The recent wildfires in Hawaii, now the deadliest wildfire event in over a century, are straining local healthcare resources as physicians and other providers care for patients who were directly injured in the fires and/or emotionally traumatized by the disaster, as well as displaced residents who need ongoing medical care. Several local clinics, physician offices, and other healthcare facilities were either destroyed in the fires or closed due to lack of access. As the state mobilizes to reinforce local hospitals and providers, concerns about rising COVID-19 cases in Hawaii further complicate efforts to preserve healthcare capacity in the state.
Since the wildfires, there have been several important temporary changes to laws and regulations at both the federal and state levels to facilitate health care for those affected by the fires.
On August 11th the U.S. Department of Health and Human Services (HHS) declared a Public Health Emergency for the State of Hawaii. The declaration is retroactive to August 8th, the date when the wildfires first occurred. With the PHE declaration, the Centers for Medicare and Medicaid Services (CMS) have waived certain requirements under Medicare, Medicaid, and the Children’s Health Insurance Program to give greater flexibility in providing medical care for those affected by the wildfires.
Additionally, HHS deployed a disaster response team to support the emergency response in Hawaii, and the Office for Rights (OCR) has issued a limited waiver of HIPAA sanctions and penalties during the PHE.
The Governor of Hawaii has issued several Emergency Proclamations in response to the wildfires; most recently, on August 19th Governor Green announced a Sixth Emergency Proclamation Relating to Wildfires. Healthcare-related suspension of laws include the following (partial list):
Chapter 328, HRS, food, drugs, and cosmetics is suspended to the extent necessary to allow a pharmacist to refill prescriptions for persons directly impacted by the wildfire emergency if the pharmacist is unable to readily obtain refill authorization from the prescriber, provided that:
- the pharmacist may only dispense up to a maximum 30-day supply.
- the prescription is not for a substance listed in schedules II-V appearing in chapter 329, HRS.
- the medication is essential to the maintenance of life or to the continuation of therapy in a chronic condition.
- in the pharmacist’s professional judgment, the interruption of therapy might reasonably produce undesirable health consequences or may cause physical or mental discomfort.
- any dispensed prescription drug bears a label with the information otherwise required by law, including but not limited to section 328-16, HRS.
- the dispensing pharmacist complies with section 328-17.7, HRS, and notifies the prescriber of the emergency dispensing as soon as practicable after such dispensing.
Section 329-40(b)(7), HRS, methadone treatment programs is suspended to the extent necessary to allow the medical director or other program physician of a Maui methadone treatment program to dispense the maximum number of take-home dosages of methadone permitted by federal law to patients who are directly affected by the wildfire emergency during the emergency period, in lieu of the 14-day limit.
Section 329-41(a)(8), HRS, prohibited acts is suspended to the extent necessary to allow, subject to any federal regulation, a practitioner who is not physically located in the State to facilitate the issuance or distribution of a written prescription or to issue an oral prescription for a controlled substance for a patient, currently in State, who is directly affected by the wildfire emergency during the emergency period.
Section 329-32, HRS, registration requirements is suspended to the extent necessary to allow an out-of-state physician or advanced practice registered nurse with a current and active license, and who holds a current United States Drug Enforcement Administration (DEA) registration in at least one state, to administer, prescribe, dispense, or store a controlled substance, on the island of Maui without a current Hawaii controlled substance registration; provided that they have never had their professional vocational license or their authority to work with controlled substances revoked or suspended and are hired by a State or county agency or entity, or by a hospital, including related clinics and rehabilitation hospitals, nursing home, hospice, pharmacy, clinical laboratory, or other health care entity. This suspension is contingent on the out-of-state physician or advanced practice registered nurse receiving federal authority from the DEA to administer, prescribe, dispense, or store a controlled substance in Hawaii beforehand and complying with any further instruction from the State Narcotics Enforcement Division (NED).
Chapter 453, HRS, medicine and surgery, and Chapters 16-85, HAR, medical examiners is suspended to the extent necessary to allow out-of-state physicians, osteopathic physicians, emergency medical service personnel, and physician assistants with a current and active license, or those previously licensed pursuant to Chapter 453, HRS, but who are no longer current and active, to practice statewide without a Hawaii license; provided that they have never had their license revoked or suspended and are hired by a State or county agency or facility, or hospital, including related clinics and rehabilitation hospitals, nursing home, hospice, pharmacy, or clinical laboratory, or other health care entity. (Similar suspensions were issued for other licensed healthcare providers)
The Governor’s Proclamation also includes several important requirements and immunities for medical professionals, including:
Health Care Response to Wildfire Emergency. Health care facilities, health care professionals, and health care volunteers shall render assistance in support of the State’s response to the wildfire emergency. For health care facilities, “rendering assistance” in support of the State’s response includes cancelling or postponing elective surgeries and procedures as each facility determines to be appropriate under the circumstances presented by the wildfire emergency if elective surgeries or procedures are performed at the health care facility. In addition, for health care facilities, “rendering assistance” in support of the State’s response must include measures such as increasing the number of beds, preserving personal protective equipment, or taking necessary steps to prepare to treat patients in need of care because of the emergency. For health care professionals, “rendering assistance” in support of the State’s response means providing health care services at a health care facility in response to the wildfire emergency, or working under the direction of HIEMA or HDOH pursuant to the Governor’s emergency proclamations. For health care volunteers, “rendering assistance” in support of the State’s response means providing services, assistance, or support at a health care facility in response to the wildfire emergency, or working under the direction of HIEMA or HDOH pursuant to the emergency proclamations.
Immunity of Health Care Professionals. Health care professionals who in good faith comply completely with all state and federal orders regarding the wildfire emergency, shall be immune from civil liability for any death or injury to persons, or property damage alleged to have been caused by any act or omission by the health care professional, which death of or injury to persons, or property damage occurred at a time when the health care professional was rendering assistance to the State by providing health care services in response to the wildfire emergency, unless it is established that such death or injury to persons, or property damage was caused by willful misconduct, gross negligence, or recklessness of the health care professional.
Additional resources for physicians and healthcare providers can be found through the Hawaii Medical Association, State of Hawaii Department of Health, Healthcare Association of Hawaii, Healthcare Ready, and Hawai’i Cares 998.
Those who wish to support the ongoing wildfire recovery efforts in Hawaii should consider donating to the following organizations:
- Hawai’i Community Foundation Maui Strong Fund
- American Red Cross
- Maui Food Bank
- Aloha United Way
- Hawaii Chamber of Commerce Foundation Business Relief Fund
For more information on disaster recovery, including wildfire information for Alaska, California, Hawaii, and Idaho, please visit MIEC’s Disaster Recovery page.
MIEC members who have been directly affected by the Maui wildfires, or who have additional questions, should contact MIEC at 800.227.4527 or firstname.lastname@example.org.