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Hawaii hospitals see overcrowded EDs at the beginning of the year

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Hawaii hospitals see overcrowded EDs at the beginning of the year


By Nina Wu
The Honolulu Star-Advertiser

HONOLULU — The new year is starting off with a bang, and not in a good way, with emergency rooms across Oahu experiencing a surge in patients. Most are running at over capacity.

“We’re seeing four to five hospitals on Oahu being overwhelmed at the same time,” said Dr. Jim Ireland, director of the Honolulu Department of Emergency Services. “It’s getting harder to find places to take people.”

When ER departments are full, ambulances either have to make a longer drive to a different hospital or deal with longer wait times to transfer patients to doctors.

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“Historically, that transfer time is under 20 minutes,” said Ireland. “We’re seeing now one hour on a semi-regular basis and, in extreme cases, even up to three hours.”

When patients aren’t transferred to the ER right away, he said, the paramedics are also unable to respond to other 911 calls.

The uptick in ER room visits has been building over the past few months, he said, but growing more intensely in recent weeks, including over the Christmas and New Year’s holidays.

What’s behind the uptick?

Ireland said there may be numerous reasons, including delayed routine care and screening during the height of the pandemic, more illness and an aging population.

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“Overall, in certain sections of the population, health is worse,” he said. “There are more heart attacks, strokes, problems with blood pressure, diabetes and overall medical conditions,” he said.

Additionally, the return of tourists, and more people getting out and about means more potential accidents on roadways, in the ocean and on hiking trails.

It’s also respiratory virus season, with some COVID-19 cases and a spike in flu cases, resulting in 911 calls for breathing problems and very high fevers. There are still calls for overdosing on fentanyl and other narcotics, along with self-harm incidents.

Cumulatively, they add up to increased demand for emergency services.

EMS these days is conducting 160 to 180 transports a day, and a greater volume overall than during the same time in 2023.

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Ireland said EMS is discussing with the state how to balance out the load and potentially reroute less serious cases to less overwhelmed hospitals.

He also encourages patients with illnesses such as colds, minor sprains and constipation to seek treatment at urgent care rather than in crowded emergency rooms.

On Friday, Oahu’s ER rooms were at 181% capacity, according to Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, according to a dashboard that went live in mid-November tracking hospitals in real-time.

The dashboard showed emergency departments at The Queen’s Medical Center-West Oahu, Pali Momi Medical Center, Kapiolani Medical Center for Women & Children and Straub Medical Center all to be at over-capacity.

That means more patients than available beds, which requires bringing out gurneys or treating patients sitting upright, and higher demands on ER staff.

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“It’s very challenging,” he said. “We were dealing with this over Christmas and New Year’s break, and in early January it’s not getting any better.”

Rise in West Oahu

What’s unprecedented, as well, is a rise in demand for ER services on Oahu’s West side.

“What’s been happening over the last few weeks is that Queen’s West on a regular basis now has more ER patients on any given day than Queen’s Punchbowl, which for years has been the biggest, busiest ER in the state,” said Raethel.

He believes the growth may have to do with new developments on the West side, along with more people working from home seeking care nearby.

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Ireland said some days, Queen’s West is the busiest hospital in the state for ER volume, with up to 40 or more ambulances, about 25% of all EMS transports for Oahu .

“If patients are in critical, we always take them to the closest facility,” said Ireland. “If it’s serious or minor, there’s definitely delays at many of the hospitals on Oahu getting care transferred from paramedics to the ER team.”

Queen’s West is the closest hospital available for the Leeward side, but if it’s full, then Raethel said patients will need to be diverted to Pali Momi or Straub, and if those are full, then possibly to Wahiawa, Kuakini or Adventist Castle.

Adventist Health Castle in Kailua recently became certified as a Level 3 trauma center, which means patients with traumatic injuries now can be taken there instead of over Pali Highway, easing the load at The Queen’s Medical Center in Honolulu.

On Oahu, Queen’s at Punchbowl is certified as a Level 1 Trauma Center for the most life-threatening and critical injuries, while Pali Momi and Castle are certified Level 3 Trauma Centers.

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Queen’s said despite the challenges, it remains committed to providing high-quality health care as Hawaii’s only Level 1 Trauma Center with a comprehensive stroke center.

“This distinction signifies our commitment to the people of Hawaii that when seconds count, Queen’s is prepared to provide comprehensive care for every aspect of injury using advanced life-saving technologies and the highest level of care and compassion,” said Dr. Rick Bruno, president of The Queen’s Medical Center, in a statement.

The West Oahu campus is using additional space at its hospital at this time to evaluate patients for their illnesses, along with high-quality video telemedicine technology.

Queen’s is also in the midst of expansion projects for the emergency departments at both its West and Punchbowl locations.

Statewide there are 304 emergency department beds — 160 on Oahu, 76 on Hawaii Island, 42 on Maui, and 26 on Kauai, according to the Healthcare Association of Hawaii.

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Hospitals overall are also at full capacity, according to Raethel, with more than 2,400 patients in hospital beds per day since Jan. 3, which is putting a strain on the system.

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The Hawaii Airport Check First-Time Visitors Never See Coming

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The Hawaii Airport Check First-Time Visitors Never See Coming


Most first-time Hawaii visitors do not know there is another airport checkpoint waiting before the flight home. No one may have thought about what was in their luggage and carry-on bags at the airport. But leaving Hawaii is where a surprise inspection happens: here’s what gets taken, what sails through, and why so many new-to-Hawaii travelers only learn the rule in line.

A reader named Justin did everything right before his first trip to Hawaii. He checked what he could bring, avoided anything questionable, and figured Hawaii would inspect him on arrival the way, say, Australia or New Zealand do.

It went the other way. He filled out a Hawaii arrival document, but no one checked anything when he landed. On departure at Kona, he had no idea the inspection was even part of leaving Hawaii.

“The first time I ever came to the islands I was diligent about not bringing anything in… I was shocked there were no inspections like you’d find in Australia or New Zealand. Before I left I picked up two papayas from a roadside stand… I was directed through the USDA checkpoint at KOA with no explanation. The inspector was rude and condescending when she took my fruit.” — Justin.

We covered the full system last fall in “Why Hawaii Trusts You Coming In But Checks Everything Going Out.” The comments then showed us something a rules explainer cannot. Even longtime travelers often do not know where TSA security ends, where Hawaii’s own agriculture check on arrival fits in, where the federal USDA inspection on the way out takes over, and why the only checkpoint they really notice is that last one, which comes after the vacation is already over.

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Arriving felt like nothing, and that is the trap.

For many first-time visitors, the odd part starts before the plane even lands. They are told Hawaii has strict agricultural rules, and that part is true. The islands are vulnerable to pests, plant diseases, seeds, insects, soil, and all the other small things that can turn into very large problems once they get loose here in Hawaii.

So visitors can expect a visible inspection upon arrival. They think someone will check bags, ask questions, or at least make the process feel serious. Instead, most domestic arrivals from the mainland complete the agriculture declaration, get off the plane, collect luggage, and start vacationing.

That does not mean the agriculture form is optional. It is a legal declaration, and false information can carry consequences. Inspectors are also, at least in theory, present in baggage claim areas for declared agricultural items, so travelers who disclose something can be sent for review.

So on paper, Hawaii has rules. In practice, most arrivals are self-reported, which is where visitors get confused. If you were worried enough to check what you packed before the trip, walking in with no inspection at all feels less like being trusted and more like nobody is guarding the entry point.

The line on the way home is where this gets real.

Leaving Hawaii feels nothing like arriving. The USDA station is real, and for most visitors, it is their first direct contact with agricultural enforcement during the whole trip. Checked bags get screened before being deposited with the airline. Then carry-on bags get checked, prohibited items get flagged, and fruit or flowers bought casually can disappear at the airport.

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That is what happened to Justin. He bought two papayas before flying home from Kona and had no idea they would be a problem. His flight was direct to Alaska in winter, and the idea that a tropical pest would survive the cargo hold and the cold seemed absurd to him.

Travelers’ logic and federal logic are not the same thing. The rules do not change based on whether the destination feels cold enough, or whether the passenger thinks the fruit is harmless. They are well-established and built around what can and cannot travel from Hawaii to the mainland.

A reader who said he’s an inspector at HNL told us what actually gets taken.

One comment came from a reader named Keoni, who said he works as a USDA inspector at Honolulu. We cannot verify that, so we are treating him as a reader who told us what he sees rather than as an official source. Either way, what he described sounded exactly like what travelers run into at the airport every day.

Keoni said he encounters passengers daily who unknowingly bring fresh fruit or vegetables to the checkpoint. Many do not understand why the items are being taken, and some even become argumentative. Anyone who has stood near those stations has probably seen some version of that discussion unfold.

Most visitors do not learn exactly how this works until it impacts them. You buy fruit legally in Hawaii, pack it with care, and figure you are fine. One catch is that where you bought it can determine whether it travels or is confiscated, and the USDA airport line is usually where it first gets sorted out.

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The rule that surprises people most is the one about cut fruit.

Keoni also raised a question about cut fruit, saying some cut fruit may be allowed for personal consumption in about 12 ounces, while cut mango or papaya would still be taken. We do not find the 12-ounce rule anywhere in the USDA guidance, which works item by item rather than by weight, so treat it as one person’s reading and not official policy. From personal experience, we’ve regularly carried cut fruit salads and have never had them questioned by USDA. What it does show is how quickly this turns into a case-by-case guessing game, as seen in travelers asking real questions.

Fresh whole fruit is easy to understand, even when visitors do not like the answer. Papayas, mangoes, and many other fresh items are exactly the kind of thing people should assume may not travel home with them from Hawaii. The more confusing situations involve prepared food, cut fruit, salads, poke, poi, and leftovers that do not seem to fit neatly into the rules.

That confusion ran through the whole comment thread. One reader declared Costco apples on arrival, had them taken anyway, and asked flat out where the inbound prohibited list even lives. Another wrote about traveling with poi. Someone else mentioned mango chutney without the seed, while another said he turns avocado into guacamole before inspection.

None of those readers were gaming anything. They were trying to understand a system they only half get. They know TSA has its rules about food and liquids. They do not know agriculture has a separate set, and that the two do not care about the same things.

So a jar of jam or liquid guacamole may become a TSA liquid problem, while a papaya becomes a USDA problem. To the traveler, it is all just food in a bag getting inspected. To the airport, it can be security and agriculture, and even potentially customs or airline policy, depending on the item and the specifics of travel.

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Coming in is not as wide open as the law says.

Several readers pushed back on the idea that Hawaii simply trusts everyone arriving, and they were right. The law is stronger than the experience feels. Domestic travelers are required to complete the agriculture declaration, and inspectors are available for items that are declared or flagged.

The rules exist. They just do not look like what visitors picture when they imagine a fragile island protecting itself. There is no universal domestic baggage x-ray line on arrival, unlike what travelers see before leaving Hawaii for the mainland.

That is what Justin reacted to. He expected the fragile island ecosystem to be protected on the way in, not mainly policed on the way out. He had already done the careful thing before arrival, then watched the serious inspection happen only when he was trying to leave.

It is why readers kept bringing up Australia and New Zealand. For years, those places have trained travelers to expect a visible inspection. We have been through plenty of those ourselves, with food sometimes confiscated but more often just checked, and inspectors even carefully cleaning the soil off our shoes. Hawaii runs it the other way, with a legal declaration on arrival and a far more visible federal inspection on departure.

Why so many visitors say the whole thing is backward.

The strongest reaction was not about papayas at all. It was about whether the whole pattern makes sense. One reader called the inbound-honor, outbound-enforcement setup dumb, and that one word speaks for more people than would put it that bluntly.

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Another reader argued that dangerous pests rarely arrive in passenger luggage and are more likely to arrive via freight, cargo containers, nursery stock, or interisland movement. He said bags should be screened on arrival for other reasons too, including illegal drugs, with agricultural material as a secondary benefit.

That argument is not going away, because both sides are pointing to something. Hawaii’s ecosystem is fragile, so visitors expect to see “the gate” at entry. The mainland has agricultural interests to protect too, so the federal departure screening exists for good reason.

Readers also corrected another common misunderstanding that appeared in the comments. There is no routine agricultural inspection when simply island hopping. The outbound USDA process is tied to flights leaving Hawaii for the mainland, not to a normal Honolulu-to-Lihue or Maui-to-Kona flight. The only exception is flying Southwest interisland through Honolulu. This is because their flights do not use the interisland terminal, so USDA inspection rules apply.

What to pack and what not to leave so you’re not the one holding up the line.

The safest Hawaii food souvenirs are obviously the boring ones. Packaged coffee, macadamia nuts, chocolates, cookies, sealed snacks, and the like move create no drama. If it looks packaged to travel, it will.

Fresh produce is different. If you buy fruit from a stand, market, farm, or grocery store on your last day, do not assume it can go home just because it was easy to buy. Check the USDA rules yourself before packing it, and do not wait until the airport line to find out whether your item is allowed.

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Prepared food is still something you have to think about. A sealed meal, a packaged snack, frozen poi, or cooked food is usually fine, while fresh fruit, seeds, plant material, or anything with soil can turn into trouble. Flowers are 50/50. Many will get through on careful inspection while others will not.

The best advice is the simplest. Eat the mangoes and papayas in Hawaii, buy coffee to take home, and do not count on USDA airport staff to turn a confusing rule into a pleasant conversation you’ll want to remember.

What surprised you most on your first flight home from Hawaii, and did anyone warn you about the inspection before you got to the airport?

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Man charged with murder in killings of 3 on Hawaii’s Big Island

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Man charged with murder in killings of 3 on Hawaii’s Big Island






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Man charged with murder in killings of 3 on Hawaii’s Big Island | CNN

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Man charged with murder in killings of 3 on Hawaii’s Big Island | CNN



HonoluluAP — 

Authorities in Hawaii have charged a 36-year-old man with murder in the killings of three people in a remote community known for its eclectic, communal lifestyle.

Jacob Daniel Baker was charged with counts of first- and second-degree murder Saturday, the Hawaii Police Department said in a news release.

Baker remained jailed without bond Sunday and police said his first court appearance was scheduled for Monday. It was not immediately known if Baker had an attorney who could speak for him.

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Charges in the killings came two days after police apprehended Baker following a manhunt on Hawaii’s Big Island, where the three victims were found in the rural Puna community known for its tropical landscape and free-spirited residents.

Robert Shine, 69, was found dead Monday partially submerged in a cement pond, according to police. The second victim, a 79-year-old man, was discovered Tuesday a few hundred feet away. Friends identified him as Chitta Morse.

Police found the third victim, 69-year-old John Carse, late Tuesday at a property 19 miles from where the other two bodies were located.

Police have not given a suspected motive for the killings. Hawaii Police Chief Reed Mahuna has said investigators found no connections among the victims other than that two of them lived near each other.

In addition to the murder charges, Baker also faces counts of burglary, auto theft and criminal damage to property.

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The killings left residents on edge in Puna, a community set amid lush jungle and barren lava fields where people seeking to live off-grid commonly trade work for lodging.

Puna resident Stephen Shaffer said that Baker had worked for his ex-wife, climbing coconut trees on land where she grows fruit, in exchange for a place to live. After several months, Shaffer said, his ex-wife sought a restraining order against Baker, saying she felt threatened by him.

Donald Hyatt, a friend of Shaffer’s ex-wife and of two of the men killed, said Baker left the cabin where he had been living months ago. Hyatt said that Baker recently returned claiming “squatter’s rights” and threatened Shaffer’s ex.

Just days before the killings, two women had requested temporary restraining orders against Baker, saying he had threatened and harassed them, according to court records. A judge denied both applications, saying there was not enough proof of harassment.

Court records showed Baker named in 20 other cases in the past two decades, many of them traffic infractions. In most of those cases, Baker had no attorney and represented himself.

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