Department of Health Reaches Settlement With Central Maui Landfill and Molokai Solid Waste Facility

The Hawaii State Department of Health (DOH) and the County of Maui Department of Environmental Management have reached a settlement on two enforcement cases concerning solid waste violations at the Central Maui Municipal Solid Waste Landfill and the Molokai Integrated Solid Waste Management Facility.

Department of Health

The combined settlement involves a cash penalty payment of $70,000 and a supplemental environmental project that is valued at not less than $70,000.

The proposed supplemental project is a household hazardous waste collection program for the islands of Maui, Molokai and Lanai to be conduct ed during fiscal year 2015 (July 1, 2014 – June 30, 2015). The County of Maui, the remaining county that currently lacks such a program, plans to continue the project beyond the inaugural year.

DOH cited the Central Maui Municipal Solid Waste Landfill with three counts of permit violations from January to April 2011 for failure to maintain leachate compliance levels in the leachate wet well and sump, and failure to monitor and record leachate levels after a storm event. The DOH initially imposed an administrative penalty of $121,900 prior to the settlement. The facility is located off Pulehu Road in Puunene.

DOH cited the Molokai Integrated Solid Waste Management Facility with a two-count violation in April 2011 for failing to minimize liter generation and failure to place daily cover at the facility. An administrative penalty of $20,955 was initially imposed prior to the settlement. The facility is located off Maunaloa Highway in Naiwa.

The County of Maui has completed all corrective actions stemming from the alleged violations.

Department of Health Restricts the Use of Electronic Smoking Devices on DOH Properties

The Hawaii State Department of Health (DOH) has issued a directive containing a policy to restrict the use of unregulated electronic smoking devices on DOH properties.  The directive is the first of its kind among Hawaii state departments.

eCigarette

Beginning Jan. 1, 2014, the use of electronic smoking devices on all DOH properties, as well as premises occupied by DOH, is prohibited any place where smoking of tobacco products is not allowed by law. The policy applies to all DOH employees, visitors, volunteer, students, contract workers, delivery personnel, Department of Accounting and General Services workers, and all others who enter the work setting or environment which includes DOH and those premises occupied by DOH.

The unrestricted use of electronic smoking devices (such as electronic cigarettes, or “e-cigarettes”) is potentially hazardous to health. “Using electronic smoking devices threatens our smoke-free laws designed to protect the public from the harmful effects of tobacco and nicotine,” said Lola Irvin, DOH Tobacco Settlement programs manager. “While electronic smoking devices are touted for being smoke-free, they have not been proven to be safe. These devices release nicotine and other chemicals and carcinogens into the environment, leaving those around them exposed to the potentially harmful vapor just like second-hand smoke.  Electronic smoking devices also confuse the public who expect a smoke-free environment and erode the strong belief in our Hawaii Smoke-Free Workplace and Public Places Law.”

Electronic smoking devices are used by inhaling vaporized liquid nicotine created by heat through an electronic ignition system. This simulates cigarette smoking, thereby reversing the progress that has been made in establishing a social norm that smoking is not permitted in public places and places of employment.

The electronic smoking device policy was one of the last policies signed by the late Director of Health Loretta J. Fuddy, who passed away last Wednesday after the plane she was on was forced to make a water landing after taking off from Kalaupapa, Molokai. “Director Fuddy believed that as the Department of Health, it is our responsibility to set the standard for health for the people of Hawaii,” said Irvin. “Today, we are taking a stand to protect our workers and our public.  We hope to inspire others to take a similar position and join us in carrying out her legacy.”

 

State Department of Health to Hold Public Hearings for New Food Safety Rules

The Hawaii State Department of Health (DOH) will hold public hearings in all counties between Dec. 2 and 6, 2013, to introduce new food safety regulations that will affect all restaurants and food establishments in the state. The last substantial change to these rules was made nearly 17 years ago in 1996.

Department of Health

Highlights of the new food safety rules include: adoption of the 2009 U.S. Food and Drug Administration (FDA) Model Food Code as the basis for the rules; introduction of a highly visible restaurant grading system that will require food establishments to post the results of their last state inspection; move to annual permitting from biennial permitting; and permit fee increases.

“Adoption of the FDA Model Food Code will provide Hawaii with nationally recognized standards based on the most current scientific findings on food safety,” said Peter Oshiro, Sanitation Branch chief. “We look forward to enhancing our current state food regulations with these new and improved rules.”

The new grading system will consist of “PASS” (green), “CONDITIONAL PASS” (yellow), and “CLOSED” (red) placards. A “PASS” green placard will be given to food facilities that have one major violation or less that is corrected prior to completion of the inspection. A “CONDITIONAL PASS” yellow placard will be issued to a facility with two or more major violations during an inspection regardless of whether the violations are corrected on site. Major violations require a follow-up inspection. Follow-up inspections are conducted the next working day after notification from the facility that all major violations have been corrected. A “CLOSED” red placard will be issued if there are imminent health hazards that warrant immediate closure of the facility (lack of water, lack of electricity, sewage overflows in food preparation areas, sick employees, vermin infestation, etc.).

Major health inspection violations at food establishments are conditions that the Centers for Disease Control and Prevention (CDC) and the FDA recognize as the main causes of food illnesses (lack of hand washing, poor temperature controls, and contamination by raw/uncooked foods, etc.)

It is anticipated that the fee increases outlined in the new food safety rules will fund 13 additional full-time inspector positions granted by the state Legislature to be filled in fiscal years 2012-2015. The additional staffing will support an expanded inspection schedule that will include a minimum of three on-site inspections each year for high-risk establishments, two on-site inspections each year for medium risk establishments, and annual visits for all other establishments to meet national program standards and reduce foodborne illness.

“The new food safety rules will mean a huge step forward for our program and will result in overall improvements by expanding food safety testing, pesticide monitoring of local produce, and shellfish monitoring, among many other activities that protect public health every day,” added Oshiro.

To view Hawaii Administrative Rules Chapter 11- 50, titled, “Food Safety Code,” go to http://health.hawaii.gov/san/. Public hearings will be held at the following dates and locations:

Hawaii (Hilo): Monday, Dec. 2, at 1 p.m.

Environmental Health Facility conference room (1582 Kamehameha Ave., Hilo)

Hawaii (Kona): Tuesday, Dec. 3, at 1 p.m.

West Hawaii Civic Center – Liquor Control conference room, 2nd Floor, Bldg. B

(74-5044 Ane Keohokalole Hwy., Kailua-Kona)

Oahu: Wednesday, Dec. 4, at 1 p.m.

Environmental Management Division conference room, 5th Floor (919 Ala Moana Blvd.,

Honolulu)

Maui: Thursday, Dec. 5, at 1 p.m.

UH- Maui College Community Services Building (310 Kaahumanu Ave., Bldg. #205, Kahului)

Kauai: Friday, Dec. 6, at 1 p.m.

Lihue Health Center conference room (3040 Umi St., Lihue)

 

Stop Flu at School Program Begins Today

The Hawaii State Department of Health (DOH) annual Stop Flu at School program begins today and will continue in more than 300 public, private, and charter schools statewide through Nov. 27, 2013. This is the seventh year for the voluntary program, which administers free flu vaccinations to Hawaii students in kindergarten through grade 8.

Flu Shot“Despite cutbacks in spending at all levels of government, we prioritized funding for this important program, which helps protect our children,” said Health Director Loretta Fuddy. “By reducing flu in our keiki, older adults in the household will have less exposure to the virus, so that fewer of them will get it. Ultimately, this cost-effective prevention program saves lives and reduces healthcare costs.”

To vaccinate more than 60,000 students during the six-week program, DOH will orchestrate a team of more than 1,000 clinic staff that include volunteers from the Hawaii Medical Reserve Corps, state Department of Defense, Kaiser Permanente, UH Hilo School of Pharmacy, nursing programs at the University of Hawaii at Manoa, Hawaii Pacific University, Kapiolani Community College, Chaminade University, UH Hilo, Kauai County Community College, and UH Maui College.

The U.S. Centers for Disease Control and Prevention (CDC) recommends an annual flu vaccination for everyone six months and older.

“The Stop Flu at School program not only helps to protect the health of Hawaii students, it is an integral part of maintaining the state’s ability to respond to infectious disease emergencies like pandemic influenza,” said Dr. Sarah Park, state epidemiologist.

“Through this program, we are able to work with our many partners to practice and refine our mass vaccination plans.”

For more information about the Stop Flu at School program, go to http://flu.hawaii.gov/sfas.html or call the Aloha United Way information and referral line at 2-1-1. The Stop Flu at School program is an innovative partnership between the State of Hawaii Departments of Health and Education, the Hawaii Association of Independent Schools, and Hawaii Catholic Schools. The program is endorsed by the Hawaii Chapters of the American Academy of Pediatrics and the American Academy of Family Physicians and is made possible through funding received from the CDC and the Hawaii Association of Health Plans.

Department of Health Requesting Voluntary Removal of OxyElite Pro Pending Investigation of Cases of Liver Failure and Acute Hepatitis

The Hawaii State Department of Health (DOH) is alerting local retailers and requesting the voluntary removal from sale of the product OxyElite Pro pending an ongoing investigation of cases of liver failure and acute hepatitis. DOH Food and Drug Branch today began notifying retailers and distributors to voluntarily suspend sales and remove the product from store shelves until further notice. The public is advised to discontinue use of the product at this time.

OxyElite Pro

DOH is currently investigating 29 cases of acute hepatitis and liver failure that have occurred in the state from May through October 2013 and may be related to the use of diet supplements for weight loss and/or muscle building. The cases under investigation include two individuals that have undergone liver transplants and one death.

“Twenty-four cases reported using OxyElite Pro before their illness,” said Dr. Sarah Park, State Epidemiologist. “No other supplement or medication has been identified in common among more than two patients.”

“The department continues to urge people who use dietary or nutritional supplements for weight loss and/or muscle gain to talk with their doctor or health care provider,” said Health Director Loretta Fuddy. “Anyone who develops symptoms such as abdominal pain or discomfort, fatigue, loss of appetite, nausea and /or vomiting, and yellow skin or eyes, should consult their doctor immediately.”

DOH is working closely with the U.S. Food and Drug Administration and Centers for Disease Control and Prevention throughout the ongoing investigation.

 

Department of Health Investigating Dietary/Nutritional Supplement in 10 Cases of Acute Liver Inflamation and Failure

The Hawaii State Department of Health (DOH) is investigating at least 10 cases of acute liver inflammation and failure that have occurred in the state from May through September 2013.  Thus far, the cases have been negative for infectious causes, have no history of engaging in high-risk social activities, and have no identified commonly expected risk factors for liver failure.

Department of Health

The only common finding among all the cases, at this point, is the use of a dietary or nutritional supplement for the purpose of weight loss and/or muscle gain in the past six months. Cases have been reported from every county in the state.

“We are still in the early stages of this investigation and we have not identified the exact source of this condition,” said Dr. Sarah Park, State Epidemiologist. “However, we want to alert the public because of our concern that more people could potentially become ill.”

DOH has issued a statewide Medical Advisory to clinicians, clinics, and emergency departments to facilitate identifying more possible cases. DOH is collaborating closely with the U.S. Centers for Disease Control and Prevention as well as the U.S. Food and Drug Administration, as the investigation may involve a federally regulated supplement with national distribution.

The department urges all persons who use dietary or nutritional supplements for weight loss and/or muscle gain to do so with caution and under their health care providers’ guidance and monitoring. Persons who develop symptoms, such as abdominal pain or discomfort, fatigue, loss of appetite, nausea and/or vomiting, and yellow skin or eyes, should consult their health care provider immediately.

DOH is responsible for monitoring, investigating, preventing, and controlling diseases of public health impact in Hawaii, as well as ensuring the state’s ability to respond to emergencies that threaten the public’s health.

Environmental Protection Agency Awards Hawaii $1.1 Million to Control Polluted Water Runoff

The U.S. Environmental Protection Agency recently awarded the Hawaii Department of Health a $1.1 million grant to implement its Polluted Runoff Control (PRC) Program and to support water quality improvement projects.

“EPA’s grant helps Hawaii reduce harmful stormwater runoff,” said Jared Blumenfeld, EPA’s Regional Administrator for the Pacific Southwest. “Our goal, along with the Department of Health, is to protect coastal waters and coral reefs from the effects of polluted surface water.”

When it rains, water flows downhill from Hawai`i’s high island ridges to the ocean, washing pollutants into the streams and rivers. (Kaaawa Valley, Oahu)

When it rains, water flows downhill from Hawai`i’s high island ridges to the ocean, washing pollutants into the streams and rivers. (Kaaawa Valley, Oahu)

Hawaii DOH will contribute $746,000 in state funds to the EPA grant for a total budget of $1.91 million to implement its state program developed under the authority of Section 319 of the federal Clean Water Act. Grant funds support both state staff and local organizations to develop and implement watershed plans to achieve water quality improvement goals. The funding is specifically for such nonpoint source water pollution control projects and cannot be used for other water pollution discharges or spills like the recent molasses spill into Honolulu Harbor.

This year, the PRC Program will update Hawaii’s State Management Program Plan for addressing polluted runoff over the next five years. The plan will identify strategic priorities, establish both environmental and program goals and milestones, and discuss how partners will be engaged to most effectively to improve water quality.

Recently, Hawaii DOH used Clean Water Act Section 319 funds to address land-based pollution in the West Maui area to protect coral reefs. West Maui is a priority area for the U.S. Coral Reef Task Force and the State of Hawaii Coral Program.

On-the-ground projects are strategically focused in specific watersheds to increase the likelihood of achieving environmental results. Previous competitively selected projects include:

  • Heeia Stream Restoration Project to stabilize eroding stream banks and restore native vegetation along the Heeia stream to reduce nutrient and sediment loads on windward Oahu.
  • Implementation of large scale agricultural management practices to reduce sediment and nutrient runoff in the Honouliuli Stream watershed.
  • A rain garden ‘how-to’ manual and the installation of several rain gardens to demonstrate an effective way to reduce the volume of polluted stormwater runoff in developed areas
  • Installation of fencing in Maui mountain watersheds to reduce the impacts of feral ungulate populations in sensitive watershed areas.

The 1987 amendments to the Clean Water Act established the Section 319 Nonpoint Source Management Program. Section 319 addresses the need for greater federal leadership to help focus state and local nonpoint source efforts. Under Section 319, states, territories and tribes receive grant money to support a wide variety of activities including technical assistance, financial assistance, education, training, technology transfer, restoratioin projects and monitoring efforts to assess progress toward water quality goals. EPA awards annual continuing program grants, based on a national distribution formula, to implement approved state programs.

The EPA’s Pacific Southwest Region (Region 9) administers and enforces federal environmental laws in Arizona, California, Hawaii, Nevada, the Pacific Islands and 148 tribal nations — home to more than 48 million people. The EPA is also a significant source of funding. In 2013, more than 85 percent of the $631 million regional operating budget flowed to state and tribal agencies, local governments, non-profit organizations and private-sector companies in the form of grants and contracts. This funding pays for drinking water and wastewater infrastructure, air pollution reduction programs, Superfund site cleanups and many other activities that protect human health and natural resources.

Federal Officials Conduct Water Sampling Tests on Molasses Spill in Honolulu Harbor

Representatives from the Coast Guard National Strike Force, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration conducted water sampling as part of a joint effort to analyze the effects of the molasses spill in Honolulu Harbor Sunday.

Crewmembers from the Coast Guard National Strike Force head to their first location to use a water quality instrument used to monitor depleted oxygen and pH levels in Honolulu Harbor, Honolulu, Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

Crewmembers from the Coast Guard National Strike Force head to their first location to use a water quality instrument used to monitor depleted oxygen and pH levels in Honolulu Harbor, Honolulu, Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

The combined team departed Coast Guard Station Honolulu Sunday morning aboard a 45-foot Response Boat-Medium. The National Strike Force crewmembers from the Atlantic, Gulf and Pacific Strike Teams used a water quality instrument to monitor depleted oxygen and pH levels at various locations around the harbor that were affected by the spill.

Coast Guard Petty Officer 1st Class James Moore with the National Strike Force Atlantic Strike Team, prepares a water quality instrument used to monitor depleted oxygen and pH levels in the Honolulu Harbor, Honolulu, Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

Coast Guard Petty Officer 1st Class James Moore with the National Strike Force Atlantic Strike Team, prepares a water quality instrument used to monitor depleted oxygen and pH levels in the Honolulu Harbor, Honolulu, Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

The National Strike Force provides highly trained, experienced personnel and specialized equipment to Coast Guard and other federal agencies to facilitate preparedness for and response to oil and hazardous substance pollution incidents in order to protect public health and the environment. The National Strike Force’s area of responsibility covers all Coast Guard Districts and Federal Response Regions.

Coast Guard Petty Officer 1st Class James Moore with the National Strike Force Atlantic Strike Team, handles a water quality instrument used to monitor depleted oxygen and pH levels in the Honolulu Harbor, Honolulu, Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

Coast Guard Petty Officer 1st Class James Moore with the National Strike Force Atlantic Strike Team, handles a water quality instrument used to monitor depleted oxygen and pH levels in the Honolulu Harbor, Honolulu, Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

The National Strike Force team members arrived in Honolulu Saturday after Coast Guard Sector Honolulu received an official request from the Hawaii Department of Health to assist with the response to the molasses spill in Honolulu Harbor, Friday.

The Coast Guard began supporting the response Monday morning when investigators from Sector Honolulu responded to a report of discolored water in the harbor. Since then, the Coast Guard has held daily meetings with the lead State agency, Hawaii Department of Health. Crews from Station Honolulu have conducted daily patrols in the affected area since Monday.

Crewmembers from the Coast Guard National Strike Force discuss data from a water quality instrument used to monitor depleted oxygen and pH levels with a member of the state of Hawaii Department of Health in Honolulu Harbor, Honolulu Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

Crewmembers from the Coast Guard National Strike Force discuss data from a water quality instrument used to monitor depleted oxygen and pH levels with a member of the state of Hawaii Department of Health in Honolulu Harbor, Honolulu Sept. 15, 2013. Personnel from the Coast Guard, U.S. Environmental Protection Agency, U.S. Fish and Wildlife, National Oceanic and Atmospheric Administration tested the water at various locations around Honolulu Harbor affected by the molasses spill. (U.S. Coast Guard photo by Petty Officer 3rd Class Tara Molle)

The request for federal assistance allows the Coast Guard to support the lead agency with a wide variety of resources to include specialized response personnel, boats and equipment from the Coast Guard and other Federal Agencies.

For more information contact the Sector Honolulu public affairs officer, Lt. Kevin Cooper at (808) 286-4675 or the Department of Health Public Information Officer, Janice Okubo at (808) 586-4442.

Coast Guard Supports State of Hawaii’s Response to Honolulu Harbor Molasses Spill

Coast Guard Sector Honolulu received an official request from the Hawaii Department of Health to assist with the response to the molasses spill in Honolulu Harbor Friday.

Molasses Sharks

“The Coast Guard is prepared to bring all the requested resources to this incident to support our state and local partner agencies” said Capt. Shannon Gilreath, captain of the port Honolulu. “We have been working closely with state partners since the spill occurred to offer advice and resources. This official request is the next step in our joint response to this incident.”

The Coast Guard began supporting the response Monday morning when investigators from Sector Honolulu responded to a report of discolored water in the harbor. Since then, the Coast Guard has held daily meetings with the lead State agency, Hawaii Department of Health. Crews from Station Honolulu have conducted daily patrols in the affected area since Monday.

The request for federal assistance allows the Coast Guard to support the lead agency with a wide variety of resources to include specialized response personnel, boats and equipment from the Coast Guard and other Federal Agencies. The captain of the port requested support from the Coast Guard’s National Strike Force for water sampling and monitoring and is currently coordinating with technical specialists from the EPA to help assess additional response mitigation strategies.

The Hawaii Department of Health remains the lead agency for the response. Other agencies involved include the Hawaii Department of Transportation Harbor Police, Hawaii Health Department Clean Water Branch, National Oceanographic and Atmospheric Administration, Environmental Protection Agency, U. S. Fish and Wildlife Service, Hawaii Division of Aquatic Resources, Clean Islands Council and the Hawaii Wildlife Center.

For more information contact the Sector Honolulu public affairs officer, Lt. Kevin Cooper at (808) 286-4675 or the Department of Health Public Information Officer, Janice Okubo at (808) 586-4442.

 

Molasses Spill Closes Keehi Lagoon

Effective today, the state Department of Land and Natural Resources (DLNR) has closed Keehi Lagoon to commercial and recreational ocean activities – including fishing and canoe paddling – for public safety due to impacts of Monday’s molasses spill in nearby Honolulu harbor. Warning signs are being posted by DLNR and the Hawaii Department of Health.

Molasses Sharks

“We are asking the public’s cooperation to keep out these waters for their wellbeing as conditions are unsafe for public activity due to risks of attracting ocean predators, as well as the possibility for contamination due to decayed marine life and bacteria,” said William J. Aila, Jr., DLNR chairperson. “We are working with the Department of Health to post warning signs along the shores of Keehi Lagoon, small boat harbor and west side of Sand Island nearest Keehi channel. Our officers will also patrol the area to warn the public to remain out of these waters until water conditions are safe again.”

The closure will affect two permitted commercial thrillcraft (jet ski) operations in Keehi Lagoon, Aloha Jetski and Diamond Head Parasails and Water Sports. These companies will not be able to continue renting jetskis to clients to use in the lagoon jetski riding area.

“The operators understand the reasons why we are closing them for the time being,” said Aila. “They are able to make a claim to Matson for lost revenues.”

DLNR’s Division of Boating and Ocean Rcreation (DOBOR) is also restricting any recreational use of thrill craft in Keehi Lagoon and the designated riding area off the reef runway. DOBOR staff is reaching out to canoe clubs that launch from Sand Island State Recreation Area, and has also contacted the ILH regarding a planned kayak event scheduled tomorrow at Keehi Lagoon.

 

Department of Health Cites United Solvent Services for Solid Waste Violations

The Hawaii State Department of Health (DOH) has filed a Notice and Finding of Violation and Order against Unitek Solvent Services, Inc. for violations that occurred in 2012 and 2013, at 330 Hukilike St., Kahului, Maui.

Unitek

The incidents involved the operation of an unpermitted solid waste management system that was accepting and processing disposed tires.

During an inspection conducted in February 2013, DOH noted the presence of approximately 10,000 tires at the 15,078 square foot site.

DOH conducted two inspections of the site, one in 2012 and one in 2013. Unitek was warned to cease operating the unpermitted facility in a letter dated May 11, 2012.

DOH imposed a penalty of $10,100 and ordered Unitek Solvent Services, Inc. to cease accepting solid waste and remove all solid waste from the facility. Unitek Solvent Services, Inc. may request a hearing to contest the allegations or order.

The DOH, Solid Waste Section regulates standards governing the design, construction, installation, operation, and maintenance of solid waste disposal, recycling, reclamation, and transfer systems. Such standards are intended to prevent pollution of the drinking water supply or waters of the state; prevent air pollution; prevent the spread of disease and the creation of nuisances; protect the public health and safety; conserve natural resources; and preserve and enhance the beauty and quality of the environment.

 

 

Tomorrow: Free Hepatitis Screenings Available to the Public – National Hepatitis Testing Day

National Hepatitis Testing Day will be observed in Hawaii on Monday, May 20, 2013. In collaboration with Hep Free Hawaii, Hawaii State Department of Health (DOH) clinics and other community-based sites are offering free hepatitis screenings to the public on May 20 to encourage people to find out their hepatitis B and C status. National Hepatitis Testing Day events will also help to raise awareness within communities and remind people with insurance to get tested through their primary care provider.

Hepatitis Testing

“Often called the silent epidemic, most people with hepatitis B or C don’t have symptoms for many years,” stated Health Director Loretta Fuddy, A.C.S.W., M.P.H. “People with hepatitis B and C shouldn’t wait until they feel sick to be tested because there are many things, including treatment, they can do to take care of themselves before they become ill. The earlier people know they have hepatitis, the better the outcome.”

According to DOH Immunization Branch estimates, between 1 and 3 percent of people in Hawaii have hepatitis B, and approximately 23,000 are living with hepatitis C. Hepatitis B and C are the most common known causes of liver cancer in Hawaii, and Hawaii has the highest rate of liver cancer in the United States.

Hepatitis B and C are spread through contact with blood and body fluids. The Centers for Disease Control and Prevention (CDC) recommend that anyone who has been exposed to blood through needle use, blood transfusion, non-sterile equipment, or tattooing should be tested for both hepatitis B and C. Anyone born in a country with high rates of hepatitis B, especially countries in Asia and the Pacific should be screened for hepatitis B. Anyone born from 1945-1965 (“baby boomers”) should also get a one-time test for hepatitis C, regardless of any known risk.

“If you are at risk, you should ask your doctor to get tested for hepatitis B or C. Putting off this simple test now can have dangerous health implications later on, such as liver disease and cancer,” said Fuddy.

Individuals without insurance may call Aloha United Way 211 or go to www.hepfreehawaii.org to find the free screening location nearest them (flyer attached). Not all sites will offer hepatitis B testing. Testing will be based on eligibility and availability at each site.

For more information about National Hepatitis Testing Day, go to www.cdcnpin.org/HTD.

For more information about hepatitis resources and events in Hawaii, go to www.hepfreehawaii.org.

State Temporarily Suspends Tuberculosis (TB) Clearance Requirements Due to Nationwide Shortage of Testing Solution

The Hawaii State Department of Health (DOH) is announcing the state’s temporary suspension of tuberculosis (TB) clearance requirements that are mandated in Hawaii Administrative Rules, Title 11, Chapter 164, for school personnel, students, food handlers, and workers in health care, domiciliary care, daycare, and residential care facilities. Beginning today, the state will not restrict attendance at work or school due to the absence of a TB clearance. The suspension is in response to a nationwide shortage of testing solution required for tuberculin skin testing.

Department of Health“With limited supplies of testing solution available due to nationwide production delays that began late last year, we anticipate people may have some difficulty getting tested for TB at this time,” said Dr. Richard Brostrom, TB Control Branch Chief. “TB clearance requirements will be suspended until further notice, and our state TB clinics will be limiting testing to specific high-risk groups to prioritize and extend current supplies.”

Because of the shortage of Tubersol® and Aplisol® purified protein derivative (PPD) solution, DOH is limiting TB testing available at state clinics to specific high-risk groups until further notice. These groups include:
• Persons with signs and symptoms of active TB disease
• Contacts exposed to an infectious case of TB
• High-risk immigrants referred from the Honolulu Quarantine Station
• Persons with immunodeficiencies
• Persons who require TB screening due to medical treatment

All other individuals seeking a TB clearance are advised to contact their private health care provider or health center.

DOH services related to the evaluation and treatment of persons suspected or confirmed to have active TB disease are not affected by the PPD shortage; these services will continue without change.

Manufacturers of the PPD have been experiencing delays in production since November 2012. It is estimated that adequate supplies of PPD solution will be available several months from now. DOH anticipates the temporary suspension of state TB clearance requirements may be in effect for up to 120 days or until the PPD shortage has ended. Public notice will be issued when the suspension is lifted and a grace period or catch-up date will be announced for individuals whose TB clearance was postponed to meet their requirement.

Hospitals and medical providers in Hawaii have received detailed recommendations from DOH on steps to take during the PPD shortage. For more information on tuberculosis or TB testing, the public may call the Hawaii TB Control Program at (808) 832-5731 or go to www.hawaii.gov/health/tb.

The DOH TB Control Branch provides effective prevention, detection, treatment, and educational services to reduce the incidence of TB in Hawaii. Program activities include diagnosis, treatment, case investigation, preventive therapy for persons at high risk, and direct testing services. Each year, DOH conducts roughly 50,000 tuberculosis skin tests, and provides treatment to approximately 120 individuals identified with TB.

 

 

Department of Health Clean Air Branch Issues Notices of Violations and Orders Against 5 Local Companies

The Hawaii State Department of Health (DOH) Clean Air Branch has issued Notices of Violations and Orders against: Huapala Senior Care, R.H.S. Lee, Inc.; Island Commodities Corporation; Road and Highway Builders, LLC; and Kalealoa Partners, L.P. for air permit and pollution violations. The violations were either self-reported, or discovered during an inspection or records review.

Department of Health

The DOH Clean Air Branch (CAB) protects the people and environment of Hawaii by monitoring air quality and regulating businesses that release pollutants into the air.

CAB reviews and approves air permits, evaluates and enforces state and federal air standards, conducts inspections, and investigates reported incidents related to outdoor air quality.

Through the air permit process, the DOH ensures companies comply with state and federal emission standards to minimize air pollution impacts on the public.

In general, penalties are assessed on violators to remove any economic benefit they may have gained from their noncompliance and put them in a worse situation than those who comply with the law.

All fines are paid into a revolving special fund used to prevent or minimize damage to the environment.

Parties have the right to request a hearing to contest DOH orders.

The following companies were cited:

1. Huapala Senior Care (Huapala), for visible fugitive dust generated without reasonable precautions being taken on February 11, 2012. Huapala is building a care home facility at 2649 Huapala Street, Oahu and a penalty of $2,500 has been paid for the violation

2. R.H.S. Lee, Inc., for failing to conduct a 2001 performance test on their crushing and screening plants. RHS Lee operates a 250 ton per hour Extec impact crushing plant and a 280 ton per hour screening plant at various locations on Oahu.  A penalty of $3,100 has been paid for the violation.

3. Island Commodities Corporation (ICC), for various air permit violations discovered during an annual inspect ion conducted on July 20, 2012. ICC operates a meat rendering plant located at 91-269 Olai Street, Campbell Industrial Park, Oahu.  A penalty of $3,500 has been assessedfor the violations and a consent order is being negotiated.

4. Road and Highway Builders, LLC (RHB), for failing to take reasonable precautions to control fugitive dust from their asphalt plant on June 6, 2012.   RHB operates a 400 ton per hour portable drum mix asphalt plant in Campbell Industrial Park, Oahu.  The violation was discovered by DOH staff during an unrelated surveillance near the facility and a penalty of $4,800 has been paid for the violation.

5. Kalaeloa Partners, L.P. (KP), for exceeding their particulate matter 3-hour rolling average permit limit of 80 pounds per hour. On May 11, 2012, KP conducted their test on the combustion turbine #1 and the particulate matter 3-hour rolling average was 93 pounds per hour.  The exceedence was self-reported and a penalty of $2,900 has been paid for the violation

Department of Health Clean Air Branch Issues Notices of Violations and Orders Against 16 Companies for Air Permit and Pollution Violations

The Hawaii State Department of Health (DOH) Clean Air Branch (CAB) has issued Notices of Violations and Orders against 16 companies for air permit and pollution violations. The companies were cited between April and November 2012 for violations that occurred between March 2011 and May 2012. The violations were either self-reported or discovered during an inspection or records review by the DOH. A total of $79,700 in penalties was imposed. To date, $63,700 in fines has been paid, with the balance of penalties under negotiation or pending payment.

Department of Health

The DOH Clean Air Branch (CAB) protects the people and environment of Hawaii by monitoring air quality and regulating businesses that release pollutants into the air. The CAB reviews and approves air permits, evaluates and enforces state and federal air standards, conducts inspections, and investigates reported incidents related to outdoor air quality. Through the air permit process, the DOH ensures companies comply with state and federal emission standards to minimize air pollution impacts on the public.

Many of the companies cited have already paid monetary fines for their violations, and several companies are currently negotiating a consent order for their fine. In general, penalties are assessed on violators to remove any economic benefit they may have gained from their noncompliance and put them in a worse situation than those who comply with the law. All fines are paid into a revolving special fund used to prevent or minimize damage to the environment. Parties have the right to request a hearing to contest DOH orders.

The following companies were cited:

• Up to Date Cleaners Kauai, Inc. located in Koloa, Kauai, for operating a dry cleaning machine without a valid air permit. The violation was discovered during a DOH inspection and a penalty of $3,900 has been paid.

• Tesoro Hawaii Corporation located in Campbell Industrial Park, Oahu, for failing to conduct a 2011 relative accuracy test audit on the cogeneration unit gas turbine nitrogen oxides continuous emissions monitoring system. Tesoro is a crude oil distillation facility with a capacity of 95,000 barrels per day. The violation was discovered during a DOH records review and a penalty of $2,200 has been paid.

• Edwin Deluz Trucking and Gravel, LLC, for failing to conduct the 2010 annual performance tests on its diesel engine generator and on its 750 TPH stone quarrying plant located at the Kapoaula Quarry, Hamakua, Island of Hawaii. The violations were discovered during a DOH annual inspection and a penalty of $8,000 was assessed. A consent order for $5,000 is being drafted for the fine after additional information was given to the DOH regarding the violations.

• Hawaii Electric Light Company, Inc. (HELCO), for exceeding the ammonia 3-hour average emission limit in March 2011 on combustion turbine generator unit CT-4. Also, combustion turbine generator units CT-4 and CT-5 exceeded its visible emission limits in April and November 2011. HELCO is an electric utility and the violations were self-reported. A penalty of $25,600 has been paid for the violations and a consent order is being drafted for an additional fine of $8,000.

• Grace Pacific Corporation, for failing an October 2011 particulate matter performance test on its 186 TPH asphalt plant located at Eleele, Kauai. The violation was self-reported and a penalty of $4,000 was paid.

• Koga Engineering & Construction, Inc., for failing to submit the January to June 2011 semi-annual report within 60 days after the end of the semi-annual calendar period. The report was submitted 142 days late. Koga operates a 400 TPH powerscreen on the island of Hawaii. A penalty of $2,400 has been paid.

• American Hauling, LLC, for various air permit violations discovered during an annual DOH inspection. American Hauling operates a crushing and screening plant in Waialua, Oahu. A penalty of $7,000 has been assessed for the violations and a partial payment of $3,500 has been received. A consent order is being drafted for additional violations.

• Michael Lurvey dba Carbon Diversion, Inc., for various air permit violations discovered during an annual DOH inspection. The company operates a 1,500-pound flash carbonization reactor in the Campbell Industrial Park on Oahu. A penalty of $3,400 has been paid.

• Garden Island Mortuary, Ltd., for submitting its semi-annual monitoring reports late. The mortuary operates two 100-pound/hour crematory units in Lawai, Kauai. The violation was discovered during a DOH inspection. A penalty of $1,700 has been paid.

• Hawaii Pacific Health, Wilcox Memorial Hospital, for exceeding its 12-month limit of diesel fuel oil consumption. The violation was discovered during a DOH inspection of the hospital’s diesel engine, boilers and pathological waste incinerator. The hospital is located in Lihue, Kauai, and a penalty of $1,200 has been paid.

• ShredCo, LLC, for submitting its semi-annual monitoring reports late. ShredCo operates a tub grinder and power screen in Kaumualii, Kauai, and paid a penalty of $1,500.

• Twin Bridge Farms LLC, for open burning of cardboard in Waialua, Oahu. The fire was investigated by the Honolulu Fire Department on Feb. 21, 2012, and the company has paid a penalty of $2,300.

• Aloha Petroleum, Ltd., for late submittal of a source performance test report. Aloha Petroleum operates a gasoline terminal in Honolulu, Oahu, and the violation was discovered during a DOH records review. A penalty of $2,100 has been paid.

• Ameron Hawaii, for not conducting monthly visible emissions observations on various baghouses at Kapaa Quarry, Oahu. The violations were discovered during an annual DOH inspection of the facility, and a penalty of $5,200 has been paid for the violations.

• Halo Halo, Hawaii, LLC dba Al Phillips Dry Cleaners, for various air permit violations on its petroleum dry cleaning facility located in Kailua, Oahu. A penalty of $7,100 has been assessed for the violations and a partial payment of $2,600 has been received. A payment plan has been negotiated for remaining penalty amount.

• Tradewinds Forest Products, LLC, for late submittal of various reports required by its air permit. The company has a boiler and veneer dryer in Ookala, Island of Hawaii, and a penalty of $1,600 has been paid for the violations.

Hawaii State Department of Health Confirms State’s First Flu-Related Child Death

The Hawaii State Department of Health (DOH) has confirmed the state’s first flu-related pediatric death during the current flu season. The individual was a four-year-old female who passed away in a Honolulu hospital on Jan. 20, 2013.

Department of Health

“This is an uncommon and tragic death,” said Dr. Sarah Park, state epidemiologist. “Not every child will become this seriously ill from the flu; however, it is a wake-up call for everyone to protect themselves and their loved ones against the flu. The flu vaccine is still the best method of protection and recommended for everyone six months of age and older.”

Flu activity in Hawaii is still considered low when compared with mainland states. Information on where to get a flu vaccination is available at http://www.flu.hawaii.gov/VaccineLocator.html or by calling 2-1-1. It is recommended that people call ahead to make appointments for vaccination as late season demand has affected vaccine availability. Other methods for reducing the spread of flu include: washing hands often with soap and water, covering coughs and sneezes, and staying at home when you are sick. For more information on the flu go to: http://flu.hawaii.gov/

The seasonal flu is one of many illnesses that are prevented through vaccination. Vaccinating each child born in the United States in a given year following the current childhood immunization schedule could prevent approximately 42,000 deaths and 20 million cases of disease.

 

Department of Health to Hold Statewide Meetings to Discuss Mental Health Services

The Hawaii State Department of Health (DOH) Adult Mental Health Division (AMHD) is conducting a series of community focus group meetings to solicit input from communities and stakeholders statewide about AMHD services for adults with severe and persistent mental illness. Information gathered at the meetings will be used for developing plans for 2013 and beyond. The meetings are open to the public and will be held in every county from Jan. 9 through Feb. 20, 2013.

Department of Health

“Gathering input from community members about the mental health system in each county plays a critical role in the state’s planning process for improving services,” said Health Director Loretta J. Fuddy. “These sessions offer an important venue for the public to provide their thoughts and insights about mental health services where they live and work. We invite and encourage all community members to participate in these focus groups.”

Schedule of statewide meetings:

Maui (Wailuku), Jan. 9, 2013, 10 – 11:30 a.m., Cameron Center Auditorium, 95 Mahalani St., Wailuku, HI 96793

Hawaii (Hilo), Jan. 16, 2013, 10 – 11:30 a.m., Environmental Health Building Conference Room, 1582 Kamehameha Ave., Hilo 96720Page 2 DOH Holds Statewide Meetings to Discuss Mental Health Services

  • Oahu (Honolulu), Jan. 25, 2013, 9:30 – 11:30 a.m., Lanakila Health Center Conference Room, 1700 Lanakila Ave., Honolulu, HI 96817
  • Hawaii (Kona), Jan. 28, 2013, 10 – 11:30 a.m., West Hawaii Civic Center Conference Room, 75-5044 Ane Keohokalole, Kailua-Kona, HI 96740
  • Oahu (Leeward), Jan. 29, 2013, 2 – 3:30 p.m., Waipahu Aloha Clubhouse Conference Room, 94-091 Waipio Pt. Access Rd., Waipahu, HI 96797
  • Kauai (Lihue), Jan. 31, 2013, 2 – 3:30 p.m., Kauai District Health Office Conference Room, 3040 Umi St., Lihue, HI 96766
  • Lanai, Feb. 15, 2013, 10 – 11:30 a.m., Hale Kupono O Lanai Elderly Conference Room, Lanai City, HI 96763 (Tentative)
  • Molokai, Feb. 20, 2013, 10 – 11:30 a.m., Office of Hawaiian Affairs Conference Room, Kulana Oiwi Complex, Bldg. D., 600 Maunaloa Hwy., Kalamaula, HI 96748

Registration is not required. If accommodations for hearing or visual impairments are requested, please contact Ms. Judith Clarke at the Adult Mental Health Division (808) 586-4686.

 

Hawaii Releases New Data on Fatal and Non-Fatal Injuries Occurring in Hawai‘i

The Hawai‘i State Department of Health (DOH) and the state’s Injury Prevention Advisory Committee are releasing the most comprehensive data available on fatal and non-fatal injuries in Hawai‘i since 2006.

Click to see plan

The report, “Injuries in Hawai‘i 2007-2011,” includes detailed statistics by county and is being released in conjunction with the state’s five-year plan to reduce and prevent the most prevalent and serious injuries occurring in Hawai‘i. These highest areas of concern for Hawai‘i include: drowning, falls, poisoning, suicide, traffic accidents, and violence and abuse.

The report provides an extensive analysis of the major causes, mechanisms and outcomes of injuries in the state including detailed descriptions of their impact in each of the counties. “Compiling and evaluating this data is a huge undertaking for our injury prevention staff and well worth the effort,” said Health Director Loretta Fuddy. “The report is invaluable for charting the course to prevent injuries that are a major cause of death and hospitalization in Hawai‘i.”

Injuries take the lives of more Hawai‘i residents ages 1-39 years than all other causes of death combined, including heart disease, stroke and cancer, according to the newly released data. Among residents of all ages, injuries are the third leading cause of death, with the greatest contribution coming from suicides, falls, drug poisonings, motor vehicle crashes, and ocean drownings. During an average week in Hawai‘i, 12 residents die from an injury, 115 more are hospitalized, and another 1,530 are treated in emergency departments.

“The report included two new DOH data sources from the Hawai‘i Emergency Medical Services Information System and the State Trauma Registry,” said Dr. Linda Rosen, chief of the Emergency Medical Services and Injury Prevention System Branch. “The addition of this new data makes this year’s report the most comprehensive we have ever released and takes us another step closer to understanding and preventing sometimes fatal and often serious injuries.”

The report contains both good and bad news for the islands. “Hawai‘i residents have lower per capita rates of fatal and nonfatal injuries compared to residents of other states,” said

Daniel Galanis, DOH injury prevention epidemiologist and author of the report. “We’re also glad to see that there was a significantly decreasing trend in the number of residents killed in car crashes; however, we are concerned about the increasing trends in the number of residents who died by suicide or drug poisonings.”

To address injury as a critical public health concern, the DOH worked closely with the Injury Prevention Advisory Committee (IPAC) and other state, county and community partners on the “Hawai‘i Injury Prevention Plan 2012-2017.” IPAC is a statewide network of representatives from various fields and organizations working together since 1990 to prevent injuries. Developed with the consensus of these partners, the new prevention plan makes clear recommendations for each of the leading causes of injury in Hawai‘i. Building on the accomplishment of the previous five-year plan, recommendations are based on Hawai‘i-specific data and the most effective safety practices in the injury field.

“The next steps included for each of the injury areas in the plan provide a stimulus for organizations, agencies and community groups to collaborate on actions to take in preventing injuries,” said Bruce McEwan, chair of the Injury Prevention Advisory Committee,

For a copy of the “Injuries in Hawai‘i 2007-2011” and the “Hawai‘i Injury Prevention Plan 2012-2017”, visit the DOH web site at www.hawaii.gov/health.

In Hawaii, Someone Dies by Suicide Every Other Day – National Survivors of Suicide Day

In observance of the 13th Annual National Survivors of Suicide Day, the Hawai‘i State Department of Health in conjunction with the American Foundation for Suicide Prevention will present the “Prevent Suicide: Survivors, Provider and Community Partners In-Action Hawai‘i Conference 2012,” on Wednesday, November 14, from 8:30 a.m. to 4:30 p.m. at the Elks Lodge in Honolulu, located in Kapi‘olani Park. Each November, survivors of suicide loss come together at healing conferences in their communities nationwide for support and guidance.

In Hawai`i, this year’s conference is being held to acknowledge the grief that survivors experience and to provide hope and assistance for them in an atmosphere of support and healing. The conference will also address the community need for education and information among service and health care providers, school personnel and professional caregivers. Sessions will be offered on survivor debriefing, healing through the arts, and strategic planning for suicide prevention in Hawai‘i. This year’s conference themes are hope (man‘olana), help (kokua), and healing (ho‘ola).

Conference keynote speakers include Dr. Kamana‘opono Crabbe, Chief Executive Officer of Office of Hawaiian Affairs; Dr. David Brown, Regional Director, Behavioral Health, Pacific Regional Medical Command, Tripler Army Medical Center; and Dr. Ishmael Stagner, Program Specialist at Alu Like.

In addition to the DOH Injury Prevention and Control Program and the Child and Adolescent Mental Health Division, conference sponsors include Hawai‘i Suicide Prevention, Education, Awareness, and Research (SPEAR); and Queen Liliuokalani Children’s Center.

The conference will be enhanced by an Awareness Walk in Kapi‘olani Park at 5 p.m. and an Aloha Reception at 6:30 p.m. at Elks Lodge. Both events will be held on November 14, the same day as the conference. For registration information for the conference, walk and reception, contact Pua Kaninau-Santos at (808) 271-8582 or kkanina@qlcc.org

One million people die by suicide every year in the United States. In Hawai‘i, someone dies by suicide every other day. These individuals leave behind countless family members and friends to make sense of the tragedy. Survivors often experience a wide range of grief reactions, including anger, shock, and symptoms of depression and guilt.

Kupuna Fall Prevention Awareness Week Activities Begin September 22

The Hawai‘i State Department of Health (DOH) Emergency Medical Services and Injury Prevention Systems Branch and the Hawai‘i Fall Prevention Consortium, in collaboration with The Queen’s Medical Center, FOODLAND Supermarkets, MINA Pharmacies, TIMES Supermarkets, and KTA Superstores, are sponsoring Kupuna Fall Prevention Awareness Week activities from September 22 to 30, 2012. The week coincides with National Fall Prevention Awareness Day on September 22, established by Congress.

“On average, every five hours in Hawai‘i a senior suffers a fall injury so serious he or she must be hospitalized,” said Director of Health Loretta Fuddy. “Fall prevention is a major concern for the safety and well-being of our beloved kupuna, the fastest growing segment of our population.” Falls and fall-related injuries impact individuals, families, the community at large, and the health care system. Fall incidents increase dramatically in the years after age 65, and those who have fallen once are much more likely to fall again. Every year in Hawai‘i, an average of 108 kupuna die, 1,840 are hospitalized and 5,715 are treated in emergency departments due to falls, resulting in almost $118 million in hospital and physician charges. Adding the costs of rehabilitation and nursing care can double that amount.

“We are very excited about the commitment to senior well-being exhibited by our partners: The Queen’s Medical Center, FOODLAND Supermarkets, MINA Pharmacies, TIMES Supermarkets, and KTA Superstores,” said Dr. Linda Rosen, Chief of Emergency Medical Services and the Injury Prevention Systems Branch. “By conducting free in-store reviews of seniors’ medications, pharmacists will be providing a much-needed and valued service that can help prevent serious and tragic accidents.”

Throughout the week, partnering pharmacies will be offering free medication reviews, and “Fall Prevention Tips for Seniors” bag-stuffers will be distributed statewide by participating stores. Sponsor newsletters will also include fall prevention stories and tips, and magnets with fall prevention messages will be available.

On September 22 at the Athletic/Wellness Fair at Sangha Hall (Hilo Hongwanji Mission), free physical screening of kupuna to assess their risk for falling will be provided by Hawai‘i County Fire Department volunteers and Fall Prevention Consortium members.

Beginning September 24, in-store pharmacists at participating stores statewide will conduct free medication reviews, by appointment, for kupuna to check for medicines that could cause or contribute to a fall.

From September 28 to 30, free physical screenings will also be provided by Fall Prevention Consortium members and Queen’s Hospital volunteers at the Seniors’ Fair Good Life Expo at Blaisdell Exhibition Hall in Honolulu.

Kupuna fall prevention tips include exercising regularly to increase balance and flexibility, having your doctor or pharmacist review medications yearly, having eyes checked annually, and making the home safer by removing fall hazards, installing safety devices like railings and grab bars, and improving lighting.

For more information about fall prevention for kupuna, contact the DOH fall prevention coordinator at (808) 733-9202.