 Bingo two o'clock rock Tuesday, okay? It's health care in Hawaii with Senator Josh Green Hawaii State Senate District 3 and we're talking about developments in Hawaii's health care system Welcome to your own show Josh. Glad glad to be here with myself You know let's let's do so much that's going on so I'm really glad we have this moment of respite We in the waterfall and all that must be the back end of Manoa, maybe yes But Question what's going on here with Maui Memorial Hospital? Can you can you help us sort it out because what happens in Maui is kind of a forerunner for what's going to happen in the big island? Yes, and I hope we don't have the same kind of Cirrus in the big island as we've had in Maui. No, well we have learned some lessons about this So you're talking about the privatization of the Maui region three hospitals, but mainly it's Maui Memorial They're into the final stage. So Governor E. Gay Was given the power through legislation to create a privatized model on Maui That was last year now he asked to negotiate the contracts with UPW and HGE a he reached an agreement with UPW and Now HGE a has to have an agreement by August 26th Which is about three days or four days away in order to get this thing to go And if it does go then they're gonna start on November 6th. So that's an agreement for Compensation severance pay package for before. Yes, not for the future well to kind of settle up because we are Curtailing their contract which would have gone till June 30th. Otherwise, it's been important that we take care of the workers And it's important we take care of the patients and the people of Maui So there's a lot of compromise. It's necessary if they miss this deadline I fear the privatization and the new model won't occur until July 1st next year Which I also believe will mean that Maui will lose services in the interval that they will have uncertainty They will not have the budget that they want and they will cut services So my Maui colleagues are very passionate about this thing getting done And it's why we if people want to know out there why we were so adamant of overriding the governor's veto and pushing this issue Because we felt if they didn't take a push we didn't have a nudge there This just wasn't gonna happen and I know that that's a fact So we're pushing them right to the edge to get this settled And I hope that they will because I want to see if this works so then we can move on to big island if it's good for the people Yeah, this is a whole Transformation of health care in the neighbor islands and it's so important because we as we've discussed so many times There's a shortage of doctors there and as a you know It's a shortage of health care there and here we're looking the beast right in the face So to speak yes, because if we don't do it and do it soon We're gonna we're gonna lose further ground and providing health care to the neighbor islands if we don't have a new model because this The state government is not really in the business of doing health care. It's just not it's in the business of doing public health And we'll talk about that maybe later about things like Immunization and hepatitis and restaurants and these you know surveys and stuff But it's not in the business of running hospitals So we for years run a major deficits Which has been kind of an important and civilized thing to do for the neighbor island communities like mine back home But it's not a way to lead for the future because we never invest in extra resources We can never attract doctors or nurses with decent pay packages We can't actually grow and provide services keeping up with the modern times So it's something had to give Maui decided it wanted to be the first one to try it and as long as we can Have a fair package. I think everyone will be able to accept it Yeah, well when it came out more than a year ago now, yeah, and people got aware of it I remember the program you were involved in a program of Pacific Club about this. Yes It was really optimistic was a great thing great idea solution with so many problems So what is that what has to happen now to get to that solution? What do you what do you want to happen? I want Governor you gave to do just a fair reasonable settlement with HGEA and I want Kaiser to take over responsibility on November 6th And then I want to see how it works and make sure it's very fair We have provisions that no one will lose their job at all for a long period of time See that it works see that it's cost-effective see that people get more services And then the other regions could see if this model fits them. That's what I want I want us to move forward Hawaii. I don't want to be cruel But Hawaii has a way of doing nothing if people don't somehow provide some actual momentum and a catalyst And it took a catalyst we would have otherwise just dwindled for a year after a year after a year and never taken this You know upon ourselves and that's no good because patients They haven't been getting new technologies or new care and eventually it will hurt our neighbor islands Yeah, and it's disparity and unfair disparity between a wahoo and the neighbor Which also speaks to a disparity a wealth disparity because people don't have the same wealth on the neighbor islands There's also a lot more people of native Hawaiian descent They have very very significant gaps in health care. It's totally unfair So it's important to at least always try to do something better if this doesn't work We will then know but I'm almost certain it will work because Kaiser's a very good trusted partner I will hold them to account like I would anyone to make sure that they treat and they will because this is what they Do treat the system with respect and treat all the patients and the providers with respect But they have a long track record and they have resources resources that the state can't offer Long-term and so that's why it's a good move and they're still excited about it Kaiser's still willing and able and Focused on I'm taking over as soon as it can their gung-ho. They told me point blank They will still do it even if it's a total failure of negotiations They'll still do it on July 1st next year, but it will cost them 40 or 50 million dollars extra They've already invested 40 million dollars in infrastructure contracts. So you can't just walk away. It's not the right thing It's yet another one of those business situations where now we walked away from Super Fair. We may Walk away from TMT if we walked away from this deal, it's like the trifecta and so You know, I don't think we can afford to do that because sooner or later people are gonna say look Okay, you guys do tourism. Well, that's it and I don't think that that's what we want We want more for our families. Yeah, it's into generational looking for the future generation. Yes, let's let's change Let's let's talk about infectious diseases. Yes, and public health. We have seven cases of Zika reported recently There was an issue at least in the in the mainland rather the mainstream news Organizations that there might have been a problem here because the Department of Health did not reveal that earlier Yeah, I don't know why they didn't reveal it. I think it's important that First, let's talk about the facts on this one. So all seven of those cases were imported people had contracted them in their own travels So these were not cases of disease that were picked up like we had the dengue fever outbreak last year on big Island These were not cases that were churning in our own state They came to our state Of course, the concern is is that once someone's infected if God forbid the mosquitoes become a vector for this illness For Zika then it gets into our population of mosquitoes here and then it starts spreading I would say the Department of Health made a mistake They seem to say that yesterday in the news. They made a mistake not being Transparent these kind of things you have to be transparent because people's trust the public trust must be respected If you lose the public trust then they won't take you at face value when you really have to be heard Yeah, I don't think there's gonna be an outbreak knock on wood But I do think that this underscores the larger point which we've been making for the last year, which is Hawaii has to be Dead serious about taking care of all of our mosquito-borne questions So we have to use whatever means our nest are available and necessary to knock down the 80s Egypti and 80s Alpapictus. Those are the two Species of mosquitoes knock those things down so that even if there are a couple cases it doesn't become an outbreak If Zika were to break loose you're gonna have children with birth defects And you're also gonna have panic and if you have panic and you're a tourism driven state and you're gonna come around Yeah, big trouble. So This is really serious. I think that we probably haven't heard the last of this oversight By not mentioning the cases, but the good news is it didn't lead to a big outbreak a couple of thoughts So one is from what you said it sounds like Zika is not transmitted from one person to another It's by way of the environment way by way of the ecology with the mosquitoes So the mosquito bites me it gets into the mosquitoes then they bite somebody else and that's how it's trained am I right? That's the primary transmission. Yes I believe that there have been a couple cases very rare cases where a couple has transmitted it from one to another and I'm not an expert on Zika and It definitely is mostly ninety nine point nine nine percent I would guess from mosquitoes as the vector giving it to people the good news is Zika is pretty or Minimally symptomatic a lot of people don't even know they had it the bad news is if you're pregnant It's a it's an enormous risk to your fetus and you can have what's called microcephaly in the baby Which is small head and that that child will never be developmentally normal really problem But you know one thing is a little tricky here It's because if it's if it's without symptoms then you could have it you'd go through the whole course of the disease Never knew you had it right and at the same time, you know You could be spreading it by way of those mosquito bites or whatever Then I wonder what what I can do What I should be looking for to see if I got it or anybody got it right most people would have a serious rash is my understanding These illnesses chicken gluya Zika and dengue are all in kind of a similar cluster dengue fever I think being the worst Thematically where you get these terrible bone pains and high fevers Basically if you have any concern and you've read up on Zika and you've noticed the rash or you've noticed that there was someone else in your Community that had it and you were worried you go get tested see if you've been creating antibodies The good news is once it burns through you once it's done. You're not going to be transmitting You know risk to your feet is how many days are we talking that I don't know I mean, I think it's there's a lot of research going on about that I think you want to be pretty far out though. They've told people if they've been exposed to Zika They want them to spend like six months not getting pregnant at least I would defer to the CDC and the Department of Health infectious disease experts. I asked them to come on today, but it was too short notice And they're very busy. I mean they're dealing with this and they're dealing with dengue fever And they're dealing with you know hepatitis A. All of a sudden the Department of Health is very busy lately infectious diseases there it's always been there, but It's been I think as we kind of We suggested in our crystal ball moment not long ago that infectious diseases are going to be our big challenge Globally in this in this century. It's not going to be only terrorism or only You're playing crashes and heartbreaking things It's going to be infectious diseases because we're now a giant population of over eight billion people Everyone's traveling. We're here being traveled to and we're going to see this as a big issue Which is why they have to get it right and why we have to spend extra resources on infectious disease control in the state of Hawaii It's actually why one of the very few departments. They got extra positions this year was this branch and they got 22-0 extra positions for vector control. We need them to do this job Yeah, that vector control means they go around and spray against mosquitoes. Yeah, and they have expertise They can bring These specialists that know about mosquitoes to bear so that if there's an extra cluster here or there they can You know, they can ask the mayors to deploy services. What about those? those GMO type devices that GMO Mosquitoes technologies GMO mosquitoes. Yeah, that kill off mosquitoes. So are we trying that? Should we try that? We are not trying it yet It's only gotten its initial approval from the FDA and then it got there was a lawsuit in that region I believe in Florida which blocked them. I think that that could be a solution for us You know, I tend to if this is ironic because I tend to be a little bit more of the natural anti-gmo guy But I'm also aware that there are times when technology can be very valuable to us. What those GMO mosquitoes do is when they Hook up or have sex with other mosquitoes The offspring become infertile and it kills out the breed and that's what you want That could very well be a good solution for us although again, we would want to defer to the real experts at the CDC and our Department of Health because For instance big islands very spread out and if we're going to take any risk whatsoever with any kind of genetic manipulation I really want to be pretty sure that it's going to number one be well studied and followed and to very effective and worth it Yeah, worth it. One of the questions. Can I do anything? This is a virus. This is a seca virus Yes, can I do anything to protect to to improve my chances? You can really just it's the basics, right? You can put on extra Mosquito repellent you definitely should use mosquito repellent if you're in an area with mosquitoes Every family in the state of Hawaii should clear free-standing water if we all did our part and then some if we all went the extra Mile and got rid of all of the extra free-standing water around us We could probably knock down the mosquito population so dramatically that we would not be worrying about this It's tough because there are regions in the state that are very rural and they have water that stands in leaves It's just not easy to beat There will be some spraying that will help there will perhaps be some technology that will help and then if people When they're going to their sporting events and during the peak seasons do put extra whether it's deets or whatever on you know That's the whole thing about infectious disease if you knock down the numbers You don't have to knock them out to zero to prevent an outbreak You just have to bring it down so that the population doesn't explode and if we all do that we will see very very minimal risk We're gonna take a short break. That's Josh Green Senator Josh Green District 3 Hawaii State Senate talking about developments in Hawaii's health care system will be right back. You'll see Hi, I'm Steven Philip Katz. I'm a licensed marriage and family therapist here in Hawaii And I'm the host of shrink wrap Hawaii which is on Tuesdays at three o'clock Have a great summit. Take care of your mental health For a very healthy summer watch Viva Hawaii We're giving you the best tips and with our best health coach here. So Viva health coach Viva la comida saludable Aloha, I'm state senator Russell Ruderman I represent the Pune and Ka'u district on the big island and the host of Ruderman round table We're here on think tech Hawaii every other Tuesday at 2 p.m You can join us at think tech Hawaii comm you can find a link there to To a page where you can see past episodes and we talk here about good government Environmental issues and issues of the day facing the state of Hawaii. I'm Russell Ruderman Please join us for the Ruderman round table. Yeah, Mahalo Think I went back we're here with Josh Green the senator District three talking about developments in Hawaii's health care system And we're on to one other infectious disease issue and that is hep a keep hearing about it here about it at restaurants Gee and most recently scallops. Yes, I mean I and I can't tell whether it's the way It's prepared or the or the food itself or a combination. How does this happen? Well, it's both so scallops came in from the Philippines that already were contaminated with Hepatitis a which is another virus Once they're on there. It's a very hearty virus It was in the food and so people who ate it got the disease also those who handle the food can then transmit it because It gets on your hand The oral fecal transmission route is what we say with this hepatitis a and that means if it's not cleaned up Well, or if say someone has a diarrhea illness, and they've got a disease They ate they ate the hep a food right and then they're sick and then they're puking and they're in diarrhea So body fluids and then you get it on your hands And then everything you touch is also at your home and your kids could get it or your other family members and so on So it's highly contagious. It's highly contagious The good news is children have been immunized who have been immunized are immunized against hep a also We got on this pretty quickly there have been a total of 200 in some cases 206 cases I think that is the number as of last week It's very scary hepatitis a affects your liver your liver is right here in your body You can have liver damage from a lot of stuff from hepatitis and there's five types main types ABCD and E You can get hepatitis You can get hepatitis or hepatic injury from drinking too much alcohol Taking too much Tylenol or again the disease and if you get a really bad hepatitis or a bad form of hepatitis a You get yellow which is jaundice your liver gets damaged and you can get very sick It can affect how your blood clots. It can kill you. It didn't kill anybody You do you tend to get better, but there's no direct treatment You just have to sustain yourself and get IV fluids and maybe be in the hospital People lose a lot of weight they feel sick as heck sometimes for months They feel sick and then they get better in this case though They did a good job that the Department of Health did a very good job working very hard with partners from the mainland also to track down where it was they figured it out and They they tracked it to ganky sushi that had brought in these scallops feel bad for that company But that's what happens sometimes we have to take every precaution going forward that doesn't spread further So if I have happy am I gonna have long-term effects? Am I gonna be at risk in some way after I recover from the initial course of the disease? No, you should be okay Most people will be fine very very few proceed on to cirrhosis Which is chronic liver damage and five fibrotic changes of your liver if that happens Which is very rare happens much more commonly with hep B and C Those other viral forms mostly affiliate mostly associated with drug abuse Or sexual transmission If you get cirrhosis you are gonna either die or gonna need a liver transplant but happy you'll get better you'll then be immune which is good news and You know you won't be able to get it again But it could be a long long period of time until you feel yourself months We have a friend that we had over for a barbecue. His wife was over her husband was one of the 200 cases He's lost 20 25 pounds. He was yellow as a sheet of yellow paper You know that you get for school writing and it was just Unbelievable no one else in the family got it. They got immunized. We got immunized in my family because I'm a doc as well I wanted to get immunized We're recommending basically the people it's their choice if you have any risk factors at all Like you are a food handler you work in health care or if you've had other issues Let's say you do do drugs. Let's say you have had immune system compromise You should get immunized, but I think it's everyone's prerogative It's about 50 bucks you call your doctor they do a prescription you get the shot and then you get a second shot six months later But even after the first shot you're very likely Beginning your immunity in a positive way Does does a hep a lead to hep bcd? Are they related in any way does this one make you more vulnerable to the other not to my knowledge? Although if you've done yourself liver damage, then you want to be super duper careful to not abuse your liver with booze and Tylenol and whatnot, but also you do want to be tested for any other possibilities and you're still just as Sceptile as anyone else is if you have sex with someone who's got hep B or C. You could get it You got to be careful. Well, why do I have to get a prescription for this? Why can't it be just like a you know a regular flu shot or something? Maybe that's coming. It may be I think that there are some things that well historically we didn't need to give a lot of hepatitis a shots Just if you were traveling or you were in these risk categories We may come to an era where a lot more immunizations are permissive, which is what you're describing Yeah, I Don't think anyone's really doing themselves much harm There really aren't any contraindications from getting the the hepe shot or practically none And pharmacists are quite astute also they know when to do things and when not to do things most of the time So what is there anything else I can do aside the shot? I mean, I guess I got to avoid raw food. What else in this case? Yes raw food that was as designated by Department of Health. I would go to the Department of Health website I was on there today in preparation for our time together and they List very nicely the restaurants that were of concern We pretty much seem to have the tiger by its tail as I'm reading and hearing That these restaurants have been shut down. They're getting cleaned up probably will reopen at some point in the future But I don't think you have any special worries I think you you do have to be cognizant of the fact that the virus itself incubation periods from 15 to 50 days So there could be some people that were exposed to it and we may see in fact I'm sure we will see still some more cases. Yeah, and if that happens then You know, there'll be more cases. Yeah, but I would say get a shot I don't think it's a big deal. I got my shot. I felt totally fine. I didn't have any Any side effects I didn't even have a sort any soreness. You know, my wife and I went over to our doctor and got a shot Okay, moving on We haven't finished all our stuff here Medical marijuana is coming soon and not yet and it's very interesting that You know that they say that the first actual offerings of medical marijuana you've grown in the state of Hawaii Yes, we'll be like in November, but they can't say exactly who that will be I don't know why it's a secret to me. It should not be a secret Let's be completely transparent from the outset about this. Yeah, the well We passed out about I don't know was a licenses or something and they bid on them and applied So they're supposed to be and I think they will be very reputable people Running these businesses. It's a technical business surprisingly and maybe not so surprisingly for those who know it I think there will be good experts involved I Be frank. I thought we could have done it in a more streamlined fashion, but I mean a quicker fashion quicker fashion Yeah, but there will now be medical marijuana available. You'll need to go to your Physician or nurse practitioner get a certificate if you have a actual illness or need I don't think people should get it for recreational purposes. It's not okay It doesn't help in either Zika or Hepay, huh? Probably not although if you had severe severe nausea it might Actually, and it would probably be better than some other pills that go to your liver But it it's certainly a medicine. I support Provided it's done safely and not for young people. I think people's minds should be fully developed before they use marijuana I think it's better though than narcotic pain pills. We have an epidemic of that Different issue for a different day probably but I think it's gonna be a decent program for the state of Hawaii I think it will evolve quite quickly. I think there'll be a move toward legalization I don't know whether that will happen or not. Yeah, and There definitely will be an inclination to decriminalize it because I think more people are going to be smoking pot So if I could say to people out there who are going to use marijuana for their health conditions Please don't drive cars at all. Let someone else drive you be very safe, but also Enjoy better health, and I hope that that will be the case But definitely be safe until we have a more adult grasp scientifically of What it does to you as far as your capacity to drive and move about what it does in some other systems Your lungs and so on. I don't think we've fully developed the research. So I think it's gonna help a lot of people But take it a little slow, you know, I'm going to put you said about driving cars Is there a way to determine this is more like alcohol really it could be drunk from marijuana Yes, and they're not quite capable of driving a car. Is there a way for the the friendly HPD? To determine how much is there a legal standard for how much of something is in your blood? So that you might be in violation of something else. I don't know well There isn't a legal standard in the state of Hawaii, which is something that I Recommended but didn't happen yet. I think that in some states it's five micrograms of active Marijuana to you know to describe it basically and that's being debated and tested across the country I take a zero threshold of risk. I think just simply don't drive if you're using medical marijuana have someone else drive you I so I have people help me drive all the time if I'm otherwise busy or occupied or on the phone or whatever So and then I drive when it's my turn and they're busy. So just like alcohol I would say even though the legal limits point oh eight if you've had a drink or two don't drive You're more likely to crash if you've smoked marijuana for your health condition or let me just be blunt If you've smoked marijuana because you're just smoking some marijuana Don't drive because you run a risk of hurting yourself and killing someone else And I do think that because medical marijuana is kind of flourishing in a lot of different states There's gonna be a lot of good basic public health research on it and we'll get to know very clearly Maybe it's not gonna be a big deal. Maybe it is okay, but until we know this case we did put the card before the horse and It just it's not the best way always to legislate and so please be safe out there Well, you know one one point you just mentioned just to dwell on a couple of things, you know I noticed something in the paper about somebody who accidentally was a negligent homicide recently and that person You know got a serious Criminal penalty yes So this was not the case 20 30 years ago your insurance company would step in and pay off the claim It would be a civil negligence action now you kill somebody with your car forget about marijuana or alcohol You kill somebody with your car and it's negligent homicide. Yeah, it's also a criminal case against you So you really have to be careful in 2016 about driving your car Responsibly in every way you do the the emergency room physician in me really worries about people. That's one of the There's only a couple things I really worry about I worry about Accidents like that because they can of course they devastate the life of the family where the person's been lost They can ruin your life as well because you could end up going to jail for a long time away from your family Which is from an accident Even a negative action. Yes, you're talking on your phone something stupid happens And you end up losing a good part of your life and taking someone else's and then drug and alcohol Drugs used to be much more benign marijuana is pretty benign for instance Alcohol fairly benign overall don't drive and don't drink and drive for sure But aside from that not a big deal, but now people get hooked on methamphetamine Or other major drugs heroin and all of these synthetic action I'm waiting to happen you could be addicted for good and you could be kind of a person that's I mean look I'm like on the most straight narrow path in history. I've never even tried a drug honest to God not once But if if you put some methamphetamine into my system, I would be an addict immediately Just like anybody else and so I really caution people watch over your kids Watch yourself don't ever try these drugs because they will ruin your life Yeah, and they'll ruin the lives of others. Yeah one other thing is something you know derived out of what you said And what I saw as an article about about medical marijuana in this morning's civil Pete and it would Being subjective about this, but what it raised in my mind is that when you decriminalize marijuana? Which I think everybody assumes is going to happen in two or three or four years around here All of the regulation all of the statutory structure that the legislature built around medical marijuana may not apply It may be that you can grow it in your garden just the way you were doing before And and we don't have licenses that we don't have special people making uku bucks selling marijuana We don't have all the you know all the rules regulations what not when it gets decriminalized Am I right it becomes open season for everyone? No if yes to a degree once it becomes legalized fully Yes, it decriminalization would carry with it Just civil penalties and certainly no criminal Major criminal penalties jail time or what have you so people would be more willing to do it Use it for themselves sell a little marijuana Nothing that I really recommend personally, but hey, you know people are people Since you legalize totally yes, then you can grow it right out in the middle of State capital lawn and probably that would make people very happy. Yeah, so some of my colleagues I'm sure I would love that so I would say if legalization occurs It will disrupt the whole system the country may go that direction And we have to actually know from a sociologic standpoint what the impact will be whether it's a good move Whether it cures us of some of our other evils or whether it sets us down a path. That's a little risky I don't want my kids smoking pot But when they're 25 years old what they do with their lives they do with their lives And if they've got some severe illness some terrible chronic pain I will support them in their needs and if that helps them I'm there for them So it's going to be a really dynamic part of our health care system and probably one of the more interesting parts in the next few years Josh Green one of my favorite hosts here at Think Tech Healthcare in Hawaii with Josh Green senator Josh Green district three in the big island Developments in Hawaii's health care system. We got to do this again Josh