HGEA alarmed over hospital
Maintaining mental health patient numbers above capacity puts staff at risk, the union says
Hawaii State Hospital is running slightly over capacity, prompting the Hawaii Government Employees Association to file a grievance against the state, citing concerns about staff health and safety.
"We just feel for our members their safety is in jeopardy there," said Sanford Chun, HGEA field services officer. "There is just as much concern by our staff for patient safety."
The number of patients has fluctuated between 190 and 194 and was 193 yesterday, said hospital interim Administrator Bill Elliott. The hospital is licensed for 190 patients and budgeted for 168, according to the Department of Health.
The Kaneohe hospital operated under federal oversight from 1991 to December 2004, when it was released from a federal lawsuit alleging unconstitutional conditions, including overcrowding and unsanitary conditions.
The Department of Health was given a one-year extension to June 30 this year to complete plans for a community mental health system. U.S. Magistrate Kevin Chang, special master in the federal court case, said last July that the hospital's increasing population -- then totaling about 178 -- was proof of lack of progress in developing the community system.
State Health Director Chiyome Fukino yesterday established a special task force to tackle the hospital population issues.
Fukino said she wanted "to ensure accountable and effective collaboration" between her office, the Adult Mental Health Division, Behavioral Health Administration and Hawaii State Hospital to resolve the problems.
"We must protect the extraordinary gains that have been made at HSH in recent years and move forward to assure the safety and well being of all patients and staff members," she said in a memorandum.
Dr. Thomas Hester, Adult Mental Health Division chief, who heads the special task force, said a number of programs are in the works to provide alternatives to the hospital for mental health services.
With easier access to the system and crisis services available 24 hours a day, he said the community mental health population has jumped to 9,756 from 4,500.
With more patients both in and out of the hospital, the Health Department has asked the Legislature for an emergency appropriation of $3.7 million for the hospital and $7.4 million for community services.
Nearly all patients admitted to the hospital are from the criminal courts and the hospital cannot refuse anyone, Hester pointed out in a recent interview.
Elliott said: "We would like to be at 168 to 178 at the high end. That might be pie in the sky."
He said with more patients, the hospital runs short-staffed, "not to the point where it is considered dangerous" but where some activities had to be cut back.
"The staff is real concerned," Hester said, adding that he, Fukino and Michele Hill, deputy director for behavioral health, discussed the issues with the union. "None of us want to see things go back to before federal involvement."
The officials are closely monitoring the hospital for indications of overcrowding, such as use of more medications or restraints or an increase in assaults, Hester said.
Elliott said staff burnout has occurred because "what you have is a dedicated group that always comes to work and at times, when others are not coming to work, you demand more of those individuals."
He said the hospital may be short six to eight staff members on any day just because "we have more patients to take care of." It is using nurses from outside agencies and drawing on other resources, he said.
Chun said, "We understand that the hospital may not be able to control the (number of) patients admitted, but certainly we still hold them accountable to provide adequate staffing for an established acuity system they use."