERR. OF HAW. POP. 523,984 General 2547 4.9 per 1,000 784 1,5 per 1,000 2357 4.5 per 1,000 Mental 809 1.5 per 1,000 689 1.3 per 1,000 2620 5 per 1,000 Tuberculosis *1048 3.9 x 265 439 1.7 x 265 661 2.5 x 265 Chronic 114 .2 per 1,000 0 0 per 1,000 1048 2 per 1,000 * Excludes 30 beds for tuberculosis patients who are mental patients at the Territorial Hospital, and which are not available to any other tuberculosis patients in the Territory. 55 General Bed Ratios According to the preceding tabulation, the existing normal general bed ratio for the Territory is 4.9 per 1,000, and this compares favorably with the authorized ratio of 4.5. This Territorial ratio of 4.9, because of higher existing ratios on the other islands, (8.5 on Hawaii, 8 on Maui, 4.6 on Kauai, 24 on Molokai, 7 on Lanai) hides a moderate shortage on Oahu with an existing ratio of 3.4. Referring again to the preceding tabulation, the existing acceptable nor- mal general bed ratio for the Territory is 1.5 per 1,000; for Oahu 1.5, for Hawaii 1.9, for Maui .5, for Kauai 2.5, for Molokai 0, for Kauai 7, for Lanai 0 per 1,000. It is evident, therefore, that when the non-acceptable beds are deducted from the existing beds, we may, under the Act, plan for the construc- tion of a considerable number of additional general beds, as will be shown in later tabulations. The authorized standard of 4-.5 per 1,000 for general hospitals is gener- ally accepted. For the continental United States, in 194-0, the existing ratio was 3.5 beds per 1,000, many of which will probably also be rated as non- acceptable. However, the range varies widely according to geographic areas, namelys New England 4-,8 Middle Atlantic 4-.4- Mountain 4-«3 Pacific 4-.3 East North Central 3.6 West North Central 3.5 South Atlantic 2.S West South Central 2.3 East South Central 1,8 Within the areas, the differences are also marked. Among the more popu- lated and wealthy states, Massachusetts had 5.5, California 4.5 and Michigan 4.4 beds per 1,000. At the other extreme were Alabama with 1.8, Arkansas with 1,7 and Mississippi with 1.6. The distribution of these facilities conforms to the pattern of high or low purchasing power. By comparison, the survey figures show that the Territory taken as a whole, compares favorably with the states in its ratio of existing normal general beds —4.9 per 1,000. Attention is invited to the fact that in the Territory of Hawaii, in those areas where there is an excess of beds, the excess is strictly in general beds, since no allied special hospitals exist in those areas (except on Molokai which has 62 isolation beds for lepers) whereas, the ratio for Oahu remains low even with the inclusion of the allied special beds in the term general beds. Elimi- nating the existing allied special beds, the ratio for the Island of Oahu is 2.6 and for the Territory as a whole, it is 4.1. Attention is again invited to what has been stated concerning plantation hospitals and the uncertainty concerning their future. The 21 plantation hos- pitals inventoried have a total of 783 "normal" beds. These hospitals, with low 56 occupancy rates contribute to the existing high ratios. The ratios for existing normal beds and for existing normal acceptable beds, in the plantation hospitals by islands are shown in the following tabulations Ratios of Existing Normal and Existing Acceptable Normal General Beds in Plantation Hospitals by Islands Existing Existing Existing Existing Acceptable Acceptable Normal Normal Bed Normal Normal Bed Beds Ratios Beds Ratios Oahu * Pop. 18,287 203 11 per 1,000 0 0 per 1,000 Hawaii * Pop. 25,828 230 9 per 1,000 0 0 per 1,000 Maui * Pop, 15,671 2LA 15 per 1,000 0 0 per 1,000 Kauai * Pop, 13,807 61 A.5 per 1,000 0 0 per 1,000 Lanai ♦ Pop, 3,630 26 7 per 1,000 0 0 per 1,000 Molokai ** Pop. 7 19 ? 0 0 per 1,000 Census of Hawaiian Sugar Plantation - HSPA June 30, 1945 ** Plantation population not known Mental Bed Ratios The authorized standard for mental beds is 5 per 1,000 population. Our comparison of Existing Normal Bed Ratios, Existing Acceptable Normal Bed Ratios, and Authorized Bed Ratios, shows that the Territory has, with all its mental beds on Oahu Island the followings Existing normal mental beds 809 Ratio 1.5 Existing acceptable normal mental beds 689 Ratio 1.3 Authorized mental beds 2620 Ratio 5 This indicates that the Territory is greatly in need of more mental beds and if the full authorization of 2620 beds is allotted, 1,931 additional beds can be constructed. 57 Tuberculosis Bed Ratios The authorized standard for tuberculosis beds is 2.5 times the number of annual deaths averaged for the five-year period 194-0 to 1944-. The number of annual tuberculosis deaths, by islands and for the Territory, is shown in the following tabulations Civilian Deaths from Tuberculosis 19A0-19LL Territory of Hawaii 1940 1941 1942 1943 1944 Annual Average T.H. • 266 238 269 271 281 265 Oahu 167 U8 178 175 172 168 Hawaii 44 33 46 41 22 43.2 Maui 35 33 27 29 32 31.2 Kauai 15 21 13 22 21 18.A Molokai 5 1 1 3 2 2.4 Lanai 2 1 1 2 1.2 Niihau Kalawao 2 .6 From Division of Health Statistics, Department of Health, Board of Health, Territory of Hawaii Our comparison of Existing Acceptable Normal and Existing Acceptable Nor- mal Bed Ratios with Authorized Ratios shows that the Territory has 4.39 acceptable normal tuberculosis beds and when calculated on the basis of the average annual deaths, our existing ratios for each island and for the Territory are (Table 2, line 63)s Oahu 1.4. x 168 annual deaths Hawaii 0 x 4-3.2 annual deaths Maui x 31.2 annual deaths Kauai 0 x 18.4- annual deaths T.H. 1.7 x 265 annual deaths Since the authorized ratio for each island and for the Territory is 2.5 times the number of average annual deaths, we have for each island except Maui, a deficit which may be constructed. This deficit amounts to 222 beds for the Territory, which may be constructed 58 Chronic and Convalescent Bed Ratios The authorized standard for chronic beds is 2 per 1,000 population. Our comparison of Existing Normal Bed Ratios, Existing Acceptable Normal Bed Ratios and Authorized Bed Ratios, shows that the Territory has no accept- able normal chronic beds. The ratios are as follows; Existing normal chronic beds 114. Ratio ,2 Existing acceptable normal chronic beds 0 Ratio 0 Authorized chronic beds—— 104.8 Ratio 2. This indicates that the Territory is greatly in need of more chronic beds and if the full authorization of 104-8 beds is allotted, 104-8 additional beds can be constructed. Normal Beds - Acceptable and Non-Acceptable Beds With reasons for non-acceptability Name of Hospital or Health Center Type Non-Acceptable Code Numbers No.N.A, Beds No.Norm, Acc.Beds Oahu County Berg, Bertha Chr. 1-4-5-15-16 5 P Ewa Plantation Co. Hospital Gen, 1-7-8-12-U AS P Honolulu Plantation Co. Hosp. Gen. 1-4.-5-7-8-9-12-13-14 33 P Kahuku Plant, Co. Hospital Gen. 1-4-6-7-8-12-13-1/. 34 Kalihi Hospital A.S. 1-2-19-Lepers only 63 Kanilao, Mary & Nott, Annie Chr. 1-2-4-6-7-8-15-16-19 20 Kapiolani Mat. & Gyn. Hosp. A.S. 105 Kauikeolani Children*s Hosp. A.S. 1-2-5-7-19 84 16 Kuakini Hospital Gen. 1-2-19 83 35 Leahi Hospital T.B. 1-2-19 269 237 Maluhia Horae Chr. 1-2-19 62 Mannion. Sophie Chr. 1-4-5-15-16 8 Ogawa Lying-in Home A.S. 1-4-5-7-9-13-14-15-16 A P Oahu Sugar Co, Hospital Gen. 1-2-8-9-10-12-14-19 52 Queen*s Hospital Gen, 1-2-19 125 *2A5 St. Francis Hospital Gen, 1-2 30 127 Salvation Army Women's Home Chr. 1 __ A 0 Shriner*s Hospital A.S. 28 Silva, Ida Chr. 1-4-5-15-16 11 Tamura Hospital Gen. 1-2-4-5-6-7-8-10-12 13-17-18 7 Territorial Hospital Ment. 1-2-8 120 —694 2s Mental Beds 59 Normal Beds - Acceptable and Non-Acceptable Beds With reasons for non-acceptability (oonte) Name of Hospital or Health Center Type Non-Acceptable Code Numbers No.N.A. Beds No.Norm. Acc.Beds Oahu Countv (cont.) Wahiawa General Hospital Gen, l~2-5“7-B-10-12-13“19 107 P Waialua Agric. Co. Hospital Gen. 1-4-6-8-12-14 36 Hawaii County P Hakalau Plantation Co. Hoso. Gen. 1-4-8-9-10-14-17-18 1,205 24 1,487 P Hamakua Mill Co. Hospital Gen. 1-2-4-5-6-8-9-10-11 13-14-16 11 P Hawaiian Agric. Co. Hosp. Gen. 1-4 35 Hilo Memorial Hospital Gen. 1-7-8-14 50 138 P Honokaa Sugar Co. Hospital Gen. 1^2-4-6-8-9-10-11 13-14-19 30 Kohala County Hospital Gen. 1 50 Kona Community Hospital Gen. 1-4-5-6-8-9-10-11 13-14-19 18 Kona Hospital (County) Gen. 1 52 P Laupahoehoe Sugar Co. Hosp. Gen, 1-4 27 Matayoshi Hospital Gen, 1-2-4-5-6-7-8-9-12 13-14-17-18-19 26 Matsumura Hospital A.S. I- II- 8 Mitamura Hospital Gen, 1-2-4-5-6-7-8-9-10-11 12-13-16-19-20 9 Okada Hospital Geno 1-2-4-5-6-8-9-10-11 12-13-14-16-19 6 P Olaa Plantation Hospital Gen. 1 51 P Ookala Hosp. (Kaiwiki Sug.Co.) Gen. 1=4=» 5-6-8-9-10-11 13-14 9 Oto Hospital Gen. 1-4-5-6-7-8-13-14-15 16 P Pepeekeo Hospital Gen. 1-2-5-6-8-9-14-18-19 43 Puumaile Hospital T.B. 1-3-20 —225 Yamanoha Hospital Gen. I- II- 8 698 138 60 Normal Beds - Acceptable and Hon-Acceptable Beds With reasons for non-acceptability (cont.) Name of Hospital or Health Center Type Non-Ac c eptable Code Numbers No.N.A. Beds — No. Norm. Acc. Beds — .... Kauai County Betsui Hospital Gen. 1-4-6-7-8-12-13 14-20 14 P Koloa Sugar Go. Gen. 1-2-4-12-13-20 22 P Eleele Dispensary (McBryde) Chr.* 1-2-4-19-20 4 Samuel Mahelona Hospital T.B. 1-6-7-11-17-19 115 P Waimea Hospital Gen. 1-2-4-8-9-12-14-19 35 Wilcox Memorial Hospital Gen, 93 190 93 Maui County Hana County Hospital Gen, 1-2-4-5-6-8-9-10 12-13-14-17-19 30 Kula General Hospital Gen. 22 Kula Sanatorium T.B. 202 P Lanai City Hospital Gen. 1 26 Malulani Hospital Gen. 1-2-5-6-7-12-13-14 18-19 82 Maunaloa Hospital Gen. 1-4-5-6-7-8-9-10-11 12-13-17-18-19 19 P Maui Agric. Co, Hospital Gen. 1-2-8-19 80 P Pioneer Mill Co. Hospital Gen, 1-2 67 P Puunene Hospital Gen. 1-8 97 Shingle Memorial Hospital Gen. 1-2-5-6-7-8-11 50 451 224 Kalawao Countv Kalaupapa Settlement Hosp. A.S. 1-2-19 Lepers only 62 62 Grand Total 2,606 1,942 P « Plantation-owned hospitals 61 Authorized Beds for Territory of Hawaii Island Pop. Area Rate General & Allied Special Beds • _ At Area Ratio At Terr. Ratio Mental Beds T.B. Beds Chronic Beds Oahu 358,911 4.5 1.615 1.615 1*795 420 718 Hawaii 73,276 4. 293 330 366 108 147 Maui 46,919 4. 188 211 23$ 78 94 Kauai 35,636 4* U2 160 178 46 71 Molokai 5,340 2.5 13 24 27 6 11 Lanai 3,720 2.5 9 17 19 3 7 Niihau 182 Total 523,98-1 2 9 260 2,357 2,620 661 1,048 Allocated General Beds - by island: T. H, Area Ratio Ratio Oahu 1,618 - 1,615 authorized, plus 3 pool beds Hawaii 331 - 293 ” "38 ” ■ Maui 210 - 188 " ”22 ” ” Kauai 158-142 ■ "16 « " Molokai 23-13 " " 10 " n Lanai 17 - 9 " « 8 « " Totals 2,357 2,260 authorized, plus 97 pool beds Declaration of Acceptable Beds (General, Tuberculosis, Mental & Chronic) For each County & Island and of additional beds which may be constructed Hawaii County (Island of Hawaii) 19A6. has Population 73,276 Square Miles 4,030 Acceptable General Hospital Beds 138 Acceptable Tuberculosis Hospital Beds 0 Acceptable Ment. & Nerv. Hosp. Beds 0 Acceptable Chr. & Conv. Hospital Beds 0 is entitled to additional General Hospital Beds 155 additional Tuberculosis Hospital Beds 108 additional Ment. & Nerv. Hospital Beds 366 additional Chr, & Conv. Hospital Beds IA7 62 Declaration of Acceptable Beds (General, Tuberculosis, Mental & Chronic) For each County & Island and of additional beds which may be constructed (cont.) Honolulu. City & County (Island of Oahu) 1946. has Population 358,911 Square Miles 604 Acceptable General Hospital Beds 531 Acceptable Tuberculosis Hospital Beds 237 Acceptable Ment. & Nerv. Hospital Beds 689 Acceptable Chr. & Conv. Hospital Beds 0 is entitled to additional General Hospital Beds 1,084 additional Tuberculosis Hospital Beds 183 additional Ment. & Nerv, Hosp. Beds 1,106 additional Chr. & Conv. Hospital Beds 718 Maui County (island of Maui only) 1946, has Population 4^,919 Square Miles 728 Acceptable General Hospital Beds 22 Acceptable Tuberculosis Hospital Beds 202 Acceptable Ment. & Nerv. Hospital Beds 0 Acceptable Chr. & Conv, Hospital Beds 0 is entitled to additional General Hospital Beds 166 additional Tuberculosis Hospital Beds -124 additional Ment, & Nerv. Hospital Beds 23$ additional Chr. & Conv. Hospital Beds 94 Maui Countv (Island of Molokai only) 1946, has Population 5>340 Square Miles 260 Acceptable General Hospital Beds 0 Acceptable Tuberculosis Hospital Beds 0 Acceptable Ment. & Ner. Hospital Beds 0 Acceptable Chr, & Conv. Hospital Beds 0 is entitled to additional General Hospital Beds 13 additional Tuberculosis Hosp. Beds 6 additional Ment. & Nerv. Hospital Beds 27 additional Chr. & Conv. Hospital Beds 11 Maui Countv (Island of Lanai only) 1946. has Population 3*720 Square Mile s 141 Acceptable General Hospital Beds 0 Acceptable Tuberculosis Hospital Beds 0 Acceptable Ment. & Nerv. Hospital Beds 0 Acceptable Chr. & Conv. Hospital Beds 0 63 Declaration of Acceptableßeds (cont.) Maul Countv (Island of Lanai only) 19A6, (cont.) is entitled to additional General Hospital Beds 9 additional Tuberculosis Hospital Beds 3 additional Mental & Nervous Hosp. Beds 19 additional Chr. & Conv. Hospital Beds 7 has Population 35>636 Square Mile s 551 Acceptable General Hospital Beds 93 Acceptable Tuberculosis Hospital Beds 0 Acceptable Ment, & Nerv. Hospital Beds 0 Acceptable Chr. & Conv. Hospital Beds 0 is entitled to additional General Hospital Beds 4-9 additional Tuberculosis Hospital Beds 4-6 additional Mental & Nervous Hosp. Beds 178 additional Chr. & Conv. Hospital Beds 71 64 Chapter VI HEALTH CENTERS Inventoried existing public health facilities in the Territory of Hawaii number 44. Table 3 indicates their distribution by islands, their names and addresses, the type of services rendered, the type of facility and the owner- ship status of each,, Bearing in mind the definition of a public health center, as stated in P. L. 725, Sect. 631 (f) and in U.S.P.H.S. Regulations, par. 10.1 (p), the Territory has 7 such centers? One is the Territorial Department of Health, central office for the Terri- tory and for the City and County of Honolulu (Oahu Island) at Honolulu, Oahu. One is a Territorial Department of Health branch office for the City & County of Honolulu, the Lanakila Health Center at Honolulu, Oahu, One is a Territorial Department of Health branch office for the City & County of Honolulu, the Kapahulu Health Center at Honolulu, Oahu. One is the Territorial Department of Health branch office for the County and Island of Hawaii, at Hilo, Hawaii. One is the Territorial Department of Health branch office of the Hawaii County office for the Honokaa area at Honokaa, Hawaii. One is the Territorial Department of Health branch office for the County of Maui and the Island of Maui at Wailuku, Maui. One is the Territorial Department of Health branch office for the County of Kauai and the Island of Kauai at Lihue, Kauai, The centers described above are all administrative, but the central office in Honolulu also operates laboratories; the Lanakila Center is mainly for tuber- culosis control; the Kapahulu Center operates a laboratory, pre-natal care, child health, venereal disease and crippled children control programs; the center at Honokaa, Hawaii operates pre-natal care, child health, tuberculosis control, crippled children programs; the center at Wailuku, Maui also operates tuberculo- sis control, crippled children and mental hygiene programs. In addition to the above public health centers, each island has a number of nsubsidiary” or auxiliary health center clinics in nearby and outlying areas which bring pre-natal, child health, tuberculosis and crippled children programs to the inhabitants of those areas. There are also auxiliary laboratory facilities on Oahu, Hawaii, Maui and Kauai Islands. 65 These "subsidiary" or auxiliary facilities are tabulated as follows: Oahu Island hass 9 auxiliary clinic centers 1 auxiliary laboratory facility Hawaii Island hass 4 auxiliary clinic centers 3 auxiliary laboratory facilities Maui Island hass 4- auxiliary clinic centers 2 auxiliary laboratory facilities Molokai Island hass 2 auxiliary clinic centers Lanai Island hass 1 auxiliary clinic center Kauai Island hass 10 auxiliary clinic centers 1 auxiliary laboratory facility The above centers and auxiliary facilities are publicly owned, rented or loaned and all are operated by the Territorial Department of Health and its county and island branches. According to U.S.P.H.S. Regulations, par. 10.31, we may exclude from the inventory of public health centers, auxiliary public health clinics and auxi- liary public health laboratories; we may also exclude existing facilities which are "unsuitable," i.e.s 1. "Existing facilities which the Territorial agency, after consultation with the Territorial health authority, has determined to be unsuitable for use as public health centers, and 20 "Auxiliary facilities such as laboratories and clinics, whether exist- ing or proposed, and whether they are located within the same structure as the health department office or in a separate structure." Generally speaking, "unsuitable" health centers and health center facili- ties are those in buildings which are considered to be public hazards because they are fire hazards, are old and dilapidated, or lack the space or the struc- tural appurtenances necessary for the conduct of the health programs and func- tions for which they are operated. The factors which this Territorial agency considered in the determination of unsuitability include; 1. Structure not fire resistant 2. Old, dilapidated building 3. No hot water system U. No electric wiring 5. Inadequate office space for administration 6. Inadequate waiting room space 7. Inadequate clinic space 8. Inadequate conference and educational space 9. Inadequate laboratory space 10. Inadequate auditorium space 11. Inadequate library space 66 12. Inadequate storage space 13. Inadequate parking space li. Inadequate toilet facilities 15. Location unsuitable for area population served 16. Discontinuance of facility has been decided After careful inspection of each public health center, clinic, laboratory or other facility listed on the inventory, those classified as unsuitable are indicated in the inventory, Table 3, with the reasons for unsuitability. With a total of 7 public health centers and 37 auxiliary clinics and lab- oratories existing in the Territory, it is evident that public health services have not been lacking; in fact, it may be said that few states have enjoyed such wide spread coverage in public health services; scarcely a village has been with- out public health clinic facilities of some kind. That some of the facilities are ”unsuitable'1 is apparent from a study of Table 3; the urgency of need, and the shortages imposed by World War II made necessary the use of single rooms or groups of rooms in courthouses, schools, plantation storage areas, and abandoned service buildings—utterly unsuitable to public health work, but their utiliza- tion, with a remarkable degree of successful results from the public health ser- vices rendered, lend testimony to the ingenuity, perseverance and sincerity of the public health workers in the field. The following tabulation shows the identification number, location, and usage of each public health facility, indicating its classification as a pub health center or as an auxiliary—and its suitability or non-suitability. public Health Center Facilities. Territory of Hawaii Islands. 19A6 ftft ftft ftft f A N 0 C c T P. A E A Ident. « H. U P C No. Facility Location Usage Code c. X. T. C. Island of Oahu 1 Dept, of Health, T.H. & Oahu Honolulu 1-2 X X 2 Lanakila Health Center ft 1-2-$ X X 3 Kapahulu Health Center it 1-2-3-4-6-8-CG X X 4 Animal Laboratory w 2 X X 5 Mental Hygiene Clinic t« 8-MH X X 6 Kailua Health Center Kailua 1-3-4-5-8-CC X X 7 Kaneohe Health Center Kaneohe 1-3-4-5-6-8-CC X X 8 Hauula Health Center Hauula 3-4 X X . 9 Wahiawa Health Center Wahiawa 1-3-4-5-6-8-CC X X 10 Nanakuli Health Center Nanakuli 3-4 X X 11 Waialua Health Center Waialua 1-3-4-5-6-8-GC X X 12 Waipahu Health Center Waipahu 1-3-4-5-6-8-GC X X _12 1 Aiea Health Center Aiea 1-3-4-5-6-8-CC X X 67 Health Center Facilities. Territory of Hawaii By Islands. 194,6 (Cont.) Ident. No. Facility Location « Usage Code P. H. c. A U X. #* A c C E P T. ** N 0 T A C G. u Dept, of Health, T.H, & Gy of Hawaii Island of Hawaii Hilo 1 X X 15 Bacteriological Labora- tory n 2-5-6-8-BH X X 16 Plague Laboratory tt 2 X X 17 Dept, of Health, T.H. & Cy of Hawaii, Branch Honokaa 1-3-4-5-8-CC X X 18 Plague Laboratory n 2 X X 19 Kohala Health Oerter Kohala 3-4-5-8-CC, MH X X 20 Kona Health Center Kealakekau 3-4-5-8-CC-MH X X 21 Pahala Health Center Pahala, Kau 3-4-5-8-GC-MH X X 22 North Kona Health Cent, Holualoa, Kona 8-MH X X 23 Dept, of Health, T.H. & Cy of Maui Island of Maui Wailuku 1_ 5-8-CC-MH-N X X 24 Plague Laboratory Kahului 1-2 X X 25 Bacteriological Lab, Wailuku 1-2 X X 26 Lahaina Health Cent. Lahaina 1-4-5-8-CC X X “57“ Makawao Health Cent. Makawao 1-3 -4 X X 28 Haiku Health Center Libby, Kuiaha 1-4 X X 29 Waiakoa Health Cent. Waiakoa, Kula 1-4 X X 30 Dept, of Health, T.H. & Cy of Maui, Branch [sland of Molokai 1 X X Kaunakakai 31 Irwin Health Center Pukoo 3-4-6 X X 32 Dept, of Health, T.H, & Cy of Maui, Branch Island of Lanai 1-3-4-5 X X Lanai City 68 Health Center Facilities. Territory of Hawaii Bv Islands* 19Z.6 (cont.) Ident, No. Facility Location * Usage Code ** P. H. C. A U I. ** A G C E P T. *» N 0 T A C C, 33 Dept, of Health, T.H. of Kai Island of Kauai 1 X X & Cy lai Lihue 34 Bacteriological Lab. n 1-2 X X - 35 Kilauea Health Center Kilauea 1-3-4-5 X X 36 Kapaa Health Center Kapaa I-.3-4-.5-B-CC X X 37 Koloa Health Center Koloa 1-3-4-5-8-CC X X 38 Kalaheo Health Center Kalaheo 1-4-5 X X 39 Eleele Health Center Eleele 1-3-4-5-8-CC-MH X X 40 Waimea Health Center Waimea 1-4-8-MH X X 41 Hanalei Health Center Hanalei 4 X X 42 Kealia Health Center Kealia 4-5 X X 43 Hanamaulu Health Cent( t Hanamaulu 4 X X 44 * New Mill Health Centea ; ■ New Mill, Eleele 4 X X ► *Usage Code **USPHS Definitions 1 - Administration 2 - Laboratory 3 - Pre-natal Care U - Child Health 5 - TB Control 6 - Ven. Dis. Control 7 - Dent. Hygiene 8 - Other (Specify) CC - Crippled Children MH - Mental Hygiene N - Neurology For reasons for non-acceptability or "unsuitability," see our Table 3, Inventory of Public Health Centers Stated briefly (see Table 2, lines 138 to 14.6), the Territory has 7 public health centers of which 2 are suitable and 37 auxiliary clinics and laboratories of which 23 are suitable. The suitability or unsuitability of each facility was based on recommendations of the officers of the Department of Health for each facility and on personal inspection by the survey director. Standard ratios authorize 17 public health centers for the Territory—so 15 could be constructed with federal financial aid. 69 There are no standard ratios for auxiliary clinics and laboratories, so it is assumed that 14- or more could be constructed with federal financial assistance. The existing distribution and location of public health centers and auxi- liary clinics and laboratories are considered desirable by the Department of Health and by the survey director; this is because with present road and trans- portation facilities, they have brought efficient public health services to the rural communities. When road and transportation facilities improve, which is possible, a concentration to fewer auxiliary clinic facilities is worthy of con- sideration. It is considered desirable, at this time, to change the status of certain auxiliary clinics on Oahu to that of public health centers (branches), namely, at Kaneohe, Wahiawa, Waialua and Waiphau, because of rapidly increasing population in those areas and to provide more efficient administration of auxi- liary facilities in these areas. The allocation of health centers and auxiliaries for the Territory are shown in the following tabulations. Those marked with a C are, because of pre- sent unsuitability, recommended for construction or reconstruction with federal financial assistance. Thus, there will be programmed for construction with federal aid; on Oahu, 4 public health centers and 4 auxiliary facilities; on Hawaii, 2 public health centers and 3 auxiliary facilities; on Maui, 1 public health center and 3 auxiliary facilities; on Molokai, 1 auxiliary facility; on Kauai 1 public health center. Allocation of Health Centers and Auxiliaries Island Popu- lation Type of Facility P. H. C, A U X. Location & Existing Facility Oahu 358,911 T.H., Dept, of Health PHC C X Honolulu, T.H., Dept, of Health Branch, n ” ” ” X Honolulu, Lanakila Health Center .Branch. M " n n x Honolulu. Kapahulu Health Center Laboratory, Animal X Honolulu, Plague Animal Lab. Mental Hygiene Clinic C X Honolulu, Mental Hygiene Clinic Kailua H. C. Clinic C X Kailua Health Center Clinic Autho Kaneohe P.H.C. C X Kaneohe Health Center Clinic P.H.C.s Hauula H. C. Clinic C X Hauula Health Center Clinic 12 Wahiawa P.H.C. C X Wahiawa Health Center Clinic Nanakuli H. C. Clinic C X Nanakuli Health Center Clinic Waialua P.H.C. C X Waialua Health Center Clinic Waipahu P.H.C. X Waipahu Health Center Clinic Aiea H. C. Clinic X Aiea Health Center Clinic 70 Allocation of Health Centers and Auxiliaries (Gont.) Island Popu- lation Type of Facility p. H. p 0 A U X, Location & Existing Facility Hawaii County Depto of Health, PHC C X Hilo, Hawaii Cy Dept, of Health 73,276 Laboratory, Bacteriological C X Hilo, Bacteriological Lab, Laboratory, Animal X Hilo, Plague Animal Laboratory i Countv Dent, of Health. PHC C X Honokaa, Honokaa Health Center Author- Laboratory, Animal X Honokaa Plague Animal Lab, ized Kohala H. C. Clinic c X Kohala Health Center Clinic P.H.C.S Kona H. C, Clinic c X Xealakekua H. C, Clinic 2 Pahala H. C. Clinic X Pahala Health Center Clinic North Kona H. C. Clinic X Holualoa Health Center Clinic Maui County Dept, of Health, PHC c X Wailuku, Maui Cy Dept, of Health 46,919 Laboratory, Animal X Kahului, Plague Animal Lab. Laboratory, Bacteriological c X Wailuku Bacteriological Lab, Author- Lahaina H. C. Clinic X Lahaina Health Center Clinic ized Makawao H. C. Clinic c X Makawao Health Center Clinic P.H.C.s Haiku H. C. Clinic X Libby, Kuiaha, H. C, Clinic 1 Waiakoa H. C. Clinic c X Waiakoa Health Center Clinic Molokai 5,34-0 County Dept, of Health, Branch G X Kaunakakai, Molokai - Branch, Maui County Dept, of Health Auth. Irwin H. C, Clinic X Pukco, Health Center Clinic P.H.C.s 0 Lanai 3,720 County Dept, of Health Branch X Lanai City, Lanai Branch, Maui County Dept, of Health Auth. P.H.C.s 0 Kauai 35,636 County Dept, of Health, PHC c X Lihue, Kauai County Dept, of Health Laboratory, Bacteriological X Lihue, Bacteriological Lab, Kilauea H. C, Clinic X Kilauea, Health Center Clinic Kapaa H. C. Clinic X Kapaa Health Center Clinic Auth. \ Koloa H. C. Clinic X Koloa Health Center Clinic P.H.C.s Kalaheo H. C, Clinic X Kalaheo Health Center Clinic 1 Eleele H. C, Clinic X Eleele Health Center Clinic Waimea H. C. Clinic X Waimea Health Center Clinic Hanalei H. C. Clinic X Hanalei Health Center Clinic Hanamaulu H. C. Clinic X Hanamaulu Health Center Clinic New Mill H, G. Clinic X New Mill, Eleele, H, C. Clinic 71 Chapter VII SUMMARY OF THE TERRITORY’S NEEDS General Hospitals and Beds The Territory needs fewer but larger general hospitals on Oahu, Hawaii, Maui, Kauai and Molokai. The Territory needs additional acceptable general beds; Oahu 1,084, Hawaii 155, Maui 166, Kauai 49, Molokai 13. Lanai needs 9 acceptable beds. Mental Hospitals and Beds The Territory needs no more mental hospitals, but it does need a small men- tal unit of less than 10 beds as an integral part of the largest general hospi- tal on each island. The Territory needs 1,931 additional acceptable mental beds on Oahu for the mental disease patients of the entire Territory. Tuberculosis Hospitals and Beds The Territory needs no more tuberculosis hospitals; one on each of the larger islands, Oahu, Hawaii, Maui and Kauai will suffice. Maui’s hospital can provide for Molokai’s and Lanai’s meager needs. The Territory needs additional acceptable tuberculosis beds; Oahu 183, Hawaii 108, Kauai 46, Molokai 6, Lanai 3. The nine for Molokai and Lanai can be allotted to Maui, These are the additional acceptable beds authorized on the basis of standard ratios which may be constructed with federal aid. It is believed that upward revision of the standard ratio by the United States Public Health Service may occur as a prelude to an increase in the number of authorized beds, to provide the number estimated as the total actually needed, 1,348 in a subsequent paragraph (see page 78). Chronic Hospitals and Beds The Territory needs more and larger chronic hospitals or units, at least one on each island, preferably close to and affiliated with, or a part of a large general hospital. The Territory needs additional acceptable chronic beds; Oahu 718, Hawaii 147, Maui 94, Kauai 71, Molokai 11, Lanai, 7. Notes The additional acceptable beds needed for the Territory, of all categories cited above, are those which can be provided with federal financial aid within the limitations of appropriated funds and in conformity with priority or relative need. 72 Alterations in Number of Hospitals The downward revision of the number of general hospitals and the upward revision in the number of chronic hospitals (or units) considered desirable is expressed in the following tabulation„ Although a still greater concentra- tion of the authorized general beds in fewer hospitals seems desirable, the needs of rural communities will not permit it at this time. Hospitals, Existing and Proposed Oahu Hawaii Maui Kauai Molokai Lanai T. H. General Existing 15 18 6 4 3 1 47 Proposed 12 6 5 2 2 1 28 Mental Existing 1 1 Propo sed 1 1 Tuberculosis Existing 1 1 1 1 4 Proposed 1 1 1 1 4 Chronic Existing 6 1 7 Proposed 3 1 1 1 1* 1* 8 Small units in- general hospitals Public Health Centers and Auxiliary Facilitie The Territory needs 4 additional public health centers for a total of 11 (Oahu 7, Hawaii 2, Maui 1, Kauai l). Assuming retention only of those existing and acceptable, it needs 8 additional public health centers (Oahu 4? Hawaii 2, Maui 1, Kauai l)„ The Territory needs fewer auxiliary facilities for a total of 32 (Oahu 6, Hawaii 7, Maui 6, Kauai 10, Molokai 2, Lanai 1). Assuming retention of those existing and acceptable, it needs 11 additional auxiliary facilities (Oahu 4, Hawaii 3, Maui 3, Molokai l). Alterations in Number of Public Health Centers and Auxiliary Facilities The upward revision of the number of public health centers and downward revision of the number of auxiliary-facilities considered desirable is expressed in the following tabulation. Although a still greater concentration of auxil- iary facilities seems desirable, the needs of rural communities will not permit it at this time. 73 Public Health Centers and Auxiliary facilities Existing and Proposed Oahu Hawaii Maui Kauai Molokai Lanai T. H. P. H. Centers Existing 3 2 1 1 7 Proposed 7 2 1 1 11 Aux. Facilities Existing 10 7 6 11 2 1 37 Proposed 6 [ 7 - 6 10 2 1 32 74 Chapter VIII SUMMARY AND RECOMMENDATIONS Summary General Hospital Beds The number of general hospitals, which tenn includes maternity, children’s, orthopedic, is 47. Their distribution by islands is shown in Table 2, lines 8 to 20, extracted below? Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 80 General Hospitals 0-24 beds 1 8 1 2 1 13 9o General Hospitals 25-49 beds 3 5 1 1 1 11 10o General Hospitals 50-99 beds 2 3 4 1 1 11 11o General Hospitals 100-199 beds 3 1 4 12. General Hospitals 200-500 beds 1 1 13. Allied Special Mat. Hospitals 0-24 beds 1 1 2 16, Allied Special Mat, Hospitals 100-199 beds 1 1 17o Allied Special Children8 s Hospitals 1 1 18c Allied Special Orthopedic Hospitals 1 1 19. Allied Special Isol. (leper) Hospitals 1 1 2 20o Total General (and Allied Spec.) Hospitals 15 18 6 4 3 1 47 The number of hospitals is excessive. This is due in part to the number of general and maternity hospitals of less than 25 beds (Table 2, lines 8 and 13) which are in the majority individually owned profit hospitals (Table 2, line 30). It is also due in part to the existence in several areas of two or more planta- tion corporation owned hospitals where one might suffice (Table 2, line 29)j this is true of Oahu, Hawaii and Maui. 75 Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T, H. 30, Prop, Indiv.- owned Hospitals 6 7 1 U 29* Prop, Corp. Plant,-owned Hospitals 5 8 3 3 1 1 21 The number of existing normal beds (Table 2 line 74) is slightly excessive; this is so because of surplus beds on Hawaii, Maui, Kauai, Molokai and Lanai (see Table 2, line 77 for authorized beds). This excess on the other islands hides a deficit on Oahu, Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 77e Auth. Gen. & * ** «* *«* *** « A. S. Beds 1615 293 188 U2 13 9 2357 74-. Normal Gen. & A. S. Beds 1237 611 378 16^ 131 26 2547 Deficit -378 +318 ❖190 ❖ 22 .118 ❖17 + 190 On ratio of 4,5 per 1000 On ratio of 4. per 1000 On ratio of 2.5 per 1000 Notes Net excess of islands is 97 greater than excess for T. H. because of smaller authorized ratios for islands compared with T. H. This dif- ference constitutes a pool which may be allotted to islands. When the non-acceptable beds (Table 2, line 75) are separated from the normal beds (Table 2, line 74), we have the acceptable beds (Table 2, line 76), If we subtract the acceptable beds (Table 2, line 76) from the authorized beds (Table 2, line 77), we find a decided deficit for each island (Table 2, line 78). Assuming that the authorized number of beds is the minimum number needed, the deficit represents the additional number of beds needed and which may be con- structed with federal aid (Table 2, line 78). Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 74-. Normal General & A, S, Beds 1237 611 378 164 131 26 2547 75, Non-Ac cep table Gen, & A. S. Beds 706 473 356 71 131 26 1763 76. Acceptable Gen. & A. S. Beds $31 138 22 93 0 784 77. Auth, General & A. S. Beds 1615 293 188 142 13 9 2357 78. Additional Gen. Beds which may be constructed 1084. 15$ 166 49 13 9 « 1573 *1573 includes 97 poo! . beds 76 Mental Hospital Beds The number of mental hospitals for long-term hospitalization, one on the Island of Oahu at Kaneohe, is the desirable number. The mental unit (25 beds) at Queen’s (general) Hospital at Honolulu, Oahu, is comparable to a proposed smaller unit for each other major island, for pre-commitment observation of mental disease patients (Table 2, line 23) . Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 23. Mental Hospitals 1 1 The number of existing normal beds (Table 2, line 89) is totally inade- quate for the Territory’s needs. If we deduct the existing normal beds (Table 2, line 92) this inadequacy becomes apparent. Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 92. Authorized Mental Beds 1795 366 235 178 27 19 2620 89. Existing Norm. Mental Beds 809 809 Deficit -986 -366 -235 -178 -27 -19 -1811 When the non-acceptable beds (Table 2, line 90) are subtracted from the normal beds (Table 2, line 89), we have the acceptable beds (Table 2, line 91). If we subtract the acceptable beds (Table 2, line 91) from the authorized beds (Table 2, line 92), we find the deficit increased (Table 2, line 93). Assuming that the authorized number of beds is the minimum number needed, the deficit represents the additional number of beds needed and which may be constructed with federal aid. Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 89. Normal Mental Beds 809 809 90. Non-Acceptable Mental Beds 120 120 91. Acceptable Mental Beds 689 689 92. Authorized Mental Beds 1795 366 235 178 27 19 2620 93. Additional Ment. Beds which may be constructed 1106 366 235 178 27 19 1931 Tuberculosis Hosoital Beds The number of tuberculosis hospitals (Table 2, Line 21) one on each island is the desirable number. It is believed that this is practicable and that 77 tuberculosis patients should be enabled, where possible, to enjoy the visits of relatives and that these visits should be made easy of accomplishment. Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 21. Tuberculosis Hospitals 1 1 1 1 4 The number of existing normal beds (Table 2, line 79) is in excess of the authorized beds (Table 2, line B 2) but inadequate for the needs of the Terri- tory, Though there is an excess of 387 beds, the percent occupancy of the four hospitals is 96, 96, 84. and 88, or an average of 91. The Territory could uti- lize a 28$ increase over its present normal bed capacity (for Oahu and Hawaii) to bring its total to 1,348 and it could utilize a 104$ increase over its author- ized bed capacity to achieve the same total, 1,348. It is believed that this is justified by the fact that Oahu has a waiting list of 75 tuberculars and Hawaii one of 100 as of 1946. This waiting list, it is safe to say, will be augmented by the case-finding program now in operation. Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 82. Authorized T. B. Beds 420 108 78 46 6 3 661 79. Normal T. B. Beds 506 225 202 115 1048 Excess 86 117 124 69 *6 *3 387 When the non-acceptable beds (Table 2, line 80) are subtracted from the normal beds (Table 2, line 79)> we have the acceptable beds (Table 2, line 81) . If we subtract the acceptable beds (Table 2, line 81) from the authorized beds (Table 2, line 82), we find a deficit for each island except Maui which has an excess of 124 beds (Table 2, line 83). Assuming that the authorized number of beds might be the minimum needed, this deficit represents the additional number of beds needed and which may be constructed with federal funds (Table 2, line 82). Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 79. Normal T. B. Beds $06 22$ 202 11$ 1048 80. Non-Acceptable T. B, Beds 269 22$ 11$ 609 81. Acceptable T. B. Beds 237 202 439 82. Authorized . T. B. Beds A20 108 78 46 _j6 - 3 661 83. Additional T. B, Beds which may be constructed 183 108 -124. 44— 6 -.3 222 With 439 acceptable beds and 66l authorized beds, we can, under existing authorized ratios, construct only 222 more beds for a total of 661, Unless, 78 at a later date, the federal authority (USPHS) revises the authorized ratios upward, we cannot construct the additional beds required (687) to achieve es- timated needs, 1345, with federal funds. This deficit of 687 could be met in part by the allotment to Leahi, Puu- maile and Samuel Mahelona Hospitals of 387 unallotted chronic beds (201 to Leahi on Oahu, 117 to Puumaile on Hawaii, 69 to Samuel Mahelona on Kauai) to take care of chronic tubercular patients. This would fit in with two recently expressed theories, i.e. (a) that many tubercular patients can be classified as chronic disease patients and (b) that when the incidence of tuberculosis declines, beds in tuberculosis hospitals may be used for chronic patients, whose incidence is rising and may be expected to continue rising. Chronic and Convalescent Hospital Beds The number of chronic hospitals, which term excludes institutions for the care of the aged and for mental defectives, totals 7. These distributed by islands, are shown in Table 2, line 22, extracted below. Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 22. Chronic & Convalescent Hospitals 6 1 7 One of these hospitals (or homes) is the Maluhia on Oahu, the only one of any size. Five more homes with from 5 to 20 normal beds are also on Oahu, and one is on Kauai (see Table 1, extracted below). Eliminating the small ones, the remainder, one, is entirely inadequate in number. It is assumed that each island should have a chronic hospital or a chronic unit which is part of or af- filiated with the island’s major general hospital. Table 1 Inventorv Name of Hosd. or Home Location No. of Norm. Beds Ownership Berg, Bertha Honolulu, Oahu 5 Prop.-Indiv. Kanilao n n 20 n n - .... . X . Maluhia n n 62 Gov't Non-Prof Mannion n it 8 Prop.-Indiv. Salvation Army n ft A Pvt. Non-Prof. Silva n tt 11 Prop.-Indiv. McBryd© Disp. Eleele, Kauai A Prop.-Corp, The number of existing normal beds (Table 2, line 84-) is definitely inade- quate for the Territory's needs. If we deduct the existing normal beds (Table 2, line 84.) from the authorized beds (Table 2, line 87), this inadequacy becomes apparent. 79 Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T. H. 87, Authorized Chronic Beds 718 U7 94 71 11 7 1048 BA. Existing Normal Chronic Beds 110 4 114 Deficit 608 147 94 67 11 7 934 The need for additional chronic beds is attested by the following observa- tions: An average of 200 patients daily in general hospitals occupy accommodations intended for the acutely ill, but who are convalescent, chronic, incurable and, in some cases, custodial, and who might more suitably be cared for in other in- stitutions or hospitals where the cost would be less. Some of these are in plantation hospitals at the expense of plantation owners or of the Department of Welfare. An average of 175 patients daily, in the Territorial (mental) Hos- pital, who are 6$ years or older, senile and deteriorated, but not true psycho- tics, occupy accommodations intended for mental disease patients; they are largely custodial cases but require some nursing care and supervision. Many more such cases, not yet institutionalized (an estimated 500) exist in the Terri- tory and their number is steadily increasing because the average life expectancy is reaching the age when chronic diseases predominate. The Maluhia Home has 62 normal beds but it has set up, in all available spaces, an additional 114 beds (total 176) resulting in unbelievable crowding with all the hazards which this implies. When the non-acceptable beds (Table 2, line 85) are subtracted from the normal beds (Table 2, line 84), we have no acceptable beds (Table 2, line 86). If we subtract the acceptable beds (Table 2, line 86) from the authorized beds (Table 2, line 87), we have a complete deficit for each island (Table 2, line 88). Assuming that the authorized number of beds is the minimum number needed, the deficit represents the additional number of beds needed and which may be constructed with federal aid (Table 2, line 88). Table 2 Oahu Hawaii Maui Kauai Molokai Lanai T, H. 84. Normal Chronic Beds 110 4 114 85. Non-Acceptable Chronic Beds 110 4 114 86. Acceptable Chronic Beds 0 0 87. Authorized Chronic Beds 718 U7 94 71 11 7 10A8 88. Additional Chronic Beds which may be constructed 718 147 94 71 11 7 1048 80 Bed Needs Based on the standards established by the United States Public Health Ser- vice and population for the Territory of 523,984, the shortage of beds is dis- tributed as follows: Needed Ag,qeptab}s Shortagg General 2357 784 1573 Tuberculosis 661 09 222 Mental 2620 689 1931 Chronic 1048 0 1048 6686 1912 oiu Notes Actually, the totals of "shortages" or beds which may be constructed with federal aid, when allocations are made and reported on U.S.P.H.S. forms, will be; General 1573 Tuberculosis 222 Mental 1931 Chronic 104-8 1931 Areas Some Thoughts Behind a Plan Each island is practically a separate geographic area as far as hospital service is concerned. Because of ocean expanses between them, one island can- not depend on another for reasonably quick aid except by air, either to carry the patient to the needed medical care or to bring the latter to the patient. One island, Oahu, population 358,911, has facilities and personnel to pro- vide all types of medical care, including the most technical specialized ser- vices, for its inhabitants and for those who inhabit the other islands. Three islands having populations from 25,000 to 100,000 have facilities (or should have) and personnel on each island to provide all but the most highly technical specialized services for their inhabitants. These are Hawaii, popula- tion 73,276, Maui, population 46,919, and Kauai, population 35,636. Two islands having populations from 3,000 to 25,000 have facilities (or should have) and personnel on each island to provide all of the general and some of the less technical specialized services for their inhabitants. These are Molokai, population 5,340, and Lanai, population 3,720. Two other islands, Niihau, population 199, and Kahoolawe, population 1, remain. Niihau is a plantation-owned island and Kahoolawe a barren rock pile. Their inhabitants must depend on transportation to the other islands for hos- pital and medical care. Neither hospital facilities nor personnel are available 81 to them on these islands unless brought to them in an emergency, by chartered plane (only small planes can land on Niihau)* Each of the large islands, generally speaking, has an area of fairly dense population concentration at or near a city or town on its coast line. Lesser concentrations are also on the coast line, usually within 50 miles or less of the principal population center. A few of the lesser concentrations are more than 50 miles distant, seldom more than 100 miles. These are road distances. Each island has a good road network, mostly hard-paved highway, usually running fairly parallel to the coast line, with branch roads inland or shore- ward to villages or towns. Few villages or towns are far inland since the in- land areas are, for the most part, mountainous and very sparsely inhabited. Travel is by motor car or air. Air travel is by well established and well equipped airlines between islands and, in the case of Hawaii, between two points on that island. Flights are frequent, daily, and scheduled, Hawaii Island has two commercial air ports, one at Hilo and one at Upolu; Maui has one at Puunene; Lanai has one at Lanai City; Molokai has one at Hoolehua; Oahu has one at Honolului and Kauai has one at Barking Sands. There is none on Niihau or at Kahoolawe to accommodate large planes. Favorable all year round weather stimulates the use of air transportation for passengers and small, light freight. Ship transportation takes care of heavy freight and some pas- sengers. A study of the map of the Territory which follows will bear witness to these facts. With the closest possible compliance with Sect. 10,1, Sub-part A, Part 10, Chapter 1, Title 4-2 (U, S. Public Health Regulations re P, L, 725) which defines areas and with consideration for the fact that the Territory is made up of islands, separated by considerable distances of ocean, it is believed that? Oahu Island, population 353,911, should be designated as a base area. Hawaii Island, population 73*276, should be designated as an intermediate area. Maui Island, population 4-6,919, should be designated as an intermediate area. Kauai Island, population 35*636, should be designated as an intermediate area. Molokai Island, population 5,34-0, should be designated as a rural area. Lanai Island, population 3,720, should be designated as a rural area. And that bed allotments in the various categories should be calculated ac- cordingly, Certain smaller outlying towns and villages on each island should have community health centers with provisions for a few emergency beds at each— these beds not to count in the allowed bed quotas for general, tuberculosis, mental disease or chronic and convalescent hospitals. 82 warn r///f 7 'i NAME r LOCATION MILES Il* ■ ROUTE STOPS MILES _ HONOLULU TO MOLOKAI 57 BETWEEN y HONOLULU TO LANAI 72 1 KAIEIEWAHO CHANNEL KAUAI and OAHU 60 HONOLULU TO LANAI MOLOKAI 82 KAIWI CHANNEL OAHU and MOLOKAI 22Vi HONOLULU TO MAUI 106 KALOH! CHANNEL MOLOKAI and LANAI 9 HONOLULU TO MAUI MOLOKAI 109 AUAU CHANNEL LANAI and MAUI 816 HONOLULU TO MAUI MOLOKAI and LANAI 1 16 PAILOLO CHANNEL MOLOKA and MAUI 10 HONOLULU TO UPOLU 155 KEALAIKAHIKI CHANNEL LANAI and KAHOOLAWE 17 HONOLULU TO UPOLU MOLOKAI 158 ALALAKEIKI CHANNEL KAHOOLAWE and MAUI 6 HONOLULU TO UPOLU LANAI 150 ALANUIHAHA channel - HONOLULU TO UPOLU MAUI 165 HONOLULU TO UPOLU MOLOKAI and MAUI 170 “ L 8 Wm HONOLULU TO UPOLU MOLOKAI and LANAI 166 .. , i < T/>-- ’i.-hK-ic HONOLULU TO UPOLU LANAI and MAUI MOLOKAI, LANAI and MAUI 167 177 1 ■ - if 7 -HONOLULU TO HILO 216 HONOLULU TO HILO MOLOKAI HONOLULU TO HILO MAUI 232 mg fable. The island of Hawaii is about one-fifth smaller, and Ihe Ter- . HONOLULU TO HILO LANAI 216 ritory as a whole is about one-third larger than the State of Connecticut. - . HONOLULU TO HILO MQLOKALtird MAUI ns r—. — — HONOLULU TO HILO — MQLQKAi and LANAI 24? ISLAND Length Mile* Width Mile* i Sd HONOIUUJ TO Square Miles Ac rM »p i HONOLULU TO HILO MOLOKAI, LANAI and MAUI HAWAII 93 76 4,030 2,579,200 - HONOLULU TO BARKING SANDS 135 MAUi 48 26 728 MOLOKAI 7Q LANAI 25 MOKpKAI Tp MAUI £? j KAUAI 33 3S 555 — MOLOKAI TO UPOLU 106 355,200 MOLOKAI TO HiLO MOLOKAI 38 10 360 166,400 1ANAI TO MAUI *A I LANAI 13 13 141 90,200 LANAI TO UPOIU 84 NIIHAU 18 6 72 47,100 —LANAI TO HILO 153 I KAHOOLAWE 11 6 45 38,800 MAU' TO UPOLU M>_ j Total 6,435 4,119 400 UPOLU TO H.LO Re c ommenda ti on s OrganlzatL on of Hospital Facilitie A plan, territorial in scope, by islands, for the coordination of facili- ties to meet the needs of all the people, with special reference to those in rural sections. Included are several types of interlocking facilities, namely: 1. Teaching hospital: on Oahu 2. Area hospitals one on each major island (Oahu, Hawaii, Maul, Kauai) 3. Community hospitals one or more on each island (Oahu, Hawaii, Maui, Kauai, Molokai, Lanai) 4.. Mental hospitals one on Oahu 5. Tuberculosis hospital: one on each major island (Oahu, Hawaii, Maui, Kauai) 6. Chronic hospital (or unit) one on each island (Oahu, Hawaii, Maui, Kauai, Molokai, Lanai) 7. Infirmary or dispensary health center 8. Health centers at least one on each major island (Oahu, Hawaii, Maui, Kauai) 9. Health center auxiliary (branch office, clinic, or laboratory): as required on each island (Oahu, Hawaii, Maui, Kauai, Molokai, Lanai) 1- The teaching hospital to make its facilities available to other facilities in the Territory. 2- The area hospital to make its facilities available to other facilities on its island. 3- The community hospital to make its facilities available to its community including health center auxiliaries. 4- The mental hospital to make its facilities available to the Territory. 5- The tuberculosis hospital to make its facilities available to its island (Maui’s to include Molokai, Lanai), 6- The chronic hospital or unit to make its facilities available to its island. Note: 1,2, 3, to be classed as general hospitals, including allied special such as maternity, children’s, orthopedic and isolation or leper. 7-a. The infirmary or dispensary health center to make its facilities available to its community, including health center auxiliaries. 83 B-a. The health center to administer public health activities for the local health department unit on each major island. 9-a. The health center auxiliary to provide clinic or laboratory facilities on each island for the community it serves. Note; 7 not to be classed as a hospital, but as an emergency facility to provide emergency medical and obstetric care, with less than 10 beds and an out-patient service and to include in its set-up a public health auxiliary clinic facility. General Recommendations In the general recommendations, immediately following, there are embodied some universally accepted principles. These are well known to those who are en- gaged in the construction and operation of hospitals and to their professional staffs and will be of interest to others who read this report. They are advisory only; no compulsion by territorial or federal authorities is implied except as already provided by existing territorial law. Function of the General Hospital That the general hospitals provide for the care of communicable disease patients. That the general hospitals provide for the care of some tuberculosis pa tients until diagnosis is established and transfer is arranged. That the general hospitals provide for the care of acute mental disease patients until diagnosis is established and transfer is arranged. That the general hospital provide for the care of chronic disease patients in units of its own, or lacking the latter, until transfer to another hospital is arranged. That the general hospital in the smaller community be the focal point round which local health services are integrated. That relationship be established between the general hospital, tuberculosis hospital, mental hospital and chronic hospital or unit, so that the equipment and personnel of the general hospital will be available to the patients of the others and vice versa. That voluntary general hospitals be utilized by government welfare agencies for the care of medically indigent patients, with equitable remuneration, where a government hospital is not available. That the government general hospitals in communities without voluntary hos- pitals provide service for pay patients. That all hospitals conduct routine examinations including chest x-rays for the detection of tuberculosis in patients and employees. 84 Acute Communicable Diseases That general hospitals provide physical facilities and services necessary for treatment of communicable diseases, including poliomyelitis. That special hospitals for contagious diseases be not constructed or operated. That contagious disease patients financed with tax funds be cared for in voluntary hospitals, with adequate remuneration, when government hospitals are non-existent. Pulmonary Tuberculosis That new tuberculosis hospitals be placed near and in relation with gen eral hospitals. That tuberculosis hospitals provide routine physical examinations, includ- ing chest x-rays for its patients and employees and for those of nearby or re- lated general hospitals. That the tuberculosis hospital establish a relationship with a general hospital to provide surgical and consultative service which may not be avail- able in the former. That the tuberculosis hospital establish strict isolation techniques to protect personnel and patients from cross infection. That the government provide adequate subsidy to provide for tuberculosis care in government and voluntary hospitals. That the government provide subsidy or hospital beds for the care of non- resident tuberculosis patients as well as residents. Mental Diseases That the larger general hospitals provide facilities for the detention, diagnosis and treatment of mental patients residing in the area served, at least until transfer is arranged. That mental hospitals establish relationship with general hospitals to pro- vide surgical and consultative services if the latter are not available in the mental hospital. That mental hospitals provide training to personnel of general hospitals so that the latter may be better prepared to care for the acute and transient mental patients it may receive. That mental hospitals provide top-grade training in the care of mental patients to its own personnel. 85 Chronic Care That special facilities for the care of the chronically ill patients be constructed adjoining to or as units of the larger general hospitals. That regulation of small nursing homes, if any continue to operate, be strictly enforced to guarantee a high grade of service. That the medical staff organization of general hospitals having chronic hospital or chronic unit affiliation, include a chronic disease service under the guidance of physicians interested in that type of patient. That construction of special facilities for medically Indigent chronic disease patients be financed from tax funds and be made available to all resi- dents in either tax-supported or voluntary hospitals. That hospitals and units be equipped and staffed to provide for the care of convalescents and of chronically ill children, and that such care may be con tinued in out-patient departments when such patients no longer require hospital- ization. Occupational Programs in Hospitals That all hospitals, to the extent that their size renders it practicable, provide facilities and services which will aid in restoring the patient to the fullest possible measure of physical and mental health to enable him to resume his usual employment as soon as possible. These should be available to out- patients also. Rehabilitation Programs That a suitable rehabilitation program for the Territory be initiated and developed along the lines suggested by the Report on a Community Rehabilitation Service and Center by the Baruch Committee on Physical Medicine. It is assumed the occupational therapy and physical therapy in hospitals will take care of re- habilitation for hospital in-patients. Public health centers of a special type might provide the rehabilitation program envisaged above. Expansion of the Use of Hospital Facilities That a closer relationship between hospitals and public health facilities be established to conserve space, equipment and personnel and provide more ef- fective service to the population, especially in rural communities. That a well organized outpatient department be an integral part of the hospital and health service of the community. That hospitals make their laboratory and other diagnostic facilities read- ily available to members of the local medical profession as well as to those of their medical staffs. 86 Health Education in the Hospitals That hospitals conduct programs in health education for patients and the general public and that such programs be coordinated with those of public health agencies. That hospitals provide for physical examinations and health promotion for their employees. Standards of Service to be Maintained by Hosnita That all hospitals meet the standards for hospitals devised by national hos- pital associations. That hospitals comply with the minimum standards prescribed by the American College of Surgeons, That standards for hospital personnel and services be established by the Territory. That schools of nursing comply with the minimum standards of the Board for Licensing of Nurses, Territory of Hawaii. That hospitals with highly departmentalized medical staffs comply with the standards of proficiency and training requirements established by specialty boards, when appointing specialty members to the staff, and that they, as far as possible, comply with standards of competency and efficiency of their own promul- gation, for other professional, technical and trained personnel. That hospitals encourage members of the medical staff and other professional and skilled personnel to continue their education and training. Whenever pos- sible, local intramural programs should be initiated. That hospitals make available opportunities for clinical research by staff members. That voluntary, non-profit general hospitals and public hospitals expand their staff membership to include physicians engaged in the general practice of medicine in the community, as well as those limiting practice to a specialty. The criteria for acceptance to be based on education, ability and ethical con- duct. Licensure of Hospitals That all institutions which provide over-night bed care to the sick (or aged) should be licensed to operate and be subject to inspection by a Terri- torial authority. That the Territorial authority provide regulations concerning the physical facilities and operations of such institutions. That the Territorial authority be provided with the advice and counsel of hospital administrators and professional personnel in the preparation of such regulations and in their enforcement. 87 Hospital Trustees That boards of management of voluntary hospitals be composed of members who are broadly representative of the public they serve. That hospitals operated by territorial, county or municipal governmental agencies be conducted under the supervision of or have the advice of a board of managers composed of representatives of the public which they serve. That hospitals operated by religious organizations appoint representative citizen boards to advise the administration concerning community needs. That the proprietary hospital supplying services to a community, when it is the only one available, be converted into a true not-for-profit community enterprise with a representative board of managers. Administration That full authority for the administration of a hospital be vested in a single administrator appointed by the board of managers and that he be respon- sible only to that board. That the administrator, if he be a doctor of medicine, be not engaged in the practice of medicine in the community. That the administrator be selected because he is especially trained in the field of hospital administration by formal education or previous experience in hospitals. That hospital boards of managers encourage administrators to attend hospi- tal association meetings and formal post-graduate courses of instructions in hospital management. Medical Staff That each hospital, commensurate with its size, set up a formal medical staff organization with appropriate departmentalization. That the medical staff adopt by-laws and regulations to govern itself and to prescribe standards for membership. That the medical staff maintain vigilant supervision and continuing eva- luation of the medical care in the hospital. That liaison between the board of managers, the administrator and the medi- cal staff be formally established for the discussion of professional matters and of administrative and professional relationships. This is usually accomplished by a "joint committee" composed of the administrator, one or more members of the board of managers and one or more members of the medical staff. Oral and Dental Services in Hospitals That a dental service be made available in each hospital with dental physi- cians and surgeons as members of the medical staff. 88 That dental interneships and residencies be made available in the larger hospitals. Nursing Service That a statement of functions, policies, responsibilities and relationships of the nursing service be adopted and periodically reviewed by each hospital and that they be in accordance with the recommendations of the American Nurses1 Asso- ciation. That authority and responsibility for the nursing service be delegated to the director of nursing service and that she be responsible to the administrator. That special committees be appointed as appropriate to act in an advisory capacity to the administrator and the Board of Directors upon matters which con- cern nursing service and nursing education. That personnel policies affecting nurses should be formulated in cooperation with representatives from the nursing groups which they affect. That hospitals employ graduate trained nurses in numbers sufficient to pro- vide adequate nursing care for patients and obviate to a great extent the need for "special nurses." That hospitals employ practical nurses licensed to practice in the Territory to assist and supplement the graduate professional nurses. That the student nurses in schools of nursing be accorded the greatest pos- sible measure of nurse1s education and training and be not utilized solely for the purpose of supplying low-cost nursing service. Medical Social Services That in general hospitals the qualifications of the social workers and the functions of the department be in accordance with the standards of the American Association of Medical Social Workers. That in mental hospitals the qualifications of the social workers and the functions of the department be in accordance with the standards of the American Association of Psychiatric Social Workers. Physiciansl Offices in Hospitals That, especially in rural areas, medical services be more effectively dis- tributed and diagnostic facilities made more available to the physician if office space in the hospital is made available to him. That the use of hospital office space and hospital equipment by the physi- cian be financed under arrangements equitable to the hospital and to the physi- cian. 89 Rural Hospital Service That hospitals be constructed only in those communities in which size of population, availability of medical and technical personnel, economic condi- tions, etc., justify their existence. That the location of rural hospitals be contingent upon a reasonable ex- pectation that a high quality of medical care can be developed and maintained therein. That rural hospitals provide office space for physicians, facilities for public health activities and diagnostic services for out patients. That infirmary or dispensary health center facilities be provided in the more outlying rural districts in which physicians can conduct scheduled clinics or be available for consultation, and in which a nurse can be available for emergency care, pending a physician’s arrival. That the territorial or county government be ready to finance or partially subsidize the hospitals and infirmaries in the rural sections which cannot fi- nance their own facilities. That the larger community and area hospitals undertake to supply medical and nursing personnel, in a rotating plan, to the smaller community hospitals and infirmaries. This would provide good training for physicians and nurses and good professional medical personnel where the latter is most apt to be scarce. It would also create an interest in the practice of rural medicine. Size and Location of Hospitals and Size of Hospital Communities That, with topography, roads and means of transportation being adequate, there be a minimum of 15,000 persons within a radius of 30 miles to justify the construction of a 50-bed hospital in a rural community. That the community be large enough to finance adequately its hospital ser- vice or that, if its economic status is low, it can expect financial assistance from government or tax funds. That small hospitals establish relations with larger ones to assure the services of specialist-consultants and advice or assistance in administrative matters. That the rules and regulations of small hospitals adopted by their medical staffs and boards of managers be consistent with limitations of facilities and of medical practice within the hospital. That hospitals, to be considered self-contained and self-supporting and capable of providing comprehensive medical service, be not smaller than 100-bed capacity. 90 That in larger cities, medical facilities be established in residential sections and so constituted that all health services for the residents of those areas are readily available in a central location within each district. Public Health and Medical Service Cente: That in areas and communities which do not justify the presence of a hos- pital of from 25 to 50 bed capacity, smaller facilities such as infirmary or dispensary public health service centers be established and that if necessary, these facilities be established and financed as units of local or territorial government. That these infirmary or dispensary public health service centers provide preventive and curative services and that their public health activities be un- der control of local or territorial public health authorities. That these infirmary or dispensary public health service centers provide facilities for carrying out public health programs; for the commonly used diag- nostic procedures; for services to ambulant patients; for patients requiring emergency bed care; for office for private physicians in local practice; for emergency service by assignment of a local health office or nurse assistant until transfer to a larger hospital can be arranged. Interrelationship Among Hospitals That medical service centers and small hospitals affiliate with larger institutions in their areas which can provide comprehensive and competent ser- vices in special fields of medicine. That each island have a health or hospital council which will initiate and define these interrelationships between the area hospital, the community hospital, the infirmary or dispensary health center and the public health cen- ters and auxiliaries on each island. That the members of the "health" or "hospital council" for the Territory and for each island (or county) (l) familiarize themselves and their communi- ties with the Hospital Construction Plan, (2) coordinate activities of other organizations, committees and individuals toward a solution of the problems in- volved in providing for the needs indicated in the plan, (3) urge the initiation of construction projects and the formation of management groups to operate the completed facilities, and (4.) initiate fund-raising campaigns to provide match- ing construction funds and maintenance funds for each project. 91 ALLOCATION OF HOSPITALS AND BEDS EXISTING I siand Population Area Location Facility Number of Beds Allotted Type of Beds Fanilitv Accept. -Beds- Oahu 358,911 Base Area No. 1 Honolulu AREA GEN. ) HOSPITAL ) General Queen’s 0_ n Community ) Gen. Hosp.) 860 General St. Francis 127 n Community } Gen. Hosp.) General Kuakini 35 n Community Gen. Hosp. 150 General (Maternity) Kapiolani 105 H Community Gen. Hosp. 200 General (Children’s! Kauikeolani ... 16— it Community Gen. Hosp. 30 General (Orthop.) Shriner1s 28 H Community Gen. Hosp. 50 General (Isol.) Kalihi 0 Wahiawa Community Gen. Hosp. 100 General Wahiawa General 0 Ewa ) Aiea ) Area Waipahu) Community Gen. Hosp. 100 General Ewa Plant. Co. Aiea General Oahu Sugar Co. 0 0 0 Uesato Hospital Tamura Hospital 0 C Waialua Community Gen. Hosp. 50 General Waialua Agric.Co. 0 Kahuku Community Gen. Hosp. 4-0 General Kahuku PI. Co. 0 Kaneohe Community Gen. Hosp. 38 General None 0 Honolulu AREA T. B. HOSPITAL A20* Tuber- culosis Leahi 237 n Chronic Hospital 4.00+ Chronic Maluhia 0 n Chronic Hospital 20 Chronic Salvation Army Home 0 it Chronic Hospital 100 Chronic None 0 Kaneohe Mental Hospital 2595 ... Mental Territorial _69i__ Hawaii 73,276 Inter- mediate Area No. 1 Hilo AREA GEN. HOSPITAL 159 General Hilo Memorial 138 iCohala Community Gen. Hosp. 50 General Kohala Co. 0 Pahala Community Gen. Hosp..- 25 General Hawaiian Agric. Co. 0 - Sealakekua Community Gen. Hosp. 52 General Kona County Kona Comm. 0 0 _ ionokaa Community Gen. Hosp. 15 General . Honokaa Sugar Co. Q 92 ALLOCATION OF HOSPITALS AND BEDS (Gonto) ‘ALLOCATION EXISTING Island Population Area Locatiorf Fad. litv Number of Beds Allotted Type of Beds Facility Accept. Beds Laupahoehoe Community Infirmary 10 General Laupahoehoe Plant. Co. 0 Hilo AREA T. B. HOSPITAL 108+ T. B. Puumaile (Vacant) 0 Hawaii Hilo Chronic Hosp. or Unit 147 Chronic None 0 (Cont.) Holualoa Comm. Health Cent. Inf. 2 to 5 Emergency None 0 Pahoa Comm. Health Cent. Inf. 2 to 5 Emergency None n Maui Wailuku) Puunene) Area Kahului) AREA GENERAL HOSPITAL 138 General Malulani or Puunene 0 0 4,6,919 Inter- Hana Community Gen, Hosp, 30 General Hana County 0 mediate Area No. 2 Waiakoa Community Gen, Hosp, 22 General Kula General 22 Lahaina Community Infirmary 10 General Pioneer Mill Co. 0 Paia Community Infirmary 10 General Maui Agric. Comnany 0 Waiakoa AREA T. B. HOSPITAL 78+ T. B. Kula Sanatorium 202 Wailuku or Puunene Chronic Hospital or Unit 94 Chronic Malulani or Puunene 0 0 Lihue AREA GEN. HOSPITAL 100 General Wilcox Memorial 93 ______ Kauai 35,636 Inter- Waimea ) Eleele ) Koloa ) Area Kilauea) Community Gen. Hosp, 58 General Waimea PI. Co. McBryde Disp. Koloa Sugar Co. None 0 0 0 0 mediate Area No.3 Kealia AREA T. B, HOSPITAL 46-«- T. B. Samuel Mahelona 0 Lihue Chr. Hosp. or Unit 71 Chronic None 0 Hoolehua AREA GEN. HOSPITAL 23 General Shingle Memorial 0 Molokai Kalaupapa Community General 62 General (Xsol.) Kalaupapa Settlement 0 5,340 Rural Area Hoolehua Chronic Unit 11 Chronic None 0 No. 1 Maunaloa Comm, Health Cent. Inf. 2 to 5 Emergency None 0 Kaunakakai Comm. Health Cent. Inf. 2 to 5 Emergency None 0 93 ALLOCATION OF HOSPITALS AND BEDS (Cont.) Island Population Area ♦ALLOCATION EXISTING Location Facility Number of Beds Allotted Type of Beds Facility Accept, Beds Lanai 3,720 Rural Area No. 2 Lanai AREA GEN. HOSPITAL 17 General Hawaiian Pineapple Co, 0 Lanai City Chronic Unit 7 Chronic None 0 beds equal the total number of beds authorized by standard ratios given in the Hospital Survey and Construction Act. The dif- ference between the "acceptable" beds and the "allocated" beds may be constructed with federal aid. Notes: Except on Oahu, the chronic beds to be in a unit which is a part of the general hospital in the town named. On Oahu, Maui, Kauai, Molokai and Lanai, the largest general hospital to have a mental unit for several patients for diagnosis until transfer is made to the Territorial Hospital at Kaneohe, Oahu. On Molokai and Lanai, a few tuberculosis beds in the general hospital to be available until diagnosis is made and transfer to a tuberculosis hos- pital on one of the other islands is made. Community general hospitals and community infirmaries should have health center facilities attached. Patients requiring services not available there should be transferred to the larger hospital on the island. Community health center infirmaries should have two to five (or more up to 9) emergency beds. Patients to receive ambulatory or emergency bed care, no overnight care, and to be transferred to the larger hospital on the island. Should have health center facilities attached. 94. Chapter IX PRIORITIES The determination of priorities or relative need is a complicated process and is described in the Hospital Survey and Construction Act and in greater detail in the U.S,P,H.S. Regulations pertaining thereto, Section 623 (a) of the Act,.,,"such state plan must,*.. (5) set forth the relative need determined in accordance with the regulations prescribed under Section 622 (d) for the several projects included in such programs, and provide for the construction, insofar as financial resources available therefor, and for the maintenance and operation made possible, in the order of such relative need.” The U.S.P.H.S. Regulations contain the following: Section 10.72 (c) "After having determined hospital and public health cen- ter needs, the state agency shall establish an overall construction program. This program shall set forth all such needs in accordance with the standards specified in Sections 10.12, 10.21 and 10.31 and shall show the relative need for each project included, irrespective of the availability of funds for con- struction and for maintenance and operation.” Section 10072 (e) "The state agency shall establish a separate construction schedule on such forms and for such periods as the surgeon general may prescribe. Insofar as funds are available for construction and for maintenance and opera- tion, construction shall be scheduled in the order of relative need,” Section 10.41 "Manner of determination. The general manner in which the state agency shall determine the priority of projects included in the state con- struction program shall conform with the principles set out in Sections 10.40 to 10.47 inclusive,” Section 10,42 "Balance among categories of facilities. Insofar as practi- cable, the State agency shall develop its construction program in relation to the proportionate need for each of the five categories of facilities (general, men- tal, tuberculosis, chronic and health centers,) In determining proportionate needs, consideration shall be given to existing facilities and those under con- struction without assistance tinder the Federal Act.” Section 10„43 "All categories of facilities; additional facilities as against replacements. Initial installations and additions to existing hospitals and health centers shall be given priority over replacements, except; (a) "where the replacement is of minor character and necessary to the provision of needed additional facilities; (b) "where, in the case of a hospital, replacement is essential to eli- minate an existing needed hospital which constitutes a public hazard. 95 (c) "where, in the case of a public health center, the State health authority has certified that the existing facility is unsuitable for use as a public health center." Section 10.44 "General hospital category. The relative priority of these projects shall be determined after consideration of the following factors in the order of importance as given: (a) "The relative need for beds in the area (base, intermediate, or rural) in which the project will be located, taking into account the utili- zation of existing general hospital beds in the area, and giving spe- cial consideration to projects providing service for persons located in rural communities and areas with relatively small financial re- sources. (b) "The extent to which beds will be made available for groups of the population which by reason of race, creed or color are less adequately served than other groups of the population." Section 10.45 "Chronic disease category. Priority shall be given to those projects in which the chronic disease facilities will be operated as sub-units of general hospitals." Section 10.46 "Public health centers. Highest priority in this category shall be given to the provision of facilities for local health units serving rural communities and areas with relatively small financial resources. Where the agency designated to administer the State plan is not the State health au- thority, the State agency shall determine the relative priorities to be estab- lished after consultation with the State health authority." Section 10.47 "Size and character. Insofar as practicable, and without affecting the priority of hospitals serving rural communities and areas with relatively small financial resources, special consideration shall be given to applications for construction of projects of a size and character consistent with efficient and economical operation." The development of a system of priorities is the responsibility of the State agency. The system adopted must conform with the principles established in the regulations quoted above. Regardless of the kind of system adopted by the State agency, the percentage of need met (discussed below) shall be deter- mined for each area and Form P.H.S. 13 (HF) submitted with the State plan. The following method was suggested by the U.S.P.H.S. for establishing priorities: 1. For general hospitals, determine the relative bed need for each base, intermediate and rural area; for tuberculosis, mental and chronic disease hospitals, determine the relative bed need for each geo- graphic area for which these facilities are programmed. If they are programmed on a State wide basis, this is unnecessary. In determining the relative bed need, compute the percentage of need met by existing acceptable beds as follows: 96 a. Divide the total number of existing acceptable beds in each area by the total number of beds needed in the area and multiply by 100 to obtain the percentage of need met by the existing accept- able beds. 2, Establish tentative area priorities a. Arrange areas for each category facility in the order of percent- age of need met, working from the lowest to the highest. b. Determine the number of priority groups essential and the range of percentage of need met for each group. 3. Adjust the tentative area priorities established in 2 above by con- sidering the following factors; a. The extent to which services will be provided for persons located in rural communities or areas with relatively small financial re- sources. b. Availability of beds constructed in the area to groups of the po- pulation which by reason of race, creed or color are less adequately served than other groups of the population. c. Local conditions exist which affect the relative need for facilities among areas. 4. If a state contains a relatively large number of areas with zero per- centage of need met, the State agency may wish to consider dividing these areas into two or more priority groups. The group of areas deter mined by the State agency to have the greatest relative need, based on all the priority principles should be placed in priority group A and the next highest in group B. 5. Prepare and submit Form P.H.S. 13 (HF) Relative Need Report, with the State plan. One set of forms to be filled out, general hospitals. If tuberculosis, mental and chronic disease hospitals are programmed on a geographic basis, one set of forms to be filled out for each of these categories. 6. Determine the priority of individual projects at the time the Project Construction Schedule is being prepared. a. Establish priorities for individual projects when the Project Con- struction Schedule is submitted. In determining the priority of individual projects, the area priority is of major importance. Normally, projects in areas of lower priority will not be ranked higher than projects in areas of higher priority. However, this may be done if other priority principles are of such significance 97 that the project in the area of lower priority is more urgently required in providing adequate hospital services for the people of the State. The principles given in Sections 10.4-3 to 10.47 of the regulations to cover determination of relative need are not exhaustive. State agencies may wish to apply additional princi- ples in determining the priority of projects. These additional principles shall be incorporated in the State plan as required in r,Dn below. b. The priority of public health center projects should be determined by the State agency at the time the construction of projects is being considered. In determining the priority for public health center projects, the State agency must comply with Section 10.46 of the regulations quoted above. c. When tuberculosis, mental and chronic disease hospitals are pro- grammed on a State wide basis, the priority of these projects should be determined by the State agency at the time construction of these projects is being considered. In establishing these priorities, the State agency must comply with the applicable provisions of the regu- lations quoted above. 7. Priority of areas and projects within such areas will change at the time the construction of additional facilities is scheduled. The prior- ity changes occur whether or not the proposed construction is aided with federal funds. The priority change takes place when construction is definitely scheduled. D. Material to be submitted with the State Plan: 1. Fill in Form PHS 13 (HF) and give the information requested. Attach to Form PHS 13 (HF), the statement regarding areas placed in higher or lower priority groups on the basis of factors other than percent- age of need met by existing beds. The priority system must include at least four priority groups. 2. Attach a statement concerning: a. The procedure followed and the factors considered in determining area priorities, and b. The principles which will be applied and the procedure which will be followed for individual projects in the various categories of facilities. See 6 above. In accordance with the above, the following area priorities were calculated: 98 Area Priority Calculations General Beds Area B-l Existing acceptable 531 x 100 s 39$ Oahu Needed 1618 Area 1-1 Existing acceptable 138 x 100 - 4-2$ Hawaii Needed 331 Area 1-2 Existing acceptable 22 x 100 - 10$ Maui Needed 210 Area 1-3 Existing acceptable 93 x 100 s 59% Kauai Needed 158 Area R-l Existing acceptable JD x 100 ■ 0% Molokai Needed 23 Area R-2 Existing acceptable JD x 100 ■ 0% Lanai Needed 26 Arrangement gf NgeQfet and PriQxltl ..SlQupa Order of Need Met Priority Groups R-l Molokai - 0$ 3 Areas R-l Molokai R-2 Lanai - 0$ R-2 Lanai & 1-2 Maui - 10$ 1-2 Maui oto 11$ B-l Oahu - 39% 1-1 Hawaii - 4-2% 2 Areas B-l Oahu & 1-3 Kauai - 59$ 1-1 Hawaii 39 to 42% 1 Area 1-3 Kauai 59% Arrangement of Priority Groups Range A Areas R-l Molokai) R-2 Lanai ) 0 to 2A% 1-2 Maui ) B Areas B-l Oahu ) 1-1 Hawaii ) 25 to 49% C Area 1-3 Kauai 50 to 74$ D None 75 to 100$ 99 Ttfrersvlpg&g Bs&a Area B-l Existing acceptable 237 x 100 = 56% Oahu Needed 4-204- Area 1-1 Existing acceptable 0 x 100 « 0% Hawaii Needed 108+ Area 1-2 Existing acceptable 202 x 100 - 269% Maui Needed 78+ Area 1-3 Existing acceptable _0 x 100 s 0% Kauai Needed 4-6+ Arrangement in Order of Need Met and priority . Groups Order of Need Met Priority Groups 1-1 Hawaii -0% 2 Areas 1-1 Hawaii & 1-3 Kauai -0% 1-3 Kauai 0% B-l Oahu - 56% 1 Area B-l Oahu 56% 1-2 Maui - 269% 1 Area 1-2 Maui 269% Arrangement of Priority Groups Range A (Areas 1-1 Hawaii and 1-3 Kauai 0 to 24-% C (Area B-l Oahu 50 to 74% D (Area 1-2 Maui 100 + % Chronic Beds Area B-l Existing acceptable 0 x 100 a 0% Oahu Needed 718 Area 1-1 Existing acceptable 0 x 100 s 0% Hawaii Needed 147 Area 1-2 Existing acceptable _0 x 100 s 0% Maui Needed 94 Area 1-3 Existing acceptable JD x 100 ■ 0$ Kauai Needed 71 Area E-l Existing acceptable _0 x 100 • 0% Molokai Needed 11 Area R-2 Existing acceptable J x 100 -0% Lanai Needed 7 100 Chronic Beds (Conte) Arrangement in Order of Need Met and Priority Group, g Order of Need Met -Priority Groups 1-1 Hawaii =os 6 Areas - 0$ 1-2 Maui - 0$ 1-1 Hawaii 1-3 Kauai - 0$ 1-2 Maui R-l Molokai - 0$ 1-3 Kauai R-2 Lanai - 0$ R-l Molokai B-l Oahu - 0$ E-2 Lanai B-l Oahu Arrangement of Priority Groups Range A (Areas 1-1 Hawaii, 1-2 Maui, I~=3, Kauai R-l Molokai, R-2 Lanai, B-l Oahu 0 to 2IS Mental Beds Area ■= Territory of Hawaii Existing acceptable 719 x 100 » 27$ Needed 2620 Arrangement in Order of Need Met and Priority Groups Order of Need Met Priority Groups Territory of Hawaii - 27$ 1 Area T. H* - 27$ Arrangement of Priority Groups Range B Area To H„ 25 to 4-9$ Priority Order It is apparent that the areas of greatest priority are expressible in the following orders 10 Each island for chronic beds Need met 0$ 1. Hawaii and Kauai for tuberculosis beds Need met 0$ lo Molokai and Lanai for general beds Need met 0$ 2. Maui for general beds Need met 10$ 3c Territory of Hawaii for mental beds Need met 27$ Uo Oahu for general beds Need met 39$ 5o Hawaii for general beds Need met 4-2$ 60 Oahu for tuberculosis beds Need met 56$ 7c Kauai for general beds Need met 59$ Establishment of a Project Construction Schedule a 0 After approval of the Territorial plan by the Public Health Service, the Board of Health will develop a Project Construction Schedule which will list the 101 projects for which construction can be commenced immediately. The schedule will be developed by soliciting applications from sponsoring agencies in areas of the greatest unfilled need and in the order of the area priorities as shown in the overall construction program. The number of projects included on the Project Construction Schedule will depend upon the amount of the federal allotment to the Territory. b. Project will be selected for the Project Construction Schedule after con sideration of the following factors! (l) The priority of the project as determined in accordance with the principles outlined in the Territorial plan for determination of relative need. (2) The intent of sponsoring agencies to begin construction within reasonable length of time. (3) The ability of the sponsoring agency to meet the financial re- quirements for construction, maintenance and operation of the proposed facility. (4.) The maintenance of an appropriate balance in the construction of the various categories of facilities, (i.e., general, tubercu- losis, mental and chronic disease hospitals and public health centers) The balance between categories of facilities need not be reflected in each Project Construction Schedule. However, construction which is scheduled over the five-year program will reflect an appropriate balance betv/een the various categories of facilities. c. If a project is removed from the Project Construction Schedule by the Board of Health, the schedule will be revised to include the next highest prior- ity project which meets the requirements for inclusion. d. The fact that a project is excluded from the Project Construction Sche- dule for any of the several reasons will not change the project priority rating (although for other reasons this priority may change). Such projects will be considered for inclusion in each succeeding Project Construction Schedule. e. If a project is in the highest priority group, Part I of the Project Construction application, which is prescribed by the Public Health Service may be approved and forwarded prior to approval of the Project Construction Sche- dule. If the project is not in the highest priority group, Part lof the Pro- ject Construction application will be submitted with the schedule. f. The first Project Construction Schedule will be submitted to Public Health District Office #5 no sooner than two months after the approval of the Territorial plan. This two-month period is provided to enable higher priority projects to develop construction interest and furnish the essential financial assurances. Thereafter, the Schedule will be submitted on or before July 1 of each year. g. Applications for federal assistance under P. L. 725 will be submitted on the Project Construction application which is prescribed by the Public Health Service. 102 TABLE 1 INVENTORY OF AT.T, HOSPITALS AND BEDS IN THE TERRITORY OF HAWAII, 19A6 BEDS AS REPORTED ON SCHEDULES OF INFORMATION BY THE HOSPITALS, "NORMAL" BEDS AS CLASSIFIED BY P T., 7?5 AND INSTRUCTIONS U.S.P.H.S. NO. OF BEDS WHICH ARE NOM-ACCEPT. HOSPITALS & NURSING HOMES ISLAND TYPE NORMAL BEDS C0MPL, BEDS GEN, MED. GEN, SDRG. OBSTE- TRICAL PEDI- ATRIC CONTA- GIOUS T. B. NERV.& MENTAL CHRONIC CONV. & REST VEN. DIS. ORTHO- PEDIC SENT SKIN & CANCER UNAS- SIGNSD % occ. GENERAL MENTAL T. B. CHH. & CONV. NON PROFIT PROPRIETARY ft. REMARKS CONCERNING NON-ACCEPTABILITY GOV'T PVT. PLANT. INDIV. Honolulu County Bergr Bertha Oahu Conv. Nuts. Home _5 5 5 5 X 5 1-A-5-15-16 Ewa Plantation Co. Hosp. n General A8 A8 A A /,o AS 48_ X A8 1-7-8-12-1A _ Honolulu Plant. Co. Hosp, n General 33 33 12 10 A 7 jL 12 X 33 1-A-5-7-8-9-12-13-1A _ Kahuku Plant, Co. Hosp. ft General 3A 3A A 7 2 21 62 24_ X 3A l-A-6-7-8-12-13-IA —Kalibi Hospital it A.S. Isolation. Leoer 63 63 63 21 62 X 63 1-2-19 Leperij pnJLy - Kanilao, Mary & Nott. Annie n Conv. Nureine Home 20 20 20 20 X 20 1-2-A-6-7-8-15-16-19 Mat. & Gyn. Hoso. tt A. S., Maternity 105 105 32 73 , .44 105 __JL— - Kauikeolani Children’s heap. it A. S.. Children 100 100 100 100 _JL— 84 T .2-5—7—19 _ Kuakini Hospital it General 118 125 39 AA 1ft .81 118 X 88 1_2_1Q , Leahl Hospital it Tuberculosis 506 A85 A83 2 96 506 X — 26Q 1-2-19 - Un I uhia HOB0 n Conv. Nursing Home 62 176 176 al 62 X 62 1-2-19 , Mannlon, Sophie n Conv. Nursing Home 8 8 8 8 X 8 1_A-5-15-16 _ Ogawa Lving-in Home tt A. S.. Maternity A A A 4 X A 1.A-5-7-Q-13-1A—15-16 _ Oahu Sugar Co. Hospital tt General 52 52 30 10 6 6 52 52 X 52 1-2-8-9-10-12-1A-19 _ Pulolo Chinese Men's Hone n Home for the Aged 128 128 128 *(128^ _JL—-| m hospital bed oal onaltion _ Oueen's Hospital tt General 370 370 5A A2 30 25 6 10 10 _123 81 3A5 25 X 1 25 1-2-1Q _ St. Francis Hospital it General 157 165 83 30 52 69 157- X 30 1-2 Salvation Army Women's Home n Conv, Nursing Home A A A __X—1 A 1 _ Shriner's Hospital it A. S,, Orthopedic 28 28 28 78 28 X . tt Conv. Nursing Home 11 11 11 11 X 11 l-A-5-15-16 it 7 7 8 L 7 X 7 1-2-A-5-6-7-8-10-12-13-17-18 Territorial Hospital c it Mental 81A L.150 30 1120 25 78A 30 X 120 1-2-8 Wahiawa General Hosoital it 107 107 in 8 68 __26 _JZQ 22_ T 68 X 107 1.2-5-7-8-10-12-13-19 Waialna Apric. Co. Hospital tt 36 37 37 32 26 X 36 1U4. - Waimano Home —„— Feeble-minded 718 718 718 -*1718) X Omitted fro m hospital bed calculation Total 1538 3983 135 179 202 1A7 99 581 1863 332 11 6 33 IQ 360 JU169 - 809 - 60A . 110 A . __1Q—- 5_ . 6 1f205 Hawaii County , Hakalau Plantation Hospital Hawaii General 2A 2A 3 5 16 2A X- 2A 1-/ -8-9-10-1A-17-18 Hamakua Mill Co. Hospital tt General 11 11 2 9 11 X 11 1-2-A-5-6-8-9-10-11-13-1A-16 — It General 35 35 5 A 26 —55 . 35 X 35 1—A . Hilo Memorial Hospital n General 188 183 75 A 5 22 26 12 6 —51 188 X 50 1-7-8-1A _ Honokaa Sugar Co. Hospital- " General 30 30 3 _22 42 22 _ X 30 1-2-A-6-8-9-10-11-13-1A-19 Kohala County Hospital It General 50 A5 27 12 6 30 . 50 X 50 1 _ Kona Community Hospital It General 18 18 2 16 18 X 18 1-A-5-6-8-9-10-11-13-1A-19 _ Kona Hospital II General *2 LL 7 A A 1 _2S —LL 52 X 52 1 Lauoahoehoe Sugar Co. Hosp. II Goners1 27 27 A 6 17 3C 27 X 27 1-A , Matavoshi Hospital .. Genera1 26 26 2 2 22 6C 26 X 26 1-2-A-5-6-7-8-9-12-13-1A-17-18-19 Matsumura Hospital It A. S., Maternity 8 8 8 8 X 8 1-2-A-5-6-7-8-9-10-11-12-13-14-16-19 „ q q 9 — 9 X 9 1-2-A-5-6-7-8-9-10-11-12-13-16-19-20 II 6 6 1 1 1 6 X 6 1-2-A-5-6-8-9-10-11-12-13-1A-16-19 . Olaa Plantation Hospital It *n /i 7 • *19 31 31 51 —-X__ 51 1 _ (inknl* Hosp.(Kaiwiki Sue. Co). It Q . 9 9 2 X 9 Oto Hospital II General 16 16 16 16 X 16 1-A-5-6-7-8-13-14-15 . . It A3 A3 A / - 35 J. 3 A3 —£ A3 1.2-5-6-8-9-14-18-19 Puumaile Hospital tt Tuberculosis 225 225 22c 96 . 225 X 225 1-3-20 , Yamanoha Hospital It General 8 8 6 2 8 X 8 1-2-A-5-6-7-8-9-10-11-12-13-1A-16-19 Total 836 81A 1C6 57 87 53 16 225 7 263 611 225 L 8 7 698 TABLE 1 (C INVENTORY OF ALL HOSPITALS AND BEDS I BEDS AS REPORTED ON SCHEDULES OF INFORMATION BY THE HOSPITALS ont.) N THE TI 1RRIT0RY OF HAWAII ■u-1946 "NORMAL" BEDS AS CLASSIFIED BY P. L. 725 AND INSTRUCTIONS U.S.P.'H.S. NO. OF. BEDS WHICH ARE NON-ACCEPT. * HOSPITALS & NURSING HOMES ISLAND TYPE ««« NORMAL BEDS *« COMPL, BEDS GEN. MED, GEN. SURG. OBSTE- TRICAL PEDI- ATRIC CONTA- GIOUS T. B. NERV. & MENTAL CHRONIC CONV. & REST VEN. DIS. ORTHO- PEDIC EENT SKIM & CANCER UNAS- SIGNED % OCG. GENERAL MENTAL T. B. CHR. & CONV. NON PROFIT PROPRIETARY *- REMARKS CONCERNING NON-ACCEPTABILITY GOV'T PVT. PLANT. INDIV. Kauai County — Bfttfrui Hospital Kauai General 1A 1A A • 10 1A X 1A 1-A-6-7-8-12-13-1A-20 -—Koloa Co. Hosoital ri General 22 22 3 3 16 22_ X 95 1 9_y,_1 9-1 3-20 , Eleele Disp. (McBryde) n Chronic & Conv. A A A A —— y, i_2_yt_ 19-20 _ Samuel Mahelona Hospital n Tuberculosis 115 115 115 88 115 X 115 1-6-7-11-17-19 Waimea Hospital n General 35 38 5 21 67 X X__ 35 1-2-A-8-9-8-9-12-1A—19 Wilcox Memorial Hospital tt General 93 93 12 19 13 7 6 6 6 6 18 52 21_ ■ Total 283 286 12 19 25 10 6 115 10 6 6 .. 77 16Z, ns /. 1 1— 3L_ L 1 ion Maui County , Hana County Hospital Maui General 30 30 3 A 2 21 30 2fi_ X 30 1-2-A-5—6-8-9—10-12-13-1A-l7-19 Kula General Hospital It General 22 22 A 2 16 22_ y —Kulfl Sanitorlum ft Tuberculosis 202 202 202 §4 202 X — Lan&i City Hospital Lanai General 26 26 26 36 26 X 26 1 Maui General 82 82 1A 8 3 57 60 82 X 82 1-2-5-6-7-12-13-1A-18-19 _ Maunaloa Hospital Molokai General 19 19 19 19 - x 19 1-4-5-6-7-8-9-10-11-12-13-17-18-19 —. MmH Acrrlc. Co. HoscitAl Maui General 80 80 11 16 A A2 52 S£_ X 80 1-2-8-19 Pioneer Mill Co, Hospital If General 67 67 7 6 8 A6 60 —67. X 67 3-2 _ Puunene Hospital It General 97 97 1C 87 A5 22_ — 97 1-8 ... _ Shinrle Memorial Hospital Molokai General 50 28 A 7 17 A7 50 r_i— 50 1-2-5-6-7-8-11 — Total 675 653 7 52 37 6 202 3 8 338 .... A72 - 202 A 1— 5 A51 Kalawao County 62 X 62 1-2-19 Lep&N3._9Ply , Tp^al 62 A? A? 62 1 62 TERRITORY OF HAWAII - TOTALS 5798 253 262 366 2A7 189 1123 1873 350 . 11 .. 6 . LL 16 1058 2.AV9 - 809 1.1A6 . X1A 1A _ 21 . 1A 2.eofe Total Inventory •-Code for Pemarks Concerning Non-Acceptability 1 - Structure not fire resistant 2 - Old, dilapidated building 3 - Proven natural hazards - tidal waves, storms, etc. 4 - Capacity too small for type of services or economical operation 5 - Inadequate facilities for medical records maintenance 6 - Inadequate facilities for storage of supplies, 7 - Inadequate facilities for laundry service 8 - Inadequate facilities for dietetic service 9 - Inadequate facilities for laboratory service 10 - Inadequate facilities for X-ray service 11 - Inadequate facilities for pharmacy service 12 - Inadequate facilities for operating section 13 - Inadequate facilities for obstetric deliveries 14 - Inadequate facilities for nurseries 15 - Inadequate or no regular physician attendance 16 - Inadequate or no trained nursing service 17 - Inadequate nurses' quarters 18 - Inadequate employees1 quarters 19 - General obsolescence 20 - Closure of hospital has been decided "Normal" bedg_aj_pla3sified by P. L. 725 and USPHS instructions General xxxxx 2,4.79 Mental 809 Tuberculosis «**« 1,146 Chronic & Convalescent 114 Total 4,548 (Includes beds which may be unacceptable) •Excluded from totals xxxxx Excludes 68 general beds at Wahiawa temporarily used for TBS *•«* Includes 68 general beds at Wahiawa temporarily used for TBS Total "Normal" Beds 5,394) Includes beds in hospital for the feeble-minded Total "Complement" Beds 5,798) and in home for the aged; also beds which may be unacceptable •••Normal means bed capacity for which building was planned at 80 sc, ft. per bed ••Complement means beds installed regardless of floor space built for beds T Temporary arrangement - These are ordinarily general beds 105 TABLE 2 ITEM OAHU HAWAII MAUI KAUAI MOLOKAI LANAI 1 HIIfiAU T2KHIT0R-* OF HAWAII lo Dimensions (nilsa) 44 x 30 93 *76 48 x 26 35 * 25 38 x 10 18 s 13 18 x 6 2. Area (Sq» Milos) £03 4*021 n 8 551 259 141 72 6,375 3. Population O 358,311 fir * 73»276 46,319 35,636 • • 5,340 to 3,720 162 523,984 4, Population pep sq« mile, 1340 595 18 64 65 20 26 2 82 5. Population largest city. Bureau Census Honolulu 179,326 Hilo 23,353 lailuku 7,319 6, Population 1345 Bureau Census Est. 415,379 7o Population 1346 Bd. of Health To S. Kstisates 358,911 70,871 44,807 34,911 6,173 3,630 199 519,502 8* General Hospitals 0-24 Beds 1 8 1 2 1 13 3. General Hospitals 25-43 beds 3 5 1 1 1 11 10 General Hospitals 50 - 33 Beds 2 3 4 1 1 11 11, General Hospitals 100 - 133 Bed* 3 1 4 12. General Hospitals 200 - 500 Beds 1 1 13. Allied Special Maternity Hospital 0-24 Beds 1 1 2 14. Allied Special Maternity Hospital 25 - 43 Beds 13. Allied Special Maternity Hospital 50 - 33 Beds 16. Allied Special Maternity Hospital 100 - 133 Beds 1 1 17. Allied Special Children's Hospital 1 - V 1 18. Allied Special Orthopedic Hospital 1 1 OMNISUS INFLATION BY ISLANDS ASD THE TERRITOHT OF HAWAII * Population 1?46 estimate. Bureau c f Vital Stastie*, Board of Health, October 28, •• Population IJ4O Bureau of Census, Department of Commerce Report Notes These population figures will be the basis for calculating ratios, allowances of beds, eto. TABLE 2 (Cont.) ITEM OAHJ HAWAII MUI KAUU MCLOKAI XANU. NT imu IERRITCRY rp Hrtwa 111 19. Allied .Special Isolation Hospital (Leper) 1 1 2 20. Tota1 Genera 1 and Allied Special Hos pita Is 15 18 6 4 3 1 47 21, Tuberculosis Hospitals 1 1 1 1 4 22, Chronic and Convalescent Hospitals 6 1 7 23, Mental Hospitals 1 1 24, Total Hospitals 23 19 7 6 3 1 59 2 5 . Home f or Aged 1 1 2 6, Home for the Feeble-minded 1 1 2 7. Non Profit Gov’t Hospitals 4 4 4 1 1 14 2 8. Non profit Private Hospitals 10 1 1 12 2 9. Proprietary- Corporation plantation Hos pita Is 5 8 3 3 1 1 21 3 0, Proprietary- Individual - ow ned Hospitals 6 7 1 14 31. *Nor ma1 Beds General Hospital 0-24 Beds 101 22 36 19 m 32. Normal Beds General Hospital 2 5 -4 9 Beds 151 161 30 35 26 403 33. Normal Beds General Hospital 50-99 Beds 52 153 326 93 SO • ■674 34. Normal Beds General Hospital 100-199 Beds 3 82 188 570 35. Normal Beds General Hospital 200-J00 Beds 345 345 3 6. Normal Beds A. S. Maternity 0-24 Beds 4 8 12 QMS'I BUS INFORMATION BY ISLANDS AND TIE TERRITCRY OF HAWAII 1 denotes the number of beds for which the institution was built; usually at an allowance of 80 sq„ ft of floor space per bed TABLE 2 (Cent.) ITEM OAHU HAWAII MAUI KAUAI MOLOKAI LANAI NIIHAU TERRITORY OP HAWAII 37* Normal Bed# A. S* Maternity 25 _ 43 Bads 38. Moran! Bad# A. S. Maternity 50 - 39 Bads 33 0 Marsal Bads A. S. Maternity 100 - 199 Bads 103 105 40. Moral Bads A. S. Children's 100 100 41. Moraal Bads A. S. Orthopedic 28 28 42. Moral Bads A. S. Isolation (Uper) 63 62 125 43. Total General A Allied Special Moral Beds • 0 1,237 611 378 164 131 26 ** 2,547 44. Moral Beds Tuberculosis 536 225 202 115 1,078 43. Moral Beds Chronic and Convalescent 110 4 114 460 Moral Beds Mental 8O9 809 47. Total Moraal Beds All Hospitals ♦ 2,692 836 580 283 131 26 » *548 48. Moraal Beds Hone for Aged 128 128 43. Moral Beds Rom for feeble- minded 718 718 50. Moraal Beds In Governant Hospitals * 939 515 336 115 62 • 1,567 31. Moraal Beds in Mon-proflt Private Hospitals 1,495 93 50 1,638 32. Moral Beds In Prop.-Corporation (Plantation) Hosp. 203 230 244 61 19 26 783 33. Moral Beds in Prop.-Individual-Owned Hospitals 55 91 14 160 34, Jt General Hospital Moraal Beds 48J6 OMNIBUS INFORMATION BY ISLANDS AND THE TERRITORY OF HAWAII ® Excludes 718 beds in hOM for feeble-minded; and 128 beds in home for aged. ** Includes 68 beds in Wahiaa General Hospital temporarily ueed for T.B. patient* (so* inventory) TABLE 2 (Cent.) OMNIBUS INFORMATION BT ISLANDS AND THE TERRITORY OF HAWAII ITEM OAHU HAWAII MAUI KAUAI MOLOKAI LANAI NIIHAU TERRITORY OF HAWAII 55* * Maternity Hospital Normal Beds 56. $ Children's Hospital Normal Bods 2.2* 57» * Orthopedic Hospital Nor ml Beds .6* 58« * Isolation Hospi tal Normal Beds 2.* 55. * Tuberculosis Hospital Normal Beds 23.7* ♦ 600 * Chronic A Con- valescent Hoep. Normal Beds 2.# 6l. it Mental Hospital Normal Beds 17.7* 62, Existing Accept. Normal Bod Ratio, General A A. S. 1.5 per 1,000 1.9 per 1,000 •5 per 1,000 2.5 per 1,000 0 per 1,000 1.5 per 1,000 63. Existing Acceptable Normal Bed Ratio, Tuberculosis 1.4 x 168 0. x 43.2 6.4 x 31.2 0. x 18.4 1.7 x 265 64. Existing Accept. Normal Bed Ratio, Chronic A Conv. 0 per 1,000 0 per 1,000 Existing Acceptable Normal Bed Ratio, Mental 1.9 per 1,000 1.3 per 1,000 66. Area, Base Assisted B—1 670 Area, Intermediate, Assigned 1-1 1-2 1-3 68, Area, Rural Assigned R—1 H—2 63. Area, Regional Assigned Tent* itlve Honolulu TO. Area-Ratio Authorised for General A A. S. Beds Base 4,5 per 1,000 Interned. 4. per 1,000 Interned. 4, per 1,000 Interned. 4. per 1,000 Rural 2.5 per 1,000 Rural 2.5 per 1,000 4.5 per 1,000 71* Ratio Authorised For Tuberculosis Beds 2.5 X ♦168 2.5 X ♦43.2 2.5 X •31.2 2.5 X ♦18.4 2*5 x ♦2.4 2.5 x ♦1.2 2.5 x •265 72. Ratio Authorized for Chronic A Convalescent Beds 2. per 1,000 2. per 1,000 2. per 1,000 2. per 1,000 2. per 1,000 2. per 1,000 2. per 1,000 ♦ Average Annual Deaths, in Period 1340-1344. OMNIBUS INFORMATION BT ISLANDS AND THE TERRITORY OF HAWAII TABLE 2 ICont.J ITEM OAHU HAWAII MAUI KAUAI MOLOKAI LANAI BIIHAU TERRITORY Jtf-HAIAIL.' 73* Ratio Authorized for Mental Beds 5. per 1,000 5, per 1,000 5- P*«* 1,000 5. per 1,000 5» P*5* 1,000 5. p«r 1,000 $. 1,000 74. Existing Hot sal General A Allied Special Beds 1*237 6ll 378 164 131 26 ** 2,547 75. Existing Non- Aeoeptable General A A. So Beds 706 473 • 356 71 131 26 1*763 76. Existing Acceptable General A Allied Special Beds 531 138 22 93 0 7&4 77« Authorized General and Allied Special Beds 1*^15 273 188 142 13 9 «** 2,357 78« Additional Gen« A Ao S. Beds which nay Constructed 1,084 155 166 49 13 9 1,573 yj0 Existing Nornal Tuberculosis Beds 506 225 202 115 * 1,048 800 Existing Non-Aecept. Tuberculosis Beds 2 67 223 115 607 81. Existing Acceptable Tuberculosis Beds 237 202 437 82, Authorised Tuberculosis Beds 420 108 78 46 6 3 661 83. Additional T. B. Beds which say be constructed 183 108 -124 46 6 3 222 84. Existing Nornal Chronic A Conv. Beds 110 4 114 83« Existing Non-Acocpt. Chronic A Conv. Beds 110 4 114 86. Existing Acceptable Chronic A Conv. Beds 0 0 870 Authorised Chronic and Comfelescent Beds 718 147 94 71 11 7 **«• 1,048 88. Add'l Chronic A Conv, Beds which nay be constructed 718 147 74 71 11 7 1,048 09, Existing Nornal Mental Beds 807 80 7 70. Existing Non-Aecept. Mental Beds 120 120 * Sr’mlude* f»8 beds inSahiawa General" Hospital temporarily used for t.B, patient* (See Inventory) n *• Includes 68 beds in Vahiawa General Hospital temporarily used for T.B« patients (See Inventory) ••• Population 523,984 and ratio 4.5 per 1,000 •••• Population 523,984 and ratio 2, per 1,000 •••• Includes 97 pool b®ds 111 TABLE 2 (Cent.) im OAHU HAWAII MAUI KAUAI MOLOKAI LANAI NIIHAU imm 91 - Existing Acceptable Mental Beds 689 689 92. Authorised Mental Beds 1*735 366 235 178 27 13 2,620 93* Additional Mental Beds which may be Constructed X,io6 566 235 178 27 13 1*331 94. Total Additional Beds which say be Constructed 3*031 776 371 344 57 38 4,774 95* Physicians, 1940 233 45 23 23 4 2 336 ♦ 960 Population per Physician 1940 1*073 1,184 2,033 1*543 1*335 1*360 1,258 97° Physicians, 1946 269 45 28 14 3 1 360 •• 98, Population per 1946 1*364 1*611 1,600 2,494 2,058 3,630 1,472 990 Physician* 1946 Institutional 16 3 3 1 1 24 100, Physicians 1946 Board of Health 12 1 13 101, Physio ions 1946 Plantation 8 3 8 7 1 33 102. Physicians 1946 Group 46 46 103, Physicians 1946 Individual 187 32 17 6 2 244 104. Physicians 1946 General Practice 33 31 17 11 2 1 161 105. Physicians 1946 Surgery 38 3 2 43 IO60 Physicians 1946 Eo Eo No To 21 3 3 2 23 107. Physicians 1946 Obstst. & Gynso. 13 1 l 21 108. Physicians 1946 T. Bo and Chest Surgo 14 3 3 1 \ 21 OMNIBUS INFORMATION BY I SUMPS AND THE TERRITORY OF HAWAII 5 of Commerce, I^4o •• Based on e stints s for 1946*, Bureau of Vital Statistics, Board of Health, T. H. October 28, 1?46 ••• Population 523,984 and ratio 5» P®p> 1,000 ••*• Includes 89 Pool General Bed* , - 0 112 TABUS 2 (Cent.) ITEM OAHU HAWAII MAUI KAUAI MOLOKAI LANAI — NIIHAU TERRITORY OP HAWAII lOJ. Physicians 1946 Pediatries 17 2 13 110. Physicians 1946 Int. Medicine 15 I 16 111. Physicians 1946 Neur op sychia try 10 1 11 112. Physicians 1946 Urology 7 7 113* Physicians 1946 X-ray 4 Radiology 6 • 6 114. Physicians 1946 Pathology 5 5 115. Physicians 1946 Public Health 4 4 116. Physicians 1946 Derm. & Syph. 4 1 4 117* Physicians 1946 Orthopedics 3 3 118. Physicians 1946 Hematology 1 1 119* Physicians 1946 Allergy 1 1 w 120. Dentists 1946 162 25 3 3 1 1 20 7 121. Dentist per Population 1946 2,210 2,834 4,978 3,873 6,173 3,630 2,503 122. Reg. Hursts 1946-47 Institutional 313 52 38 23 13 4 443 I23. Reg. Nurses 1946-47 Private Duty 76 5 2 2 1 86 124. Reg. Nurses 1946-47 Industrial 41 7 7 5 1 2 63 123. Reg. Nurses 1946-47 Office 73 2 1 82 126. Reg. Nurses 1946-47 School 12 2 1 1 16 OMNIBUS INFORMATION BY ISUNDS AND TH£ TERRITORY 01 HAWAII • Based on estimates for Bureau of Vital Statistics, Board of Health, T. H., October 28, 1?46 113 TABLE 2 (Cent.} OMNIBUS INFORMATION BY ISLANDS AND THE TERRITORY OF HAWAII ITEM OAHU HAWAII MAUI KAUAI MOLOKAI LANAI HIIHAU TERRITORY OP HAWAII 127* Registered Nurses 1946-47 Public Health 59 13 7 9 ■ 88 128. Registered Nurses 1946-47 Not Working 207 29 19 16 3 2 276 129« Registered Norses 1946-47 Totals 787 110 74 56 19 8 1,054 130. X-ray Tech. 1946 in Hospitals 16 8 4 3 2 33 131. Lab. Tech. 1946 in Hospitals 27 9 6 5 2 49 132, P. T, Tech. 1946 in Hospitals 5 2 7 133. Occ. Therapists 1946 in Hospitals 16 1 1 18 134. Public Health Facilities Inventoried 13 9 7 12 2 1 44 135. Public Health Paoilitles Publicly Owned 5 5 1 6 1 18 136. Public Health Facilities Rented 4 3 1 1 9 137. Public Health Facilities Donated 8 3 5 1 17 138. Existing Public Health Centers (USPHS DEP.) 3 2 1 1 7 139. Existing Public Health Centers Unsuitable 1 2 1 1 5 140. Existing Public Health Centers Suitable 2 2 141. Authorised Public Health Centers 12 2.4 1.5 1 17 142. Authorised Public Health Center Ratio 1-30,000 1-30,000 1-30,000 1-30,000 1-30,000 1-30,000 1-30,000 143. Public Health Centers which nay be Constructed 10 2.4 1.5 1 15 144. Existing Aux. Pao. (clinics and Labs.) 10 7 6 11 2 1 37 1U TABLE 2 (Coat.) OMRZBDS INFORMATION BY ISLANDS AND THE TURRIT OR Y OF HAVA II ITtt OAHU HAWAII ‘ WADI KAUAI HDLOKAI LANAI SI1BAU TSRRIfCRY OF HAWAII 14$. existing Aux. fkoiliUst Unaultable 7 3 3 j 1 14 146. Existing Aux. facilities Suitable 3 4 3 11 1 1 23 - 115 NAME OF FACILITY ADDRESS IDENT. NO. « USAGE CODE c. if S. A. P.0. K»« He D. FACILITIES WHICH ARE UNSUITABLE REMARKS CONCERNING UNSUITABILITY Island of Oahu Dept- of Health, Territory of Hawaii Quean & Punchbowl Sts., Honolulu, Oahu _ 1 1,2 1 x I Lanaklla Health Center 1722 Lanaklla St.. Honolulu, Oahu 2 1,2,5 X X KapahiOn Health Center 54S Kapahni 11 Avsnus, Honolulu, Oahu 1 1,2,3fX,6,8,00 X X Plants Animal Laboratory Halo Street. Honolulu. Oahu L _2 x x Mental Hyjrlene Clinic. Queen's Hosnital. Honolulu, Oahu 5 8.MH x X X 5-7-8 Kailua Health Center Kuulei Street. Kailua, Oahu 6 lr3,Z.r5,8rCC X X X 1-2-3-5-6-7-8-11-12-1A Kaneohe Health Center Kaneohe, Oahu 7 lr3fZ.,5.6f8.CC x X X 1,2-3-5-6-7-8-12 Hauula Health Center Hauula School, Kauula. Oahu 8 3.4- X X X 1-5-6-7-8-11-12-14 Wahiawa Health Center Wahiawa Court House, Wahiawa, Oahu 9 1.3.A.5.6.3,00 I X X 1-3-5-6-7-8-12-14 Nanakuli Health Center Nanakuli, Oahu 10 3,4 X z X 1-2-3-5-6-7-8-12-14 Waialua Health Center Waialua Court House, Waialua, Oahu 11 1.3,4.5,6,8,CC X X X 1-2-3-5-6-7-8-11-12 Waipahu Health Center Oahu Sugar Co. Hosp., Waipahu, Oahu 12 1.3.4,5,6.8.CC X I " ai m Canter 11 1,1,/, *5,6,8,00 X I . .. ... Totalg._, ,_j 3 9 1 5 8 8 Island of Hawaii Dept, of Health. T.H.r County of Hawaii 17 Kekaulike Street. Hilo. Hawaii 1A 1 X X I 5-6-7-8-11-12-14 Bacteriological Laboratory Waiakea. Hilo. Hawaii 15 2.5.6.8.MH I X X 5-9-12 Plague Laboratory Walakea. Hilo. Hawaii 16 2 X X Dept, of Health. T.H.. Cy of Haw., Branch Honokaa. Hawaii 17 1.3.X.5.8.CC X X X 5-6-7-8-12 Plague Laboratory Honokaa, Hawaii 18 2 X X Knhala Health Center Kohala, Hawaii lb 3(/,5,r,cc,mk x X X Kona Health Center Kealakekua. Hawaii 20 3,A,5r8rCC.MH x X X 5-7-8-12 Pahala Health Center Pahala, Kau, Hawaii 21 3.A.5.8.CC.MK X X N. Kona Health Center Holualoa, Kona, Hawaii 22 8,MH X X Totals 2 4 3 5 A 5 SUBSIDIARY PUBLIC HEALTH CLINICS AND AUXILIARY PUBLIC HEALTH LABORATORIES, TERRITORY OF HAWAII INVENTORY OF PUBLIC HEALTH CENTERS TABLE 3 117 NAME OF FACILITY ADDRESS IDENT. NO. » USAGE CODE C. ** s. A. P.0. R, D. FACILITIES WHICH ARE UNSUITABLE REMARKS CONCERNING UNSUITABILITY Island of Maui Dont. of Hon1th. T.H.. Countv of Maul Hieh Street. Wailuku. Maui 23 1.5.8.CC.MH.N X X X 3-5-6-7-8-9-10-11-12 Plague Laboratory Kahukui, Maui 24 1,2 X X 25 1 r2 X X I Lahaina, Ma\ii 26 1.4.5.8.CC X X Makawao Health Center Maluhia Road, Makawao, Maui 27 1,3.4 X X X 1-2-3-5-7-8-14 28 l.A |_X_ JL Lower Kill a Road. Walakoa. Kill a. Maui 29 l.A X X X __J=5=6=2 Total 3 1 4 2 1 3 3 4 Island Of Molokai 30 _] x _JL_ X 1.-2.-3-5-6^2.-8-9-10-11-12 Pukoo, Molokai 31 3,4,6 X X Totals 2 1 1 1 Island of Lanai 32 1 r3rZ.f 5 X _X Totals T..T --- ■— ■' ■ a. ■ ■ ■-—■== 1 1 SUBSIDIARY PUBLIC HEALTH CLINICS AND AUXILIARY PUBLIC HEALTH LABORATORIES. TERRITORY OF HAWAII INVENTORY OF PUBLIC HEALTH CENTERS TABLE 3 (Cont.) NAME OF FACILITY ADDRESS IDENT. NO. • USAGE CODE C. «« s. A. P.0. *«» R. D. FACILITIES WHICH ARE UNSUITABLE REMARKS CONCERNING UNSUITABILITY Island of Kauai Dept, of Health. T.H.. County of Kauai Tax Buildins. Lihue. Kauai 33 1 X X X 3—*5—6-7-8—10—11-3A Bacteriological Lshoratory Terr. Hire. Court Kauai 34 1,9 T X Kilauea Health Center Kilauea Dispensary. Kilauea. Kauai 35 1.3.A.5 X X Kapaa Health Center Kapaa, Kauai 36 1.3.A.5.8.CC X X Koloa Health Center Koloa, Kauai 37 1,3,A.5.8,CC X I Kalaheo Health Center Kalaheo. Kami 38 1.A.5 X X Eleele Health Center Eleele Dispensary, Eleele, Kauai 39 1.3.A.5.8.CC.MH X X ffaimea Health Center Waimea, Kami AO 1.A.8.MH X X Hanalei Health Center Hanalei, Kauai a _4 X X Kealia Health Center Kealia, Kauai A2 A.5 X X Hanarnaulu Health Center Plantation Office. Hansmauln, Kami A3 A X x New Mill Health Center Plantation Cottage. New Mill. Kauai AA A X X . . .. Totals (Eleele) 1 10 1 6 1 1 TERRITORY - TOTALS 7 30 7 18 9 17 19 Code - Reasons for Unsuitability (cont.) 4 - Ho electric wiring 5 - Inadequate office space for administration 6 - Inadequate waiting room space 7 - Inadequate clinic space 8 - Inadequate conference and educational space 9 - Inadequate laboratory space 10 - Inadequate auditorium space 11 - Inadequate library space 12 - Inadequate storage space 13 - Inadequate parking space 14 - Inadequate toilet facilities 15 - Location unsuitable for area population served 16 - Discontinuance of facility has been decided SUBSIDIARI PUBLIC HEALTH CLINICS AND AUXILIARY PUBLIC HEALTH LABORATORIES. TKRRITORI OF KA»AII ••Type Facility Code C. Public Health Center (U.S.P.H.S. Definition) S. Subsidiary Public Health Clinic (Auxiliary U.S.P.H.S. Definition) A. Auxiliary Public Health Laboratory (U.S.P.H.S. Definition) ••♦Ownership Code P.O. Publicly owned P.. Rented D. Donated or Loaned Code - Reasons for Unsuitability 1 - Structure not fire resistant 2 - Old, dilapidated building 3 - No hot water system IKVENTORI OF PUBLIC HEALTH CENTERS TABLE 3 (Cont.) •Usage Code 1 - Administration 2 - Laboratory 3 - Prenatal Care 4 - Child Health 5 - Tuberculosis Control 6 - Venereal Disease Control 7 - Dental Hygiene 8 - Other (Specify) CC - Crippled Children MH - Mental Hygiene N - Neurology 121 Delineation of General Hospital Service Area Exh. D*l Page 1 * cir} Area Hoep. (intermed ) 1 Community Hosp. * L. Community Infirmary *H.C. Base Area No 1 Area Hospital Center ‘ Honolulu Island of Oahu Legend 44 Miles 30 Miles 603 Sq. Miles 356911 (1946) Length Width Area Population 123 Delineation of General Hospital Service Area Exh.D'l Page 2 Legend • cu=3 Area Uosp. (Ixiiermed..) • *4" Community Uosp- • L Community Infirmary -H. C. Length 93 Miles Width 76 Miles Area 4021 Sq. Miles Population 732T6 ( 1940 ) Island of Hawaii Intermediate Area Ho. 1 Area Hospital Center ~ Hilo 124 Delineation of General Hospital Service Area Exh.lH Page 2. Island of Maui Intermediate Area No.2. Area Hospital Center Wail u leu Legend • Area Hosp* £ Intermed. ] • "f" Community Uosp. • L» Community Infirmary - K.C Length 4-8 Miles Width 2 6 Miles Area 7 2 8 SB.9 II ( 1940 ) Ment. Mental Hosp. or Unit Average T.B. Deaths 1940“ 1944 ~ 168 Islani of Oahu 135 Exh D-4 Pag? 2 Designation of Chronic Hospitals or Units Tuberculosis Hospitals Mental Hospitals or Units Island of Hawaii Length 93 Wiles Legend Width Tt> Miles Chr. Chronic Hosp or Unit. Area 4021 Sq. Miles Tub. Tuberculosis Hosp. Population 7327’6 (1940 ) Ment. Mental Hosp. or Unit Average TB Deaths 1940 * 1944 ~ 43.2 136 Designation of Chronic Hospitals or Units Tuberculosis Hospitals Mental Hospitals or Units Exh.D'4 Page 3 Length 48 Miles Legend Width 26 Miles Chr. Chronic Llosp. or Unit Area *728 Sq. Miles Tub. Tuberculosis Hosp. Population 46919 (1940) Kent. Mental Hosp. or Llnit T.B, Deaths 1940“ 1944 ~ 3 1.2 Island of Maui 137 ExkD~4 Paj^4 designation of Chronic Hospitals or Units Tuberculosis Hospitals Mental Hospitals or Units Length 3E> Miles Legend Width J2S Miles Chr. Chronic Hosp. or Unit Area 551 Sq. Miles Tub. Tuberculosis Hosp. Population 33636 ( 1Q40) Merit. Menial Hosp, or Unit Average TB Deaths 1940 ~ 1944 IS.4 Island of Kauai * 138 Mi, D"4 Pa|eS Designation o£ Chronic Hospitals or Units Tuberculosis Hospitals Mental Hospitals or Units Length 3 8 Miles Legend Width lO Miles Chr. Chronic Hosp, or Unit Area 2.5 Q Sq. Miles Tub. Tuberculosis Hosp. Population. 5340 ( 1940 ) Ment. Menial Hosp. or Unit Average TB Deaths 1940 " 1944 • ” 2.. 4 Island of Mololcai 139 Designation of Chronic Hospitals or Units Tuberculosis Hospitals Mental Hospitals or Units Exll D~4 Page 6 Length. 18 Miles Legend. Width. 13 Miles Chr, Chronic Hosp. or Unit Area 141 Miles Tub. Tuberculosis Hosp. Population 372.0 ( 1940 ) Ment Mental Hosp. or Unit Average T.B. Deaths 1940 - 1944 - Island of Lanai 140