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Hawaii Department of Health Release Names, Scores and Rankings of ALL Applicants for Medical Marijuana Dispensary Licenses

The Hawaii State Department of Health (DOH) today released the scores and ranking of the applicants for Medical Marijuana Dispensary Licenses.

Honolulu Applicants

Click to enlarge

The list of applicants and their respective scores and ranking are posted at http://health.hawaii.gov/medicalmarijuanadispensary/latest-updates-and-news/.

Hawaii Applicants

Click to enlarge

A total of 66 applications for eight dispensary licenses were reviewed, evaluated, and scored (based on 13 merit criteria) by four members of a selection panel. Each application could receive a maximum of 520 points (10 points maximum could be awarded for each merit criterion by each of four individual panelists).

Kauai Applicants

Click to enlarge

All applicants were required to submit documentation to prove compliance with the statutory and administrative requirements for both individual applicants and applying entities.

Maui Applicants

Click to enlarge

“To meet the ambitious and expedited time schedule for the selection process and given the large number of applications to review, the vetting process was conducted concurrently with the scoring of the applications,” said Keith Ridley, Chief of the DOH Office of Health Care Assurance.

While all applications were scored, 12 applicants who did not submit the requisite documentation or whose documentation did not establish compliance with the requirements were not ranked in the final compilation of scores.

Non Applicants

Unselected applicants

DOH notified all unselected applicants by certified mail this week prior to the posting of the applicants’ scores. To help ensure the medical marijuana dispensary program can be available for patients, DOH has been working on other requirements for the programs implementation.

The department is continuing work with Bio Track THC to establish the web-based seed-to-sale computer tracking system for dispensaries.

The DOH State Laboratories Division has established a certification process for medical marijuana testing facilities and applications are available at http://health.hawaii.gov/statelab/.

“It’s an exciting time, launching this new industry in Hawaii,” said Margaret Leong, supervisor of the Medical Marijuana Dispensary Licensing Program. “So far, the licensing staff have met in person with seven of the licensees and the discussions have been really productive and beneficial to all of us. The licensees have generously shared their knowledge of the industry gained through the application process, and we’ve been able to provide more specific guidance to ensure that their facilities conduct operations in compliance with all state requirements to be able to open their dispensaries in a timely manner.”

Additional information about the medical marijuana dispensary program and the registry program is available at health.hawaii.gov/medicalmarijuana.

Hawaii Senator Calls for Ban on Sunscreen with Oxybenzone

Compound found in sunscreen and personal care products blamed for damaging coral reefs

Some sunscreens known to have Oxybenzone

Some sunscreens known to have Oxybenzone

As the 13th annual Coral Reef Symposium comes to end in Waikīkī, State Senator Will Espero (Dist. 19 – ‘Ewa Beach, Ocean Pointe, ‘Ewa by Gentry, Iroquois Point, portion of ‘Ewa Villages) has announced he will introduce legislation for Hawai‘i to ban sunscreen with oxybenzone beginning in 2018.

“A ban is the right thing to do in order to protect our fragile marine eco-system,” said Sen. Espero. “Since our ocean environment is key to our tourism industry and our economic lifeline, banning a chemical substance that harms our coral and other marine animals should be a top priority next year in the state legislature.”

Speakers and scientists at the Symposium shared the dangers of oxybenzone on our coral reef and other marine life. Scientists said testing has revealed high levels of oxybenzone in Hawai‘i waters. Oxybenzone is found in personal care products and is a component of many sunscreen lotions.  It has been found to kill coral and negatively affect other Marine organisms.

“At the very least, a serious discussion should be had on the value and need of oxybenzone in sunscreen and other products,” Sen. Espero noted.

Hawaii Representative Asks Attorney General to Investigate School Air Conditioning Bids

Contractors bids so high that project delayed and students to suffer

As summer heats up and public schools prepare to begin Aug. 1, plans to spend $100 million to cool off 1,000 classrooms have been delayed due to the outrageously high bids from contractors to install air conditioning.

Rep. Matthew LoPresti

Rep. Matthew LoPresti

Rep. Matthew LoPresti has asked the Attorney General to investigate if there is a conspiracy to defraud taxpayers by artificially inflating bids for profit at the expense of school children – who will suffer through yet another unbearably hot summer in stifling classrooms.

“We cannot just wait for another round of bids and hope they are reasonable,” said Rep. Matthew LoPresti. “Classrooms in my district and across the state will soon be too hot for students to learn and teachers to teach. We must find a way to get this project moving forward.

“At the same time, the bids for the work came in so high that it is possible contractors who know the state is hard pressed to get this work done conspired to submit bids much higher than reasonable to make unreasonable profits.”

This past session the Legislature approved more than $100 million to add air conditioning to 1,000 classrooms by the end of the year and Gov. David Ige has been working with the state Department of Education and private companies to get the work done.

The DOE now says the project must be either delayed due to the high bids or far fewer classrooms then expected will be cooled.  As an example, the DOE said the bid for one photovoltaic-powered air conditioning project with an estimated cost of $20,000 came in more than $100,000.

LoPresti said there have also been complaints from contractors that the bid specifications for a $20,000 project were up to 100 pages long and that makes submitting a bid expensive and complicated.

“I would like the DOE to take a look at the bidding process and simplify the documents if possible,” he said. “We need to get to the bottom of why these bids are so high. Whatever the reason, we need to fix it.”

The cool schools project now is being pushed back with bidding reopened with the new fiscal year which begins July 1, 2016.

“If contractors are gouging the state at a time of great need in our schools and the students have to suffer because of this, the Attorney General must find them and prosecute to the full extent of the law,” LoPresti said. “The public deserves answers as to why bids are coming in suspiciously high and we cannot just sit by and accept this.”

As part of his “Cool Schools 4 Ewa” initiative, LoPresti is reaching out to the public to create a hui of professional volunteers willing and able to contribute to the heat abatement effort by donating their time and labor to help the DOE cool classrooms at realistic and reasonable costs.

LoPresti urges those able to install PV or PV AC systems to contact his office so he can help organize and facilitate those willing to step up and help our keiki to move beyond those who would rather profiteer from their suffering.

Commentary – Cardiac Care Unit Needed on the Big Island

THE PROBLEM:  The GOLDEN 2 HOUR WINDOW FOR CARE: People with cardiac problems- heart attacks and strokes must be airlifted to Queen’s Hospital in Honolulu or to Maui Memorial to be treated.   There is a 2 hour window when patients need to be treated in order to expect a full recovery.  Think about where you live on the Big Island.  At least from my home it would take 45 minutes to get to Kona Community Hospital Emergency Room, then the time to be diagnosed and then get the helicopter and then the 45 minute + time to Oahu, getting checked in and a cardiologist hopefully is at the hospital and you need to be seen, an Operating Room hopefully is available.  Get the picture?

THE SOLUTION?  Read the report below.

QUESTION:  How many people do you know on the Big Island that have had a heart attack or stroke?  That have needed ablations or pacemakers or stents?  Please contact me with your story. Debbie Hecht


A Cardiac Care Unit is needed on the Big Island.  Several well-known community members have been airlifted to Queens Hospital in Honolulu or Maui Memorial Hospital with heart problems or strokes:  Mayor Kim, Council Chair Pete Hoffmann, and OHA Representative Bob Lindsey.

Before going to Kona, I discussed a cardiac care unit for West Hawaii with Jon Luft, Architect and Teri Oelrich, medical planner at NBBJ Architects, who specialize in planning and designing hospitals. They are currently involved in building a one million square foot, state-of-the-art replacement hospital for Loma Linda University Medical Center in Loma Linda, California. Jon lived on the Big Island in the 1980’s and Teri has also worked in Hawaii.  Teri thought that a hybrid Operating Room (OR) and Catheterization Lab would be a first step to assessing the need/use of a Cardiac Care Unit.  She was helpful in explaining the process for a Certificate of Need.

From these discussions, I learned that hospitals make money on their operating rooms.  North Hawaii Community Hospital is booked solid with orthopedic and gastroenterology procedures.  Queens Medical has taken over the operations of North Hawaii Community Hospital.  There is currently no facility or any cardiologists to staff a dedicated cardiac care unit for West Hawaii.

We came to the conclusion that Kona Community Hospital (KCH) was the best location for a Cardiac Care unit.  I also learned there is additional, unused land adjacent to the Kona Community Hospital for expansion if a full-scale cardiac care unit is needed in the future. I also learned that here is a 2-hour window where a patient must receive intervential care to recover completely. By the time a cardiac victim would get from their home to KCH is evaluated and airlifted to Maui or Oahu, much more than two hours have elapsed- 4 hours is a more likely estimate. All of the people I talked to expressed the need for a new hospital closer to the Kona International Airport.

Kona Community Hospital has one cardiologist listed on their list of specialists, Dr. Michael Dang who comes periodically from Honolulu.  Dr. Larry Derbes has applied for privileges at KCH and is an interventional cardiologist in private practice in Kona.  He agrees that a Catheterization Lab to do stents and ablations and to treat strokes is very necessary for West Hawaii, would save lives and result in better outcomes and quality of life for cardiac patients. He is interested in helping to establish, and in working at a Cardiac Care Facility.  He also outlined the challenges of a doctor trying to make a living on the Big Island because of the Medicare reimbursement rate, which is roughly 93% of the actual cost of living. He was working in Waimea, but is closing that office and moving his practice to downtown Kona, approximately 20 minutes from KCH.

Jay Kreuzer, is the CEO of KCH, and has also been a cardiac patient. He said that the problem with the the Medicare reimbursement rate of only 93% of the actual cost, is compounded by Hawaii Medical Services Association (HMSA-the State of Hawaii’s biggest healthcare insurer) compensates at only 110% of the Medicare Reimbursement Rate as compared with most mainland insurance companies which reimburse at 130% of the Medicare rate.  These explanations further illustrate the negative impacts of insufficient reimbursement rates for attracting and retaining good doctors on the islands.

He told me that there is an airlift almost every day from KCH to either Queens in Honolulu or Maui Memorial and they are usually for heart or stroke patients.  He confided that Queens and KCH are in negotiations to acquire KCH.   He said the difficulty with a Cardiac Care unit is finding cardiologists to staff the clinics,  “There is no sense in building it if we don’t have the staff.”  If Queens acquires KCH, he believes more doctors would be available for rotations at KCH for specialties.

Queens’ strategy would be to enable more patients to stay on the outer islands instead of going to Oahu because their beds are always full. He also told me that the recent heavy rains had caused extensive flooding and damage to one of the Operating Rooms, which might represent an opportunity to remodel for a hybrid OR and Cath Lab.

I also met with Dr. Frank Sayre, Chair of the Board for the West Hawaii Regional Hospital Board of Directors, which oversees Kona Community Hospital and the North Kohala Community Hospital.  He reiterated what Jay Kreuzer said about why it is difficult to keep good doctors.  He told me that he had discussed setting up a “funded chair” for specialists (similar to academic chairs) as a stipend to keep doctors on the island.

This discussion was between Frank and a staff member from the Hawaii Community Foundation. Frank and I also discussed setting up an annuity pool with the Kona Hospital Foundation to fund several stipends for cardiac specialists who are willing to be “on call” at the hospital.  We talked about the possible need to hire a grant writer and/ or approaching several donors interested in better cardiac care on the island.

SOLUTIONS:

A HYBRID CATHETERIZATION LAB/ OPERATING ROOM FOR KONA COMMUNITY HOSPITAL: According to the medical planner, Teri Oelrich, affiliated with NBBJ architects, many rural areas first create a hybrid Catheterization Lab out of an existing Operating Room.  She estimated that this could be accomplished for approximately $1.5 million for equipment only; remodeling would be an additional cost.

The recent flooding of the Operating Room at KCH presents an opportunity to remodel the Operating Room and accommodate Cath Lab equipment.

STAFFING: Funding mechanisms could be established through donations to the Hawaii Community Foundation or the Kona Community Hospital Foundation

Establish a funded “chair position” for each specialty that is needed with a yearly stipend.

OR establish a pool of money as an annuity that will provide a stipend each year for several specialists.

STEPS TO ACHIEVE:

COMPILE STATISTICS to show the need for the Catheterization Lab by using billing for the last 2 years, or assessing airlifted patients as to why they were being carried off-island. The goal of this would be to establish the need for a Catheterization Lab or other specialties and give direction to the hospital and the Board as to what doctors, staff and facilities would be needed. This is important because:

With this data KCH would know what specialties and specialists were needed to treat and allow patients on the island to recover, which is a huge benefit for better outcomes for the patient and keeps interventions in the 2-hour window.  In the event of a Queen’s acquisition, it would expedite a facilities upgrade and staff hiring.

Having this data available would help determine the best strategies on how to repair the flood damaged ER (possibly into a cath lab hybrid).

Having the data could illustrate the need for a cath lab, and support the Board and CEO’s strategic planning.

FUNDRAISING

Consider hiring a grant writer to apply for grants from the Hawaii Community Foundation, HMSA Foundation, Kona Community Chamber of Commerce, and Rotary of Kona, Heart Association, Bill Healy Foundation, Ironman Foundation etc.

Establish an annuity to provide stipends of $50,000 for one or two on call cardiologists or a visiting cardiologist for KCH.  For example:  An annuity could be set up for $1,000,000 to invest at 5% to raise $50,000 per year for a stipend to pay a cardiologist to be on-call in addition to their private practice.

Contributors (Alphabetical Order) – Dr. Lawerence Derbes, Debbie Hecht, Jay Kreuzer, John Luft Teri Oelrich, Dr. Frank Sayre


Here is the Response from the West Hawaii Regional Board of Directors.

The response:  WHRBOD Decision Letter Cath Lab Proposal 6.10.16

To see the Board members in case you might want to speak to them about this:  http://www.kch.hhsc.org/about-us/senior-leadership/regional-board-of-directors/default.aspx

There is an ongoing problem to keeping doctors in Hawaii that is outlined in the report.  There is more information needed on how to best serve the Community.

Please contact me to become part of the movement to have community needs met by the Kona Community Hospital.  Mahalo!    Debbie Hecht

EPA Enforces Ban on U.S. Army’s Cesspools on Oahu and Big Island – Army Fined $100,000

Today, the U.S. Environmental Protection Agency announced an agreement with the U.S. Army to close four illegal large capacity cesspools on Oahu and eight on the Big Island. The Army will pay a $100,000 fine, the first time EPA has imposed a civil penalty against a federal government facility for operating banned cesspools.

Click to read

Click to read

“The convening of the International Coral Reef Symposium in Honolulu this week serves as a reminder of why EPA is focused on shutting down all large capacity cesspools,” said Alexis Strauss, EPA’s Acting Regional Administrator for the Pacific Southwest. “Our goal is to protect Hawaii’s coastal waters.”

EPA found that the Army continued to use the cesspools despite a 2005 ban under the federal Safe Drinking Water Act’s Underground Injection Control program. The Army had failed to close three large capacity cesspools at Wheeler Army Airfield and one at Schofield Barracks on Oahu, as well as eight on the Big Island at the Pohakuloa Training area and the Kilauea Military Camp.

As a result of EPA’s enforcement action, the Army has closed one cesspool, and replaced two others at Wheeler Army Airfield and another at Schofield Barracks with approved wastewater treatment systems. Under the settlement agreement, the Army must also close or replace all eight of the large capacity cesspools still in use on the Big Island.

Cesspools collect and discharge untreated raw sewage into the ground, where disease-causing pathogens and harmful chemicals can contaminate groundwater, streams and the ocean. They are used more widely in Hawaii than any other state. Throughout Hawaii, over 3,000 large capacity cesspools have been closed since the 2005 ban, many through voluntary compliance. The EPA regulations do not apply to single-family homes connected to their own individual cesspools.

For more information on the case, please visit: https://www.epa.gov/region9/enforcement/pubnotices/pubnotice-us-army.html

For more information on the large capacity cesspool ban, please visit: https://www.epa.gov/uic/cesspools-hawaii

Governor Extends Emergency Homeless Proclamation in Hawaii

Gov. David Y. Ige today signed a fifth supplemental proclamation on homelessness, which will remain in effect until August of this year. The supplemental proclamation provides an additional 60 days in which to continue the state’s cross-sector collaboration and coordinated efforts with the counties.

Click to read proclamation

Click to read proclamation

“The state has taken strides forward in creating a truly client-centered system among federal, state, county and community organizations,” said the Governor’s Coordinator on Homelessness Scott Morishige. “We are seeing unprecedented alignment of services and a commitment to the common goal of connecting people to permanent, stable housing as quickly as possible.” Morishige made the statement from the Maui Landlord Summit, where he outlined progress in the state’s unified response to homelessness:

Section 8 Landlords Recruited

The Maui Landlord Summit is the fourth in a series of state-supported events aimed at increasing government-assisted housing inventory. It serves to introduce potential landlords to homeless service providers and government agencies providing landlord support. The summit dispels misperceptions about Section 8 and the Housing First program, and is a collaborative effort between the State of Hawai‘i, County of Maui and Maui’s nonprofit service providers.

100 Homeless Families to be Housed

The Hawai‘i Public Housing Authority (HPHA) board has approved emergency rules to establish a special rental subsidy program, which will make available approximately $600,000 to quickly move at least 100 homeless families statewide into housing. HPHA Executive Director Hakim Ouansafi said, “With partnership with local nonprofits, this program is specifically focused on homeless families, where we expect to have an immediate, noticeable and lasting impact across generations.”

Scott Morishige underscored the importance of the developments: “These are two examples of community partnerships the state is forging to effectively and quickly address homelessness.  We are looking at new and creative ways for the community to pool funds, leverage resources, and work in alignment across all sectors to house and stabilize people experiencing homelessness.”

Over the past week, representatives from the United States Interagency Council on Homelessness and the National Governors Association have been in Hawai‘i as the Governor’s office has convened cross-sector meetings with stakeholders from every county and every sector.

Hilo Medical Center Announces First “CNA of the Year” Recipient

Hilo Medical Center celebrated National Nursing Assistant Week, June 9th – 16th, by hosting HMC’s First Annual CNAs of the Year Recognition.

Lex CNA of the Year

Lexus Enriquez-Isabel receives the “CNA of the Year” award at the Hilo Medical Center.

Here’s Lexus Enriquez-Isabel, CNA from the Emergency Department, and just some of the qualities that made her a member of this year’s Top CNA Class.

Lexus is dedicated to improvement of patient and staff care and safety in the Emergency Department. She has dedicated her personal time to our ED Shared Governance committee and has made a positive change in morale, empowerment, and accountability. She is always positive and willing to go out of her way to ensure the unit is running smoothly.

Enriquez-Isabel is acknowledged for taking on the role for lead of the equipment committee for our shared governance/patient safety council. She has revised our equipment map and also provided visual education pieces to ensure that staff in the ED are notified and aware of where specific patient care equipment is located.

This assists with patient safety and care as staff are not confused and frustrated when they are unable to locate important equipment that is needed to provide immediate care during a crisis/emergent situation. Always positive and wants to find solutions for problems and issues, rather than just complain about them. She has initiative and is proactive.

Her commitment to the ED makes the flow more efficient, she is a true team player.

Backpack Drive for Children Who Cannot Afford Them

The Hawaiʻi Police Department is proud to participate again in a backpack drive for children who cannot afford to buy them. As in previous years, all police stations around the island will double as drop-off points for persons interested in helping children in need. Backpacks may be dropped off between now and August 30.

Backpack1

Backpacks have been identified as the most requested non-food item for charities in Hawaiʻi. The donated backpacks will be distributed to children at women’s shelters, homeless shelters and transitional housing facilities around the Big Island.

This is the eighth consecutive year the Police Department has worked in partnership with HOPE Services Hawaiʻi (formerly known as the Office of Social Ministry).

Hope Services Hawaiʻi provides a continuum of homeless and transitional programs from outreach to emergency shelters, including permanent supportive housing placements.

UH Hilo College of Pharmacy Names Spring 2016 Dean’s List

UH Hilo Inouye College of Pharmacy

The following students from the Daniel K. Inouye College of Pharmacy at the University of Hawaiʻi at Hilo have been named to the Dean’s List for the 2016 spring semester:

Class of 2017: Sean Abreu, Trenton Aoki, Lena Asano, Robert Bautista, Mark Allen Bibera, Megan Calderwood, Christopher Cao, Rhea Castro, Nicole Chin, Francesco Console, Terri Anne Corpuz, Ronnijean Delenia, Christopher Diaz, Andy Diep, Mark Finlay, Madeline Fu, Audrey Fung, Gibe Gelan, Melissa Giachetti, Ryan Higa, Dann Hirayasu, Abraham Jose, David Khan, Mickey Ku, Shaun Lasky, Jaclyn Lee, Lauren Levine, Caleb Malinski, Sean Menda, Kevin Meno, Kelsea Mizusawa, Lauryn Mow, Jonathan Muna, Loc Ngo, Angela Nguyen, David Nguyen, Khanh Nicholas Nguyen, Phuc Nguyen, Kelia Parrilla, Asal Rafie Delijani, Kimberlee Roseman, Hannah Shin, Ryan Shiroma, Nadine So, Jaime-Rose Tangonan, Lillian Tran, Jenni Ueno, Hoa Vo, Hong Vong, Brenda Yuen, Zi Zhang

Class of 2018: Chelsea Aipoalani, Goody Cacal, Robby-Sean Cayetano, Matt Chen, Jane Choi, Karen Christian, Sara Evanko, Jennifer Fujio, Cierra Gauvin, Kelli Goo, Jui-Yu Kao, Jonathan Kataoka, Cindy Khamphaphanh, Macie Kim, Krystle Kiyuna, Bernice La, Tram Le, XuanLam Le, Jessica Lee, Nicolette Lew, Niaz Nafisi, Christopher Nakagawa, Kerri Nakatsu, Phuong Nguyen, Vicky Nguyen, Megan Olaguer, Marina Ortiz, Carli Owan, Joann Phan, Niko Pogorevcnik, Caroline Rhee, Lauren Sato, Andrew Skorheim, Lauren Skorheim, Mari Takushi, John James Taman, Lucilla Tong, Ha Tran, Vivian Tran, Paolo Vinh Tuan Truong, Quan Truong, Seungyeun Yoo

Class of 2019: Sydney Barney, Deniz Bicakci, Athena Borhauer, Rene-Scott Chavez, Samantha Gonzalez, Leigh Heffner, Vance Hill, Tyler Hirokawa, Preston Ho, Logan Kostur, Kevin Lei, Kate Malasig, Tyler Millar, Veronica Morales Colon, Jennifer Nguyen, Thu Nguyen, Kelsey Noetzelmann, Kara Paulachak, David Pham, Gam Phan, Rachel Randall, Jae Sung Shim, Shannon Trinh, Nicholas Tsoi, Ashley Uehara, Nancy Wong, Veronica Wong, Carrie Yeung

Family Donates Prosthetic Leg to Homeless Man Assaulted in Pahoa

A Pahoa family that wishes to remain anonymous, has stepped up to the plate and donated a prosthetic leg to assist John Hartley, the one-legged homeless man that was attacked by Lava Shack manager Chris Mohr.

John Hartley. (Photo via Hawaii News Now)

John Hartley. (Photo via Hawaii News Now)

In a video that has gone viral on social media, John Hartley and his dog are seen getting splashed with water, then sprayed with something that may be mace or pepper spray and then punched in the head a few times.

Pahoa community member Mark Hinshaw posted the following on the Big Island Thieves Facebook page where folks were obviously very upset about the video:

Hate crime in the 808!!! This just reported to us.

Allegedly, the manager of the Lava Shack in Pahoa has used mace and violence against many people, in this case a well liked homeless man in Pahoa for over 30 years, named John. Now bear in mind, John only has one leg and is wheelchair bound. This must stop. If this manager of Lava Shack has assaulted you please let the prosecutors office know.

As is clearly shown, John’s dog was hit by the mace as well…

No hate in the 808!!!

Police and Prosecutors are aware of the situation and are in possession of the full length video.

If you have any information and/or further details about this situation, please contact the Pahoa Police Station at 965-2716.

We must NOT allow this kind of behavior to continue in Pahoa Town!!!

According to Hawaii News Now:

“Victim John Hartley, who has been homeless for eight years, said the attack was unprovoked.

“I was blinded that night for five hours,” Hartley said. “The next day, I didn’t realize, I had the oils in my hands and I rubbed my face and I was blinded for three more hours.”

Hartley, who lost his right leg in 2015, is something of a fixture in Pahoa. He’s always got his dog right beside him.”

The donors family reached out to me last night and wanted to know how I could get them in touch with Hartley and I was able to make the connections and today the family was able to meet with Hartley in person.

“Our meeting (with Hartley) went well.  I saw Aunty Madie Greene outside of Luquins just as I got there. We fitted John with the prosthetic leg. Some minor adjustments need to be made but he was able to stand on it and is hopeful that in time he will be mobile again.  He’s an amazing man. It was nice to talk story and find out more about him.”

John Hartley gets fitted with his new leg.  Photo by Sara Williams of the Pahoa Village Museum.

John Hartley gets fitted with his new leg. Photo by Sara Williams of the Pahoa Village Museum.

Hartley has filed a police report and does plan to pursue charges.

Ku’ikahi Mediation Center Brown Bag Lunch Series – “Finding Solutions, Growing Peace”

The non-profit Ku‘ikahi Mediation Center hosts a free talk on June 16 as part of their “Finding Solutions, Growing Peace” Brown Bag Lunch Series.  Talks are Third Thursdays from 12 noon to 1 pm in the Office of the Prosecuting Attorney at 655 Kilauea Avenue in Hilo.

Dr. Gregory Chun

Dr. Gregory Chun

This month’s speaker is Dr. Gregory Chun on the topic “T-Shirts, Banners, and Badges: Reflections on Community Advocacy and Intractability in Hawai‘i.”

“Why do we get stuck in so many of our community conversations?” asks Dr. Chun.  “Why is there a growing trend towards people taking nonnegotiable positions in sometimes controversial issues?”

He says, “I want to help those working in advocacy, development, conflict resolution, and community, and government with historical, cultural, and social factors that I feel contribute to this intractability and introduce strategies for them to consider.”

Gregory Chun, Ph.D. has lived and worked on Hawai‘i Island since 1999, serving in positions with Parker Ranch, Kamehameha Investment Corporation, and Kamehameha Schools. Currently with the University of Hawaii at Manoa, he is developing a program of interdisciplinary studies that includes resource management, community development, and well-being, with a particular focus on serving Native Hawaiians and underserved communities.

Ku‘ikahi’s Brown Bag Lunch Series is free and open to the public.  Attendees are encouraged to bring their own lunch, enjoy an informal and educational talk-story session, and meet others interested in “Finding Solutions, Growing Peace.”

This lunch-and-learn series is made possible thanks in part to funding from the Atherton Family Foundation.  For more information, contact Ku‘ikahi Program Coordinator Gail Takaki at 935-7844 x 9 or gail@hawaiimediation.org.  Or visit www.hawaiimediaiton.org.

New Findings Show Promising Trends in Hawaii Student Health Behaviors

Today the Hawaii State Department of Health, Department of Education (HIDOE), and University of Hawaii released high school data from the 2015 Hawaii Youth Risk Behavior Survey (YRBS) for the state and all four counties. The YRBS is a bi-annual survey that regularly monitors the health risk behaviors of public, non-charter school students statewide. Over 12,000 Hawaii students in grades 6 through 12 participated in the 2015 survey.

Click to see results

Click to see results

Topics covered in the survey include unintentional injuries and violence; tobacco, alcohol, and other drug use; sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection; unhealthy dietary behaviors; and physical inactivity. The survey also monitors the percentages of students affected by obesity and asthma.

“The results reflect our recent initiatives to raise the bar at all levels in education,” said Superintendent Kathryn Matayoshi. “The downward trend of students engaging in risky behaviors and an increase in healthy choices is testament to the work done by our schools and the commitment of our students to strive higher.”

The 2015 YRBS results show trends towards less-risky behaviors in many important areas, and highlight needed improvements in others:

Physical fighting continues to decline, with 15 percent of high school students reporting that they were in a fight at least once during the 12 months before the survey. Bullying has stayed relatively steady, with 1 in 5 high school students reporting that they were bullied on school property during the same time period.

Consistent with objectives outlined in the State’s Physical Activity and Nutrition Plan, many YRBS indicators suggest an increase in youth behaviors that support healthy lifestyles. Only 13 percent of high school students report drinking at least one can, bottle, or glass of soda or pop at least once per day, compared to 23 percent in 2007. The survey does not cover drinking other types of beverages with added sugar such as sports drinks, energy drinks, fruit drinks (other than 100 percent fruit juice) or sweetened tea and coffee. The proportion of high school students meeting physical activity recommendations remains steady, with 20 percent achieving the national recommendation of at least 60 minutes per day on each of the seven days before the survey. However, sedentary time continues to increase, with 2 in 5 high school students spending three hours or more per day playing video games or using a computer for non-school purposes.

Alcohol use has declined among Hawaii’s youth, with 1 in 4 high school students reporting that they drank alcohol within the 30 days before the survey. Similarly, we continue to see steady declines in smoking; 90 percent of Hawaii’s high school students do not smoke cigarettes. However, many have tried using electronic smoking devices, with 1 in 4 reporting that they currently use electronic smoking devices.

“This data shows that we are improving as a state in many areas,” said Director of Health Virginia Pressler. “However, the sharp rise in the use of electronic cigarettes reminds us of the importance of continually monitoring student behavior. We will continue to work in partnership with HIDOE to ensure that our programs and interventions target these emerging issues.”

One area that remains a concern is adolescent mental health. In 2015, 29.5 percent of high school students reported feeling sad or hopeless almost every day for two or more weeks in a row at least once in their lifetime. Rates of attempted suicide over the past 12 months has steadily decreased since 1993, but remain unacceptably high at 11 percent.

Survey procedures protect students’ privacy by allowing for anonymous and voluntary participation. The data is gathered from students in public high schools across the State of Hawaii. In a change from the previous years’ survey administration, parents were offered the opportunity to “opt-out,” rather than requiring a form to “opt-in” to the process. This resulted in a 30 to 40 percent increase in response rate, providing a more comprehensive picture of student behavior across the state and all four counties.

The Hawaii YRBS is part of the Youth Risk Behavior Surveillance System, developed by the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC). National YRBS survey results were also released today by CDC. For a comparison of Hawaii’s data to national rates, please visit http://nccd.cdc.gov/youthonline/App/Default.aspx.

For more information on the Hawaii YRBS, visit http://apps.hidoe.k12.hi.us/research/Pages/YRBS.aspx.

The full survey report, including more detailed data reports by county, gender, grade and race/ethnicity, and the survey questionnaires are available at the www.hawaiihealthmatters.org.

Free Window Screening Workshop #FightTheBite

Lowes, Habitat For Humanity West Hawaii and the State Health Department have created a “Free Window Screening” workshop day on June 16th from 10-1 in the Lowe’s parking lot near the garden area to help repair people’s screens and teach residents how to do it themselves, as well.

Lowes Fight the Bite

Qualified residents can sign up to have Habitat folks provide the materials to make sure people have homes with screens to avoid contracting mosquito borne illnesses. Perk? A free BBQ from Randy’s BBQ!

Use of Video Decision Aids Increases Advance Care Planning in Hilo

Pilot study part of statewide program to improve end-of-life care

A program encouraging physicians and other providers to discuss with patients their preferences regarding end-of-life care significantly increased the documented incidence of such conversations and the number of patients with late-stage disease who were discharged to hospice.

Filling in an advance health care directive

In a Journal of General Internal Medicine paper that has been released online, a team led by Massachusetts General Hospital (MGH) investigators describes the pilot program, which is part of a larger initiative to transform medical care for serious illness in the state of Hawaii. The program included video decision aids in 10 languages and was carried out in the city of Hilo, Hawaii.

“By collaborating with the people of Hawaii and recognizing the diversity of the community, we were able to honor and respect patients’ individual choices when it came to medical care,” says Angelo Volandes, MD, MPH, of the MGH Department of Medicine, lead author of the report. “Doctors are often uncomfortable having end-of-life conversations and have rarely been trained in advance care planning. The videos can be a valuable supplement to, not a replacement for, the doctor-patient relationship.”

Advance care planning – conversations with patients regarding the type of care they would like to receive, or not receive, if they become seriously or terminally ill and cannot speak for themselves – has been the subject of considerable attention in recent years. Earlier this year Medicare began reimbursing clinicians for advance care planning discussions with patients, and the process was mentioned in, but not funded by, the Affordable Care Act. But there have been few studies examining the impact of advance care planning efforts on medical documentation of such conversations, on the care actually delivered or on costs.

A broad coalition of stakeholders, led by Hawaii Medical Service Association (HMSA), an independent Blue Cross/Blue Shield licensee, has been working since 2012 to improve advance care planning rates statewide through innovative collaborations, including implementation of educational videos. Hilo Medical Center, a 276-bed hospital, was the first in the state to make advance care planning the standard of care for patients, and the JGIM paper reports on the first 21 months of the program’s implementation in the city of more than 43,000.

Beginning in early 2013, Hilo Medical Center clinicians, Hospice of Hilo staff and 30 primary care physicians in the city were offered a one- to four-hour training program and access to advance care planning video decision aids in English, Japanese, Cantonese, Vietnamese, Samoan, Korean, Ilocano, Tagalog, Spanish and Marshallese. Less than 10 minutes long, the videos are designed to be accessible to general audiences and include broad questions that patients should consider regarding their individual preferences and how they could affect future medical interventions. How or whether providers used the videos in subsequent advance care planning discussions was neither required nor tracked.

The primary study outcome for Hilo Medical Center was any change in the rate at which advance care planning conversations were documented in medical records of patients with late-stage disease. For outpatient care, any difference between the rates of advance care planning in Hilo and in a control group of similar Hawaii communities was analyzed. The researchers also compared the number of hospice admissions for late-stage patients before and after the program was implemented – compared with the control communities – as well as the rate of in-hospital deaths. Any impact on health costs was determined by analyzing HMSA claims data.

Prior to implementation of the training program, the rate of advance care planning documentation for late-stage patients at Hilo Medical Center was 3.2 percent, but during the 21 months after training was offered, the rate increased to almost 40 percent. Among almost 4,000 HMSA patients over age 75 in Hilo who saw a primary care physician during 2014, the year following primary care physician training, 37 percent received advance care planning, compared with 25.6 percent in the control communities.

The percentage of late-stage Hilo Medical Center patients who were discharged to hospice, which was 5.7 percent before the training, rose to 13.8 percent. Overall Hospice of Hilo admissions increased 28 percent in 2013 and 51 percent in 2014, compared with 2012. While average HMSA reimbursements for care during the last month of life increased from 2012 to 2013 in both Hilo and the control area, the increase for Hilo was only 5.5 percent, compared with more than 22 percent in the control area, reflecting an average per-patient savings of $3,458 for the last month of life.

Although this study was conducted in a relatively small region, the authors note that the diversity of the Hawaiian population may offset that limitation. The program has now expanded to all hospitals in Hawaii, 10 hospices, military facilities and many other providers; and Volandes expresses the hope that this study’s results will renew calls for continuing innovation in advance care planning, including certification and reimbursement for patient decision aids.

“Advance care planning videos and other decision aids offer cost-efficient and broadly applicable methods of placing patients at the center of their care,” he says. “They also allow doctors and other health providers to have critical conversations with patients that were rarely encouraged during their training. Making these decision aids widely available could be a real health care game-changer.”

Planned Parenthood Launches Online Access to Birth Control in Hawaii

Today, Planned Parenthood of the Great Northwest and the Hawaiian Islands (PPGNHI) officially announced the launch of Planned Parenthood Care in Hawaii.

Birth Control ApThe app allows people to talk to a Planned Parenthood provider online and face-to-face through a secure video consultation system, and then receive birth control in the mail. Consultation for urinary tract infections is also available. This mobile app will bring reproductive health care services directly to women and men across the state.

“Planned Parenthood Care provides the same high-quality health care people have trusted Planned Parenthood to provide in Hawaii for 50 years.  What’s new is now our clinicians can literally meet people where they are—wherever they are—to get them the care they need,” said Chris Charbonneau, CEO of PPGNHI. “Telehealth is an incredible tool in expanding access to care. We know that life gets busy and that is why we are proud to lead with this technology that allows us to deliver health care and information to people who need it, regardless of their location.”

PPGNHI launched Planned Parenthood Care in Washington state in 2014 and in both Alaska and Idaho in 2015. Planned Parenthood Care™ builds upon decades of innovative health care and information delivery from Planned Parenthood and its affiliates nationwide. Planned Parenthood’s websites provide accurate, nonjudgmental information about contraception, sex, and reproductive health to 60 million visitors each year. Planned Parenthood’s Chat/Text program, which has served nearly 577,000 users so far, has been successful in reducing worry around sexual health issues by connecting youth to a real person through their computer or phone in real time.

“Hawaii is uniquely positioned to benefit from this service given the geography of this great state and the limited access to local health centers,” said Sonia Blackiston, Hawaii Education Manager at PPGNHI. “This app allows people to consult with a physician in real time via video on their device and determine what makes the most sense for them. It provides convenient access to Planned Parenthood’s trusted, high quality health care.”

The app is available at the iOS app store or from Google Play, but at present health care can only be delivered through Planned Parenthood Care to residents of Hawaii, Alaska, Idaho, Washington, and Minnesota.

New Imported Case of Dengue Fever Reported on the Big Island of Hawaii

This is a Civil Defense Message. This is a dengue information update for Friday, May 20, 2016.

Mosquito BiteThe State Department of Health has identified a single imported case of dengue on Hawaii Island. Vector control crews have treated the person’s residence and adjacent properties today.

Again, this is a single imported case. There is no evidence to indicate a local transmission has occurred. There have been no reported dengue cases attributed to local transmission since March. Imported cases occur from time to time and remind all of us to always be vigilant and fight the bite.

As the summer approaches and more travel is anticipated, the public is reminded that the most effective method to reduce the spread of dengue or other mosquito borne illnesses is for everyone to avoid and prevent mosquito bites. Fight The Bite by wearing clothing that minimizes exposed skin, using mosquito repellent, and avoiding activities in areas of high mosquito concentration during the early morning and late afternoon periods when mosquito activity is greatest. If feeling ill and unsure if you may have dengue, remain indoors to avoid getting bitten and infecting mosquitoes and contact your health care provider.

For information on dengue, visit health.hawaii.gov or call the Department of Health at 974-6001.

Hawaii Department of Health Issues Medical Marijuana Dispensary Licenses – Posts Merit-Based Scores for Licensees

The Hawaii State Department of Health (DOH) began issuing licenses today for Medical Marijuana Dispensaries.

Medical MarijuanaThe eight selected licensees have completed the full payment of licensing fees and were given the option of picking up their license or having it delivered by certified mail.

Licensees were selected based on the scoring of 13 merit criteria. The total scores used in the selection of each licensee are provided below and will be posted today at health.hawaii.gov/medicalmarijuanadispensary/latest-updates-and-news/.

City & County of Honolulu Score
Aloha Green Holdings Inc. 475
Manoa Botanicals LLC 470
TCG Retro Market 1, LLC dba Cure Oahu 470
Hawaii County
Hawaiian Ethos LLC 480
Lau Ola LLC 471.5
Maui County
Maui Wellness Group, LLC 510
Pono Life Sciences Maui, LLC 470
Kauai County
Green Aloha, Ltd. 433

DOH is in the process of notifying in writing all unselected applicants of their total score and ranking for their respective group. After all unselected applicants confirm receipt of their written notification from the department, the total scores of all applicants will be posted on the medical marijuana dispensary website.

For more information and updates from the Medical Marijuana Dispensary Program go to health.hawaii.gov/medicalmarijuanadispensary/ and select “News & Updates.” Questions about the Medical Marijuana Dispensary Programs may be emailed to medmarijuana.dispensary@doh.hawaii.gov.

First Annual Waipi’o Kalo Festival Coming Up

The first annual Waipi‘o Kalo Festival will take place on Saturday, June 4, 2016, 9 a.m.-4 p.m. at Koa‘ekea, near the Waipi‘o Valley Lookout. Presented by the grassroots state-recognized nonprofit, Hā Ola O Waipi‘o Valley, the free event is a tribute to kalo (taro), Waipi’o, and the kupuna and others who live, work, and find inspiration there.

Waipio Valley Taro Festival

The Kalo Festival is designed to be educational as well as entertaining, and will include much that Hawai‘i Island loves: live music and hula, craft vendors, games and great food. In addition, there will be displays and talk story sessions about the region’s rich history, and its significance in Hawaiian culture.

Central to Hawaiian culture, kalo is considered the “older brother” of all Hawaiians. Legend says that a child named Hāloa was born to deities Wakea and Ho‘ohōkūkalani. Hāloa died at birth and was buried in the garden, where soon shoots of kalo plants began to grow. Their next child was named Hāloa in his honor, and to forever acknowledge the familial tie between people and nature.

Waipi‘o was home to many deities and notable ali‘i, and at its peak, the thriving agricultural community may have supported a population as high as 10,000 people. Waipi‘o is also a storied wahi pana, sacred place, site of seven important heiau (temples) including  Pāka‘alana, a pu‘uhonua, “place of refuge.”

The Kalo Festival is designed to be educational as well as entertaining, and will include much that Hawai‘i Island loves: live music and hula, craft vendors, games and great food. In addition, there will be displays and talk story sessions about the region’s rich history, and its significance in Hawaiian culture.

Every aspect of the Kalo Festival is connected to the Valley in some way. Presenters may come from multigenerational kalo farmers on ancestral lands; cultural practitioners appreciate its vast resources; artists and musicians, even chefs, are inspired by Waipi‘o for their creations.

Hands-on ku‘i kalo gives festival-goers a feel for the art of poi pounding, and other cultural activities like lei-making, lau hala and lau niu weaving are available. More competitive attendees can enter the Taro Team Relay, a fun obstacle course with a simulation of a typical taro farmer’s jobs.

On the scholarly side, agricultural exhibits and demonstrations offer a chance to learn about varieties of kalo and how they are cultivated, its preparation as food and nutritional/health benefits. Displays from USDA, DLNR, Natural Resources Conservation Service (NRCS), North Hawaii Education and Research Center (NHERC) and others cover a broad range of related topics, from healthy soils, to agro-forestry, the importance of water, and more.

For the foodies, a Kalo Cookoff offers prizes to home chefs who bring their best kalo pupu, main dish or dessert for a friendly competition with prizes. Any part of the kalo plant may be used in the dish. (To enter, please bring at least five portions for judges to taste. Kalo must be an ingredient.) Kalo Contest Winners will be announced after the Relay, and receive a Makana Basket and a Gift Certificate.

In addition, homestyle Hawaiian plate lunches will be available for sale, with kalua pig, laulau, squid lū‘au, chicken long rice, sweet potatoes, fernshoot salad, haupia, kulolo, poke and of course, poi.

Koa‘ekea (the former Rice property is located at 48-5546 Waipi‘o Valley Road, and event parking will be available at Kukuihaele Park, with free shuttles provided. No parking at the Lookout.

The schedule for the day includes:

  • 9 a.m. Gate opens. Opening Pule and Oli at 9:05 a.m.
  • 9:10 a.m. Hālau Na Lei Punahele, Kumu Hula Punahele Andrade
  • 10 a.m. Larry Miller and Jeff Quinn
  • 10:50 a.m. Hālau Kou Lima Nani E, Kumu Hula Iwalani Kalima
  • 11:50 a.m. Sons of Keawe
  • 1-1:50 p.m. Kalo Team Relay/Kalo Cookoff
  • 2 p.m. Rubbah Slippah Productions, Ryan Hiraoka
  • 2:50 p.m. Masoe ‘Ohana
  • 3:50 p.m. Closing Pule and Hawai‘i Aloha

The Kalo Festival is sponsored by the Office of Hawaiian Affairs, the County of Hawai‘i and other generous supporters. Friends of the Future and Pōhāhā I Ka Lani both serve as the fiscal sponsors for this project. For more information about the Kalo Festival, email HaolaoWaipioValley@gmail.com or follow Hā Ola O Waipio Valley on Facebook.

Joint Task Force Established to Combat Rat Lungworm Disease in Hawaii

The Hawaii State Department of Health (DOH) and the East Hawaii Liaison to the Office of the Governor announced today the establishment of a Joint Task Force to assess the threat of rat lungworm disease (Angiostrongyliasis) in Hawaii. The mission of the task force is to share scientific knowledge in the application of diagnostics, treatment, mitigation and public education activities.

rat lungworm

Rat lungworm disease is caused by a nematode, which is a roundworm parasite called Angiostrongylus cantonensis. The parasitic nematode can be passed from the feces of infected rodents to snails, slugs and certain other animals, which become intermediate hosts for the parasite. Humans can become infected when they consume, either intentionally or otherwise, infected raw or undercooked intermediate hosts.

Although rat lungworm has been found throughout the state, Hawaii Island has a majority of the cases. Some infected people don’t show any symptoms or only have mild symptoms. For others, the symptoms can be much more severe, which can include headaches, stiffness of the neck, tingling or painful feelings in the skin or extremities, low-grade fever, nausea, and vomiting. Sometimes, a temporary paralysis of the face may also be present, as well as light sensitivity. This infection can also cause a rare type of meningitis (eosinophilic meningitis).

“Establishing a joint task force with local experts in the medical field and leaders in government will produce a set of best practices that be used to target rat lungworm disease not only on Hawaii Island, but on a statewide scale as well,” said Wil Okabe, East Hawaii Liaison to the Office of the Governor. “There is no specific treatment yet identified for this disease, so finding the best ways to prevent its spread and educate the public is crucial.”

The members of the task force are as follows:

  • Wil Okabe (Facilitator), East Hawaii Governor’s Liaison Office
  • Robert Cowie, Ph.D., Pacific Biosciences Research Center, University of Hawaii at Manoa
  • Robert Hollingsworth, Ph.D., U.S. Department of Agriculture (USDA)
  • Sue Jarvi, Ph.D., School of Pharmacy, University of Hawaii at Hilo
  • Jerry Kahana, Hawaii State Department of Agriculture
  • Kenton Kramer, Ph.D., Department of Tropical Medicine, John A. Burns School of Medicine (JABSOM)
  • John Martell, M.D., Hilo Medical Center
  • Marian Melish, M.D., Pediatric Infectious Disease, Kapiolani Medical Center
  • Donn Mende, Research and Development, County of Hawaii
  • DeWolfe Miller, Ph.D., Tropical Medicine Microbiology and Pharmacology, JABSOM
  • Peter Oshiro, Sanitation Branch, DOH
  • Sarah Park, M.D., F.A.A.P., State Epidemiologist, DOH
  • Joanna Seto, Save Drinking Water Branch, DOH
  • Aaron Ueno, Hawaii District Health Office, DOH
  • Chris Whelen, Ph.D., State Laboratories Division, DOH
  • Jonnie Yates, M.D., Kaiser Permanente

High Rates of Hepatitis C Found Among Hawaii’s Kupuna

Hawaii’s kupuna — baby boomers between the ages of 51 and 71 — are among those most at risk for hepatitis C, which can lead to liver disease or liver cancer. The Hawaii State Department of Health is partnering with CVS Minute Clinics and Hep Free Hawaii to protect kupuna and others by offering convenient hepatitis C point-of-care testing, on an ongoing basis starting on Thursday, May 19, 2016, which is National Hepatitis Testing Day.

clinic locator

All nine CVS Minute Clinics, located within selected Longs Drugs stores on Oahu, will offer a finger-prick test (instead of a blood draw) to check for hepatitis C in persons at risk, especially baby boomers born between 1945 and 1965. Results from the rapid hepatitis C antibody test are available in 20 minutes. This preventive health service is fully covered by most insurance plans with no out-of-pocket costs for members.

Hepatitis C and Liver Cancer

Hawaii is the state with the highest rate of liver cancer in the U.S., and the majority of liver cancer cases in Hawaii are caused by viral hepatitis types B and C. An estimated 23,000 persons in Hawaii are currently living with chronic hepatitis C, which can lead to liver disease and cancer.

Hepatitis C is spread by blood-to-blood exposure (such as sharing injection equipment), but there are also high rates among baby boomers (born 1945-1965), regardless of any known blood exposure. More than one out of four people in Hawaii are baby boomers and should be tested at least once for hepatitis C infection.

Early Detection is Critical
“Most people with hepatitis C don’t know that they have it,” stated Thaddeus Pham, Viral Hepatitis Prevention Coordinator with the Hawaii State Department of Health.  “If undetected, hepatitis C can lead to liver disease, liver cancer, or even death. Since hepatitis C is manageable and, in some cases, even curable, people can prevent liver cancer through early detection. We encourage all baby boomers, as well as other Hawaii residents at risk for hepatitis C, to get tested right away. Getting tested is the first step in liver cancer prevention.”

CVS Minute Clinics are staffed by nurse practitioners who not only can administer the test, but also offer other services such as immunizations and non-urgent medical care. They are also committed to ensuring the patients get connected back their primary care providers. The CVS Minute Clinics are currently at 9 select locations on Oahu.  See http://www.cvs.com/minuteclinic/clinics/Hawaii for exact locations and times.  Appointments are first come, first serve, although you can hold a place in line using the Minute Clinic location website.

Partnering with Community

“We’re partnering with local CVS Minute Clinics because we recognize the increasing importance of non-traditional healthcare delivery models,” Pham said. “Many of us often go to our local pharmacy or drug store more often than we go to our doctor. It’s important to use every opportunity to increase awareness and screening for our ohana. Ultimately, it doesn’t matter where you go, as long as you get tested to prevent liver disease and cancer.”

For list of participating sites, go to http://www.cvs.com/minuteclinic/clinics/Hawaii or www.hepfreehawaii.org.