Unable to find beds in Hawai'i nursing homes, The Queen's Medical Center has been transferring some patients to the Mainland for long-term care, a development that bothers some advocates for the disabled and several state lawmakers.

Queen's estimates that about 40 patients a day are waiting to transfer to long-term care homes and, on rare occasions, some patients have been moved to the Mainland for care.

"It is only done as a last resort when all local options have been exhausted," said Cynthia Kamikawa, vice president for nursing and the chief nursing officer at Queen's, in written testimony yesterday for the state House. "In every instance, the clinical needs of the patient are addressed and the family participates in the process."

Healthcare experts have been warning about the lack of long-term care capacity in the Islands for several years, predicting it could worsen with the retirement of the baby boom generation and as people live longer because of advances in medicine.

But several people who learned that Queen's has been transferring patients to the Mainland were surprised.

"It's mind blowing," said Louis Erteschik, staff attorney with the Hawai'i Disability Rights Center, which has documented several cases in which patients have been moved from Queen's to nursing homes in Ohio. "The long-term care issue really is about a lack of capacity.

"It's a problem that's only going to get worse."

The center has asked state lawmakers to approve a bill requiring hospitals to notify it of any transfers in advance so it can protect patient rights and gather information on the scope of the transfers.

State House lawmakers yesterday urged the state attorney general's office and the center to research concerns by the state Department of Health that such notification might violate patient privacy rights under federal law and the state Constitution.

Lawmakers also clarified that the notification requirement would not apply to prisoners sent to the Mainland, and deleted language in the bill that appeared to guarantee patients the right to stay in long-term care in Hawai'i. Lawmakers also specified that the intent of the bill is to protect elderly and disabled patients.

LAWMAKER 'DIDN'T KNOW'

Some lawmakers seemed genuinely troubled.

"It almost borders on the unconscionable," said state Rep. John Mizuno, D-30th (Kamehameha Heights, Kalihi Valley, Fort Shafter), who sponsored the bill. "It's just not right to be sending our kupuna to the Mainland."

State House Minority Leader Lynn Finnegan, R-32nd (Lower Pearlridge, 'Aiea, Halawa), is a co-sponsor of the bill but thought it was related to patient transfers between nursing homes in Hawai'i. She did not learn until yesterday that Queen's was sending patients to the Mainland.

"I didn't know they did that," Finnegan said. "I'm glad that we're inquiring into this because we want to make sure we are not transferring the responsibility of our state to care for its elderly and disabled."

State Rep. Josh Green, D-6th (N. Kona, Keauhou, Kailua-Kona), chairman of the House Health Committee, said the state should require notification to the Hawai'i Disability Rights Center.

"Really, there should be almost no cases where we can't offer long-term care services here," said Green, a Big Island emergency-room doctor.

The center, after receiving a call in November 2005 from an Ohio state health official about Hawai'i patient transfers, worked with a patient advocacy group in Ohio to document 10 patients who had been sent from Queen's to two nursing homes in Ohio.

BEDS IN SHORT SUPPLY

Rebecca Pollard, a spokeswoman for Queen's, said yesterday she could not immediately provide a total number of patients who have been transferred to the Mainland or when the practice started, but noted that Kamikawa described it as rare.

Kamikawa, in her House testimony, said more than 20,000 patients are admitted to Queen's each year for acute inpatient services and most are discharged to their homes or to long-term care homes. She said that due to the shortage of long-term care beds, about 40 patients are waiting for transfers each day.

The Hawai'i Health Information Corp., in a report on health trends, found that in 2003 the state had 25 long-term care beds per 1,000 residents aged 65 and older, a bed rate that was one-half of the national rate. The state's occupancy rate for certified nursing facilities was the highest in the nation at 94.6 percent.

The Hawai'i Disability Rights Center, in its testimony, said hospitals are not entirely to blame because the state does not keep an updated registry of available nursing home beds, making it difficult to find local beds. But the center also believes there should be safeguards to prevent hospitals from pressuring families to consent to Mainland transfers.

The State Council on Developmental Disabilities also supported the bill, saying it would help assure that patients being considered for transfer know their rights and are protected from unnecessary placement.

WOMAN FELT PRESSURED

Corliss Hayashikawa of Kaimuki, who works in teller operations at a bank, said her sister spent several months at Queen's after suffering a stroke in September 2005. When her sister was well enough for release, Hayashikawa said the hospital told her it could not find a care home on O'ahu and that she would have to care for her.

Hayashikawa said she told the hospital she was unable to care for her sister at home, and was informed that the alternative was a nursing home in Ohio. Hayashikawa sought help from the center and her sister eventually found a bed in an adult foster home in Kalihi. But she said she felt pressured by the hospital to agree to the Mainland transfer.

"When you're experiencing that and going through all the emotions, it's easy for people not to know what their rights are," Hayashikawa said. "Basically, for the hospital, it comes down to, 'Hey, we need the bed.' "

Reach Derrick DePledge at ddepledge@honoluluadvertiser.com.