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Medical vans to aid homeless could cost state $1.4M annually

Dan Nakaso
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“Our acute-care hospitals are spending tens of millions of dollars over and above what they’re being reimbursed for. This is going to be a high priority.”

Josh Green

State senator and Big Island emergency room physician

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Homeless camped outside Thomas Square Park.

The state would spend $1.4 million every year to operate two mobile medical clinics aimed at helping sick or injured homeless people under a Senate bill aimed at cutting emergency room costs to treat homeless people for non-life-threatening issues.

State Sen. Josh Green (D, Kona-Kau) moved SB 347 out of his Human Services Committee on Friday on a vote of 3-0.

Green, a Big Island emergency room physician, said he would volunteer for mobile clinic shifts himself and would recruit other doctors and nurses — and health care students — to join him.

Green envisions the two mobile clinics operating primarily on Oahu but periodically shipping one to the neighbor islands to treat the medical needs of the homeless there.

Ideally, Green said, each of the vans would include a driver, doctor, nurse and psychiatrist.

“This is an attempt to address the nexus between homelessness and the intense pressure that it’s putting on downtown and across the state so we can get people care in a much, much, much, much more affordable setting,” he said. “We could do it 20 times cheaper.”

An emergency room trip to treat staph infections and other minor injuries that turn nasty on the street easily could run up to $2,000 to treat in a hospital, Green said.

Oahu’s primary trauma center, the Queen’s Medical Center, annually faces $90 million in costs just to treat homeless people from the downtown area and is hardly reimbursed in full by the federal government, Green said.

“Our acute-care hospitals are spending tens of millions of dollars over and above what they’re being reimbursed for,” he said. “This is going to be a high priority.”

Green expects that it would cost $500,000 to buy and outfit each medical vehicle and then $1.4 million annually for operating costs.

Green’s bill comes as Waikiki Health’s two Care-A-Vans — a van and car — will sit idle now that Waikiki Health lost its state contract to provide homeless serv­ices.

Among the homeless, especially in the heart of Waikiki, Care-A-Van is a name brand. They had been using Care-A-Van for a wide array of services — from first aid to longer-term health care to receiving mail, a critical lifeline to staying connected.

The state has contracted with the Institute for Human Services to provide homeless services for the region that used to be covered by Waikiki Health and its Care-A-Vans. The IHS contract takes effect at the beginning of February.

But IHS has no mobile clinic similar to either of the two soon-to-be-dormant vehicles that make up Care-A-Van, said IHS spokesman Kimo Carvalho. Until Green’s bill receives final approval, there will be no mobile medical service for the homeless.

“We do medical outreach, such as wound care, but we currently only have one registered nurse to do both outreach and treat clients in our clinic,” Carvalho said. “We have a staff of just one RN.”

In an emailed statement, Waikiki Health CEO Sheila Beckham said its drop-in center in Kaimuki continues to offer medical and other homeless services.

But starting Wednesday, its two rolling medical clinics that treat the homeless on the street will shut down.

In the void, IHS maintains that Green’s idea “would be awesome,” Carvalho said. “We don’t have the nursing staff to keep up with demand. It’s a legitimate concern that should be addressed. Health care should be one of the many homeless solutions, in hand with housing and health and human services so we’re moving folks off of the street quickly and reducing their use of the Judiciary and hospitals, while preventing more people from falling into homelessness.”

19 responses to “Medical vans to aid homeless could cost state $1.4M annually”

  1. st1d says:

    this is a good idea that delivers needed health services directly to the homeless who would otherwise monopolize emergency ambulance services and hospital emergency rooms for medical services that are not emergencies.

    unlike the senator’s idea of writing prescriptions to house mentally affected homeless, the use of mobile medical services is justified and purposeful.

    the cost-savings benefits, reducing homeless misuse of emergency ambulances and emergency rooms for emergencies make this bill attractive

    • Pirate says:

      I’m not sure how this would actually work. Does the van drive around looking for people that need to be treated?

      It seems like a waste of resources to staff the van with a doctor. Maybe use a physician assistant or nurse practitioner instead.

      • st1d says:

        medical van operators could start out using expanded versions of rep. ward’s map of homeless camps and make regular rounds to meet with and treat homeless who need the non-emergency medical services.

        also, homeless advocates who walk the camps daily to offer their services could notify the medical van whenever and wherever needed.

  2. Bdpapa says:

    Now you’re talking! I didn’t like Green’s other ideas but I can buy into this one!

  3. Wazdat says:

    I’m all for helping people but this is only going to encourage MORE people to come to Hawaii and get taken care of.

    Don’t Feed the Birds !

  4. justmyview371 says:

    Another dumb bill wasting our money. Too much staffing is being provided per van — a doctor and/or a nurse is enough. One of the two should drive. Calling for a psychiatrist is ridiculous. Usually a psychiatric patient needs more than one appointment and providing the right medication often requires trying a trial and error of several different medications.

  5. fiveo says:

    Finally Dr. Green has a reasonable idea which makes total sense however my only reservation is that his proposal is for the state (taxpayer) to ante up for the cost.
    I think it would be much better and fair if the hospitals such as Queens who end up treating the homeless when they show up at the emergency rooms were to contribute financially
    to fund the cost of these medical vans and the medical staff and supplies that will be needed. After all, this proposal would save the hospitals a great deal of money if these
    homeless could receive medical care early on before their condition requires them to seek treatment at their emergency rooms.
    This would be perfect for a state/private parternship which would benefit everyone.

    • Bothrops says:

      The hospitals are already subsidizing the c and c by eating the emergency room costs, why should they pay for this in addition? Or rather in both cases, the taxpayer and people with insurance end up paying, but at least the mobile unit will save everyone money.

      • RetiredWorking says:

        Bothrops, are you sure all the hospitals are eating the ER costs? Aren’t they billing Med-Quest or Medi-Care? Just asking.

        • Manoa_Fisherman says:

          Why do you think an aspirin cost $5 at the hospital. We all pay for the over priced charges at local hospitals, especially Queens, because they are losing millions of dollars every year on uninsured/homeless patients using the ERs as clinics. These costs only keep rising as the usage goes unabated and eventually gets passed on to those who ultimately pay for medical services, the insured and the taxpayers.

          Green and the rest of the bleeding hearts at the legislature keep making Hawaii as attractive as possible for the homeless. Why do you think the bulk of the homeless are from the Mainland? Like the national Democratic Party, the local idiots seem to no longer care about the working people of Hawaii who have to struggle to make ends meet. Rather than waste money on the homeless, spend taxpayer’s money on more affordable housing and start cracking down on the toxic waste that is being dumped on our shores from the Mainland.

  6. gmkhawaii says:

    how much is the “hardly reimbursed in full by the federal government”?…..10, 20, 30…70 million?, …….however, IF manning mobile medical units will SAVE 70 – 80% of costs I’m for it.

  7. traveld says:

    I believe if this saves Queens $90 million in unreimbursed annual emergency room cost then, we have a party that should be more than willing to finance this idea as they would save enough the first year to finance this for the next 90 years. No additional tax money needed. Great…….

  8. saveparadise says:

    The idea seems to be a good one. One way or another taxpayers should support this as it is humane and will will help the emergency rooms. If it works out maybe add a third van?

  9. 64hoo says:

    and the medical van would have medical pakalolo with them to get them high.

  10. Canefire says:

    Good intention bad idea. Mo bettah give grant to non-profit to run and operate. The myriads of state procurement rules, government personnel rules, and medical practice liability will choke the light out of it.

  11. ready2go says:

    good idea but hire a private company to bid ad provide this service. If government gets involved, the costs and liability go sky high, and the taxpayers wind up paying the bill.

  12. Papaya123 says:

    The goal should to get these people off of our streets and out of our parks and bus stops so we can hope to raise children in a decent environment. Not encourage people to remain on the streets.

  13. gofigga says:

    As usual, this idea looks good on paper but in the five minutes of pondering, I already have several reservations. Who will staff these vehicles? Does this proposal rely on volunteers or will they be compensated for their time? Who will absorb the liability for diagnoses,treatment, and follow up? Where will these vehicles “clean” themselves after each visit? These are just three of the many questions that come to mind immediately. Bad plan.

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