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HomeMy WebLinkAboutMIN CRCOC 2023/09/05 (2022-2024) Committee on Communications, Reports, and Council Oversight 13th Session Hawaii County Building 25 Aupuni Street Hilo, Hawaii September 5, 2023 CALL TO The regular meeting of the Committee on Communications, Reports, and ORDER: Council Oversight was called to order at 1:31 p.m., in the Council Chambers, Hilo, by Ms. Rebecca Villegas, Chair. ROLL CALL: Present: Ms. Rebecca Villegas, Chair Ms. Jenn Kagiwada, Vice Chair Ms. Cindy Evans, Member(came in later) Ms. Michelle M. Galimba, Member Mr. Holeka Goro Inaba, Member Mr. Matt Kaneali`i-Kleinfelder, Member Ms. Ashley L. Kierkiewicz, Member Ms. Heather L. Kimball, Member Ms. Susan L. K. Lee Loy, Member STATEMENTS The Chair directed the Committee to proceed to the next order of business, FROM THE Statements from the Public on Agenda Items. PUBLIC ON AGENDA ITEMS: The following individuals registered to speak and came forward when called by the Chair: Toby Hazel Comm. 399, comment. (representing elders) Dr. Federick A. Nita MD INC Comm. 399, comment. Lori A. Thal Comm. 410, comment. Vicky Robbie Comm. 410, comment. CHR. VILLEGAS: We're going to take things a little bit out of order today, at the request of Director Mansour. Mr. Clerk, can we go ahead and read in Communication 400. CRCOC-13 September 5,2023 Change Order As directed by the Chair and with no objection from the Council of Business: Members, the following items were taken out of order: Comm. 400: REQUESTS A PRESENTATION BY CONSULTING FIRM AECOM REGARDING THE PUNA WASTEWATER FACILITY PLAN AND THE PAHOA WASTEWATER FEASIBILITY STUDY From Environmental Management Director Ramzi Mansour, dated August 10, 2023. Motion to Close File: Ms. Lee Loy moved to close file on Comm. 400. Seconded by Ms. Kimball. (Note: Comm. 400.1, from Environmental Management Director Ramzi Mansour dated August 29, 2023, transmitting a presentation to Comm. 400, was circulated.) CHR. VILLEGAS: And with that I will go ahead and give the floor to Director Mansour. And just as a quick reminder today, we have four presentations. So we are hoping to keep us within our time allotments that were requested for the different presentations, and for this one it was a request of a 30-minute presentation with questions to follow. Thank you. (Note: At this time, Director Ramzi Mansour came forward to address the members of the Committee.) MR. MANSOUR: Good afternoon, thank you, Madam Chair and committee members. Today we're here before you to present to you the Puna, Pahoa wastewater feasibility study. The study was done in accordance to EDA (Economic Development Administration) funding that money was secured by Council Member Kierkiewicz. And we were able to enter into an agreement with AECOM, and they did the study. Introduce Ray, she can introduce her staff and go through the reports, since we only got 30 minutes. I just want to give kudos to my environmental planner as well, Kelly Hartman she was the lead on this proj ect. MS. LIU: I'm Ray Liu. I've got to say that I'm born and raised in Hilo. I'm with AECOM (Architecture, Engineering, Construction, Operations, and Management). I'm a Civil Engineer, and I have two engineers with me today; Bob Stallings and Adrienne Fung in case I cannot answer the question (laughter). We gave you some handouts: one is the PowerPoint itself and this is the QR Code; if you scan it, you'll be able to get to the draft reports for both Pahoa and Puna. More detailed than you probably could ever ask for. Page 2 CRCOC-13 September 5,2023 (Note: At this time, Civil Engineer Ray Liu provided a PowerPoint presentation to the members of the Committee. For viewing of the presentation, see the DVD copy of the proceedings on file in the Clerk's Office, or online at http://hawaiicounty.granicus.com. A copy of the presentation is made part of the record, see Comm. 400.1.) MS. LIU: I'm sorry I went so fast, but any feedback, questions, thoughts, feelings? CHR. VILLEGAS: That was wonderful. Thank you for recapping a document that is full of so much information for us. And with that, I'll open it up to comments from my colleagues. Go ahead, Council Member Kierkiewicz. MS. KIERKIEWICZ: Thank you, Chair Villegas. Thank you, Director Mansour, Ray Liu, and your team. I really appreciate all this really great information coming forth. I know that we secured the grant back during the Kim administration, and thanks your leadership and really the hard work on your team's part. We are able to come to this place and have a lot of really great information to make decisions. Wow, this is going to cost a lot of money. For me it really comes down to the affordability, right. I know that there needs to be some kind of solution that's put forward because of the social and environmental impact, but the cost of living in Hawaii is so outrageous. And to factor in one more bill, we're pricing people out of paradise at this point. I'm really curious around, if at all, what sort of exploration of innovative technologies, other approaches were considered in developing this report. I know a lot of us had met with folks at Vie, but I wondered if there was anything else happening nationally to look at innovative technologies that are currently being funded by state or federal partners? MS. LIU: Not that I know of, but the stuff that we reviewed is in the report. MS. KIERKIEWICZ: Okay. MS. LIU: Yeah, including Vie's I think, right? Yeah. MR. MANSOUR: That is correct. So as they were doing the study, we've tried to lift every rock and look underneath it,possibilities. So, they were challenged. MS. KIERKIEWICZ: Would they fall under an individualized wastewater system? MR. MANSOUR: Yes. MS. KIERKIEWICZ: Okay. Page 3 CRCOC-13 September 5,2023 MS. LIU: Yeah. I think, you know, it comes down to cost again. We have got to get better cost for individual wastewater systems definitely, right, because it's the lowest cost of all of these alternatives. If we can make it work, and if there's something innovative or something like that out there, let's go for it, right. So yeah, we need to keep researching that. MR. MANSOUR: In addition to that we have been working with the Department of Health, through the Cisco conversion committee when we were trying to finalize the report. So we looked at every technology that exists approved by the Department of Health under the NSF 40. So we have been looking at different models, even for IWS's (Individual Wastewater System) to be able to extract nitrogen on phosphorus out of it before it goes to the ground water. The challenge here is we out priced ourselves in a waste treatment plan, Puna is the size of Oahu. To come back after the city is being built to build the system, it's going to be very costly. That's why it's a challenge, it is not affordable, it's very pricey. MS. KIERKIEWICZ: Has your department considered or are you folks considering doing some kind of request for information, to see if we might be able to invite folks that have burgeoning new technologies to come forth and share that with us? MR. MANSOUR: We could, we have been working very closely with Vie and other entities, and we could have him come here and present to you as well. MS. KIERKIEWICZ: Okay. Any thoughts around maybe doing a pilot project? MR. MANSOUR: That's probably a subject we're going—let me back up a little bit. This study is going to be a portion of the entire wastewater integrated management plan. We have another consultant that's putting that together with the cesspool conversion master plan for the whole island. So with that, study is going to look at all possibilities from financial, from private, verses public entities and how we can merge them together if we can. And look at our current laws we have, like the Kona decisions and others and navigate a way forward for our constituents. MS. KIERKIEWICZ: Director, remind me again. When did you say that larger plan was going to be completed? Because what I'm hearing you say is this report for Puna is just one piece of a larger puzzle, where we might be able to identify synergies between different communities and kind of leverage that buying power when it comes to identifying cost effective solutions. MR. MANSOUR: We executed that agreement with Carollo Engineering, and they start the work on it. We anticipate probably to have a draft of the cesspool conversion sometime in the spring of next year. But then to—waste management plan is going to be contingent on South Kohala and PuakO with AECOM is Page 4 CRCOC-13 September 5,2023 working on. And I think, Ray, is your masterplan 2026 for Puako and South Kohala. MS. LIU: Oh no, we're going to finish next year. MR. MANSOUR: So if they finish them next year, the whole idea is to get the two consultants to make sure that within a year and a half or two we should have all the road maps that we need for cesspool conversion, integrated waste management plan, facility plans, and all that is being worked on as we speak. MS. LIU: And I guess each plan will be presented to the County Council, so I'll be back to do South Kohala. MR. MANSOUR: You're right, we're trying find synergy and we're trying to find a more efficient way to connect the dots. Even though we so decentralized in our communities, if we could capture innovation and new technologies that we can implement somewhere. Carollo is working on a pilot program as well, we're trying figure out a decentralized system that could provide services to small communities, because we are looking at a cumulative flow. When Ray was talking about 8.5 MGD, that's eight and half million gallons per day, is percolating into our ground water. So, there's a lot of challenges comes in to play as we move forward or are we going to go with it. If we outpriced ourself in a prior instance, should we continue outpricing ourselves or should we start looking at different ways to do business. MS. KIERKIEWICZ: Just a few more questions. How does this plan consider our island's need to be truly resilient in the face of climate change? How do those systems hold up to this new reality? MR. MANSOUR: It's a good question. Depends on the system, right. Right now, the affordable system is IWS (Individual Wastewater System). Because how does it work, given the climate change, given our ground water it's going to be a challenge. The Clean Water Act is very clear about we cannot discharge and that's a cumulative flow. I don't know how it's going to be perceived, but definitely to be resilient we have to get with the technology, and try to have better treatment, environmentally, to our ground water. MS. KIERKIEWICZ: I really appreciate that slide where you mentioned additional revenue sources, and would love for there to be an expansion around the economic benefits, even job creation related to this industry, if you call it that. That way we are able let folks at Hawaii Community College, University of Hawaii know what sort of learning curriculum needs to be instituted. So that folks that are interested in pursuing careers in this industry, can learn right here at home. Page 5 CRCOC-13 September 5,2023 MR. MANSOUR: Just to give you an update, we already started that with the University of Hawaii. MS. KIERKIEWICZ: Beautiful. Brag about it. MR. MANSOUR: We created the position as IWS specialist position, it's going to be at the University grant funded by Vie that is being rolled. MS. KIERKIEWICZ: Excellent. Final question is related to the next step and timeline. So the formality of coming before the Council presenting this report, is there an effort also to go back to the community and present what's been, you know, developed here? MS. LIU: Yeah, we've been through the outreach, and you've helped us so many times. But yeah, this is the final stages sort of like we want to gather as much feedback as we can on this draft final plan, and hopefully finalize around October. MS. KIERKIEWICZ: So there's an evaluation criteria form that you shared with us, is this available online too? I just want to make sure that my constituents have the ability to read the report and weigh in or is this an internal document. MS. LIU: We've talked about not giving that to everybody because it's so complicated, but we did mail it to you. Is that why you have that. MS. KIERKIEWICZ: It was provided to us with the materials today. MS. LIU: Oh, it was. MS. KIERKIEWICZ: Thanks to you. MS. LIU: We'd like your feedback. And we will definitely put that on the site with the QR Code, and get input that way from each of the community. We did send it to the Department of Health, Senna responded, somebody else did too, but yeah, we haven't had good feedback. I think it might be a little complicated, I don't know. MS. KIERKIEWICZ: I mean, I just wonder if you can gamify this somehow. No, I'm being serious. A lot of times really complex information can be better explained through some sort of interactive game. I just want to offer; you folks have taken me up on invitations to go the revitalize Puna activations. We have two to three hundred community members attend;they are very active. We have another one planned on October 21st. So again, not quite sure the timeframe for finalizing your report, but just invite you to come, hold that space with us, talk story with folks, let them know what's been learned, and like what the next step is here. Just offer that. Page 6 CRCOC-13 September 5,2023 MS. LIU: Okay. MR. MANSOUR: That's a good idea. MS. KIERKIEWICZ: Thank you. MS. LIU: I guess the thing that kind of bothers me is the prioritization needs to be done island-wide. Like we can come out with the best one for Puna, best one for Pahoa, but it still needs to be weighed island-wide. So we're sort of like in the beginnings of that process to like pull it all together. But yeah, getting it out at revitalize Puna, I think that would be great. Thank you. MS. KIERKIEWICZ: I mean, I agree with you, right. Like I do think, we need to start that conversation and educate residents around. This may be your preferred solution for your community, but how does that fit in the larger grand scheme of things for the entire island, right. How do we suffer a little, so that no community has to suffer a lot. MS. LIU: Right, okay. Got it, thank you. MS. KIERKIEWICZ: Okay, alright. Thank you so much, brilliant work you guys. Thank you. Chair, I yield. CHR. VILLEGAS: Thank you, Council Member Kierkiewicz. Council Member Kaneali`i—KIeinfelder. MR. KANEALI`I—KLEINFELDER: Thank you, Chair. Thank you very much for the report, well done. Remember speaking with you folks months back, kind of wondering where everything sat, and here it is. So, thank you. Speaking to the evaluation piece, you're asking for feedback on your evaluation strategy. Yeah, Council Member Kierkiewicz touched on it, more the environmental impact and things that we're looking at for the move to sewer in our entire area and at an extraordinary cost. What I'm looking at as far as evaluation areas that would drive me to want to do a project of this size would be high density areas, town center ships or town centers that are evolving, growing. So you're starting to pipe two areas that are becoming town centers. That would be an evaluation piece in my mind. As well as current areas of concern. I remember sitting in the vie presentation on zoom and they had a slide that went by, and I don't have it, but they actually showed where they're starting to see bacteria inundating well water. And those would be high areas of concern for me because that's where our sewer system, whatever it may be; individual wastewater systems, on sight disposal, cesspool, septic, it is starting to leach into our ground water that people are drinking from the wells. Page 7 CRCOC-13 September 5,2023 MS. LIU: Was that in Puna? MR. KANEALI`I—KLEINFELDER: That was in Puna. That was presented in their presentation to the community that they did and that was the Vie group. MS. LIU: Yeah. I'll follow up, because we checked with the Department of Water Supply and they have not seen any contamination so far, but it must be someplace else. MR. KANEALI`I—KLEINFELDER: It might be that private wells that they're getting these from. MS. LIU: Okay, I'll check. MR. KANEALI`I—KLEINFELDER: I thought was really interesting when you're starting to see human bacteria in well water, because that really does drive us towards taking care of that area. We seem to be more makai of Highway 130, so the lower portion of Puna. Because everything does drain eventually downhill, yeah. MS. LIU: To the ocean, right, yeah. MR. KANEALI`I—KLEINFELDER: Yeah. So that's my evaluation, thoughts, and then all of that in mind with kind of cost comparisons and return on investment, which you kind of touched upon. Something I threw at your team early on was comparing this all to the cost of providing everyone in Puna a check to put in their own private septic system to remove their cesspool. And if we couple that with the grants from the state, which they've already begun doing, you may be able to alleviate some of the more distant reaches of this treatment facility plan and still get the environmental protection that we're trying to provide to the community. And then lastly, the QR Code was a really nice piece. I liked that a lot. We were in discussion a long time ago at Council and it was something about QR Codes. But they're so easy to use, you just use your camera, and it gives you the link, and then you have the whole MS. LIU: You'd be surprised. We sent it to a legislator, and they didn't know what to do with it, so. Not county, state. MR. KANEALI`I—KLEINFELDER: Okay. I think one question I wanted to ask, and this is kind of what you gave us. The maps that you have, are they—let me regroup my brain. You provided us the alternatives; six and seven were urban sewered and full flow sewered. What's the difference between those two? Page 8 CRCOC-13 September 5,2023 MS. LIU: So urban is just the denser, so less than or equal to one acre for residential, and commercial, and industrial, sort of like town areas. And flow sewered is everybody. So, largely the larger lots also are sewered with the 8 MGD, yeah. MR. KANEALI`I—KLEINFELDER: Okay. And that would all come back to Hilo, would be the plan for six and seven? MS. LIU: That's the particular alternative. MR. KANEALI`I—KLEINFELDER: What is the capacity of the Hilo treatment facility, and where they at right now? MS. LIU: It would have to be improved. MR. MANSOUR: Right. Currently Hilo is permitted around six MGD's designs for peak flow 13 and a half MGD. Currently, we've taken about 2.8 million gallons per day, so we're at half capacity currently. So the intent if that option ever works, we need to add more component to expand the treatment, but it still would be cheaper than building a whole facility. MR. KANEALI`I—KLEINFELDER: Alright one more time, so currently 2.8 million gallons per day? MR. MANSOUR: Yes. MR. KANEALI`I—KLEINFELDER: And then at full capacity five? MR. MANSOUR: It's about six, 5.8 if I remember. MR. KANEALI`I—KLEINFELDER: Potential for 13? MR. MANSOUR: Peak flow at 13 and a half. MR. KANEALI`I—KLEINFELDER: I know, then I'll yield Chair. But if current wastewater from Puna right now came to Hilo, then would we max out Hilo's capacity? MR. MANSOUR: If you're going to connect them all, yes. We're looking at gradual connections, not all at once. MR. KANEALI`I—KLEINFELDER: Okay. Thank you. Well done on the report, thank you very much. MS. LIU: Thank you. Page 9 CRCOC-13 September 5,2023 MR. KANEALI`I—KLEINFELDER: Yup. I'll circle back, thank you. CHR. VILLEGAS: Thank you, Council Member Kaneali`i—Kleinfelder. Council Member Kimball. MS. KIMBALL: Yeah, thank you, Chair. And thank you for this really excellent and detailed report, I really appreciate it. I wanted to make sure just to be crystal clear on the two graphs that had the gap between the cost and affordability with the affordability measures being 101 on the top and 122 respectively. When you say it's the gap, the subsequent lines that is not the difference between it, it is what the actual payment would be, right? MS. LIU: Yes. MS. KIMBALL: I just want to make sure that there's clarity. So we're not adding it to MS. LIU: No. MS. KIMBALL: Okay, very clear. The other question I had was, you know, Ramsey you and I've talked before about the calculations of million gallons a day per household, and how the currents are standard from DOH (Department of Health) is probably much higher than what it's actually produced on a household level. How do you think that would play into some of these estimations for the capacity? MR. MANSOUR: Yeah, we did work on that, because we're using the City and County standards. The County of Hawaii, we don't have our own standards. But I think with I&I(Infiltration and Inflow), you could still lower down the flow rate. I don't know if there were any adjustments, Robert. MS. KIMBALL: Yes, please. In order to get it on record it will be helpful. (Note: At this time, Solid Waste Superintendent Robert Diego came forward to address the members of the Committee.) MR. DIEGO: Yes, there was some need for I&I removal in Hilo in order to fit the Puna flow in. But the alternatives were priced up assuming that we will put a flow equalization facility at the Hilo plant to kind of dampen out the kinks. So that you would discharge a constant rate of sewage to the outfall, matching the outfall capacity of 13.5. So that's how the Puna flows were accommodated. The treatment also was being upgraded; it wasn't just equalization. We also had cost estimates in there for the additional capacity, building more tanks. Page 10 CRCOC-13 September 5,2023 MS. KIMBALL: Okay, so my question was more along the lines of given that we're using the City and County of Honolulu's mechanism for calculating flow rates which by some estimations or an over estimation of what is actually produced here, is that accounted for or is it just flat out that, okay, there's a shaking of the head in the back, so. MR. DIEGO: Yes, so if you use the county rates, they're conservative, so you should have extra leftover because the county rates are conservative. The plumbing fixtures they make now days use a lot less gallons per flush, so the standards were developed way back when they use to have a big tank on everybody's MS. KIMBALL: To my colleagues, that's something I think we should take into account for a later decision making is a better estimate of what the gallons per day might be. You know, particularly we are looking at west side stuff where its drier anyway, people are using less water. In some of the calculations, we're looking at almost double the estimate of flow rate. And so we have to build a bigger facility than what we actually need based on that. The other question I had for the consultant, is this the level of granularity on this sufficient, you know, looking at in an even smaller scale, smaller resolutions within these two geographies. You know, would it be a good investment to spend time like that to say okay, this is a better area for decentralization, this is better for individual wastewater systems or is the granularity you have here you think that's enough? MS. LIU: I don't think it's enough. MR. DIEGO: No, it's a good starting point. But if you had an area, you really needed sewers, you need to go out and get soils, information; we use USGS (United States Geological Survey) data. You need to get a utility study to find out where the roads are, we just used GIS (Geographic Information System) data. MS. LIU: I think we need better granularity on the potential growth and development in each of those neighborhood communities. I mean, I understand the concept, you know, that they're going to have,but then that's a whole lot of different locations in all of Puna. MS. KIMBALL: Yeah, that was going to be one of my other recommendations as part of the evaluation process, determining how many undeveloped lots currently exist in the area. Because it's going to be a lot easier for us to hook up people that are not already using a cesspool, than the ones that do have a cesspool and now we've got to get them to convert. I would use that as an evaluation criteria. Additionally, and I'm not sure if it's the scope of this project; the larger integrated study, but one of the challenges that I think we face is that people are used to Page 11 CRCOC-13 September 5,2023 paying nothing for wastewater. And yet if you have a cesspool, there is an impact on the reef, on the water quality, on what not. And should we be looking at some sort of fee associated with not converting. I mean, I don't know if that's appropriate here, but it's something I think there's discussion we do need to reflect to our communities that there's a true cost in not addressing the wastewater problem which is not reflected right now. Then finally, I'll make a point for Council Member Kaneali`i—Kleinfelder. I think this is the number that you're looking for to just give everybody a check to convert, it's about$3 billion on the last page. Alright. Thank you, I yield. CHR. VILLEGAS: Alright. Thank you, Council Member Kimball. Council Member Lee Loy. MS. LEE LOY: Thank you, Chair. I think I'm just going to send this conversation in a whole different direction, but I had to reflect a little bit on what Council Member Kimball talked about through cost. And some of these alternatives put it all back in Keaukaha, and I got a community who's over it. They're done carrying everybody's waste. And so when I look at your evaluation criteria and the alternatives, absolutely, I think what's missing in some of this is the historical carrying capacity of a community who's done doing it already. We're absolutely done. So when we talk about growth, and expansion, and where that all is going to go, people need to learn their lesson that they got to carry their own kuleana in their own spaces. While people in Puna went for years without infrastructure, our community here in Hilo carried it for them. And so now, to Ms. Kimball's point,people need to recognize what the true cost has been over the years. So if you're going to write checks, the first check should go to the community that has carried our waste; both solid and waste water for the last 45 years. So as we all reflect back on our communities and what's best for our communities, everybody's got to carry this, everybody. So that's my thoughts. Welcome you guys down into Keaukaha to give a presentation to the homestead and get it full blast from them. We meet every third Wednesdays of the month, come on down. That's where I stand, thank you, I yield. CHR. VILLEGAS: Thank you, Council Member Lee Loy. Anyone else? MS. EVANS: Chair? CHR. VILLEGAS: Oh, yes, thank you. Go ahead, Council Member Evans in Kona. MS. EVANS: So when I was looking at your evaluation criteria and listened that you were hoping to get some input on that, and when I look at your environmental and permitting, I would like to see that expanded a little bit more on Page 12 CRCOC-13 September 5,2023 environmental impact. Usually when you do an EIS, you look at what other alternatives to doing whatever proposal you have. Not quite sure where you landed on your final proposal on what you would pick as the solution. But I wanted to comment that while we're planning and evaluating, there are people in the community that take the cesspool issue so to heart that they are converting as we continue to plan. I don't want to get us into analysis paralysis, but I do think we're doing a lot of planning. I love the information. I think it's really important, it will probably help with whatever we do with the federal agencies and the state agencies to show that we've done a really good job of identifying what the problem is. And we're showing them all the stuff that I know we're going to need to have those conversations with them. But I'm not sure this leads us to getting a quicker solution as we continue to talk it out. So, my bigger question would be how much money are we spending on doing all this analysis? And if we had a grant and gave each person right now $25,000 to $35,000 per household right now, would we get our cesspool really quickly instead of spending more and more money on continuing to hire people to evaluate this? It must be pretty costly to do these types of planning and evaluations, and we still have people that need to get off of cesspool. I would rather see us, if it was me, I'd rather see money dumped into a fund and giving it to people to get off cesspool. But the other comment is I see your evaluation, I would love to see a really, really, indebt evaluation of individual wastewater systems and needs to centralize treatment plans as just the focus as you move forward and pick something that really dig deep on it. That would be where I put my time and energy, but that's me. That's how I would see a way forward. And then lastly, I'm going to say, you know, I have a community that has really got problems with cesspools, it's impacting the health of the coral reef. They're really trying to find answers. In the meantime, people are taking it upon themselves to get off of cesspools onto these specialized air rated systems, because they're trying to be environmentally conscious. But they're not waiting, they're continuing to do things because they feel so guilty about their stuff going out and harming the reef. And so I think while we're talking, we have a lot of community people that are stepping up, I just want to acknowledge them. But what concerns me is the risk factor of not only being in a lava zone. The reality is they're in a tsunami zone. And so, you know, we're having people do these things, trying to do the right thing, and yet they're still vulnerable and at risk. If you do your evaluation criteria, I would throw something into future risk of potentially, you know, all this good work could end up basically being washed out, so to speak or covered over with lava, so to speak. So, there's a lot of risks that people are taking. And should we put the money in a big sewage wastewater treatment plant that might be in harm's way, or should we up right now that people have and get them off cesspools. I would just assume+ get them off cesspools asap, and I'm Page 13 CRCOC-13 September 5,2023 just worried that we're spending way too much time trying to analyze the problem and not fixing the problem. Thank you, I yield. CHR. VILLEGAS: Thank you, Council Member Evans. Anyone else? Council Member Galimba. MS. GALIMBA: Thank you. I guess I wanted to just ask about your calculations on county-wide monthly cost. So I just want to understand what you used to sort that—what does county-wide mean, was it every household in the county as like one number? MS. LIU: You're talking about these numbers? MS. GALIMBA: Yes. MS. LIU: Yeah, so it's the rate payers across the county. MS. GALIMBA: So the rate payers who are already on or MS. LIU: Paying to the county for wastewater services. So basically MS. GALIMBA: Current or projected? MR. MANSOUR: Currently the people that are connected to the waste treatment plan pay their monthly rate of about$45 dollars a month. So the projection of that study if you connect more people it's going to spread. And that's where the dollars are for the people that will be connected, not for everybody in the county. MS. GALIMBA: Okay. That would be everybody that's currently on plus whatever that particular system would be bringing on. And it's not necessarily including a Puako you know, we got a system there, et cetera, et cetera. MS. LIU: Right, yeah. MR. MANSOUR: We charge our wastewater treatment as a system. So, not per district or area. So, we spread it all over the sewer connection, I mean sewer services. So they only got one rate for everybody within the island, they pay the same rates. MS. GALIMBA: I see. What is that right now, is it like MR. MANSOUR: I think it's about$48 dollars. And we currently sign a contract with a consultant to re-evaluate, we're due for a new study so they're doing the rate study. The rate study was done based on the actual cost for service, which only includes operation and maintenance, but it doesn't include any capital Page 14 CRCOC-13 September 5,2023 improvement. And yet, we don't have connections fees and we never had a connection fee. We're probably the only county that doesn't charge connection fees, so we need to look at that and revisit that as well. MS. GALIMBA: Okay. Yeah, I don't really have any other criteria. I think my colleagues brought up some really good points, and I think if anything it would just be around the granularity potentially. Because I mean, different communities are going to have different costs and maybe there should be some incentive disincentive there for some communities to carry more of their own kuleana rather than the whole county. And there's probably arguments on both sides of that, but I think there is some merit, because it's such a big island with so many different kinds of situations as far as wastewater. So, that would be my only thought. Thanks, it's an amazing amount of information. Thank you. CHR. VILLEGAS: Thank you, Council Member Galimba. Council Member Kagiwada. MS. KAGIWADA: Just a couple quick things, so I understand this. So the timeframe of the growth that you mentioned; the 12,000, the 18,000, and the 51,000 to 80,000, what's the timeframe on that? MS. LIU: Thirty years. MS. KAGIWADA: Thirty years, okay. And Director, what are we currently doing when people build a new home? What do we have them do; they're not building cesspools, right? MR. MANSOUR: That's a tough question. The Department of Health; the entity that issues the permits for the septic, not the county. If they are within county sewer service area, let's say within the Hilo treatment plant, if it comes across our desk and there is a nearby sewer line, then they need to connect. If they are not, then the Department of Health is probably going to issue a permit for them to put in a septic. MS. KAGIWADA: To put in the individual wastewater system? MR. MANSOUR: Yes. MS. KAGIWADA: Okay. And are there different levels and types of individual wastewater systems? I understood there's some that, you know, do more with treatment within the individual wastewater systems. MR. MANSOUR: There is, there are multiple technologies that have already been approved. The ATU, which is Aerobic Treatment Units, and that's usually recommended for priority number one or two, if you're near shoreline. But does Page 15 CRCOC-13 September 5,2023 it work better than septic? Yes, it does, it gives you a better treatment level conventional septic tanks which is your standard leech fields. The leech field itself over the years has been modified to be able to extract more nitrogen and phosphorus out of it. Because what the treatment is targeting is the nitrogen amount making it into the drinking water, because eventually that could create a blue syndrome baby, and it's proven through the CDC (Centers for Disease Control). You know, multiple cities and the country has that happen to them, the blue baby syndromes. So there's a limit on the nitrogen that, you know, Department of Health and—would like to keep. The individual septic tanks, they are not monitored. MS. KAGIWADA: Okay. That was going to be my question, was what level and we're looking at projected costs here, what level of individual septic tanks are we talking about here? Are we talking about just like the basic what we are proving currently, or are we looking at cost for MR. MANSOUR: I think these are based on the basic conventional septic tank, because it's priority number three. So my understanding is they use the conventional standard septic tanks. MS. KAGIWADA: Okay, so there's a lower level of requirements, because they're in level three? MR. MANSOUR: It's not the level requirement, it's approved by the Department of Health. It meets compliance for conversion. MS. KAGIWADA: Okay. Alright, thank you. Yeah, I love the idea, I mean I don't love it because people don't want it. But people currently have cesspools of considering, you know, people, and I am one of them, being charged a fee. Because we need that money to figure out ways to convert everybody off of cesspools. So whatever that's going to be, whether it's paying into a fund that eventually they could use to help convert off of cesspools themselves, or paying into a fund that's used on a larger scale for the county to do something about the issue. I think it makes a lot of sense that everybody in the community is paying some fair share for making sure that we deal with this issue. So, looking at that I think would be great. Thank you, I yield. CHR. VILLEGAS: Thank you, Council Member Kagiwada. Council Member Matt. MR. KANEALI`I—KLEINFELDER: Thank you. Ramzi, what's the possibility of us getting grants, because we mentioned 80 percent grant? I mean, what is the possibility? The sale of this app and we go for the most expensive project, what is your take on us getting a grant for this? Page 16 CRCOC-13 September 5,2023 MR. MANSOUR: This is a high dollar figure. The likelihood of getting a grant is probably zero to none, but most of the grants we deal with are small numbers. So this has to be funded in more creative ways, and just get into billion-dollar grants. MR. KANEALI`I—KLEINFELDER: Thank you. I was just wondering. Then, any thought given to privatization of not making this county at all, and just making this private industry sewer systems throughout the areas we're looking at? And then again, this is specific this is the Puna wastewater study, right? Yeah, and Pahoa being part of Puna, okay. MR. MANSOUR: Yes, I spoke to Hawaii Water, I've been there talking to them about creative waste. The challenge we have even with privatization, nobody's going to come in with the capital and not get the return of investment if there's no enforcement. So they're going to come and put your treatment plan and collection if you cannot enforce connection and be able to get off their septic and connect it's a losing option. MR. KANEALI`I—KLEINFELDER: Our laws that we have relate to people having to connect to county sewer systems when in "x" amount of feet of their parcel. We've discussed that on the floor, right. Does the same thing apply to private systems? MR. MANSOUR: It's probably the same thing will apply; they cannot force individuals to connect to the system unless the laws are changed. MR. KANEALI`I—KLEINFELDER: Okay. And then Ms. Kimball pointed out an estimated cost breakdown, I think is what is IWS, Individual Wastewater System, on the back of the presentation. I was looking at this, but it seems off. This is the 2052 projected IWS cost along with cluster treatment plans. I looked at this, I thought this was information. Slide 34, this wasn't in the nice plastic booklet we just got, this was in the one we had already. It just breaks down I think the projected or estimated cost of IWS and 22 decentralized treatment plants. I just want to point out if we're looking at this, this is the year 2052, the estimated number of wastewater treatment. Sorry, if you're going to speak you got to be on the mic. MS. LIU: okay, so it's the 30,000 quantity, times 60,000. MR. DIEGO: Right. The 60,000 is in 2023 dollars, the quantity is 2052. So as you execute these things each one would have to be engineered individually and priced individually. This is just a budget estimate for comparing the alternatives, but every one of those 30,000 people would need to get their own engineer, and make their own plans, and get a contractor to build it. So, the number you see there is a budgetary number. Page 17 CRCOC-13 September 5,2023 MR. KANEALI`I—KLEINFELDER: Okay. I think this slide needs a little bit of work. I would throw in, please give us the current number, not the estimated number. As far as I know, anyone going forward has to put in a septic system, you can't put in cesspools anymore, so 2053 shouldn't have more people on septic systems, should be what we have now or minus. MR. DIEGO: Right. And the reason we did that is to make it apples to apples with the sewering alternatives, because the sewering alternatives were out to the year 2052. MR. KANEALI`I—KLEINFELDER: Okay. MS. LN: So you just want something that shows current cost versus the 2052. MR. KANEALI`I—KLEINFELDER: Yeah, the current cost of that price. I'm guessing that's going to be really, really low compared to everything else. But this slide just threw me off, because I'm looking at the dates, the total, the quantity per unit, the whole thing kind of threw me off a little bit. MS. LIU: Okay, got it. MR. KANEALI`I—KLEINFELDER: Thank you. I yield, Chair. CHR. VILLEGAS: Thank you, Mr. Kaneali`i—Kleinfelder. And with that unless anyone has anything else, I'll just quickly wrap us up here. Wow, what a project to have to undertake and a scope of work to embrace. Unfortunately, to me it's not great news. And it kind of breaks things down fairly black and whitish is like this would be a massive project that would take very extenuating circumstances for the resources to be available to not only do this project, but for those that live in this district to even afford it. I guess, my concerns having been looking at and I'll admit selfishly, I live in Kona, I represent Kona, and we have a priority one zone which is off Kahaluu area on Alii Drive. And I believe Puako is the other priority one and Hilo Bay is the other priority one. So just in my own mind, I've been focusing on those areas and those capacities because they are priority one, and they are going right into the ocean right now. I really appreciate Council Woman Lee Loy's comment about Keaukaha. Pau(no longer) already, and the wastewater treatment facility there, and the people there. They're at capacity, and they're over it, and they're not going to take anymore. Those are environmental racism issues and there are a lot of environmental justice issues surrounding that. Also, the state of the Hilo wastewater treatment facility while being improved, still has a long way to go in order to feasibly take in massive amounts from the Puna and Pahoa area. Page 18 CRCOC-13 September 5,2023 And I also appreciate my counterpart, Ms. Evans,pointing out I just can't help but question the wisdom of putting in facilities like this in areas where not so long ago the roads opened up and lava came forth. And so this kind of money in an area that is so volatile and vulnerable, and we don't know the next time for that. There's opportunity, and now is the time for all us to recognize our own personal kuleana and how we handle our kukai. And moving forward, I'm really grateful for the different science and technology we have out there that's providing opportunities to transition the ways that we manage our waste, but we have a long way to go and boy the price tag is formidable. Thank you, Director Mansour, for going forward with these studies, which without this kind of information we cannot make the best decision possible, right, based on the information we have. And even this right here makes it pretty clear to me what the real potential of a project like this could be. And as future reports like this come forward looking at the whole island, we'll be able to have a more succinct perspective on what can be done, how it can be done, what it would cost, whether or not everybody pays for it with the different variables. But thank you for putting this together, and wow what a project. Yeah, and with that, I'll go ahead and yield, unless you have anything else. MR. MANSOUR: Thank you so much. CHR. VILLEGAS: Alright, thank you so much. All those in favor of closing file on Communication 400. Vote on Comm. 400: The motion to close file on Comm. 400 was carried Filed by the following voice vote: Ayes: Committee Members Evans, Galimba, Inaba, Kaneali`i—Kleinfelder, Kierkiewicz, Kimball, Lee Loy, and Chair Villegas —8. Noes: None. Absent: Council Member Kagiwada— 1. Excused: None. CHR. VILLEGAS: Mr. Clerk let's go back to the top of the list and start with Communication 399. Return to Order The Chair directed the Committee to return to the order of business. of Business: COMMUNI- The Chair directed the Committee to proceed to the next order of business, CATIONS: Communications. Page 19 CRCOC-13 September 5,2023 Comm. 399: REQUESTS A PRESENTATION BY JOHN UGHARA, MD., ADDRESSING THE CURRENT PHYSICIAN SHORTAGE IN THE COUNTY AND STATE OF HAWAII From Council Member Heather Kimball, dated July 20, 2023. ; and Comm. 399.1: From Council Member Heather Kimball, dated August 22, 2023, transmitting a PowerPoint presentation. Motion to Close File: Ms. Kimball moved to close file on Comm. 399. Seconded by Ms. Lee Loy. CHR. VILLEGAS: I'll go ahead and turn this over to Council Member Kimball. MS. KIMBALL: Thank you, Chair. Thank you, everyone. I wanted to introduce Dr. Uohara, many of you may know him already. Maybe he delivered one of your babies, but he and I had a lengthy conversation at one point in my office about the physician shortage. And as we got deeper into the discussion, I thought okay, this is a sort of conversation we need to have as a body as a whole. And so, I invited him here today to share with you some thoughts, and ultimately some recommendations too about addressing the physician's shortage. So with that I will turn it over to you, Doctor. (Note: At this time, John Uohara, MD., came forward to address the members of the Committee.) MR. UGHARA: Thank you. It's very difficult to follow a wastewater presentation, but here we go. I am very much in awe of what you folks do. You will have no shortage of crisis to handle,people coming forth, tsunamis, tidal waves, lava flows, COVID, opioids, trash on the beach. I'm going to add to that; I'm going to talk a little bit about a physician shortage. My presentation will be quite short because I would like to engage you all in the conversation, rather than just a presentation of facts. (Note: At this time, John Uohara, MD., provided a PowerPoint presentation to the members of the Committee. For viewing of the presentation, see the DVD copy of the proceedings on file in the Clerk's Office, or online at http://hawaiicounty.granicus.com. A copy of the presentation is made part of the record, see Comm. 399.1.) MR. UGHARA: Thank you, I'll take your questions. MS. KIMBALL: Thank you, Dr. Uohara. I think it's you maybe too friendly and congenial to deliver such dire message, but the message is dire isn't it. And the anticipation, expectation from DBED (Department of Business, Economic Page 20 CRCOC-13 September 5,2023 Development and Tourism) is that by 2035, one in four of our population will be over the age of 65. We definitely have an aging population with already a physician shortage. So, I wanted to ask Dr. Uohara to come today just to get us to start brain storming, right. Not all of this is within our kuleana within our jurisdiction, but some of it is, and I think maybe the key one is really when we talk about obtainable housing, right. And our medical care workers, our physicians; those are the folks that we need to make sure can find a place to stay, especially those that were born and raised here and grew up through here. So anyway, want to open it up to my colleagues, but I want to thank you again for being here today. MR. UGHARA: Thank you, I really appreciate it. CHR. VILLEGAS: Thank you, Council Member Kimball. Council Member Lee Loy. MS. LEE LOY: Thanks. Thanks, Dr. Uohara, for being here. I had a couple of questions, and you know, we forgive you that you went to Hilo High School as a Waiakea Warrior grad here. But something you touched upon which I have heard multiple times was the rate of Hilo High graduates who excelled in this profession, not only doctors but attorneys. And there was definitely this offering if you were in high school to come on, we'll put you through school and I recognize that's a little missing now. But the question I had was in your post graduate education, it requires that you do this residency. Where is that rule, is that a requirement only in the State of Hawaii or is that something in every state when you're becoming a doctor? I guess I'm just trying to nail down something, and to my colleague's point, right; they have to stay here, give back to the community, how are we going to provide housing for them. What makes it attractive to come and stay? That was my first question. And then my other question was around the mechanics of a satellite campus. We see a lot of money coming in from our broadband along with some other things coming in from the Federal Government through our National Communications or Telecommunications funding. So, that was my second question. One, where does that residency requirement come from, and then two,just some of the infrastructure needs around a satellite campus. MR. UGHARA: Complicated questions. You don't have to do a residency but to practice medicine and get malpractice insurance, the fewest number of years you need is probably three for family practice. I know that there was one person trying to get insurance and open up a practice with one year—now in the old, old, old days in ancient times, in the beginning, all your required is one year. An internship year, now it's called PG, Post Graduate year one. Almost always, you need to have some training postgraduate. Page 21 CRCOC-13 September 5,2023 MS. LEE LOY: So the more training you had in residency with a doctor fellow, the better your insurance rates get, is that what it is? MR. UGHARA: You won't be able to practice unless you finish at least two or three years. You won't be able to get malpractice insurance. In other words, malpractice insurance carriers will look at your resume and be very questionable like you did one year and that will not be enough. The logistics of a satellite campus are evolving, and then now we don't want to call it—that was my term that I approached the Dean, and we were technically first on the list. Then Maui legislators got involved, and then Mark Zuckerberg came involved, and we're suddenly way down on the list. Some of the tele medicine are with Zoom. My son works for Microsoft, so it'll be Microsoft teams. Some of it would be there, but some of it will be on campus at the Kakaako campus. But hopefully, the third and fourth year will be done almost entirely on that satellite campus area. In other words, if you rotated, if you wanted to do general surgery in your third year you would rotate with a general surgeon. You know the third year is divided into several blocks: OB-GYN (Obstetrician-Gynecologist), Pediatrics, Internal Medicine, Surgery, Psychiatry, and Internal Medicine. And they would pick people for you to be associated with, so that would be your experience. MS. LEE LOY: Thank you. I think, like my colleague mentioned, we can't solve it all here at the County Council but definitely push in on areas that where we can solve. And the idea of having a campus, but not only a campus like a satellite campus, but even a community campus where you would provide the housing for our doctors, our nurses, our firefighters, right. What kind of housing community would look like with them staying there kind of offsetting that cost of living, while they provide this very needed service in community is kind of not a far fetch idea, but just thinking outside the box, right. How do we incentivize those things? MR. UGHARA: I know that the original plan for the satellite campus involved nurse practitioners, pharmacy, and to integrate many different specialties, not only just in physicians. But we wanted these physicians trained to be well aware of the services that were happening and train the whole community and not just physicians. That would be the goal. MS. LEE LOY: Yeah, and to your point earlier about the aging of our population that maybe we should front load with physicians that are paying more attention to our senior and our senior needs. And not trying to be sassy about it,just understanding this is the population and this is the population that we need to serve because we do have a growing senior population. But thanks, Dr. Uohara. Page 22 CRCOC-13 September 5,2023 MR. UGHARA: If I could kind of digress a little bit for OB-GYN. And I keep going back to OB-GYN because we are the first department in JABSOM (John A. Burns School of Medicine), to locate four ob-gyns in Hilo and these are faculty full-fledged faculty members of JABSOM. We did this because we made a requirement to finish a four-year residency program. In your third year and your fourth year, you spend one month in Hilo. I'm so proud of this, you know, faculty chairman and I are very close. And I just lobbied and lobbied and pleaded with him that this island needed it. You understand that this program was located in Maui, and it was there for seven years, and resulted in four physicians locating on Maui who had no connections with Maui. Since we've been here, we have located four physicians who have been through the program to Hawaii County. What's happen to Maui in the interim? If a woman wants to have a baby at Maui Memorial and doesn't want to go to Kaiser, she has no other options, zero. If you want to go to see—like in Hilo or in Kona, you can see Dr. Sira, or you could see Alii Health. The equivalent of Alii Health on Maui is full and taking no new OB (obstetrician)patients, and there are no other private OBs on the island of Maui. And so, I'm surprised that the women in Maui aren't speaking out in outrage that something isn't being done. MS. LEE LOY: Thanks, Dr. Uohara. Like I said,you know, we're always putting our heads together, and trying to think of very unique ways of inviting different talent to the Big Island. Thanks, Chair, I yield. CHR. VILLEGAS: Thank you, Council Member Lee Loy. Anyone else? Mr. Kaneali`i–Kleinfelder. MR. KANEALI`I–KLEINFELDER: Thank you. Thank you for coming in today and breaking this down for us, making it somewhat digestible. Actually, you came in three or four years ago, if I remember correctly, with a couple of young ladies and you spoke on behalf of a non-profit that was working on getting more people to come in, correct? MR. UGHARA: Yes. MR. KANEALI`I–KLEINFELDER: Okay, that was wonderful. I remember you from that. I was making sure you were the same guy. MR. UGHARA: Yes, sir. MR. KANEALI`I–KLEINFELDER: Okay, I like that. That seemed like it was a successful program from my memory, yeah? Okay. You laid it out for us. You came with a problem and solution which I liked, thank you. Maybe not all of them County, but at least we get the scope. My question for you kind of goes back to what Mr. Nitta said, and I've heard that from other physicians again, and Page 23 CRCOC-13 September 5,2023 again, and again. Can you just briefly kind of summarize what he was saying? Because he was upset, and I think rightly so. I've heard the same thing from other physicians, and when I hear that from a number of different people who are educated, been through the process, understand the system, and I think it plays a large role in why we see the number of physicians here on the island that we have. Can you just kind of summarize that, like a nice little pocket? MR. UGHARA: Thank you for asking that question, I think it is going to open up a can of worms. Let me explain how the new physician who is in private practice opening up his office, you now need to be pretty much capitated. In other words, HMSA (Hawaii Medical Service Association) will give you so many dollars per month that you take care of an individual. And you will share a bonus if you keep up your parameters, in other words, for women it makes sure if they're age appropriate, had their HPV (Human papillomavirus) shot, had their mammogram, etc., and then you will be rewarded on the tail end. If you deliver a baby out of network, and it won't be the case in Hilo, you will be docked. So, it's called a payment transformation system that has pretty much taken the wind out of the sails for anybody in solo practice. The incentive is to join a group. And the two big groups, I should say three. Queens Medical Systems; not medical center but medical systems, Hawaii Pacific Health; it includes Kapiolani Women's and Children's, Pali Momi, and Straub, and the last giant is Kaiser. Now the new physician comes out now after training, he doesn't want to go and get a loan from the bank after being in debt$250,000. He or she wants to just work for somebody. And I think that's what happened in Maui, and what's happening here. I disagree with Fred, there are a lot of challenges to recruiting physicians here, there's giant, giant. A new physician wanting to open up in let's say, we were talking about Puna wastewater, everywhere in that area is going to be pretty much having to deal with Medicaid patients. Reimbursements are very low, there is nothing we can do about that but that's going to be your patient profile. And the few HMSA patients; Medicare, Medicaid, and a very few HMSA patients, and those are going to be capitated rate. So to make your overhead, I know several physicians who just couldn't make it, they just couldn't make it. The overhead of paying their employees a decent salary, paying for rent on a place to your shingles, pay for malpractice. You just can't do it; you can't make the equation work; you have to see so many patients per day. But thanks to medical records it's so complicated and so long in order to get the highest reimbursement, physicians are spending my physician, my internist, who works five days a week. He really works six because on Saturday he does medical records. So it was a system devised to eliminate errors, but the productivity of the physician has gone way down. Translation, we need more physicians to see those patients because we all require medical records to be electronic or the insurance Page 24 CRCOC-13 September 5,2023 won't except paper trails anymore, they have to be electronic; it takes so long to do those. And it takes a certain number of patients to survive, to just pay your overhead. Certain number of patients for the physicians to see. And so it's sort of a circular argument that we can't ever get ahead. I advocated for Hilo to have OB-GYN; a urogynecologist. I'm going to explain that because I don't expect you to know what that is. Women having pelvic floor problems with prolapse, leakage of urine, anything that involves the bladder and the pelvic floor. So we finally got one to rotate over once and twice a week he came, but because the whole department now, and they don't work for the state, they work for HPH (Hawai`i Pacific Health). So if he does surgery at Hilo Medical Center, he's operating out of network, and so the insurance company will dash his payments. So he would likely transport that patient to Kapiolani, same surgery, short stay, do his surgery, and patient has to stay overnight and then come home the next day. That's a product of the insurance creating that situation. We advocated that a gynecologic oncologist, that is somebody who specializes in female cancer surgery, come over. And he comes over once a week, but he takes all his surgeries back to Honolulu instead of operating at Hilo Medical Center for the same reason. MR. KANEALI`I—KLEINFELDER: Why is Hilo considered out of network? MR. UGHARA: Because it doesn't belong to the HPH system. So these large medical systems, not centers but the systems, negotiate with HMSA. And HMSA tells them we will give you a certain number of patients' lives covered, so much money for one year. And if that exceeds, then we'll have to negotiate the next year. But if you deliver out of network, if you have HPH physician that delivers at Queens his reimbursement will get cut. Even if the patient wants to deliver there, and same things for the Queens physicians. Well, we have four HPH physicians located in Hilo, that's Dr. Khozaim, Dr. Stickley, Dr. Adrian, and Dr. Stowers. And we brought in those sub-specialists over, which was a real boom to Hilo. I mean, before we'd have to send them all to Honolulu to be seen. So we got part of the equation done, but to have them operate in Hilo is still going to be another story. Some higher powers in need would have to negotiate with HPH and say, "Hey, that's not fair." It's not fair for the patient. And still, we have too many patients supporting Hawaiian Airlines going to Honolulu for medical care, when really, I don't know if you ever had a personal experience doing that, but almost everyone knows of someone who's had to be transported to Honolulu for care. I think that should be less, and less, and less, and less. MR. KANEALI`I—KLEINFELDER: Is the reimbursement process lengthy from the insurance companies of what Mr. Nitta touched on as well? MR. UGHARA: Yes, especially for a new physician, it may take three months before you're reimbursed for a case which you did. But that shortens, and they Page 25 CRCOC-13 September 5,2023 claim electronic medical records should shorten that, the turnaround time is much shorter. And that's true, but you're submitting fewer cases. It wasn't unusual for any number of us, Dr. Nitta, Dr. Hirata, Dr. Ebesugawa, and myself to see 60 patients in a day. That number is probably down to about 25, and that's working really hard. So the translation is you need more physicians, which makes the problem worse. The longer wait times, et cetera. We need more docs, you know. But I must say, I'm very proud of our department because looking at the statistics that JABSOM has presented to the legislature for our Department of OB-GYN, for that specialty on this island we are still down. We still need more, but much less than family medicine,primary care doctors, internal medicine, pediatricians, etcetera, etcetera, etcetera. MR. KANEALI`I—KLEINFELDER: Thank you, thank you, thank you. I don't want to get too down into it, but I heard this a number of times. And I like having it right here on the record because people can see this and understand where we sit and why. So, thank you very much for your time. MR. UGHARA: Thank you. I really appreciate the opportunity. I'm just very, very, thankful. MR. KANEALI`I—KLEINFELDER: Thank you. I yield, Chair. MS. VILLEGAS: Thank you, Council Member Kaneali`i—Kleinfelder. Council Member Kierkiewicz. MS. KIERKIEWICZ: Thank you, Chair. Hi, Doc, great to see you. Thank you so much for the presentation. Council Chair Kimball talks about your very gentle compassionate demeanor, but we certainly understand the gravity of the situation and the urgency. Thank you for breaking it down,not just the problem but also potential solutions. And thank you so much for your hard work, and your advocacy, and for keeping on, keeping on. MR. UGHARA: And for being from Hilo High School. MS. KIERKIEWICZ: That's okay. I mean, I'm from Saint Jo cardinals but it's all in Hilo. So right on, we're all on the same team. No, but really just thank you for your advocacy. I had a couple of questions, so my primary medical home is Kaiser, not by choice. I'll share that with you, my partner has insurance and decided we're going to go that route and it has its pros and cons. Many of the physicians there are not from Hawaii Island or Hawaii. And there's a lot of cycling in and out of physicians. And one thing that I just wanted to highlight it and I'm curious about your thoughts on this because it wasn't noted in some of the things that you mentioned to be an issue. But with physicians cycling in and out, are you finding that it's hard for them to integrate into the community, Page 26 CRCOC-13 September 5,2023 are there issues with their families' making connections with other families in the community? Are there issues with schools or a lack of activities? I'm just wondering if folks decide to choose Hawaii Island as the place to practice, how do we ensure that they are able to root here and stay here. MR. UGHARA: Wow, that's a very insightful observation. I applaud you for being able to see through, it's not about money, it's not about this. I used to joke that Kona used to have a revolving door for OB-GYN's, because that's my specialty, you know, we share patients going across island. I wouldn't know who they were after a while because they're gone. What about Dr. so and so, oh they're gone. You're absolutely correct. And that's why I believe a rotation during the training during residency on this island is essential. So in other words, you know what you're getting into. We have advocated for the longest time and a health center on the other side of the island I met with and didn't know how to go about getting residents to their medical center. And so I had to explain to them, they have to become they have to apply; fill out some paperwork. We have to take these certain things from the university about women's rights, and dos and don'ts, and sexual harassment. So you have to do all those categories. They didn't know how to go about getting a resident to rotate there. You need to be clinical faculty and I had to explain that to them. And so that evening, I had to pull somebody from Hawaii residency to that person and say, "Here talk to this person get your physicians to be clinical faculty so they can rotate." They're not looking to come for vacation,they're looking to come for experiences. And I think living in a community for a month gives you a pretty good idea. And that's why I'm really happy that our program rotates one third- year resident for a month, and then they come back for another month; their senior year. So they can really have an experience of what is the Big Island. And you're absolutely correct, we used to say the physicians are happy, their partners are not so much. And I think also high on that agenda you already hit at that, and I think you already know that, is the educational system. We don't have a Punahou, we don't have an `Iolani, we don't have Mid-Pacific here on the island. Maybe we have HPA (Hawai`i Preparatory Academy) there, but it is difficult to convince them. So far, the physicians that we've recruited have been very happy; the latest one has been here two years, everyone else has been six, four, and three. And they've been happy. And I think the large part is that they had an opportunity to really come and visit the islands on weekends; go see Kohala, go see Ka`u, go see Kona. You know, I think that is a large part. I think housing is very expensive here, yes, no question. But if any of you have ever looked at Honolulu prices, and they're willing to work for groups, and get paid, and still afford real estate there. So I believe it's pretty much what your expectations and what you want for you, and in most cases your Page 27 CRCOC-13 September 5,2023 family. Thanks for seeing through that, and you probably have your own personal experience with the Kaiser system there. MS. KIERKIEWICZ: Thank you for that. You know, you touched on physicians visiting other communities. I'm curious if you had thoughts around how we can sort of buildup health eco systems in the various rural communities around Hawaii Island. It's such a commute say for a resident of Puna or Ka`u to go to the nearest doctor. I mean, there are medical clinic's through Hawaii Pacific Community Health Center and other clinics, but I just wonder what's needed to buildup that health care infrastructure so that medical and health care is closer to home. What's really required if you could break that down. The top five things that we should know and do, in order to help make that happen by 2030. MR. UGHARA: Actually, it's places like Puna that have finally they have listened to the distance to Kona. The distance and actual time to commute that they've had to redo the number of physicians needed, because the commute is much, much longer. I guess in Honolulu if you get stuck in traffic it's long also, but the distance is also a part of the equation. It's really interesting. I've also belonged to another non-profit called Hui Kahu Malama. We're not applying for a non-profit grant, so I'm not in conflict there. And we are also members of Maika`i Health, which is a rural health clinic. And a rural health clinic has its own special designation that's different than a FQHC, Federally Qualified Health Center, plan at which Hamakua Health is and also West Hawaii Health, it's a FQHC. You have in Ka`u a rural health clinic, which is a very similar designation. Maika`i Health is in the process of trying to get enough grants and donations to open up a major clinic in Shipman. It's a nice piece of property there, I think Mazie Hirano was the one who designated some monies to have some studies, et cetera done, but the thought is there. Yeah, because the distance is too far. MS. KIERKIEWICZ: Yeah. You know I also wonder if going forward as we think about the strain on, you know, you mentioned EMS (Emergency Medical Services) the commute from say Seaview, Kalapana all the way to Hilo, that's a really long drive. So I just wonder if these clinics and health care centers can also be served as places where folks might be able to be seen, rather than going to the emergency room. Just a thought to explore. MR. UGHARA: Exactly, it's the vision to have at least an urgent care and it to be a huge campus. And much more than one or two physicians, but at least an urgent care there because the needs are—it's very interesting when this group was looking to find the locale, there was a talk of gosh we could have it on University of Hawaii Hilo campus. And they were interested, there was land available, and one huge donor said no, absolutely not, you have enough in Hilo. He didn't want it out there and I said, "Wow, that's great, it moves is more towards the center.". You see large medical center health plans, Queen's (The Queen's Medical Center) Page 28 CRCOC-13 September 5,2023 and HPH (Hawai`i Pacific Health) move to the center of the island. Queens has several billion-dollar projects. They claim to be their maternity center; they want it to be larger than Kapiolani. They're moving out there. So, I think us locating out there would be absolutely the right move. When I first heard that I said, "Wow that's so ." Then thinking about it,where the population is expected to move. I think that was a good move. It's still very early. And talking about using these major health plans, I've been trying to lobby HPH. I haven't done Queens because Queen's does have a presence out in North Hawaii already. But HPH, I tried to interest them in having a group of internists located in Hilo. MS. KIERKIEWICZ: Thank you. I just have one more question, you mentioned we need 187 more physicians to fill the gap on this island. I'm curious about the specialties if there's information about that because I'm assuming there is a 187 to meet the needs right now or is that projecting forward based on right now? Okay, so it's a higher number if we think about growing population, aging population, the needs folks have. And I bring that up because I'm curious about how we could be building up that work force pipeline earlier on, and exposing students say even in high school to the potential of working in the medical field. MR. UGHARA: There's several organizations of them, kind of loosely associated with—we tried to reach out to the University of Hawaii Hilo Pre-Med Program, and it's been difficult; it's been very, very, difficult. But yeah, you're absolutely, absolutely, right. I think the problem is very large that JABSOM's admission committee has to realize that this need here is greater than the need elsewhere. We probably have the greatest need on this island because of demographics as well as numbers. I dealt with somebody who said, "Oh I thought Maui was the second most popular island."I said, "No, we are." And those kinds of realizations the admission rate from UH (University of Hawaii) Hilo into JABSOM is abysmally low;just a handful. I can tell you stories and yes, they are not scientific because they would be anecdotal studies. My experience of my friend's daughter getting denied here into JABSOM with a 3.9 grade point average. I think we all have to be advocates, and we have to speak loud and long, and often. The same story, we need more of our kids in JABSOM. The experience that I said the year that I graduated we had six from Hilo High School, and granted they were over several years. But that graduating class had two from the year before me,two from my year, and two below me; we all graduated. That number has gone way down. In some years there were one or two and some casual residencies that were put in that category, but were not real residents of this county. And so our county is vastly under represented. I have to say, there must be more awareness of the admissions committee that we are a state medical school, and we need to service the needs of the state. Page 29 CRCOC-13 September 5,2023 MS. KIERKIEWICZ: Thank you, Dr, it's great to see you really appreciate all that information. The Council stands with you in advocating on these very important issues. Thank you, Chair. CHR. VILLEGAS: Thank you. And with that, I'll just quickly wrap up here today. Thank you for coming and sharing this information even though it is dire in its own way to recognize the opportunity for more accurate insights into how it's being depicted as far as population and needs. And it's really interesting that there are so many doctors that may be retired but are still considered. I'm grateful to report that a friend of mine from college, his wife,just finished her final residency and have just been hired at the Kona Hospital. And they'll be moving to the Big Island in the next few months. Also, I'm very hopeful that my daughter will continue her MA work, Medical Assistant, to get hours to then get into the PA, Physician's Assistant Program. But even that is monumental and brings her to tears thinking about the $100,000 in debt, and all of those different things. So, I am in complete alignment with you with prioritizing, supporting our kamaaina young people of whatever age as they pursue degrees in the health field, and making it more approachable, affordable, and feasible for them to do so. And with that, may I take a vote on closing file on Communication 399. MR. UGHARA: May I say one last thing? CHR. VILLEGAS: Sure, Dr. Uohara. MR. UGHARA: Do something,just don't do anything,just do something. At the least work with UH Foundation, create scholarships, start the process, don't postpone this to next year, because our deficit in physicians gets more and more. So, do something please, do something. CHR. VILLEGAS: Yeah. Thank you, Doctor. And with that I'll take a vote, all those in favor of closing file on Communication 399. Vote on Comm. 399: The motion to close file on Comm. 399 was carried Filed by the following voice vote: Ayes: Committee Members Galimba, Kaneali`i— Kleinfelder, Kierkiewicz, Kimball, Lee Loy, and Chair Villegas —6. Noes: None. Absent: Council Members Evans, Inaba and Kagiwada—3. Excused: None. Page 30 CRCOC-13 September 5,2023 CHR. VILLEGAS: I'd like to ask for a five-minute recess, to go to the bathroom. And then we'll be back, and fair warning I'll just be pushing on the future communications, because we're already at 4:10 and where we're getting a long day. Alright, thanks. Recess: At 4:10 p.m., the Chair called for a recess. Reconvene: The meeting reconvened at 4:15 p.m. CHR. VILLEGAS: And with that, Mr. Clerk, take it away. Comm. 409: REQUESTS A PRESENTATION BY DONNA THERRIEN OF HAZEL HEALTH REGARDING ADVANCING HEALTHCARE EQUITY BY PROVIDING MENTAL HEALTH SERVICES FOR HAWAII STUDENTS From Council Member Susan L. K. Lee Loy, dated August 16, 2023. ; and Comm. 409.1: From Council Member Susan L. K. Lee Loy, dated August 25, 2023, transmitting a PowerPoint presentation. Motion to Close File: Ms. Lee Loy moved to close file on Communication 409. Seconded by Ms. Kimball. CHR. VILLEGAS: Go ahead and take it away. MS. LEE LOY: Thank you. You know, it really is a privilege and an honor to introduce Donna, I hope I say it right, Therrien. I met Donna a couple months back; we were doing a health fair for our kids at Waiakea Intermediate School. And at that time, the attraction was a football athlete who won the Heisman, Marcus Mariota. And all I could think about was how exciting, you know, I get to work alongside Marcus Mariota. But that's where I met Donna, and listening a lot to her program and what she was offering for our Keiki, especially at middle school. What makes Donna truly remarkable is her unwavering commitment to the well-being of our keiki, especially those in middle school; they're going through so much. And so she's currently at the forefront of an initiative that she will share with us, but she's shared it as the best kept secret for our keiki. For my colleagues, her entire presentation is contained in Communication 409.1. And so, without any a due. (Note: At this time, Donna Therrien of Hazel Health came forward to address the members of the Committee.) MS. THERRIEN: Aloha, everybody. So, I want to tell you what the state is offering every student. We all know, especially here and today, there's a provider crisis, and that crisis is also mental health. The DOE (Department of Education) Page 31 CRCOC-13 September 5,2023 knows that in order to educate a child you have to educate the whole child of body, mind, and spirit. And so with that, the DOE has partnered with Hazel Health to offer every single public and charter school student in the state, all 175,000 mental health services. I'm going to tell you exactly what that means in a second, at no cost to family or school regardless of insurance, regardless of immigration status, and even regardless of language. There are zero barriers because it's that important. So I'm just going to quickly tell you what we do, how we do it, and then I'm going to ask you some favors on how we can get this information out. So, let's just start with that. (Note: At this time, Donna Therrien of Hazel Health, provided a PowerPoint presentation to the members of the Committee. For viewing of the presentation, see the DVD copy of the proceedings on file in the Clerk's Office, or online at http://hawaiicounty.granicus.com. A copy of the presentation is made part of the record, see Comm. 409.1.) CHR. VILLEGAS: Absolutely incredible. Thank you, with that I'll give it back to Ms. Lee Loy. MS. LEE LOY: Yeah, and as you can see how infectious Donna is. And really what we found incredibly successful was the health fair that we provided for our kids. So not only did we integrate this, but we also integrated food systems, good diet, reading, we had people donating books, and then of course physical fitness. And as she mentioned, a lot of this she'll send it to me and if we could share it on our social media platforms or take it to your community meetings. I really, absolutely agree that the fact that this is a program being offered for free in both public and charter, because Hawaii County has a number of charter schools also, that this is available to charter is huge. And the language and the culture component, which we all know, is addressed very uniquely and differently within our cultures. And Donna and this program offers it, so thank you. MS. THERRIEN: I'm just going to correct it's not free. There's no cost to family or for schools, but the state working together with the insurance companies is what makes it available for everybody at no cost. MS. LEE LOY: Thanks, Donna. I yield. CHR. VILLEGAS: Thank you, Council Member Lee Loy. Council Member Kaneali`i—Kleinfelder. MR. KANEALI`I—KLEINFELDER: Thank you. Thank you very much, quite infectious, thank you. I might need this for me, sometimes, actually. MS. THERRIEN: Yeah, that's one of the questions I get all the time is do we do adults. Teachers need it. Teachers are stressed out more than ever. And the fact Page 32 CRCOC-13 September 5,2023 is our lane is being the leaders in pediatric mental health, pediatric teletherapy, and so unfortunately, we cannot help you. MR. KANEALI`I—KLEINFELDER: That's fine. But as a parent, I like this, because sometimes I don't even know how to express what I'm thinking to my children. And trying them out as a parent, it's not easy sometimes. So as far as getting this out to the public, yeah, if you can share with us something we can share via social media or send it to every Council Member we can push it out. MS. THERRIEN: If I can send it to you, I will send you all of the above. I'll send you the digital referrals, and I will also send you social media that is already cut, you know, however they do it so it's ready to go. And if I can send it to you, that will be perfect. MR. KANEALI`I—KLEINFELDER: You can send it to all of us if you want, then you don't need to disburse. MS. LEE LOY: Okay, yeah, I'll share the truncated list of everybody. MS. THERRIEN: You share with me, and then I'll share it back. MR. KANEALI`I—KLEINFELDER: There you go. MS. THERRIEN: There you go. I appreciate that. MR. KANEALI`I—KLEINFELDER: That would help us get it out there. And I think you might find some people who are concerned about this, as far as parents that their kids are going to be talked to. So you maybe need an education piece for the community on what this is and what it provides to the kids, so there's no fear about it. MS. THERRIEN: Yeah. And so what we do is really partner with the schools and we provide resources for the Administrators, for the counselors, for the families. We provide letters, you know, what to expect along the way. We really do know that our partners are with the schools because those are the ones who have relationships with the students. That's where the trust is. And so that's where we try to make them our ambassadors. We also work with the other local agencies like the Hawaii Keiki Nurses who again, are boots on the ground in the school. MR. KANEALI`I—KLEINFELDER: Okay, beautiful, thank you, very much. MS. THERRIEN: Yes, it is beautiful, thank you. Any other questions that I can answer? I know it's late in the day. Page 33 CRCOC-13 September 5,2023 CHR. VILLEGAS: Council Member Kimball. MS. KIMBALL: Thank you. And thank you so much Council Member Lee Loy for bringing this presentation. Wonderful to meet you, Donna. Just thinking about what Council Member Kaneali`i—Kleinfelder just said. I'm really, really grateful to see that mental health care is being understood, it's something that is just okay, right, it's self-care, right. I was just having this conversation with my neighbor the other day because their daughter had kind of a traumatic experience, so they got her to see a counselor. After a while she just wanted to kind of keep going,just part of the regular routine and it was really great for her. My daughter, you know, after COVID (Coronavirus disease) such a weird time for kids in the teenage years during that, she went for a while. We were talking about, well it's just great that they feel comfortable asking us, as parents, we need this type of help. There's no shame. I bring this up now, because I want to just share that even this job is stressful sometimes. Sometimes I need somebody to talk to. I feel no shame to go call up my therapist and say hey I need to sit down and have a chat because Matt is being a real jerk, no, I'm just kidding. Anyway, I just want to take a moment to say, you know, mental health care is selfcare, no shame in this game. I just really thank you for bringing this forward, because it's so important and just an amazing program. So thank you. MS. THERRIEN: When you look at the average age of entering mental health it's usually something acute, it usually includes a hospitalization which is traumatic and causes trauma in itself. If you look at it because we can take tier one; those little life humps and be proactive and preventative, our average age and again where kindergarten to twelfth grade is around 11 and 12 years old, those middle school years are where we see. And we see it across the board, but that's where we see a bulk. So we're getting students in and around 11 and 12 years old to provide them with tools so it doesn't end up in hospitalization or acute care. So, thank you for youroh, do you have any other questions? CHR. VILLEGAS: No, she just yielded. Anyone else? Nope, thank you. In an era when children are doing live shooter drills and the level of crisis, and trauma, and potential danger is at epidemic levels. Thank you for bringing this forward. I, as Council Member Kimball, cherish my therapist, and especially in this job. And children are taking on more and more at younger and younger ages. So providing that kind of support and potential for that, I think, gives us an avenue hopefully to avoid occurrences of violence, and outbreaks, and what nots. So, thank you for providing us with your enthusiasm for doing so, and I really look forward to both of my girls are out of school already, but my grandson. So, I'd be happy to share this through email, my sister-in-law is a teacher, let's spread it far and wide. Page 34 CRCOC-13 September 5,2023 MS. THERRIEN: Yes, I am just a spreader. All credit goes to the DOE (Department of Education), who really put this together so quickly and so well to have this community public, private partnership. So that's where the kudos go, it goes to the DOE. CHR. VILLEGAS: Fantastic, if we could get that community and private partnership with our wastewater facility we could also move forward. MS. THERRIEN: Yes. CHR. VILLEGAS: Alright, thank you so much for being here today. And with that, all those in favor of closing file on Communication 409. Vote on Comm. 409: The motion to close file on Comm. 409 was carried Filed by the following voice vote: Ayes: Committee Members Galimba, Kaneali`i— Kleinfelder, Kierkiewicz, Kimball, Lee Loy, and Chair Villegas —6. Noes: None. Absent: Council Members Evans, Inaba and Kagiwada—3. Excused: None. CHR. VILLEGAS: We'll move on to our final communication of the day. Comm. 410: REQUESTS A PRESENTATION BY `AINAALOHA W. IOANE, PROJECT COORDINATOR FOR THE KELI`I IOANE LEGACY FOUNDATION, REGARDING THE KEAUKAHA STEWARD PILOT PROGRAM, KU'U HOME O KEAUKAHA From Council Member Susan L. K. Lee Loy, dated August 15, 2023. Motion to Close File: Ms. Lee Loy moved to close file on Communication 410. Seconded by Ms. Galimba. (Note: Comm. 410.1, from Council Member Susan L. K. Lee Loy dated August 31, 2023, transmitting a presentation to Comm. 410, was circulated.) CHR. VILLEGAS: I'll hand it over to you, Council Member Lee Loy. MS. LEE LOY: Great. Actually, thank you, `Ainaaloha for being here. I think I've known Aina for 15 years. For a long time, she and I were down at Ka `Umeke Ka`eo, and at that time I think she only had one baby, and now she has three. But the partnership that Aina and I have formed down in Keaukaha started with this Council passing funds for a Makahiki contingency grant, which actually Page 35 CRCOC-13 September 5,2023 began to demonstrate down in community;just some educational pieces around not only our Makahiki ceremonies but the teachings of all of that. And then through that partnership we witnessed a lava flow that took out so many of our beaches, and ocean recreation activities in Puna, and then a pandemic, and what was definitely a very quiet time down in Keaukaha. But since then, we've seen a whole bunch of new things come back, including a lot of visitors. And reaching out with Aina along with R&D (Research and Development). Frecia(Frecia Cevallos), thank you for being here. And Michelle in our Parks Department, along with Hawaii Tourism Authority was this idea about managed tourism, specifically in our hot spots; Keaukaha being one, Pololu being another one. I know that there's some work being done in Kona at our beach parks there. And if you guys actually want to take a tiny little snapshot of all of the good work that our community is doing, OHA (Office of Hawaiian Affairs) has highlighted Keaukaha and Pololu and their projects of stewardship, and working with HTA (Hawai`i Technology Academy) and R&D. So with that, Aina also has a PowerPoint presentation that's contained in our folders, so Aina please. We saved the best for last. Go ahead. (Note: At this time, Project Coordinator Ainaaloha W. Ioane came forward to address the members of the Committee.) MS. IOANE: Okay. Aloha mai kakou. My name is Ainaaloha Waika`alulu Ioane, I was born at home at Waika`alulu Bay in the village of Kings Landing on the Hawaiian Homestead; we're actually considered Keaukaha Tract 2. My father, Keli`i :Skippy" Ioane and my mother, Carol Ioane, raised six of us at home in the village of King's Landing. And as a child, we were really nurtured by the environment. King's Landing is very secluded and so we were raised off of reef fish that my father caught. We were raised off of the Ulu tree that we planted when we were keiki. And this seclusion really allowed me to be molded by the environment. And my childhood in King's Landing really is the closest that I've ever been to our kupuna, and to the way of life that our ancestors were a part of. (Note: At this time, Ainaaloha W. Ioane.,provided a PowerPoint presentation to the members of the Committee. For viewing of the presentation, see the DVD copy of the proceedings on file in the Clerk's Office, or online at http://hawaiicounty.granicus.com. A copy of the presentation is made part of the record, see Comm. 410.1.) MS. LEE LOY: Thanks, Aina. I just wanted to take the opportunity to stitch together a lot of the work that really have happened piecemeal through legislation here whether it was contingency money, whether it was the open space fund where we did with our friends, Sasa and Kaaka with Hui Ho`oleimalu6. And the conservation easement that we passed over there, whether it was Jordan Lerma with our nene project and the slowing down of traffic. We are doing everything Page 36 CRCOC-13 September 5,2023 we can, so I really appreciate Aina kind of sharing like this tiny little space that continues to be impacted. I am going to be asking for a postponement, because we're going to continue this conversation about the HEA (Hawai`i Education Association) which is right down the road. Opening it up to my Council Member, colleagues. I also asked Michelle from Parks Department to be here because there's pieces of legislation currently in our County Code about buses, and parking, and visitors at our beach park. Personally, I think the language is there about vending. And to Aina's point about selling our resources to visitors, and we're having a conversation about that with Corporation Counsel, and hope to advance legislation around that space. I really wanted to lean in on my other colleagues, especially those who have other beach parks in their area that are experiencing these high traffic areas. In addition to also having Frecia here to do our kapu and kanawai with the kanakaole foundation which I think some of us intrinsically get it, and had to recognize that I personally, as a native Hawaiian acknowledging all of these things, have to be able to translate our kanawai; our policy, around a couple which we know is environmentally driven into this colonial space. And I think often times there's, the dais is full of a lot of people who have all kinds of thoughts, but it's hard for them to stitch together all the pieces. And just in this committee alone, we had wastewater treatment conversation, we had a mental health conversation, we had a shortage of doctor conversation. And it's all actually really stitched together real nicely, right here with everything that Aina has presented by way of how we balance all those things. And truly the caring capacity in this situation is Waiuli, Wai`olena, but the larger carrying capacity of Hilo, East Hawaii, and then our entire Moku o Keawe as a whole. Thank you, Aina. I'll let them ask you questions, but I'm going to ask at the end of this for a motion to postpone to October 3rd, so Aina can present the second half of this. The slide that she has. I yield. CHR. VILLEGAS: Thank you, Council Member Lee Loy. Anyone else, Council Member Kaneali`i—Kleinfelder. MR. KANEALI`I—KLEINFELDER: Thank you, Chair. You're awesome. Thank you for this, because you've done a number of things you've presented what the community is seeing is issues. I think what we all intrinsically know of what's going on in the area. You have actually given us data that we can look at that shows where we sit, where the tourist sits, where the numbers are at. And then you took it home to different solutions that actually helped us make movement. And from when you first started, and working with Frecia and to try and find a way through to get a handle on our tourism till now. I mean you've done a tremendous job. I have a lot of good memories and I haven't gone in a long time,just because I can't seem to find the time to get down there. But Waiuli was always my favorite place to go, and a lot of beautiful moments. Page 37 CRCOC-13 September 5,2023 And yes, over time I remember being a lot of tourists there. And when they come to the beach it is abrasive. What are you doing, what are your kids doing? Can we take pictures of your kids, it's like I don't know you. And then they take sand, they take things, it's a very extractive process. Doesn't do anything for our residents. You touched on tourism, the dependence on tourism. You guys took this home to a lot of different places. So, I like what you got in front of us, I support you and I have from the beginning. So, look forward to you kind of finishing the presentation. I'm going to let this kind of simmer my brain, I was kind of late, so I don't want to get too deep. But yeah, I support this. I've known you for a long time, and I find this to be a very, very, special place, always has been. I don't live there, but I do go there. So I'm one of those people, but I've also come to learn, we've got to respect where you go and take care of it. We'll see what happens from here, but yeah, you got my support. MS. IOANE: Thank you. CHR. VILLEGAS: Thank you. Council Member Galimba. MS. GALIMBA: I just wanted to say thank you, it's amazing work that you've done there. It's great to have data, but also your stories. And I have a lot of spots in my district that are suffering the same kind of issues, so definitely am going to be sharing some of this with them as a place to start, like gathering the data. So, thank you very much. MS. IOANE: Thank you. CHR. VILLEGAS: Thank you, Council Galimba. Council Member Kierkiewicz. MS. KIERKIEWICZ: Thank you, Chair. `Rina, you're amazing. MS. IOANE: Thank you. MS. KIERKIEWICZ: You are such an incredible voice and champion for your community. I just wanted to take a moment to appreciate and mahalo you. And Sue, your mighty team for collecting all of that data. I remember you first bringing this forward, I think during the pandemic, after the pandemic, and you starting that data set. So this is incredible to see, it breaks my heart a little bit, it breaks my heart a little bit to see how strange this natural resource is. I remember going there as a child, I think I almost drowned there. And that's why my parents were like okay, you're getting swimming lessons, but it was my dad's favorite beach. And sometimes I just don't go because it is so over run. And I really appreciated the restraint that you practice today, where you didn't say no tourism. Page 38 CRCOC-13 September 5,2023 But you're saying we want tourism on our terms, and we also want everyone to recognize the caring capacity, and the fact that if you're going to come;please come with respect and appropriate behaviors. And also, I think we should be bold and courageous and talk about giving `aina time to rest, to regenerate. And when you brought up the example of what's happening on Kauai after that historic flooding occurred, and that `aina had a chance to rest. They saw the rejuvenation of that space, and the return of all kinds of creatures and just beauty that had been lost for a long time because it was over run. Hundred percent kako`o everything that you've said, here to support. I also just want to offer, again, this is just an offer. The community I represent is lower Puna, Pohoiki, used to be a hot spot as well, and now we are on the throws of roads being restored, infrastructure being restored, trying to get our boat ramp back. And with all of that infrastructure, we are certainly going to attract folks that are curious and want to see what happened there, what is it like. And first and foremost, we wanted to make sure that as we restore that space, community was at the heart center, you brought that up, if we're going to design a plan; it has to be something that is coming from the community. Because at the end of the day all of us here we come and go, administrations change, but the community is left with the decisions that are made. So it has to be community driven, government supported. I think Michelle, you might have been there, maybe Mo was there. We've met with lineal descendants; `Ohana of Pohoiki and that was intense. Words were exchanged, like decades of frustration were aired at that meeting. And it was hard, but I think there was a breakthrough because there was this willingness, I think by the County to recognize that you know what, we didn't do everything right, we failed to embrace community as a partner, we're going to course correct, and community is going to have a seat at the table. So over the course of a year, we did a community engagement and planning process. That had `ohana engaged every single step of the way, directing, and giving them essentially like a stamp of approval on all of this. And now we have a plan for how we're going to be leveraging federal funding, what other funding we might need to implement that plan. So, happy to share some insights and connect with folks down in that `aina to share where they came from. That it's a beautiful thing to witness. Empowering community, to steward, right, that very special place that they are able to call home. So mahalo nui for all of your hard work, really look forward to your second presentation in October. Thank you, Council Member Lee Loy, for supporting your community in this really thoughtful, innovative way. I yield. CHR. VILLEGAS: Council Member Kimball. Page 39 CRCOC-13 September 5,2023 MS. KIMBALL: Thank you. Thank you for a beautiful presentation, you're very articulate and great pictures. Your keiki are adorable. Every place on this island is unique of course, but as I'm listening obviously Council Member Kierkiewicz saw her area. I'm listening, I'm seeing Waipio, which is in my district same thing, right, this extractive process. This is people's homes, their ancestral kuleana to be responsible for one way in, one way out. And there has just been this continual bombardment of people that are profiting from public assets, whether you're talking about the roadway, or the park, or whatever. These are things that belong to us as a community, the people that live there, and they are being utilized for somebody else's profit without any giving back. And it's heart breaking, it's heart breaking for me to hear your story, it's heart breaking working with the folks up in Waipio. And we just did the process, too. Yeah, it was great, and one of things that I, you know,just this idea of rest, one of the mete that we went through and translated really focused had a section that really focused on that need for rest. And I think that's something we need for Waipio, sounds like it's something we need for you guys too. But these folks up here know that I'm a problem solver and I don't always come up with the best ideas, but always try to come up with an idea. For better or for worse, Jon laughing over there. But with respect to, you know, this is such a common occurrence in broad strokes, you know, and I'm hopeful like the hyena model on Kauai is something that we can emulate. There are some differences between our areas, who's got kuleana, who's got jurisdiction. I'm bringing this up now because we have our HSAC (Hawai`i State Association of Counties)package coming in two weeks. And I do have a proposal in there that has to do with our ability to address road usage space on carrying capacity. So I think that we work together, those of us that have these areas, bringing a little bit more of that responsibility to the Council jurisdiction so that we can actually implement some of these things that you folks genuinely need. I think that's something we can all work together towards. Just want to mahalo you one more time. Beautiful presentation. And I'm glad to have you here, and I'll be happy to see you in the next couple of weeks. And thank you, Susan, for your work too, appreciate the graphs. I always love the graphs. Thank you, I yield. CHR. VILLEGAS: Thank you, Council Member Kimball. Council Member Kagiwada. MS. KAGIWADA: Thank you, Chair. Thank you so much. This is so great to see this all pulled together in one place because you hear snippets here and there, but this is really important. I especially love the page about recommendations request. I think it's such a good start, obviously community being at the center of making some of these decisions. I just want to say that similar to what Council Member Kierkiewicz was mentioning, I think, you know the fact that Hilo Bay Page 40 CRCOC-13 September 5,2023 Front has become so polluted and unusable by our community; it has really affected all the beaches at Keaukaha. So looking at that as a potential way to maybe spread out the carrying capacity if we could do something about improving the water quality and the usage at Hilo Bayfront. I think that would also help. And then just as a community effort and it's something that the county, I think, should get behind and support. I hope that we will look at additional solutions, other than just more parking spaces, because given these other goals you have here, I think just making a whole bunch more parking spaces is going to work against some of these goals. And so what are some of the things we could do to look at ways of getting people there, not in individual cars all the time, or spacing things out and using the parking spaces we have. So that would just be my thought there, but thank you so much. I really appreciate it. I yield, Chair. CHR. VILLEGAS: Thank you, Council Member Kagiwada. And with that, I'll just bring up the finish here for the end of the day. Thank you, Aina, for being here; for your legacy; for your family's lineage; and for your continued dedication to this space; and to perpetuate the sense of place that is supposed to be there in alignment with cultural practices and kuleana. It reminds me a lot of Kohanaiki and working with Uncle Angel Pilago, Karen Eoff, and Maile David, and a lot of these issues even about commercial use in public parks. I think there are some models. I love what you're looking at in Ha`ena. And perhaps there's opportunity to look at what has been done, mind you not perfect, at Kohanaiki. Also still inundated, also struggling with keeping commercial activity out. But your ability to recognize the issues, to state them so eloquently, and then to point to solutions and where accountability resides. Some of that accountability resides with the cruise ships, some of it resides and would probably be pushed from the people; the kamaaina here who have made it their business to take people on tours. But I suppose it's heart breaking for me in a certain way because on the west side I feel like we've been inundated like this for so long. And there's something so sacred about these gems of hidden spaces on the east side that have now been discovered and being exploited in the same capacity. And so I'm heartened to hear the intention, and the commitment, and the solidarity from these voices on the Council, from the voices in the administration, and then the different departments, and statewide for us to declare capacity. Enough and too much. And Kohanaiki has resting two nights a week also, so that practice is priceless. So you are a beacon of light and hope, and a capacity for bridging the older ways, and speaking the language, unfortunately, of a colonial society that does require too often times a different vocabulary in order for it to be embraced in legislative procedure and all that kind of stuff. As Uncle Angel taught us through the Kohanaiki case, environmentalism is one thing, you know, which is good in all the data, and all that, but the victory resides in culture and what the law provides Page 41 CRCOC-13 September 5,2023 in protection and perpetuation of these secret spaces. So I'm excited to see the rest of your presentation, and for this continued conversation. And for as you navigate, whatever the model becomes, that it can be a template for places around the Island which also suffer under the strain. So, mahalo to you for that. You have very fortunate keiki to have a mom who is keeping them this grounded, and connected to the place where they're from. So, mahalo you. And with that, can we have a vote? Oh sorry. MS. LEE LOY: Thanks Chair. I don't want to oversimplify this process because this process has taken years. I mean, I think back to the time when we had to even rename Wai'uli and Wai`olena. That's some of the stuff that no member of this dais has ever experienced. So, I even think back to just grounding ourselves in the appropriate place names. And so there might be some urgency from my colleagues to yeah, let's go ahead and do this, and we'll put in legislation, it is an evolution. I just, again, mahalo, Aina and the Ioane `Ohana, the Nahale-a `Ohana; just so many families from Keaukaha who have shouldered a lot of this work for us to reach a place where we're collecting data that Council Member Kimball can geek out on, right, and articulate, you know, all of the historical understandings that we have about place and place names. And then, the overall carrying capacity. I would like to share with my colleagues. Again, I've had this conversation with Parks Department. We have legislation already that talks about commercial carrying capacity and vending in our parks, but there's some wonkiness. Because when that legislation was written, you had to physically bend at the beach park. We're still selling our beach park on a QR (quick response) code from a cruise ship on the internet, which there is no exchange of physical money. Again, I think it's still all there in our Code, we just have to adjust it to our current times. And I look forward to the pledge of support that I've heard from my colleague, because it would actually impact everybody on how we frame that in our County Code, which I think is there. I'm going to say it a million times. But I think we are close, and I would encourage everyone to go through that process of engaging our lineal descendants and that place. So with that, a motion to postpone Communication 410 to our October 3rd committee meeting. Page 42 CRCOC-13 September 5,2023 Vote on Motion to Ms. Lee Loy moved to postpone Comm. 410 to Postpone: October 3, 2023. Seconded by Ms. Kagiwada and (Approved) carried by the following voice vote: Ayes: Committee Members Galimba, Kagiwada, Kaneali`i—Kleinfelder, Kimball, Lee Loy, and Chair Villegas—6. Noes: None. Absent: Council Members Evans, Inaba and Kierkiewicz—3. Excused: None. There being no further business, at 5:50 p.m.,Ms. Lee Loy moved to ADJOURN- adjourn the meeting. Seconded by Ms. Kimball and carried by the MENT: following voice vote: Ayes: Committee Members Galimba, Kagiwada, Kaneali`i—Kleinfelder, Kimball, Lee Loy, and Chair Villegas—6. Noes: None. Absent: Council Members Evans, Inaba and Kierkiewicz—3. Excused: None. CHR. VILLEGAS: Meeting is adjourned. Approved: '\\ \1`�1(2:623 Ms. Rebecca Ville s, Chair (Date) Communications, Reports, and Council Oversight Committee RV/rk Page 43