Hawaii Legislature passes bills addressing workforce issues

The Legislature passed three bills addressing healthcare workforce issues this session.

Addressing the Provider Shortage

Two of the bills target the provider shortage. Senate Bill 2298 allows APRNs, pharmacists, and physicians who act as preceptors in volunteer-based supervised clinicals to receive income tax credits.

Preceptors will receive a tax credit of $1,000 per volunteer-based supervised clinical training rotation, up to $5,000 a year.

The bill received support from the Board of Nursing, the Board of Pharmacy, and the University of Hawaii System.

Carolyn Ma, the Dean of the Daniel K. Inouye College of Pharmacy at UH Hilo also testified in support of the bill:

“Over the last four years, two major required experiential rotations (ambulatory care, hospital acute care) have experienced respectively, a 41% and 90% decrease in ambulatory care and hospital, preceptor offerings. We have supported these significant decrease trends by:

• Decreasing class size
• Eliminating certain types of clinical rotations
• Hiring as many Pharmacy Practice faculty as our budget allows

Given the degree of responsibilities our non-compensated preceptors have from their own employers, without some incentive or compensation such as this tax credit, we will continue to see declining volunteer offerings. This will lead to an increasing inability for our students to fulfill their graduation requirements, as well as a need to continue decreasing class size.”

The bill passed the Senate unanimously and passed the House with only Representative Choy voting no.

Senate Bill 2653 also addresses the provider shortage.

The bill establishes a path for the Hawaii Medical Board to license physicians, surgeons, and osteopathic physicians by endorsement if the provider holds an active license in a jurisdiction with similar qualifications. The provider also must have actively practiced medicine for at least two of the last five years.

The bill hopes establishing the licensure by endorsement will provide greater access to care, and allow applications from out-of-state physicians to be processed in a more streamlined manner.

In testimony Ahlani Quiogue, the Executive Officer of the Hawaii Medical Board, explained that from January 2016 to December 2017, the board received over 1,000 applications from physicians who are licensed in other jurisdictions.

The Hawaii Medical Association also supported the measure, highlighting the provider shortage across the state.

“The HMA is in support of SB 2653, which establishes a system for licensure by endorsement for physicians, surgeons and osteopathic physicians. Licensure by endorsement provides an efficient, safe and expedient process by which these healthcare providers from out of state may become licensed in Hawaii while preventing physicians with any disciplinary action in another state from accessing this process.

The University of Hawaii’s Physician Workforce Assessment found Oahu needs 381 physicians, up from 339 last year, while the Big Island is short 196 providers, compared with the 183 needed last year. Maui County has a deficit of 139, up from 125, while Kauai needs 53 doctors, down from 62.

Primary care providers are the largest group in short supply, followed by infectious disease specialists on Oahu and Kauai, colorectal surgeons on the Big Island and geriatric doctors in Maui County. Hawaii is facing a critical shortage of healthcare providers in nearly every field of practice. This shortfall is projected to worsen with the increased demand for health care from an aging population and the retirement of an aging physician population creating access issues on Oahu and the neighbor islands. The shortfall impacts the ability of our communities to access needed healthcare in a timely fashion.

Additionally, another barrier to access to care is the limitation placed on physicians seeking to relocate to Hawaii to practice by the requirements of obtaining a license to practice in the state, many of whom are fully qualified and licensed in another jurisdiction. Implementing a process to license out-of-state physicians by endorsement enables the Hawaii Board of Medical Examiners to recognize the qualifications and licensed status of another state and reduces the burden and time constraints of relicensing.”

The bill passed the Senate unanimously. In the House Representative Choy voted against the bill.

Improving Workplace Safety

The House addressed workplace safety in House Bill 1906, which makes intentionally causing bodily injury to certain healthcare workers a Class C felony. The class of healthcare workers does not include social workers, security officers, orderlies, or administrators.

In Hawaii, a Class C felony is punishable by up to five years imprisonment and a fine of up to $10,000.

Kaiser Permanente Hawaii, Queen’s Health Systems and HMSA all testified in support of the bill, often citing rising rates of assault on healthcare workers.

The Healthcare Association of Hawaii also testified in support:

“Currently, healthcare workers in the emergency room are protected under law, but all other healthcare workers are not. We are seeking parity for all workers through this legislation.

There are rising rates of assault and violence against healthcare workers in Hawaii. A survey of HAH members found that, in 2017, there were 1,175 incidents of assault against workers, a record number. This included assaults that occurred in hospitals, nursing homes, and against home health workers who entered a patient’s residence. In 39% of those cases, the local police department was contacted. (In the other set of cases, the facility’s security handled the matter.)

It is well-documented that all healthcare workers face high rates of violence on the job. According to the Bureau of Labor Statistics, the rates of nonfatal workplace violence against healthcare workers are from 5-12 times higher than for workers overall. The rate of nonfatal workplace violence against all workers was 2.8 incidents per 10,000 workers. For hospital workers, the rate was 14.7 incidents per 10,000 workers and for nursing and residential workers the rate was an astonishing 35.3 incidents per 10,000 workers.”

However, the Office of the Public Defender strongly opposed the bill, arguing that enhanced penalties will not prevent assaults.

“Enhanced penalties for assaults committed upon health care workers will not have a concomitant effect on their safety. The assumption that enhanced penalties will deter individuals from harming a certain class of individuals is false. Most citizens do not follow legislative action and do not give pause to possible penalties when acting out of situational emotion and anger nor when acting out because of stress or mental health issues.”

The bill passed out of the House unanimously and passed the Senate with only Senator Karl Rhoads voting no.