Lawmakers are trying to find solutions to a three-year delay in inspections for some dialysis clinics that largely remain closed as the number of residents with kidney failure continues to climb.

Three new dialysis facilities sit idle, waiting for an inspection by the state Department of Health in order to get paid by the federal Medicare and Medicaid insurance programs for seniors and low-income patients. Another half-dozen existing facilities are overdue for recertification, which ensures patient safety.

“Any delay in inspections has the potential of not catching errors or issues of noncompliance with certification requirements,” said Keith Ridley, chief of the DOH Office of Health Care Assurance, which is assigned to conduct health inspections every three years for Hawaii’s 29 dialysis facilities that treat nearly 4,000 patients.

The backlog is anticipated to get worse as another 18 facilities come up for recertification in 2019.

State Rep. John Mizuno is introducing bills this session that would allow for the hiring of six contractors for $150,000 to get the facilities inspected this year. Ridley estimates it will cost the state $375,000 to clear the backlog through 2019.

Mizuno also will push legislation to add three new DOH positions, primarily paid by the federal government, to keep inspections up to date in the long term.

Without certification, new dialysis clinics can’t get reimbursed for treating Medicare and Medicaid patients, which comprise as much as 85 percent of the dialysis population. The DOH spent about $140,000 last year to contract a half-dozen Arizona inspectors to complete delayed certifications for 11 dialysis centers.

DOH has 12 surveyors for all health care facilities, but less than half are currently trained to inspect dialysis facilities as some are recent hires, according to the DOH. Inspectors must assess whether facilities have qualified staff, emergency procedures, sufficient equipment and quality patient care.

“These are very intensive surveys and it does take time,” Ridley said, adding that the Health Department is required by federal officials to prioritize inspections of other health care facilities before dialysis centers. “We barely have staff to do higher-tier work currently.”

The DOH expects to have a new operational plan that includes additional staffing to alleviate the backlog approved by federal officials this summer, though training of additional workers could take up to two to three years, he said.

Steve Nottingham, general manager for Liberty Dialysis, which has 19 clinics that treat roughly 2,000 Hawaii patients, said there is currently a waitlist of 44 patients for clinics that are built but are not certified.

“Ultimately, the one that gets affected is the patient,” he said. “We’ve got clinics going on five years that haven’t been recertified.”

There are 168,000 residents with chronic kidney disease and about 700 new patients needing dialysis each year.

“We’re predisposed to chronic kidney disease because of ethnicity and the good food we eat,” Mizuno said.

Mililani resident Ken Enomoto, 69, who has been on dialysis for about a year and half, told lawmakers he’s been anxiously awaiting the opening of a clinic in his neighborhood, but was disappointed that the new facility has been empty while he desperately needs the services.

“It’s been there for three years already, but not open,” Enomoto said.

For six months he had to get treatments in Waipahu that ran until midnight because there were no other times available. Many of the centers are at capacity.

“It affected everything. Somebody had to drive me there and pick me up after midnight or sometimes 1 a.m. It changed my whole lifestyle,” Enomoto said. “My wife had to change her work schedule and I couldn’t do the things I wanted to do.”