WAILUKU — A communal home dialysis service in Hana would be the first of its kind in the country, but a number of hurdles remain before patients in the remote East Maui community can avoid a grueling four- to five-hour round trip to Wailuku for treatments three times a week, The Maui News reported today.

One milestone — the approval of the project by the Centers for Medicare and Medicaid Services — was celebrated Friday during a news conference at Liberty Dialysis' Maui Lani Clinic. The agency's action marks the first time such an arrangement has been approved, and it was lauded as a model for providing dialysis treatments to patients living in rural areas nationwide.

Mary Rydell, Pacific area representative for the Centers for Medicare and Medicaid Services, credited Hana resident Lehua Cosma and others in the East Maui community for their "perseverance and persistence."

"They played an important role in getting partners like the state, county and Liberty to come to the table and listen to possibilities for helping their family and friends in Hana," she said.

Cosma was on hand for the news conference and thanked all those who contributed toward making dialysis treatments in Hana possible.

She said her mother, Cecilia Park, who needs regular dialysis treatments, would benefit from having the service in Hana.

"It will be a blessing for her, for her whole family," Cosma said. "She can continue leading a quality life" and spend more time with her seven children, 18 grandchildren and 12 great-grandchildren."

To get dialysis treatment in the morning, Park leaves Hana around 2:30 a.m. and arrives in Wailuku two hours later, Cosma said. It's a 54-mile journey along the notoriously difficult Hana Highway, with its twists, turns and one-lane bridges.

An official from the Centers for Medicare and Medicaid traveled to Maui and took the road to Hana to see for himself what dialysis patients must endure.

"No patient should go through such interminable hardship if alternative means of receiving care and services are possible," said Ed Japitana in an e-mail sent to Liberty Dialysis.

But before dialysis treatments can start, a site needs to be located and money raised to purchase dialysis units for the patients, Rydell said.

The location designated for dialysis facility is a county-managed residence in Wakiu, which is along the access road to the Hana Sanitary Landfill. It has been used by a Hana Health clinic doctor, but Hana Health is giving up the house.

The state-owned home is under county control through an 81-year-old executive order that specifically requires it to be used as a physician's residence.

Maui Charmaine Tavares announced her administration would submit a formal request Friday to the Board of Land and Natural Resources to amend the executive order to allow the Hana residence to be used for the communal dialysis facility.

"This action is long overdue and will correctly reflect today's needs," she said.

But the house may require upgrades to serve as a dialysis facility. Jane Gibbons, executive vice president of Liberty Dialysis Hawaii, said it is on a septic system that would be damaged by the bleach-treated water discharge of dialysis machines.

Liberty would either need to obtain a different type of dialysis machine to work with the septic system, or the wastewater system would need to be upgraded to handle the dialysis machine discharge, she said.

Two current Hana patients would benefit immediately from having dialysis services in their community, and there are other patients who could get treatment there as well, she said.

The county has executed a $55,000 contract to make needed improvements in the house, Tavares said. Another $50,000 in county funds also has been committed to the project.

"The county is expecting the property to be vacated by the end of the year," she said.

East Maui Council Member Bill Medeiros said the Hana dialysis facility has been his top priority, and he called Friday's announcement of Medicare's approval of the project an "auspicious and historical day for Hana, East Maui and Maui County."

But he expressed sadness and apologized to the families of Hana dialysis patients who have died "for not being able to establish dialysis treatment services in Hana sooner, before their passing, in order to meet their medical needs and to provide comfort and dignity in their lives during their struggles with kidney failure."

State Sen. J. Kalani English, a Hana resident whose district includes East Maui, Upcountry, Molokai and Lanai, said he had personal experience of a loved one who was a dialysis patient and was forced to take the long road trip to Wailuku for treatments.

"The strain of that long drive, combined with her treatments, took a real toll on her," he said. "That is simply heartbreaking for anyone who cares about a dialysis patient."

A fundraising program is under way to purchase six dialysis machines, which cost $20,000 each. Gibbons said funding could come from a number of sources, but anyone can send a contribution to the Pacific Renal Care Foundation. Its address is 2226 Liliha St., Suite 226, Honolulu HI 96817. It can be reached by calling 808-585-4600.

For more Maui news, visit www.mauinews.com.