In the scheme of state budgetary things, $150,000 doesn’t seem like much of a heavy lift.

That’s the estimate to hire six contractors to do needed inspections for three new kidney dialysis facilities now sitting idle, as well as another half-dozen existing facilities overdue for recertification. The inspections are necessary to ensure patient safety and to enable payments from Medicare and Medicaid insurance programs for seniors and low-income patients, who comprise many of the dialysis users.

Hawaii is seeing an alarming increase of patients in need of kidney dialysis treatment — 700 new patients a year — with diabetes, the leading kidney-disease culprit. That’s raised demand for dialysis treatment and facilities, but unfortunately, that demand has outpaced the state Health Department’s ability and manpower to certify the facilities for operation and reimbursement. There’s now a three-year backlog.

Inspections are done every three years on Hawaii’s dozens of dialysis facilities that treat some 4,000 patients, and the delay is expected to worsen as another 18 facilities come up for recertification in 2019.

So clearly, getting the current backlog squared, as well as the new idle facilities operational, would be a prudent outlay of funds — whether it’s an extra infusion from this Legislature or reallocation from within the DOH’s budget. Last year, the DOH paid $140,000 to contract six Arizona inspectors to complete delayed certifications for 11 dialysis centers. Further, the DOH must quickly implement and adhere to a new, improved operational plan once it’s approved by federal officials this summer.

Improve state outbreak network

Public health officials took some heat last month from the state auditor, who criticized their handling of recent disease outbreaks: dengue fever on Hawaii island, hepatitis A on Oahu and Kauai, and salmonella on Oahu.

In a report issued last month, Auditor Les Kondo dinged the state Department of Health’s Disease Outbreak Control Division for poor, confused communication and inconsistent recordkeeping and reporting.

It’s a fair criticism. Well-established communication procedures, properly followed, can help ensure the swiftest possible notification of all necessary parties, especially the public, of an outbreak of potentially deadly diseases. The sooner we know, the sooner we can take action to protect ourselves.

Thorough documentation of major outbreaks can help the public understand how they were handled. Also, as the audit noted, “proper recordkeeping preserves institutional memory, so that agency officials and their successors can make decisions informed by past results.”

Kondo did acknowledge the difficulty in managing outbreaks that are always different and often unpredictable — the plan won’t always neatly fit the problem. And when outbreaks did occur, state epidemiologist Dr. Sarah Park, who heads the division, had seemed refreshingly straightforward when dealing with the public and the media. Still, what happens behind the scenes is critically important too. That needs to improve.

Kualoa Ranch needs limits

Kualoa Ranch has been fortunate, indeed, since receiving a city special-use permit in 1985 that allowed a relatively small tourist attraction on its agriculture-zoned land. That permit enabled the 4,000-acre ranch to successfully diversify beyond raising cattle, horseback rides and crop farming, to generate revenues via activities that include all-terrain vehicle (ATV) rides, paintball games, helicopter tours and ziplining.

In return, the ranch promised limits to operations: 10 a.m. to 3 p.m. Monday through Friday to avoid worsening rush-hour traffic; number of guests to 100 daily; and ATVs to 20 for guided trail tours.

But now, seeking a $4.4 million expansion, the family-owned ranch wants to lift the restrictions on its operations. It wants to add 13 new buildings and add about 100 more parking stalls, extend its business hours to 7:30 a.m. and 8 p.m. seven days a week, and do away with limits on visitors and recreational vehicles. A culinary program, crop-processing facility and farmers market are among the envisioned expansion.

It is a big request — contrary to Jeff Overton, a planner/consultant to the ranch, who downplayed it as “not huge growth.”

The ranch claims it is “keenly aware” of the responsibility to balance environmental preservation, agricultural productivity and commercial outdoor recreation. Still, trusting in Kualoa Ranch to manage its own impacts on the community’s behalf would be a misguided leap of faith. As good a neighbor as the ranch might have been these past decades, it would be wise to retain some limits on this enterprise. The public comment period runs through Jan. 22 (see 808ne.ws/2Cqk3Tu); concerned neighbors need to make sure their voices are heard.