Crowding plagues State Hospital
The state says it is working on the issue raised in federal court
Patient overcrowding at the Hawaii State Hospital could have "the catastrophic effect of undoing all that was achieved" there in 2004, says a federal judge.
In December 2004 the hospital had improved enough to be released from a lawsuit filed in 1991 by the U.S. Justice Department alleging unconstitutional conditions. However, the court continued to oversee development of a community plan for mental health services.
U.S. Magistrate Kevin Chang, special master in the case for U.S. District Chief Judge David Ezra, attributes the Kaneohe hospital's rising population to lack of progress on the community plan and "failure to take prompt action" last year to address hospital overcrowding.
"There is no dispute that overcrowding has adversely affected the quantity and quality of treatment provided to patients at Hawaii State Hospital," Chang said in a status report.
He said he does not think the state can meet a June 30 deadline to complete the community plan, but state Health Director Chiyome Fukino disagreed.
"We believe we can; we're working as diligently as possible," she said yesterday after reviewing the status report filed by Chang in federal court.
She said the department has continued to make progress since the court's evaluators were here in December, and "we are going to continue moving as fast as possible."
"However, our primary objective is to develop a quality system of care for the mentally ill in the state of Hawaii that is sustainable, regardless whether or not the court is involved in this project," she said.
The Health Department received a one-year extension to June 30 to complete the community plan.
After the state questioned the extent of federal jurisdiction over the planning, federal and state officials agreed in October that efforts to implement the community plan would continue until this Nov. 30, when the lawsuit will end.
In his 11th report to the court, Chang said the evaluation team noted "promise" and "potential" in the Adult Mental Health Division's actions and planning activities during a December visit. But the team also described areas where the state failed to make significant progress, he said.
He expressed particular concern about the State Hospital's increasing population. The facility is budgeted for 168 patients and licensed for 190 but has averaged 193 or more daily.
The Health Department contracts with Kahi Mohala for 40 beds at a total annual cost of more than $10 million, and it also has had an overflow of state patients in some months, Chang said.
He said the average daily state patient population at Kahi Mohala in the past three months was 42. "Thus, the extraordinary cost of having to pay for Kahi Mohala beds continues unabated and has increased."
Chang said some patients had to sleep on mattresses on the floor in conference or activity rooms in December because no patient rooms were available. Some patients did not have access to a proper bathroom and shower facilities, he said.
"Apparently, on one night that happened to one person," Fukino said, disputing the idea that many patients were sleeping on mattresses on the floor.
She said she toured the hospital earlier this week, and the staff confirmed that patients all have access to a bathroom and shower, although "some are less than ideal."
Chang said the staff reported that patient assaults on other patients increased in December and staff members do not want to take overtime shifts. "As a result, the frequency of daily staff-patient ratio shortages is increasing."
Most patients are court commitments and the hospital must accept them.
The evaluators stressed an immediate and critical need for forensic services, conditional release and other programs that directly affect the hospital population and readmissions, Chang said.
Fukino said the Adult Mental Health Services Division and the Health Department evaluated the situation themselves and hired forensic coordinators for all eight community mental health centers.
They also hired three more at the upper level last month to work on coordination between the hospital and outside agencies, she said.
Chang praised Fukino's commitment and direct involvement with the problems.
He said the Health Department and Adult Mental Health Division "have ample opportunity, a total of 10 months, in which they can fully and forcefully demonstrate their stated commitment to persons in the community with serious mental illness and the public at large."
He added that "anything less than a full and complete effort ... depreciates the extraordinary efforts being put forth on a daily basis" by everyone working to improve the mental health system.