State Hospital
nurses tell Cayetano
of assaults by patients

By Helen Altonn
Star-Bulletin

The Hawaii Government Employees Association is investigating patient assaults on Hawaii State Hospital employees, which some nurses say are linked to a new rehabilitation program.

Linda Fox, chief of the state Health Department's Adult Mental Health Division, acknowledges that some incidents have occurred but says the situation is "being blown out of proportion." She says staff concerns about safety are being addressed and incidents have decreased dramatically in the past four or five weeks.

Randy Perreira, HGEA field services officer, described a "groundswell" of complaints about safety since the hospital started a treatment program known as the Nebraska model. He said it involves withholding of privileges, such as cigarettes, from patients who don't behave properly, and "some are behaving violently."

One employee was punched out by a patient and suffered a broken jaw, he said. "There have been other incidents. We're trying to gather information on the number of assaults they've had."

Perreira said he was "bombarded with calls" last week and a number of nurses showed up at a meeting with Gov. Ben Cayetano yesterday that was "supposed to be like a campaign whistle stop."

They cited concerns about staff and patient safety and "inconsistent direction from the administration," he said.

Cayetano asked the nurses to come up with alternatives, which they'll meet this week to discuss, Perreira said. Another meeting will be scheduled with Cayetano after the primary election.

Fox said, "We are certainly open and meeting constantly with the staff to address concerns." But dropping the rehabilitation program isn't an option, she said. "It is a highly appropriate program for these patients.

"We're aware of the concerns," she said. "We started bringing in a lot of extra support in terms of restructuring the staff and organizing the staff so more skilled staff is available to assist those who need input."

One of the problems was that some staff members working in two units combined for the program hadn't attended many training sessions, she said. New schedules were set up to make sure they all had training, and extra training has been provided to increase staff skills, she said. "What has to happen is the nurses have to learn how to do this. I think some people are resistant to change and being accountable."

She said the staff was told when the program started that some patients would test the system. "They want to see where the limits are. Some of the statistics may be related to that."

But she said, "The report, through Randy, was that it's sort of an out-of-control picture. It was not that at all.

"We are not willing to compromise safety. We're taking every approach possible to address that . . . . The important picture is that it is stabilizing and settling, which is very different from the way nurses are reporting it."

Perreira said the staff says the Nebraska model can work, but it's inappropriate for a lot of the State Hospital's patients, which include criminal commitments.

He said data given to the union by the nurses show an increase in verbal and physical assaults and injuries. "We're trying to separate it out."

Perreira noted a spike in assaults on the staff after hospital renovations a few years ago because safety features weren't built in. The union had filed a request for hazard pay which the state denied and the issue is pending arbitration, he said.

He said Marvin O. St. Clair took measures to ensure safety after he became administrator in March 1995. St. Clair also is credited with major hospital improvements to comply with U.S. Justice Department requirements. However, he was dismissed, effective last Friday.

Health officials said he lacked skills needed for the hospital's new patient-oriented direction.

Wayne Law, head of the Kauai Community Mental Health Center, is interim administrator.

Justice Department attorneys in a recent status report to the court expressed concern about administrative changes and safety.