Saturday, July 19, 2003

The court-appointed special master for the Hawaii State Hospital said yesterday that progress is being made on court-ordered improvements at the facility but that workplace violence is emerging as a major problem.

Workplace violence
a concern at hospital

The state mental facility needs
to address safety issues, a report says

The Hawaii State Hospital is making progress with court-ordered improvements, but workplace violence has emerged as a major problem, according to a report released yesterday.

Magistrate Kevin Chang, the court-appointed special master of the state mental hospital, updated the U.S. District Court on the facility's progress in fulfilling requirements of a consent decree that arose from a 1991 U.S. Justice Department lawsuit against the state over federal violations at the hospital.

"Significantly, the evaluation team found that 'ground had been lost' since their first visit in September 2002, and there is an increased sense that workplace violence is not being taken seriously, producing a 'culture of fear' at the hospital," Chang said in his report.

Chang, who was appointed in 2001 by Chief U.S. District Judge David Ezra, said the lawsuit will not end until safety issues are addressed at the hospital, but he remains "cautiously optimistic" because of improvements and "persistent determined efforts" of the staff.

Hospital Administrator Paul Guggenheim said he is "very concerned" with the report and the safety issues. "I'm taking it all very seriously and will work with my superiors to respond to their concerns."

He said a number of people had expressed concerns about staff and patient safety in a nursing survey. Committees led by hospital medical director Dr. Rupert Goetz have been analyzing causes of workplace violence, he noted.

Guggenheim said the number of abuse and neglect allegations is down, but the facility has not reached a zero-tolerance goal.

"Obviously, no one condones patient abuse," he said. "I certainly don't condone it. We've been working on that."

About 90 percent of patients at the hospital are admitted or committed because of criminal issues.

Chang said "providing an environment in which both patients and staff feel safe is paramount to a psychiatric hospital" and a basic civil right.

Chang said that for the past 16 months, he "has seen little or no evidence that the administration of Hawaii State Hospital is committed to fostering 'a culture of safety that is committed to zero tolerance for any abuse and neglect of patients by staff.'"

While it is a "positive development" that the number of patient abuse allegations and incidents has decreased, no abuse should be tolerated, Chang said.

He said it is "more troubling" that the hospital administration has not talked to union representatives about measures to protect patients from staff abuse.

Chang said the hospital administration "should thoughtfully reconsider its feigned ignorance and reckless disregard of the plain language of the Plan for Compliance and its obligations under the federal law" and make patient protection a priority.

Guggenheim said all workplace violence charges and accusations are immediately investigated by the attorney general's office and a patient protection committee. Also, the hospital works with the union and labor organizations if corrective action is warranted.

Chang noted progress at the hospital in a number of areas, including hiring key people, such as Goetz and Reneau Kennedy, Adult Mental Health Division's forensic director, and more psychiatrists.

Chang said an "outstanding development," initiated June 9 by Guggenheim, is a Psychosocial Rehabilitation Treatment Mall, a hospitalwide program combining treatment and skills learning.

Patients and staff are enthused about the program, Chang said. A six-year patient said it is "the best thing that has happened at the hospital since I have been here."

Progress also was noted in substance abuse services, developmental disability and nursing services, community re-integration and performance improvement.

Chang said he is "generally pleased" with progress in developing a community mental health system under an omnibus plan.

Mental health officials have fallen behind deadlines to comply with court requirements, but the foundation has been built to achieve compliance, Chang said. "The task is daunting but not impossible."

He pointed out that the hospital remedial plan for compliance is due Feb. 21, and the community mental health services plan is due Jan. 23, 2005.

Dr. Thomas Hester, director of the state Health Department's Adult Mental Health Division, could not be reached for comment, but department spokeswoman Janice Okubo said Hester feels the report is positive overall.

"There are some issues here that do use some strong language," she said. "Our department has not seen any evidence of those statements (of workplace violence). Certainly, if there is evidence, we will investigate. Some of it, we feel, is due to perception of staff.

"We have confidence in the administration, which has made a lot of positive improvements at the hospital," she added.


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