That was 30 years ago, when Mitchell working with the state's administrator, Wallace Yanagi, set up the emergency room, equipped to handle trauma victims and stabilize patients suffering heart attacks.

On Wednesday, Mitchell and his colleagues with the emergency room physicians group celebrated a blessing and groundbreaking for an expansion of the facility to accommodate the increasing demand.

Since 1975, Maui's resident population has tripled from a little more than 40,000 to more than 120,000. Over the same period, the Maui Memorial emergency room grew to 21 beds with a full complement of board-certified physicians and nurses providing 24-hour service.

The $9 million expansion will add nine beds, provide additional treatment units and triage rooms and accommodate the increasing need for services, including provisions for handling the nonemergency, urgent-care patients who have to turn to the hospital when their doctors' offices are closed.

"What we're focusing on is excellence for the community of Maui. That's what we're doing here," said Mitchell, who is director of the ER physicians group.

Contractor Central Construction is expected to take a year to complete the expansion designed with the needs of the staff in mind.

Mitchell credits ER Dr. Randy Niklason and head nurse Emilou Alves for taking the lead in providing staff input on the design of the expansion of the Emergency Department.

Of note in the design is a larger, additional triage room that will allow patients to be assessed by a nurse and then be sent for either urgent medical care or receive more serious, emergency medical response.

There will also be new patient support areas and a larger waiting room with an area for vending machines and snacks, a patient/family consultation room and other larger support areas.

An isolation room will serve as a decontamination area for cases involving chemical hazards.

Funding came from a $7.9 million general obligation bond approved by the state Legislature, $1 million in municipal lease financing, a $100,000 donation from EmCare, the emergency room physician group, and $25,000 from the Maui Memorial Medical Center Foundation.

Access to the emergency room at the back entrance to the hospital will continue throughout the construction, but patients coming in for nonemergency purposes will be encouraged to enter through the front entrance of the hospital in the new Kahului Tower. Free valet parking in the front entrance is provided from 7:30 a.m. until 8 p.m. on weekdays.

For hospital staff, the work will also mean some changes. Beginning Monday, the public bus and employee shuttle bus stop location will move to the entrance at the Kahului Tower.

Access to the Pacific Cancer Institute, located at the rear of the hospital and next to the Emergency Department, will remain the same but motorists will need to follow the signs for direction to a new parking location for the Cancer Institute.

For more information about the Emergency Department expansion project, call 442-5108.

The Emergency Department at Maui Memorial is the second busiest in the state with 33,000 visits in 2006, according to MMMC. Approximately 20 percent of the 33,000 visits involved urgent care, or nonemergency visits generally involving patients who do not have a personal physician or need after-hours services.

According to a 2006 report, for patients who were examined and discharged at the emergency room, less than 4 percent were in the ER for more than six hours.

This compares to the national average of nearly 11 percent of patients having to wait more than six hours in an emergency room, according to hospital officials.

Mitchell says about 55 percent of the patients admitted into Maui Memorial each year originated from the emergency room. He said the ER expansion is evidence of the hospital administration's effort to be more efficient with equipment and the professionals needed to treat both urgent-care and emergency cases.

"We want to decrease wait time and increase efficiency," Mitchell said.