Haw. Rev. Stat. § 326-35: Sheriff, appointment, removal.

There shall be no county officer in the county other than a sheriff, who shall be a patient resident of and be appointed in the county by the department of health and who shall hold office at the pleasure of the department or until a successor is appointed by the department. When a qualified patient resident is not available, the department may appoint a staff employee or other qualified person to serve as sheriff.