A Maui county-managed house in Hana is being eyed as an ideal place to administer dialysis, but the location comes with some challenges.

The house in Wakiu, near the entrance to the Hana Sanitary Landfill, is already occupied by a physician at Hana Health, a Maui News report said. Also, its legal status needs some bureaucratic tinkering and infrastructure upgrades need to be performed before it can be a home for group dialysis.

But Hana dialysis supporters are not discouraged and say it can be done.

There has been an outcry for dialysis services in rural East Maui for a decade or more. Hana resident Lehua Cosma founded Hui Laulima O Hana in 2004, with a goal of bringing dialysis treatment to Hana. She had seen her mother, Cecelia "Cece" Park, endure the long drive to Central Maui three days a week for treatments. Hana patients and their caregivers say the more-than 50-mile one-way trip takes a toll on the patients' weak bodies. And some dialysis patients balk at the idea of moving, saying Hana is their home and they want to be with family and friends.

Cosma told the Maui News that currently three Hana residents make the drive to Central Maui for treatment and there are two more who will be needing dialysis soon.

But before dialysis can be brought to Hana, there are issues to be resolved.

The house being proposed as the site of the operation has been used as a home for Hana's resident doctor since plantation days, and the one-acre parcel on which it is situated was transferred to the county from the state by executive order in 1927, with the stipulation that it be used as a "residence site for county physician," said county spokeswoman Mahina Martin.

It is now occupied in a month-to-month lease by a physician working at Hana Health, the community clinic serving the rural town, and losing the site could be a problem for the clinic, said Executive Director Cheryl Vasconcellos.

Vasconcellos said the house is ideal for the clinic's physician, as it is less than 10 minutes away from the clinic, making it ideal for responding to emergency calls. She added that it is important for a physician to stay close to the clinic, especially in a town where cellular phone reach is limited.

"Without this house, we would be sort of at the whim of the rental market if in fact there was anything available that close to the clinic," she said.

But Vasconcellos said that if "alternate accommodations can be made so this community is not put at risk, we are wiling to give that house up."

She acknowledged there are homes on the Hana Health clinic property, but said one is already occupied by paramedics, while a larger house is used as a nutrition center and administration office, with two rooms serving as her residence.

Vasconcellos said it was necessary that she be close to the clinic at all times and added that doctors normally do not want to live on-site.

Martin said that because of the stipulation in the state's 1927 executive order that the property house a doctor, the county will need to petition the state Board of Land and Natural Resources for an amendment before the home can be used for dialysis.

Questions such as zoning and the consistency of the proposed use of the house with surrounding properties will also have to be answered, she said.

But proponents said they believe none of that is necessary.

A Department of Land and Natural Resources official said Friday the DLNR is reviewing the situation.

Proponents and county officials said electrical and plumbing upgrades also will have to be made to the home, which is estimated at more than 70 years old.

But that is the least of the proponents' worries, as the county has budgeted at least $50,000 for the dialysis start-up.

Martin said the county as well as dialysis advocates are awaiting word from the Centers for Medicare & Medicaid Services on whether it will authorize more than one dialysis patient to have treatment conducted in the same house.

She said she expects the ruling to come "any week now," after which the county can take more steps to convert the physician house.

Hana dialysis supporters have complained that Mayor Charmaine Tavares and her administration have been slow to respond to their concerns as well as failed to communicate with them about the county's efforts to bring dialysis services to Hana.

Cosma, along with Madge Schaefer, who chairs the Governor's Neighbor Island Community Advisory Council for Maui, said they have been awaiting a response from the county about the dialysis situation for more than two weeks.

Schaefer said it has been frustrating to not hear back from the county as things are lining up in favor of bringing dialysis to Hana.

Liberty Dialysis, which provides dialysis service on Maui, has pledged its equipment and training, as it does for others doing home dialysis, Schaefer said.

She said volunteers have been secured to assist with administering dialysis services, and federal Medicare officials have been positive about the plans.

But the county administration countered that it has been responsive and has been working to bring dialysis to Hana.

Martin said it would be impossible to track all the phone calls, e-mails and written inquiries about Hana dialysis, but said she knows the administration, including the mayor, has responded to concerns from Hui Laulima O Hana and the community.

In a statement, Tavares said she is committed to helping East Maui residents.

"For many years now critical dialysis services for East Maui have been discussed within the East Maui community and among health care professionals. While some may feel that the county can simply step in and remedy this situation - it is a feat that no other entity or administration has been able to accomplish," she wrote. "So to be sure the endeavor has every possible chance of success, we are taking careful and practical steps toward making this work for those in East Maui that are in need of dialysis."