The Windward Planning Commission voted 5-0 this week to approve a use permit for the Keaau Benioff Health Center, clearing a major hurdle for a $90 million outpatient facility meant to relieve pressure on East Hawaii's overburdened medical system. The one-story, 40,000-square-foot clinic will rise on 20 acres of agricultural-zoned land owned by W.H. Shipman Ltd., on the mauka side of Highway 11 between Shipman Business Park and Herbert C. Shipman Park in Keaau.
Commissioners Chantel Perrin, Paul Montz, Louis Daniele III, Jonelle Fukushima and Tom Fratinardo all voted to approve the project during the Thursday session, according to the Honolulu Star-Advertiser. Commissioners Lauren Balog and Kanoe Wilson were absent from the vote. The panel also approved a special permit for a 1.5-mile paved driveway on a 3.27-acre corridor, which includes 2.65 acres zoned agricultural and 0.62 acres zoned urban.
A Clinic Built to Ease a Growing Backlog
The need driving the project is stark. During testimony, Shauna Paylor reported that the current Keaau clinic serves more than 2,000 primary care patients with just two providers, per the Star-Advertiser's account of the hearing. Mindy Prows told commissioners that East Hawaii's health clinics simply lack the space and resources to meet existing demand, while Dean Cevallos said the accessibility need for Puna residents is clear and urgent.
Susie Osborne described the project during testimony as a much-needed facility that would expand access to local healthcare, and testimony broadly supported the plan. Puna's population has grown from about 31,000 residents in 2000 to nearly 52,000 in 2020, and is projected to top 75,000 within six years, according to figures cited in the same report. Many of those residents currently have no option but to travel to Hilo for care.
What the New Facility Will and Won't Offer
The Keaau Benioff Health Center will provide primary care, specialty clinics, laboratory services, and behavioral health and counseling services Monday through Friday from 8 a.m. to 4 p.m., plus urgent care seven days a week, including holidays, from 8 a.m. to 8 p.m. Specialty clinic services will include cardiology and imaging for X-rays, CT scans and ultrasound. The facility is designed for outpatient care only — it will not include an emergency room or receive ambulances, though ambulance transportation may occur from the facility to Hilo Benioff Medical Center when warranted.
The project is expected to include room for up to 17 behavioral health providers offering psychiatry, individual and family therapy, group therapy, psychological assessment, and treatments for treatment-resistant depression. That behavioral health emphasis addresses figures presented in testimony showing about one in three Hawaii high school students report persistent sadness or hopelessness, and roughly one in five adults statewide experience mental illness. The center will not include drug rehabilitation services.
Hilo Benioff Medical Center's emergency room is reportedly the second-busiest in Hawaii, and the new outpatient center is expected to alleviate some of that patient traffic by giving Puna residents a closer alternative for non-emergency needs. The wider physician shortage compounding that strain is severe: East Hawaii's outpatient gap sits against a countywide deficit of 224 full-time equivalent physicians, a 43% shortfall that is the highest of any Hawaii county, according to the University of Hawaii John A. Burns School of Medicine's 2025 workforce report as covered by Honolulu Civil Beat.
Funding, Timeline and Project Evolution
Project funding has raised about two-thirds of the estimated $90 million cost so far. The Hawaii Legislature had previously set aside $9 million for the project before approving a further $25 million in 2025, while Marc Benioff and Lynne Benioff have pledged $25 million in matching funds. Dan Brinkman said in a February statement that the project would benefit nearly everyone in the area and support economic development, and said the project will be completed on that basis.
Groundbreaking is planned for spring 2027, with completion targeted for late 2028 or early 2029. The project has grown considerably since it was first floated: what began in late 2024 as a smaller $60 million, 36,000-square-foot concept on nine acres near Keaau High School expanded into the current $90 million, 40,000-square-foot design on the 20-acre Shipman parcel, per Pacific Business News. The site plan calls for 204 paved perpendicular parking stalls, including 22 that are compliant with the Americans with Disabilities Act.
Hilo Benioff Medical Center, which plans to build the outpatient clinic, is itself in the midst of an $80 million to $100 million main-campus expansion that broke ground in April 2024 to add a 19-bed intensive care unit and 36 inpatient beds by early 2027 — the hospital's capacity had gone largely unchanged since 1985. That expansion followed the Benioffs' $150 million donation to Hawaii healthcare systems in March 2024, which included a $50 million gift to what was then Hilo Medical Center, matched by a $50 million state appropriation, prompting the facility's renaming.
Planning Alignment and Regional Access Gaps
Commissioners found that the project aligns with the county's General Plan 2045, the Puna Community Development Plan, and the Keaau Village Master Plan. The East Hawaii Region of the Hawaii Health Systems Corporation, the safety-net network that includes Hilo Benioff Medical Center, Kaʻū Hospital, Honokaʻa Hospital and the Yukio Okutsu State Veterans Home, employs about 1,600 personnel and 250 providers across 33 specialties, per background from the Hawaii Health Systems Corporation.
Geography remains a major barrier for many in the district. Remote Puna subdivisions such as Kalapana Seaview Estates sit more than 35 miles and up to an hour's drive from Hilo Medical Center, and market studies have projected Puna residents will make more than 12,300 emergency room visits over a five-year span, according to Big Island Now. Highway 11, which borders the new site and connects Puna to Hilo, averages roughly seven traffic fatalities a year and is considered one of the island's most hazardous roadways, as Hoodline has previously reported.
The Keaau center is also part of a broader referral network the Benioff donation established, linking Hilo Benioff Medical Center with Straub Benioff Medical Center in Honolulu and UCSF Health in San Francisco for complex specialty care such as oncology and neurosurgery. Even so, gaps remain: as Hoodline has reported, Hilo Benioff Medical Center lacks pediatric intensive care and pediatric trauma surgery, meaning critically ill children in East Hawaii must still be medevacked to Kapiʻolani Medical Center for Women & Children in Honolulu — a limitation the new outpatient center is not designed to address.
