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HomeMy WebLinkAbout2020-10-15 Leeward Exh G (Amend Zoning Code re Medical Clinics) LEEWARD PLANNING COMMISSION COUNTY OF HAWAII HEARING TRANSCRIPT OCTOBER 15, 2020 A regularly advertised hearing on the PLANNING DIRECTOR INITIATED AMENDMENT TO CHAPTER 25 OF THE HAWAII COUNTY CODE, RELATING TO MEDICAL CLINICS AND OTHER SMALL-SCALE HEALTH SERVICE FACILITIES was called to order at 4:22 p.m. via live-stream online meeting, with Chairperson Nancy Carr Smith presiding. COMMISSIONERS IN ATTENDANCE: Nancy Carr Smith, Barbara DeFranco, Perry Kealoha, Max Newberg, Mark Van Pernis, Michael Vitousek and Faith"Faye" Yates ALSO IN ATTENDANCE: J Yoshimoto, Esq. (Counsel for the Commission), Michael Yee (Planning Director), John Mukai, Esq. (Counsel for the Planning Director), Tracie-Lee Camero (Planner), Jeff Darrow (Planning Program Manager), Alex Roy (Planner), Jessica Andrews (Planner), Rachelle Ley (Secretary to the Planning Director), Kim Tanaka(Secretary to Boards and Commissions) and Noriko Sauer(Leeward Planning Commission Secretary) INITIATOR: PLANNING DIRECTOR An ordinance amending Chapter 25 (Zoning Code), Article 1, Article 2, Article 4, Article 5 and Article 7 of the Hawaii County Code 1983 (2016 Edition, as amended), relating to definitions, use permit requirements, off-street parking requirements, and zoning district regulations for medical clinics and massage, acupuncture, chiropractic and other small-scale health service facilities. Secretary's Note: "- - -" indicates that there were technical and/or internet difficulties, which made the conversation inaudible. CARR SMITH: Alright, moving on to agenda item number six, initiator's the Planning Director. An ordinance amending Chapter 25 (Zoning Code), Article 1, Article 2, Article 4, Article 5 and Article 7 of the Hawaii County Code 1983 (2016 Edition, as amended), relating to definitions, use permit requirements, off-street parking requirements, and zoning district regulations for medical clinics and massage, acupuncture, chiropractic and other small-scale health service facilities. Tracie, you again. Go ahead. CAMERO: Thank you so much. I promise this is the last presentation of the day. Good afternoon Madam Chair and members of the Planning Commission. As stated, this is a Planning Director-initiated amendment to the zoning code relating to definitions, parking requirements, use permit requirements, and zoning district regulations for medical clinics, massage, acupuncture, chiropractic, and other similar health service facilities. The next slides will highlight four amendments that the Director will be making to the code. If you have any questions, please feel free to speak up at any time or stop me. Can you all see my screen? 1 EXHIBIT G CARR SMITH: Yes. CAMERO: We'll begin with amendment one. This is relating to the definition of a medical clinic. Currently, the definition of a medical clinic states that chiropractic and massage treatment and services are not included as a medical clinic. Therefore, the Planning Director's proposing that acupuncture and other similar health service facilities uses be included under the definition of a medical clinic. The next proposed change is to the personal service establishment definition. The personal service establishment definition currently includes massage facilities and chiropractic clinics as permitted under the personal service definition. The Planning Director is proposing the removal of massage facilities and chiropractic clinics from this definition so that the definition only includes non-medical personal services. The Director has proposed to also remove "and other similar uses devoted to the care of treatment of the age, the sick, or the infirmed," out of the hospital definition located in the use permit section because the Department has historically considered these uses as medical clinics. While the Planning Director feels that these uses no longer fit in the current definition, amendment number two clarifies where these uses will be better suited especially because the need for these uses are there in the community. Therefore, in this slide the Director's proposing that a use permit can be obtained for a medical clinic, massage, acupuncture, chiropractic, and other similar health services facilities in any of the zoning districts listed in the slide above. When Planning staff was considering this code amendment, we realized there was a conflict and recognized this discrepancy between the proposed amendment and the parking section of our code. We're using this opportunity to rectify these conflicts by adding off-street parking requirements. Therefore, amendment number three adds parking requirements for commercial uses within the RS, RD, and RN zoning, as shown on your screen. The fourth and final amendment is amendment four, and it shows that areas that a use, that a massage, acupuncture, chiropractic, and other similar health service facility would be an outright permitted use. For example, listed on the screen is the resort district where the current code allows for medical clinics and personal services as an outright permitted use. The Planning Director is simply proposing to add the specific uses of a massage, acupuncture, chiropractic, and other similar health service facility as a permitted use while in these zoning districts. The Planning Director feels that these uses are appropriate in the zoning districts listed in the slide. The purpose of these amendments is to better define these uses and clarify in which zoning districts these uses will be permitted by right or with a use permit. The Planning Director feels these amendments will ultimately create a process for these uses to come into the Planning Department and get any necessary approvals for and therefore, the Planning Director's recommending that the Planning Commission send a favorable recommendation to the Hawaii County Council for these rule amendments. With that, that concludes my presentation, and I can open the floor to any questions. CARR SMITH: Thank you, Tracie. Commissioners, any questions for Tracie? Mr. Van Pernis? 2 EXHIBIT G VAN PERNIS: You clarify that the services, massage, acupuncture, chiropractic, and other similar health services are not allowed for a special use permit in residential areas, yet you allow the multiple family residential areas. It doesn't seem appropriate. That's why a use permit should be required if there's going to be medical services in clinics in any residential area. Why do you have RM with no special permit, in other words residential areas such as RS, double family residential - - - so on, so forth. DARROW: Do you want me to answer that, Tracie? CARR SMITH: Go ahead, Jeff. DARROW: Okay. Commissioner Van Pernis, if you look at the permitted uses in the RM zoning district, it allows what's called personal services. Which, as part of this amendment, we are separating massage and chiropractic from that use, which is currently permitted and creating its own new permitted use. It is currently permitted there now, all we're doing is separating it and creating a new permitted use. VAN PERNIS: But isn't this an opportunity to take those kind of commercial activities out of multiple residential, like out of condos and apartment buildings where they have commercial zoning too? DARROW: They don't have commercial zoning. They have certain uses that are commercial in nature that are allowed as a permitted use in those zoning, in that zoning district. And again, the main one is personal service uses, which at this time, prior to this amendment, allows these uses as permitted. VAN PERNIS: So you can have these kind of personal services in residential condos? DARROW: In RM zoning, correct. It has limitations, and it has to be approved by the Director. If you refer to your, let's see, page VAN PERNIS: Does it require a special use permit? DARROW: Well, normally these are found in urban zonings, not in agricultural zonings, so they would not require a special permit. VAN PERNIS: In multiple residential properties. DARROW: Correct. Yeah. VAN PERNIS: [Inaudible] changes, change it and have such uses, causal uses sneak in, be excluded from multiple residential_ If I was living in a condo, I wouldn't want commercial activity next door. 3 EXHIBIT G DARROW: Well it's, I mean, this is why we're here today, to discuss this matter. But again, up to this point there was the commission and the Council had seen a need to allow certain types of uses as part of a condo or an apartment project such as hair salons, or little personal service uses, even massage and chiropractic. So again, there hasn't been a need for a use permitting in RM zoning in condos and apartments up to this point. We as the Planning Department have not received any complaints relating to these types of uses that are affecting surrounding property owners. VAN PERNIS: But isn't it inconsistent to require a special use permit at home residential areas except multiple residential, and is this a vehicle for choosing that? DARROW: I believe I answered that previously. It is an opportunity to look at that, but at this point that's not what has done previ-, has been done previously and that's not what the Planning Director's recommending. At this point we see this as a use that has been working well in the RM zoning district. CARR SMITH: Tracie? CAMERO: Sorry, I should also mention that while these uses are going to be, well are being proposed to be outright permitted, it still doesn't allow them to just come in and get the use automatically. They still have to come in and go through the various administrative functions such as plan approval that will require them to meet certain requirements for the specific zone districts that it's going to be an outright use. CARR SMITH: Thank you. Mike? VITOUSEK: First question is, in dealing with regulation of medical uses in residential and other areas, is there an exemption to home healthcare? For instance, if someone, an elderly person doesn't want to move out of their home and requires a live-in nurse who she pays to administer medical care to her in her own home. Could that potentially be a use that would be against the zoning rules? DARROW: We current this was something that was addressed by the Council back in 2007, I believe, where they allowed what are called group-living facilities for up to eight individuals including staff. This is permitted in all zoning districts. And that, basically, it's people that need medical dispensed similar to what you're saying, and it works either lives there or there's staff that are there 24 hours a day. VITOUSEK: But not, what I'm talking about is establishing a separate facility, I'm talking about in their own home, if someone wants to have a, or just to get a massage in their own home. Would the person coming to give them a massage need to get a special permit for the property that someone lives in in order to get a massage? DARROW: There's two vehicles for that. If you're referring to massage and not a nurse or medical-type thing. There's the home occupation that we currently have that has certain limits. At this point, because that's in a residential zoning and we're requiring a use permit, we're about 4 EXHIBIT G to come in and amend the home occupation to make it clear as to what's permitted there. But we've had a number of people come in up to this point, and as long as they meet the requirements of a home occupation, it could possibly be approved as a home occupation. But that's only the people that live in the dwelling and one employee, with no signage. So there's very strict limitations to that home occupation. VITOUSEK: I guess I'm talking more about someone coming to my home to do physical therapy care. Currently I'm receiving physical therapy care at home because of an injury. DARROW: There's VITOUSEK: Is that a zoning violation? DARROW: This, that's what we call kind of like a mobile service, and it's not just massage or chiropractic, it's someone fixing a car, or somebody, you know, there's all kinds of mobile businesses. We really haven't addressed those in the sense that, because it's not something that's established on that property. It's just like a mobile service that comes to somebody's house and washes their car, fixes a car, or gives a massage. At this point I don't see anything in the code limiting that, so you're okay Commissioner Vitousek. VITOUSEK: Glad to hear it. My next question, you know, being a physical therapy recipient, and a devoted husband to a physical therapist, where would physical therapy clinics fit within the definition of medical clinic versus other activity? DARROW: Right there, it says other similar health services. So, this would be exactly what that is. VITOUSEK: And not a medical facility? DARROW: We've, we've struggled with, and that's why we separated these, we've had discussions and you know, there's been massage, and acupuncture, and chiropractors that have tried to claim that they were a medical facility or a medical clinic and we, this was, we wanted to really make clear as to what those uses were. Medical clinics were for doctors and nurses that were providing medical care. We wanted, we knew that there were needs for these types of personal services such as massage, chiropractic, acupuncture, and like you said,physical therapy, so we've created this separate use. And basically, they go through the very same process that a medical clinic does. They're treated, treated very much the same. VITOUSEK: So do, do you think we should include in the language defining medical clinic, what you just said about doctors and nurses? Cause that's absent. You said persons engaged in practices of medical or dental profession or occupation. DARROW: I think what clears it up is the next sentence which clearly says this does not include massage, chiropractic, acupuncture, and other services. So, there's the separation. 5 EXHIBIT G VITOUSEK: Yeah I still think that it, it creates a little bit of ambiguity in what is and isn't a medical clinic that would be eliminated if we're just coming out and saying that this is for doctors, MD, DO, you know, those kind of things that are very clear in the language. DARROW: Your thoughts, Director? YEE: Still pondering. DARROW: I mean we, we've tried to, at this point just make it separate. I mean we can further consider, further defining medical clinic to include doctors and nurses. I'm not sure if there's a great need for that, but it's something to be considered. YATES: Am I on? I have a question. CARR SMITH: Go ahead. Yes, I see you. Go ahead. YATES: What are we talking about? I'm totally confused. Are we talking about somebody coming to your house, or we talking about on the street, or what are we talking about? I'm lost. CAMERO: I can answer that. We are talking in regards to creating the specific uses, or allowing these uses within these different zoning districts. These uses could be anywhere from commercial big buildings, to possibly a small approved building, or possibly a dwelling-like structure that may be within these zoning districts that we're now proposing. YATES: - - - and coming to neighborhoods where people live. We're talking about commercial areas? CAMERO: The proposal is for these uses to be put in various zone districts. We're going, the range from residential, to commercial, to CDH which is our Downtown Hilo district as well as our resort districts. YATES: We need special parking for somebody to come to my house? DARROW: Commissioner Yates, I think this bill is not actually addressing mobile-type businesses. I think we YATES: Oh, okay. DARROW: The discussion that we were talking about was whether or not it does include that, and I think we've made it clear that this bill isn't addressing those. YATES: Okay. CARR SMITH: Mr. Van Pernis? 6 EXHIBIT G VAN PERNIS: Yeah, I don't think the, it's clear at all. I think the thing needs to be rewritten and I agree with Commissioner Vitousek, as to what he says. What the [inaudible] medical services, for instance physical therapy outfits have a doctor that come in, there's other forms of, well it might be called medical service or unconventional raiku [sic], screen therapy, cupping, I think that all needs to be, we need better definition. In that regard I would move to defer this until the next meeting and have the items rewritten to satisfy some of these [inaudible], in particular regards to people coming to mobile services. What does that mean? Service in a truck or driving down to a house? VITOUSEK: Second. DARROW: Could I chime in real quick before the vote? CARR SMITH: Yes Jeff. DARROW: The intention of this bill wasn't to try to identify all the different types of services out there because number one, there are a number of services, there's going to be future services that we're unaware of. What we wanted to try to do is clarify that there's these types of services that provide some sort of health-related service that we wanted to be able to give an opportunity and clear direction as to how they go about either being permitted or if they are permitted in a zoning district. This bill wasn't at all touching any type of mobile use. The medical definition that you see has been in the code for, since 1996. I don't know if it was the same prior to that. All we did in this particular amendment was clarify that the medical clinic does not include these uses because we were clearly separating those uses. I don't know what you're specifically asking the Department to do as far as you know, revising this bill or changing it or including additional things. That would be what we need, specific direction. VAN PERNIS: Well it's not clear and I think it needs amendment. And I so moved to defer for a rewrite and Mr. Vitousek has seconded it. CARR SMITH: Oh, that's not, that was not an actual motion was it? Did I miss something? VAN PERNIS: Yes it was a motion. CARR SMITH: Oh, I didn't hear. I didn't hear that. VAN PERNIS: It was to defer, deferral to the next meeting which a revised matter will be submitted, and I believe that was seconded by Mr. Vitousek. CARR SMITH: Oh, my apologies, I didn't under--, I didn't hear that that was a motion. Director Yee? YEE: Hi, so, I recall having earlier discussions with staff around how much to define or not to define things, and I do want to refer to section 20—Chapter 25-1-5 [Chapter 25, Section 25-1-5], which has definitions for medical clinic. And as we got into trying to define too much we just, we did decide that it's defined in the code, we weren't going to repeat it here, and so, there is a 7 EXHIBIT G definition for medical clinic. I guess I'll read it really quick. It means "an office building or group of offices for persons engaged in the practice of a medical or dental profession or occupation. A medical clinic does not have beds for overnight care of patients but can involve the treatment of outpatients. A medical profession or occupation is any activity involving the diagnosis, cure, treatment, mitigation or prevention of disease or which affects any bodily function, but does not include chiropractic and massage treatment and services." I might be repeating what might have been said earlier but that's the reason why we don't elaborate too much in it because it is defined elsewhere. Just wanted to add that. Thank you. CARR SMITH: But it is, it is here Mike,just so you, it's on page 2, the bottom of page 2. VITOUSEK: Yeah, I, was that to me? CARR SMITH: Sure, go ahead Mike. VITOUSEK: Oh, I wasn't sure if you're asking me, Mike, or Director Yee. CARR SMITH: Oh sorry, sorry. Two Mike's. That's right. No, I was talking to Director Yee. VITOUSEK: Okay, thank you. CARR SMITH: What I came to realize that what he just said was in the background report on the bottom of page 2. Did you want to say something, Mike, or should I move to Max? Mike Vitousek. VITOUSEK: Sure, I, I, you know, to me, looking at it, we have this definition of a medical clinic but we are amending that definition right now, that's what we're doing and so if we are going to amend that medical, a definition of a medical clinic, I think that we should take the opportunity to remove any ambiguity about what could and couldn't be under the definition of medical clinic. And, you know, the definition that Jeff said as the implied definition being doctor's offices, nurse's offices, those kind of thing is the implied definition for what constitutes a medical clinic versus [inaudible] health services facilities, then I think we should just say that in the, in the definition so that there's no room for ambiguity. CARR SMITH: But I think a lot of what, what the Department is trying to do, from my understanding, is to make the code, and the rules, and all these things jive. And so, if he, if the Director just said that this definition that's on the bottom of page 2 is what's in the code, then, then we want to change this? I'm not sure why we - - - VITOUSEK: - -VITOUSEK: This, this is the definition that's in the code, and this is the definition that they're proposing to revise with this action. CARR SMITH: Right. With just these two small underlined items. Right? Go ahead, Jeff. 8 EXHIBIT G DARROW: So, thank you Michael, for the, or Mike for the direction on that. We can work on that. Commissioner Van Pernis,just so I'm clear on your direction, are you asking that we amend this to be able to require a use permit for these facilities in the RM zoning district? VAN PERNIS: That's one thing I wish you would consider doing, yes. DARROW: Is there any other area that you would like us to consider? VAN PERNIS: I think home services, one nurse in the person's home is not a care facility or a nurse traveling to a house for a few hours to provide some services such as pills and food, I think that should be defined, and curb services like massage, I'm not suggesting that that will be licensed but I think you should define it. CARR SMITH: I personally feel like we're getting into micromanagement here. Max, you have a comment? NEWBERG: Yeah, a bit separate, but as we're getting into medical facilities, at least what I see before me makes sense to expand it slightly to, you know, maybe add additional areas. I just wanted to make sure as we were kind of getting these questions that either there would be different zoning or a different language. I guess my question would be, this wouldn't expand out to medical marijuana facilities or dispensaries, correct? I mean this is more for care and things of that nature, right? DARROW: The medical—yeah, the medical marijuana clinics are actually addressed under Hawaii Revised Statutes Chapter 46. We don't have control over those, they're actually controlled by the State. NEWBERG: Thank you for the clarification. CARR SMITH: Okay, can somebody clarify for me what the motion is? Cause I, I don't, I don't know what the motion is besides yeah, go ahead, Mark. VAN PERNIS: I made the motion. CARR SMITH: Yes. VAN PERNIS: I thought Mr. Vitousek seconded it. CARR SMITH: Yes, I get that part. I don't understand what it was. VAN PERNIS: I think the motion was to defer this item till the next meeting CARR SMITH: Because? VAN PERNIS: Because we'd like a re-draft from the County on what they intend in light of the Mayor's—in today's hearing. 9 EXHIBIT G CARR SMITH: Is the County clear about what it is that they're asking you to change? I mean that's the point—Barbara, go ahead. DEFRANCO: Yeah, I really thought this was about something that was already permitted and all that was happening is the idea of acupuncture and chiropractic, which has become quite popular, and massage was being separated out so there was a distinction there. They're still all permitted in these areas, right? We're just adding, we're just clarifying these other, you know, what other people are doing. Isn't that what this is about? We're not defining medical clinics, or midwifery, or marijuana, or anything. We're defining that these, in these zones we have all of these things are already permitted, all we're doing is giving a name to the chiropractic and massage, things that are more popular now that need to be defined. That's what I got of this item. Maybe I'm on the wrong page here. CARR SMITH: Jeff, do you want to respond? DARROW: Sure, that, I mean the bill heading, or the, is exactly what we're trying to achieve through this amendment. And again, sometimes when we're amending a particular bill, other areas pop up that may consider you know, I mean there, I gotta say there's a myriad of areas that we need to change, but we try to work on one area at a time. In this particular amendment we're trying to address this use of massage, chiropractic, acupuncture, and other similar uses as well as medical clinics which, up to this point, haven't been, there's been some ambiguity in our code because there's that part that Tracie had mentioned under the use permit section that says, "and other similar uses devoted to the care or treatment of the aged, the sick, and the infirmed. We're taking that out and just clearly defining that as a medical clinic and putting that in the areas that are either requiring a use permit or a permitted use. We're also clearly separating the use of those other health-related uses of massage, chiropractic, acupuncture, and identifying exactly where they need a use permit and where they're permitted. That's the intent of this bill. If we can adjust accordingly to that, you know like what Commissioner Van Pernis mentioned about requiring a use permit for them in the RM zoning, or we can adjust the definition to make it a little clearer in the medical clinic, but we want to kind of stay focused on the intent of the bill. This bill is not meant to address mobile type uses at all, or home occupations, or any of those types. DEFRANCO: Thank you, Jeff. I just, I just want to also say, I don't think this is a good time to be restrictive for any businesses right now. We need all of our businesses to give as much permission to them as we can, getting it together after this COVID, after we've been so shut down. So, I'm not into restricting massage, chiropractic, or any of those things by bringing it up today. CARR SMITH: Perry, do you have anything to share? KEALOHA: I kind of agree with that last statement, you know as far as we need to be sure about how we can keep people in business, not how we can prevent them, and also, I thought it was pretty clear in the definition Section 25-1-5. For me it kind of captures everything. It leaves room for everything, basically. 10 EXHIBIT G CARR SMITH: Yeah, I support the recommendation. I don't necessarily support the motion. Anybody else? Mike, go ahead. Oh, sorry Max. Go ahead Mike. VITOUSEK: Sure, I just want to indicate that I also support clarifying this and that my intention is not to hinder the Department's ability to make this changes, but to help them remove any potential ambiguity. You know, their stated reasoning for doing this amendment is to remove ambiguity, and I think that there's still a little bit of ambiguity there that we can take one month to address and then we're going to have to live with the rule for, you know,potentially the rest of our lives. So if we can do that and, and take one month to address any potential ambiguity, in the rule, in the wording that clearly defines medical facility as stated by Jeff, I think that would make it very clear and remove any ambiguity, make it much more easy to enforce and to follow. I'm also agreement with Commissioner DeFranco about in not limiting things. I, I don't support, you know, additional requirements for special use permits for these practices. I think as it is its good, I just want to see it clarified and, you know, if we can do that today great, without deferring it if you guys think we can do that now, otherwise next month we can get it done. CARR SMITH: And so your clarification that you want, Mike, is you want it stated that it includes doctors and nurses? VITOUSEK: I, I just think that there's still some ambiguity in the definition of medical services as it compares to related health industries. Because we're not explicitly saying that medical, medical clinics is for doctors and nurses. I think that if we included that specific language, that would be eliminating any confusion on it. CARR SMITH: But I'd, I'd personally push back on that because a chiropractor will argue with you that he is a doctor of chiropractry [sic]. And there may be some doctors there may be some doctors that are licensed doctors that are licensed doctors in acupuncture. I mean, I just, I don't know why we have to limit that. VITOUSEK: That's exactly why we need to clarify this. If someone can say, "hey, I'm, I'm a doctor, I'm a doctor of physical therapy, I'm a doctor of chiropractic medicine, how come I'm not a medical service." We're saying that, you know, this is for medical doctors, MD, DO, RN, nurse practitioner. We can establish specific certifications that meet the definition of medical office and those that don't, they fall into this other health services category, so that it's clear on who goes where. You know, it's not, I don't see this as being controversial. It's just a clarity thing. It's just removing any ambiguity so that we know what's what. That there's no argument about who's who, what's what, where do I fit within this, this bigger picture. CARR SMITH: Okay, hold on Barbara. Go ahead Max. NEWBERG: So, originally looking at this, I think I was, you know, maybe looking at it simply. I agree with Commissioner DeFranco. It seems pretty much here, I'm also curious, if I may ask, Mr. Vitousek are you concerned that it's not specific enough because of your concern about somebody may use a space or facility within zoning that may be a practitioner outside of it? Or is it like you're not seeing enough clarity in perhaps mobile, or 11 EXHIBIT G VITOUSEK: No, it's not the mobile thing. You know, I think that Jeff has addressed that. That this is for business entity. I just feel like that clarity, there's not a lot of, for me, there's, there's still ambiguity in the definition of medical services that doesn't actually define the licensing of that medical service, versus other health services. I feel like that could be clarified and because there is slight differences in the allowable zoning. NEWBERG: Okay. Thank you. CARR SMITH: Go ahead Barbara. DEFRANCO: Thank you. I'm just going to be really quick. Because you have MDs, you have naturopathic doctors, you have physician assistants, you have a lot of different definitions of people that can argue who's a doctor, who's not a doctor, who's a medical person, who's not a medical person. What qualifies them? I'm not sure that we want to go there, that we need to have that much definition in this. - - -really do what the motion is trying to do, is to just recognize massage, chiropractic, and maybe physical therapy or something like that, and separate it from what a medical clinic is, and, and if a medical clinic has nurses and doctors, then maybe that's all we need to say today. A medical clinic has nurses and doctors. VITOUSEK: That would absolutely satisfy my concern because that would be providing an actual definition of what a medical clinic is. CARR SMITH: Jeff? DARROW: I, I think we're close in, in hearing everyone's discussion. I think if, Mike, if you've got a minute, I don't know if you can just jot something down in the, you know, that might work on the medical clinic, and then, you know, the reality is this, whether you're a medical clinic or a massage, chiropractic, acupuncture, or other similar use, you should be going through the same process, or you should be permitted in the same zoning districts. So, there's not a benefit one way or another, except in the RM zoning that Commissioner Van Pernis brought up. What we can do is adjust that language and put the massage, chiropractic, acupuncture under the use permit section with the medical, and at that point, I think looking at the bill, all the uses would be the same as far as medical and massage, chiropractic in all the zoning districts. Wherever it requires a use permit for medical, it requires a use permit for the other. Wherever it's permitted they're both permitted. VITOUSEK: What about pharmacy? DARROW: I don't think we addressed that in this bill. VITOUSEK: Okay. So, in that case, you know, medical clinics could mean an office building, a group of offices for physicians and nurses engaged in practice of medical or dental, physicians, nurses, dentists engaged in medical practice of DARROW: Very good. 12 EXHIBIT G VITOUSEK: Would that, would that suffice? DARROW: Yes. VITOUSEK: Doctors. Doctors, nurses DARROW: And dentists. VITOUSEK: Yeah. Physicians, nurses, dentists. DARROW: Very good. CARR SMITH: So, we're talking about adding that verbiage in and then also adding the use permit for the RS zoning. RM. DARROW: RM. This would be for the massage, chiropractic, acupuncture, and other similar uses, health uses, in the RM zoning. So it was the same process as medical clinics. CARR SMITH: Mark? VAN PERNIS: Let's not forget the nurse practitioners. CARR SMITH: So Mark VAN PERNIS: I have to disagree with Ms. DeFranco if we talk about licensed individuals, medical doctors, chiropractors, some massagers and [inaudible] licensed, perhaps we could differentiate between licensed people and unlicensed people. There's lots of people out there claiming to provide services and [inaudible] medical services which are not licensed, or they're so called specialty is not one that requires a license. CARR SMITH: Go ahead Barbara. DEFRANCO: I agree with you. I think they need to be licensed. I think they have to be a licensed masseuse or licensed acupuncturist. I think if you have licensing in the state to be licensed. I wasn't talking about unlicensed people,just so you know. CARR SMITH: So Jeff, when people come for use permits for these types of businesses, do they have to show anything that says anywhere that they have to be licensed? DARROW: We haven't had a use permit yet for massage, chiropractic, acupuncture cause we're bringing this bill before you. As far as medical clinics, that's when they come before the commission they bring, there's a lot of detail that's provided as part of the permit. CARR SMITH: Mike? 13 EXHIBIT G VITOUSEK: Yeah, I again, I just, I feel like us now at the end of a long day to try to come up with an acceptable definition for medical clinic, we're more likely to miss something that could be addressed if there were more time to take a good look at how we fit our implied definition of medical clinic into the written definition, and if we take a month to do that and come back and we have a good definition that we all agree with, I think that's better for everybody than for us to try to put something together now. CARR SMITH: Jeff. DARROW: So, the commission needs to keep in mind that this is a bill that is going before Council, and that it goes before the Windward Planning Commission as well. So, whatever proposed, proposed amendments that you're making, we would want it, we get in a place where if we're not able to present it to the Windward Commission, then we're kind of stuck. Because then if we come here and it's approved differently, we go up to Council with separate bills. VITOUSEK: Then can we not provide specific language here, but just the recommendation for a revision to include that topic? DARROW: Sure. VITOUSEK: And so DARROW: What we can do is VITOUSEK: What is the best way of doing that? Would that be approving it with recommended revisions, or would that be deferring it? DARROW: Again, if we defer, we would end up having to defer the Windward until, you know, I mean we're kind of stuck, but if you were to ask the Director to consider amendments to the medical clinic definition, to come up with a more specific definition, we can work on getting that put together and maybe even consult with you on it and then present it to the Windward Commission as well. But again, it wouldn't be something that we could vote on right now because it's not available. CARR SMITH: Director Yee? How do you feel about that? YEE: You know, I guess it's more of what the commission feels comfortable with. If, if, I hear Jeff, and that yes, there is a timing issue, but we're also not, we're not up against a clock that something's expiring here that has to get done, right, so if, if Windward has to wait for us to clarify the language to show to Leeward, then we take the time to do so. If we want to expedite and we have some flexibility to make changes more on the fly to present something to Windward that we think might, might make sense to Leeward, and we all have the flexibility to, to still proceed to Council, we're doing go. I'm not sure that's what I'm hearing from, from Mike, and again, I think this is more about what the Commission needs than it is the Planning Department trying to drive a certain timeline. 14 EXHIBIT G CARR SMITH: Thank you. VITOUSEK: Is there a reason why this would have to come through Leeward before it goes to Windward? If we defer it now could it go straight into Windward and then come back to us? YEE: I think Jeff was only suggesting if we know we're going to change the language, we would want to present that to Windward, cause if we change the language Windward has to see it. So, if we know you're going to change it, we'd rather just take that step first. CARR SMITH: Since Windward can approve it as it is, Mike, then VITOUSEK: Then they'd have to see it again once we - - -but I guess my thought is that if we are recommending revisions, and you guys make the revisions and it goes to Windward and they approve it and we approve it, that's enough. YEE: Yeah, I, I think that's fine too. Like I said, one way to play it would be, we know where your concerns are, we would try to push something in front of Windward, and we could always come back to Leeward with what they approve, hopefully it's fairly solid and no changes, and we can proceed. You know, it's no different than us having to wait till the next Leeward anyway, so, I, I kind of agree. VITOUSEK: Yeah, I'd be okay with that. You know, I, this is super non-controversial, it's just trying to clarify the definition for all of our sake, to save us the headache down the road. You know, and, and I think we can get a good definition. I think we all understand where, where this definition is, so, to me, I'd be totally comfortable saying okay, we'll defer this and you guys take, you know, do your, whatever you want to put into there and take it to Windward, and then when they accept it and they come back to us, we have it in front of us, Windward's accepted it, let's go. You know, let's move forward. CARR SMITH: Mr. Van Pernis. VAN PERNIS: This is in response to Jeff's comments. Is a ambiguous or badly worded bill quickly approved better than a unambiguous good bill that we could live with forever? CARR SMITH: Obviously they felt that this was fine or they wouldn't have presented it to us. Okay VITOUSEK: I guess we can vote. CARR SMITH: I guess we can vote, yeah. We've got a motion on the table, so, let's see where we go with this. Go ahead, Tracie. CAMERO: Sorry, I just want to clarify. The motion is to defer it, correct? CARR SMITH: That's correct. 15 EXHIBIT G CAMERO: Okay, thank you, Chair. With that we'll take a roll. Commissioner Van Pernis? VAN PERNIS: Aye. CAMERO: Commissioner Vitousek? VITOUSEK: Aye. CAMERO: Commissioner Perry, Vice Chair Perry, Kealoha. Sorry. KEALOHA: Aye. CAMERO: Commissioner DeFranco? DEFRANCO: Aye. CAMERO: Commissioner Newberg? NEWBERG: Aye. CAMERO: Commissioner Yates? YATES: Aye. CAMERO: And Chair Carr Smith? CARR SMITH: Out of principle, I, I'd say no,just because I was fine with it the way it was. So, no. CAMERO: Okay. With that the motion carries six to one. CARR SMITH: Okay. Thank you very much, Tracie. The hearing was adjourned at 5:14 p.m. Respectfully submitted, Kim Tanaka Secretary to Boards and Commissions 16 EXHIBIT G