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Aloha Mayor Carvalho,


As a doctor practicing on the west side, when I received news of the County Council’s passage of Bill 2491, I was elated.  The bill, though only a partial version of the original, was a good first step that showed how the voices of medical professionals could help policymakers understand the dire need for pesticide disclosure by the companies whose vast fields surround this community. 


Many doctors of the west side, including obstetricians and pediatricians, met with several Council Members during the course of deliberation over Bill 2491.  We shared our experiences and concerns with them over rates of diseases, noticeable aberrations in certain birth defects incidences, and helped them to understand the absolute need for disclosure in our ability to deliver better patient care. 


I strongly urge you to sign this bill into law.  I hear that you may be considering a veto and know that this would be a blow to many west siders, including those within the medical community who did much work to help Council Members understand its importance.  If it is more information you need during the rulemaking process, I am happy to provide a medical perspective and feedback. 


The people’s voice and the medical community’s voice must count when the County engages in lawmaking.  To veto a bill that has been vetted by professionals and our island would be to ignore the democratic and Council research process that has taken place thusfar.  The people and medical professionals of the west side asked for help.  The Council has given it in the form of Bill 2491.  And now I ask that you do the humanitarian and upright act of honoring this process, and sign the bill into law. 


As a doctor, a father, a husband, and a west side community member who lives near the agricultural fields, and whose spouse and daughters also have health issues that may be affected by the application of pesticides near our home, I urge you to sign this frankly very mild disclosure bill into law.




Rick Goding, M.D.








Aloha Mayor Carvalho,


As a pediatrician practicing on the west side I urge you to support the County Council’s vote of 6-1 approval of Bill 2491. 


The west Kaua’i medical community worked hard to educate Council Members on the importance of Bill 2491 for the patients of west Kaua’i.  Of particular concern was our ability to correlate or rule out impacts of pesticides as we treated patients in our clinical practices.  Without the basic Right to Know provisions provided by Bill 2491, our patients, especially the young mothers and children of west Kaua’i bear the unfair risk of health impacts due to possible exposure. 


I attach a letter of support for Bill 2491, submitted previously to the County Council, of the initial group of doctors and practitioners from the west side. 


Please take this to heart.  As doctors, but also as concerned parents for our children and their children to come, I urge you to move forward with implementing Bill 2491 and sign it expediently into law.  West side physicians and families would be grateful.




Carla Nelson, M.D





Attachment to Dr. Carla Nelson's letter to Mayor B. Carvalho 10-18-13:


Kauai County Council                                      

4396 Rice Street, Suite 209

Lihue, Kauai, Hawaii, 96766


July 29, 2013

Honorable Councilmembers:


We are a group of concerned physicians who support bill 2491.  We are concerned with what we believe may be the results of the "farming" practices that are occurring predominately on the west side of our island where we provide health care.


We have no formal quantitative studies but we do have many qualitative examples that point to a higher than normal incidence of many ailments and disease processes occurring in our patient populations.  We feel this may be directly correlated to many of the chemicals and substances being consistently and systematically spread around our community.


Some of our individual and collective concerns:


We have observed a higher than normal occurrence of birth defects involving the heart and miscarriages than we have seen in other geographic areas where we have practiced.


Abnormally high rates of very severe gout in healthy populations.


Rare types of cancers in a higher than expected incidence for our small population of patients.


Almost daily reports of respiratory symptoms in patients that have no history of these respiratory illnesses.  Many of these respiratory symptoms are not responding as would be normally expected with the healthy lifestyle changes reported or the pharmacological interventions prescribed.


Hormonal changes affecting our patients including excessive facial and body hair on women and higher levels of infertility.


Reoccurring nose bleeds in children.


Patients reporting a "metallic taste" in their mouths and recurring dermatitis with no previously known sensitivity to any environmental factors and minimal improvement with treatments.


We have no direct evidence of a specific correlation between these unique variances in the health of some of our patients with the current or past agricultural practices but we do have a high level of suspicion that a strong correlation exists between the two.


While we have not seen all or some of these unique patient circumstances and ailments, we all share a deep concern for the health of our patients and the concern of what may be happening to our community by being exposed to this unique cocktail of experimental and restricted use pesticides on an almost daily basis.


We all agree that we need to understand what chemical toxins are being sprayed, how often they are being sprayed, and how close our patients live to the specific areas being tested with these pesticides.  We also agree that increasing and maintaining a mandatory buffer zone away from sensitive populations and areas where people would have long-term exposure even at minor concentration levels would be a significant improvement from current practices.  It is unconscionable to allow open air testing of new combinations and untested chemicals in any location that cannot guarantee the separation of the testing and any unwilling or unknown exposure potential to the public.


We humbly ask the Kauai County Council to thoroughly consider the proposed bill 2491 and the potential consequences to our community if no improvements are made to the current application of poisons and pesticides on the lands surrounding our community.





Dear Mayor Carvalho,


We are urging you, as physicians (including pediatricians, obstetricians) practicing on the west side, to fully support the County Council’s approval of Bill 2491.  We invite you to speak with us soon, to understand why this bill is important for west Kaua’i.


As many of us discussed with Council Members over the past several months, such disclosure will help us, as well as regulators, to begin to understand the impacts, if any, on the health situations that we are seeing in our practices.  This can be vitally important to the young families of child-bearing age, their newborns and children. 


We include an excerpt from physician testimony that exemplifies the need for the disclosure provisions of Bill 2491 here in west Kaua’i.  This is only one example of the clinical aberrations that can be better understood once disclosure is available:


of particular concern is the incidence of serious cardiac malformations; particularly those that result from early embryogenesis defects that have occurred in our population the last three years. 


We have had 5 major cardiac defects that have required early extensive surgical repair in San Diego the last 3 years: 2 cases of Transposition of the Great Vessels, 1 Hypoplastic left heart, 1 Hypoplastic Right heart with heterotaxy and 1 severe pulmonary stenosis.   The transposition cases and hypoplasia cases are considered defects that occur in early first trimester.  While cardiac birth defects are the most common birth defects these particular types of lesions are rare. 


Recent CDC statistics puts transposition at 1/3300 births, hypoplastic left heart at 1/4344 births and hypoplastic right at 1/17000 births. In the last 3 years we have had about 750 deliveries ; this gives us an incidence of 53/10,000 births for these 4 defects.  National US data shows an incidence of 5.5/10,000 births, so we have 10 times the national rate.


Please put the full backing of the Mayor’s office and administration behind Bill 2491.  There has been much support of this bill, and the County Council approved it with a 6-1 vote.  It has the support of Kaua’i’s people and deserves your support as well.  




Bernard Riola, MD                                 Pediatrics                      

Surachat Chatkupt MD                           OBGYN                         

Kupono Chong-Hanssen, MD                  Family Medicine             

Jim Raelson, MD                                   Pediatrics                    






Aloha Mayor Carvalho,


I urge you to support the passage of Bill 2491 into law and honor the 6-1 vote of the County Council as well as the tremendous showing of democratic participation of the people of Kaua’i.  A Bill with such overwhelming support, especially from Kaua’i’s medical community should NOT be vetoed.


As a primary health provider, I take to heart the oath to do no harm.  My goal is to consistently care and advocate for my patients to attain a higher level of health and wellness.


An essential part of providing health care is to examine and keep current with potential risks and evidence-based harmful environmental practices that may affect the health of the patients, their families and the generations yet to come. 


I would be happy to meet with you as a health care provider, to share selected peer reviewed medical journal articles: 


Contrary to claims from the companies whose interests may be adversely affected by Bill 2491, there is an abundance of scientific research that evidences links between populations exposed to pesticides (including pregnant women and young children) and increased risks of lifelong illnesses and disabilities including birth defects, neurological problems, onset of diabetes, miscarriages, infertility, and respiratory problems. 


Although looking at the label of each pesticide is alarming in itself, the combination of pesticides called “stacking” (combining pesticides and herbicides in quick succession or simultaneously), a common practice on the fields of west Kaua’i, remains relatively unstudied and is currently not regulated.  This is cause for concern for the medical community, for its potential health implications. Without disclosure, we are kept in the dark regarding the health implications of stacking. 


Our patients are unfairly bearing the costs and risks of non-disclosure while the west side agricultural companies continue to operate with little regulation and inadequate disclosure.


I also hope that you review the letters of island-wide physicians, nurses and other health care providers who have voiced strong support for Bill 2491 for its benefits to the young families of Kaua’i.





Margaret Maupin, Nurse Practitioner

Primary Care provider, Waimea

Resident, Kalaheo



We, the nurses from Waimea, completely concur with the letter from Marghee Maupin, APRN


Susan Provonsha (Ele’ele)

Melody McFarland (Kaumakani)

Teri Sakai (Waimea)

Jamie Agor (Ele’ele)

Marquita Granda (Kalaheo)


We, as nurses island-wide, completely concur with the letter from Marghee Maupin, APRN.


Mickey Macmillan (Lihue - RN, Oncology)
Susan Heitman (Lihue - RN, Medical Surgery)
Chris Broussard (Lihue - RN, Vice President, Hawaii Nurses Association)
Colleen Wann (Lihue - RN, retired)
Ava Woods (Kapaa - RN)
Joan Kutzer (Lihue - RN)
Darcy Attisani (Lihue - RN)
Nancy Pappas (Lihue – RN)
Brett Woods (Kapaa – RN)
Denise Lorraine (Lihue – RN)
Judi Matola (Kapaa –RN)
Dallen Johns (Lihue – RN, BSN, CCRN, CEN)
Donna Moore (Kilauea – RN)
Mallory Hudson (Kalaheo – RN)
Jill Alderete (Kalaheo – RN)
Jeanette Wolf (Kapaa – RN)
Lissa Lang, (Lihue - RN, BSN, OCN)











Doctors and Nurses Implore Mayor:

Sign Bill 2491 into Law Now!  



Sample Letters from 20 Doctors and Nurses, Delivered on October 20, 2013

"The people’s voice and the medical community’s voice must count when the County engages in lawmaking."

"...our patients, especially the young mothers and children of west Kaua'i, bear the unfair risk of health impacts due to possible pesticide exposure." 

"Many of these respiratory symptoms are not responding as would be normally expected with the healthy lifestyle changes reported or the pharmacological interventions prescribed." 

"these particular types of lesions are rare....National US data shows an incidence of 5.5/10,000 births, so we have 10 times the national rate." 

"Our patients are unfairly bearing the costs and risks of non-disclosure while the west side agricultural companies continue to operate with little regulation and inadequate disclosure."

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