AIR AMBULANCE PLT PENETRATES CLASS B AIRSPACE WITHOUT CLRNC.

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ON VFR FLT FROM KOA TO HNL IN AIR AMBULANCE CESSNA 414A. PRESSURIZATION INOP AND MEL'ED. WEAK FRONT BTWN ISLANDS WAS FORECAST TO PASS CLR OF OAHU BY ARR TIME. DID NOT WISH TO FILE IFR DUE TO HIGH (8000 FT) MDA WHICH WOULD AFFECT PATIENT CONDITION. PROCEEDED VFR WITH FLT FOLLOWING FROM ARTCC. ON REACHING LEADING EDGE OF FRONT; CLBED TO 4500 FT WHICH WAS ABOVE LAYER. ATIS INDICATED HNL 2500 FT SCATTERED; 4500 FT BROKEN WITH IMPROVING CONDITIONS. PATIENT BECAME UNSTABILIZED AND MEDICAL ATTENDANTS REQUESTED DSCNT. DSNDED TO 1000 FT AND WAS ABLE TO REMAIN VFR WITH MINOR COURSE DEVS. CTR UNABLE TO MAINTAIN RADAR CONTACT SO SQUAWKED 1200. ON APCHING CLASS B BOUNDARY; WX DETERIORATED (UNFORECASTED) AND BEGAN CLB TO MAINTAIN VFR MINIMUMS. FREQ WAS CONGESTED SO BEGAN ARC AT CLASS B BOUNDARY WHILE MAINTAINING VFR. PATIENT BECAME UNSTABLE AGAIN. ON CONTACTING APCH I NOTICED I HAD STRAYED INTO 18 DME BEFORE RECEIVING SQUAWK AND CLRNC TO DSND IFR. BOUNDARY AT THAT SECTOR IS 20 DME. BROKE OUT OF TRAILING EDGE OF CLOUD FRONT WITHIN 5 MI AND PROCEEDED FOR UNEVENTFUL VISUAL APCH.