Kona Community Hospital to seek funding from Hawai‘i Legislature for emergency department expansion

Leaders at Kona Community Hospital plan to seek state funding for what they say are much-needed improvements to the Kailua-Kona facility’s “cramped” 6,200-square-foot emergency department.

With the 2025 Hawai‘i Legislature convening on Jan. 15, the hospital administration will talk with lawmakers about securing $13.2 million to improve patient flow that will enable faster treatment.

At peak hours in the emergency department — which has 21 beds separated only by thin curtains — there are as many as 10 nurses, two technicians, a clerk and two providers, usually a physician assistant or doctor, working to treat patients in a space with narrow hallways crowded with work stations and trauma carts.

West Hawaiʻi Regional CEO Clayton McGhan said the funding would cover plumbing, electrical, negative pressure rooms that keep contaminated air inside the room and positive air-flow rooms that keep contaminated air outside.

Negative pressure would be for patients who potentially have a contagious disease such as tuberculous. Positive pressure is for patients with a weakened immune system and need protection from contagious illnesses, such as oncology patients.

The funds also would be used to help the hospital determine how to better use the emergency department’s existing tight space.

Regina Leon, director of critical care at the hospital, said emergency department staff has been meeting regularly to try to get creative in how they manage patient workflow and the space, which includes state-of-the-art equipment such as portable X-ray and ultrasound machines.

The medical emergency staff serves more than 100 patients a day in the emergency department. They are treating a myriad of health problems that range from splinting bones to life-and-death intubations.

The current logistic problems are only getting worse, with the number of patients coming to the emergency room growing and expected to continue to do so into the future.

In the 2023 fiscal year, Kona Community Hospital’s emergency department treated 22,000 people. In 2024, it increased to 24,000.

McGhan attributes the increase to a variety of things, including a lack of access to primary care physicians and the area’s growing population.

“We just simply don’t have the beds to see the patients,” Leon said. “We have the staffing. We have the equipment. We have the providers. We just truly don’t have a space for them.”

Although Leon said “our ER works so well as a team,” the logistics of the emergency department layout provide a challenge to the personnel because the space is divided into a north and south end with the two sections separated by the waiting room.

The south wing, which handles trauma patients and has 15 beds, is the largest and most busy. The north wing is for patients with less severe health issues.

With more patients and a lack of a cohesive emergency department, Leon said there are longer wait times for care. Managing flow also is made more difficult when the patient has a friend or family member with them for support.

Leon said support persons are important to patient care and so far the hospital hasn’t had to restrict them.

Kona Community Hospital’s last major renovation was in 2020 with the upgrading of its three operating rooms. In the early 1990s, the hospital built an additional building for same day surgeries, with a recovery room and Intensive Care Unit. The hospital also expanded its acute and long-term care to 75 beds.

This new request for state funding comes after Kona Community Hospital received $18.5 million in 2023 to upgrade the hospital’s heating and cooling system, and for pharmacy infrastructure expansion.

Hawai‘i Island state Rep. Kirstin Kahaloa said the hospital has outstanding needs and at one point in 2022 faced risk of closure because of its outdated infrastructure, which was avoided with recent funding.

Kona Community Hospital commissioned a study that was funded by the Hawai‘i State Legislature and released in May that assessed the 50-year-old medical facility and identified the growing health care needs of West Hawai‘i.

McGhan and other hospital leaders hosted a public meeting last year about plans to build a new hospital. The Queen’s Health Systems on O‘ahu recently announced its intentions to build a facility in Kona on land by Costco.

Kahaloa, who represents Kailua-Kona, has been involved with the funding process for Kona Community Hospital’s needs since 2022 when she took office. Funding the aging facility has always been a priority for her and her fellow Big Island lawmakers.

She said the latest request is included in Gov. Josh Green’s proposed budget that will go to the Legislature for approval. Prior to becoming governor, Green was a practicing medical doctor on the Big Island.

Kahaloa doesn’t think discussions about building a new hospital will impact whether or not the Kona facility receives funding for the emergency department.

“The focus for me is what does the hospital need now and how we meet those needs,” she said.

Kahaloa is excited about the opportunity of a new hospital proposed by The Queen’s system, adding “we need to look at what is actually going to come to fruition.”