There is the H3 tunnel. Can't we just expand it and TERP through it?
I think I remember seeing the C-20s flying the visual route, which was essentially a higher version of the helo course rules. I do wonder how that visual approach would be "better" than just circling to the to the downwind when coming off the approach for 22.
I did have to come in there one time on what I guess you could consider was a contact (-ish) approach that was only really possible because I knew the bay really well from both flying over it, but also boating in it. The viz was more windshield induced (HEAVY rain with wipers that always suck), as the crewmen said they could see out the open door and see the coast line fine. But up front, it was a, "There's the buoy....there's Chinaman's Hat.................................uhm.......okay, there's the Sand Bar...there's the turtle home...and there's the runway.
I'm curious, for medical at K-Bay, would you try and coordinate with -37 for a trip over to Trippler if it was that urgent/acute? Or just plan to take a ride over the hill and through the tunnel in an ambulance?