It’s about time.

That’s what Dan Brinkman, CEO of Hilo Medical Center, believes regarding the proposed expansion of Hawaii island’s largest hospital serving the East Hawaii community. Since 2018, Brinkman has been advocating to add a new wing to the hospital to expand intensive care and medical-surgical units.

It is, he says, past due for a hospital that has not expanded for more than 35 years even as the population it serves has grown. He likens it to buying a starter home in 1985 that has never expanded to meet the needs of a growing family.

At the same time, the hospital has been busier than ever and has run at 15% to 20% over capacity for the past year, which means it has had to get creative in order to accommodate overflow patients.

On Friday, for instance, there were 26 patients placed in overflow areas due to over-capacity.

“We’ve been gradually increasing our census, trying to add beds and squeeze out more room in our hospital for a number of years,” Brinkman said. “This is the same hospital with the same space from 1985. We gradually keep filling it and squeezing patients in every nook and cranny. Well, there’s no more nooks and crannies.”

Brinkman said he was appreciative when Gov. Josh Green in December announced an allocation of $50 million in the executive budget for the expansion of Hilo Medical Center, noting it is the most significant hospital by size for Hawaii island, serving the largest part of the population there.

Now it’s up to the state Legislature to approve that allocation, and Brinkman is hopeful support will come through for plans he has been working on for the past five years.

The new wing would add 19 more intensive care unit beds and 36 additional patient beds to the center, in two floors conveniently located over a parking garage. Hilo Medical Center currently has 166 patient beds and 11 intensive care units.

Brinkman said the blueprint and designs for the new wing already have been completed and that the project is “shovel-ready.” The $50 million is the estimated cost for construction.

If approved, it would take another year to get required permits. He anticipates another two years would be needed to build the new wing, so pending all approvals, the new wing is expected to open in spring 2026.

Upon opening, Brinkman does not expect to use the entire wing right away, but expects needs to grow in coming years. This is, he said, a proactive approach to prepare for the future.

“The situation won’t gradually improve itself if we don’t do something,” he said during a recent conversation on the Honolulu Star- Bulletin’s “Spotlight Hawaii” livestream program.

With these 55 additional beds, more patients potentially could stay on Hawaii island to relieve congestion in the state overall.

“Hospitals are full on all islands,” he said. “Traditionally, neighbor islands transferred to Oahu, but Oahu doesn’t have the capacity it used to have.”

Hilo Medical Center has been the busiest it’s been in 15 years, said Brinkman.

The hospital has been consistently full — not so much with COVID-19 patients currently, but with a growing number of patients due to multiple factors. There are still a few COVID-19 patients, but there also has been an increase in the overall illness of patients coming in.

“We are seeing the consequences for delayed and deferred care,” he said, “especially in our elderly patients. So our patients who come in are sicker than they used to be.”

Additionally, Hilo is starting to experience the “silver tsunami” of baby boomers now reaching their late 60s and 70s, when many require acute hospital services. Similar to other counties, a number of patients are also waitlisted for long-term care facilities, which are unable to admit new patients due to staffing shortages.

But also, Hilo Medical Center has not kept up with the growth in population over the years.

The ICU, with only 11 beds, has been consistently full for several years, said Brinkman.

And the situation in the emergency bed facility is not ideal, with four patients to a room, and two rooms or eight patients sharing one bathroom between them.

“That is not the best way to house our patients,” he said. “They’re safe, they get the treatment they need and get great nursing care, but the facility itself is not what we need in 2023.”

Hilton Raethel, president and CEO of the Healthcare Association of Hawaii, said continued investment in health care infrastructure, particularly for neighbor isles, is beneficial for the entire state.

Historically, rural hospitals have been able to provide only a limited range of specialists, but over the years, Hilo Medical has brought in specialists and new technology to serve its community.

“That means they can provide their own services in their own community, and that’s good for a number of reasons,” he said. “It’s not ideal to have to move patients, especially if you have to fly them.”

While there still will be certain medical needs requiring transport, neighbor isles equipped to serve their own communities would reduce the stress of flying patients to other isles, which comes with costs and risks.

Raethel said he expects demands to continue growing statewide as Hawaii’s hospital census reaches a “new normal” of a higher number of patients than pre-pandemic times.

The new year started with hospitals at full capacity, he said, with an average of 2,413 patients in hospital beds for the first six days of 2023. “We’re starting the year off with a bang, unfortunately, in terms of capacity,” he said.

Brinkman said he expects the expansion, if approved, to meet the needs of the community for the next 15 to 20 years. Hawaii needs to be prepared, he said, which is an important lesson learned from the COVID-19 pandemic.

“I think there’s so much merit from us learning from the lessons of the pandemic,” he said. “We really shouldn’t run our health care system right on the edge. We need to have some capacity to deal with the uncertainties of life.”