The Queen's Medical Center transferred 11 patients last year for long-term care on the Mainland, a fraction of the more than 700 patients who left the hospital for nursing homes, but a situation that Queen's agrees was not optimal.

Queen's could not provide estimates on the number of patients transferred to the Mainland in previous years and, citing patient privacy rights, would not identify any specific states or nursing homes. It did say the transfers were limited to a handful of facilities.

State lawmakers are considering a bill that would require Queen's and other healthcare providers to notify the Hawai'i Disability Rights Center in advance of patient transfers to the Mainland.

Several state House lawmakers were surprised last week when they learned Queen's had been quietly transferring patients to the Mainland for the past few years. But state senators, who heard the notification bill yesterday, had questions about patient privacy and whether the center was the right group to notify.

"There are lots of big issues here," said state Sen. David Ige, D-16th (Pearl City, 'Aiea), the chairman of the Senate Health Committee, which will decide next week whether to move the bill.

Queen's has described the practice as a last resort when the hospital is unable to find a nursing home bed in Hawai'i, a symptom of the state's lack of capacity in long-term care. An October survey by the Healthcare Association of Hawai'i found that 250 hospital patients statewide were waiting for nursing home beds, with about 40 patients waiting at Queen's on a typical day.

But nursing home providers caution that the waiting list can be misleading. Many of the patients have specific medical or behavioral issues that make placement difficult. Queen's would not disclose patient information but acknowledges that many of the patients moved to the Mainland have special medical needs.

"We agree it is not the most optimal situation to send patients to the Mainland. That is not our goal," said Cynthia Kamikawa, vice president of nursing and chief nursing officer for Queen's. "We have exhausted three, four, five different resources here before we are going to the Mainland."

State Senate Majority Leader Gary Hooser, D-7th (Kaua'i, Ni'ihau), the sponsor of the bill in the Senate, said notification would help ensure that vulnerable elderly and disabled patients are protected and are not being pressured. "We have an obligation to look out for these people," he said.

The state Department of Health and the state attorney general's office have told lawmakers that notification could violate patient privacy rights under federal law and the state Constitution. Jill Nagamine, a deputy attorney general, said yesterday that transferring patients to the Mainland is not a violation of their rights so there is no need to notify the Hawai'i Disability Rights Center, which is the state's designated advocate for the disabled.

Nagamine said automatic disclosure would violate patient rights. "Affected individuals and their families may, in fact, prefer that the advocacy agency not be notified of a person's impending transfer," she said.

State Sen. Robert Bunda, D-22nd (North Shore, Wahiawa), said he did not oppose the concept of notification but asked why the center should be the one to be notified, rather than a state agency. "I think this bill has too many unanswered questions," he said.

But the Healthcare Association of Hawai'i, which represents Queen's and other hospitals, announced its support of the bill yesterday, along with the Kokua Council, an advocacy group for the elderly, which sent in testimony that characterized the transfer of patients to the Mainland as appalling. The State Council on Developmental Disabilities and the Center on Disability Studies had previously supported the bill.

Moelilia Soa, an 'Ewa Beach office assistant, said she felt pressured when Queen's wanted to transfer her mother to the Mainland for long-term care several months after a 2002 stroke. Her mother had a tracheotomy and needed dialysis, so Soa understood it was not an easy placement, but she feels the hospital did not look hard enough in Hawai'i.

Soa said she found her mother a bed in a Kapolei facility on her own. "I just feel like they did not go out there and look," she said.

Ida Sagadraca, a Pearl City educational assistant, said she was initially concerned when Queen's wanted to move her husband, who had a brain injury and was violent, to a nursing home in Ohio last year. But the family was able to visit him and felt he received the care he needed to get better and return home.

"Initially, I felt pressured," Sagadraca said. "But I really was pleased with the nursing home that he went to. The people there were very, very nice and accommodating and they made it really easy for us. He needed to be somewhere else besides home because he wasn't healed yet.

"There is no good way to handle it, but we're happy with the outcome."

Reach Derrick DePledge at ddepledge@honoluluadvertiser.com.