By Dennis Oda, Star-Bulletin
Gov. Ben Cayetano's plans to shut down and
privatize services at the Hawaii State Hospital
is gaining support.
State Hospital
closure backed
But some are still wary
By Pat Omandam
of governor's proposal to
privatize services
and Mike Yuen
Star-Bulletin
Legislative leaders are grudgingly ready to go along with the Cayetano administration's plans to shut down the much-criticized State Hospital in Kaneohe.
But to ensure that Gov. Ben Cayetano's plan to privatize services does what it promises, lawmakers intend to withhold until October an emergency appropriation of about $16 million for implementation. That means lawmakers would have to come back in special session to appropriate the funds, five months after the regular session's scheduled adjournment, said House Speaker Calvin Say (D, Palolo).
This approach allows for legislative oversight and also signals to U.S. District Judge David Ezra that the Legislature is serious in providing mental health services for the 168 patients now at the hospital and that there is no need to have a special master appointed, Say said.
"I think the courts will be very open to this because the Legislature would now be putting the (Health) Department's feet to the fire, along with the federal court," Say said.
And by having the special session in October, lawmakers will be able to discern the extent to which the administration's action plan - which must be submitted to Ezra by June 15 - has been implemented, Say added.
Cayetano wants the hospital closed by June 30, 2000. Privatizing the hospital's services would cost about $16 million a year, much less than the hospital's annual budget of $30 million. But the cost savings would not be immediate since none of the hospital's approximately 600 workers would be laid off, Cayetano said.
Roughly 75 can easily be transferred to the Health or Public Safety departments and the others would be retrained, Cayetano said.
Senate President Norman Mizuguchi (D, Aiea), who yesterday huddled with Say over breakfast to discuss their reaction to Cayetano's proposal, said Cayetano's plan was brought to lawmakers "in a rather hasty way" that put legislators "in a take it or leave it situation."
"It's a real problem for the speaker and me," Mizuguchi added.
Cayetano said the proposal was conceived about 10 days ago. "We came to the conclusion that it would be very difficult for us to make the changes at the State Hospital, which would bring about federal compliance," Cayetano added.
The most insurmountable hurdle, Cayetano said, was retraining hospital staffers, who, for instance, can cope with elderly patients with dementia but who have had difficulty with "forensic patients." They number about a dozen at the hospital and include mentally unstable child molesters placed there by the courts.
The most violent and unstable patients would be confined at a state facility or, if Say has his way, shipped to the mainland for treatment.
"We know it can be done cheaper on the outside," said Cayetano, whose tenure has been marked by budget cutting. "We think this is a good opportunity to pursue privatization of most of the services we now provide at the State Hospital."
By privatizing, Cayetano said, Hawaii can avoid what happened in Puerto Rico, which "ended up spending $300 million because a federally appointed master came in, took over the management of their mental health system and ordered that things be done and things be built without any concern for the cost - just focusing on delivering services to the patients."
Gary Rodrigues, state director of the United Public Workers, whose union includes 275 nurses, hospital aides and custodial workers at the hospital, was skeptical of Cayetano's plan, particularly the retraining of the facility's employees and whether there will be adequate private providers for State Hospital patients. That's a question Say and Mizuguchi also voiced.
Rodrigues said when lawmakers tried to close down Waimano Home for the retarded, the state had a difficult time providing the alternative services.
"Yes, all the people went back into the community. But many of them turned out to be homeless, not because there wasn't somewhere for them to go, but because they chose now to be homeless," Rodrigues said.
"This is a different type of clientele where they need constant treatment until they're cured."
Cayetano said the private sector already can take most of the hospital patients.
Loss of funding for
By Helen Altonn
patients big concern
Star-BulletinPrivate mental health officials applaud the idea of transferring Hawaii State Hospital patients to community-based facilities but question whether state funding will go with them. "The science is there to provide good care for people with mental illness outside the hospital," said Richard Behenna, past president of the Mental Health Association in Hawaii. "My fear is that money doesn't really follow."
Community mental health leaders have been meeting several months with Adult Mental Health Division chief Linda Fox to express the need for more community services, said Greg Farstrup, Mental Health Association executive director.
But the proposal to phase out the Kaneohe hospital was a surprise, Farstrup said, stressing: "We have to make sure planning is done and carried out in a way that's a good move for everyone involved for patients especially."
Behenna and others remember when the State Hospital's adolescent unit was closed some years ago. "The state couldn't make it work right," he said. Youths were transferred to private facilities, but they weren't monitored and funding wasn't there, he said.
State still responsible
"It's something all of us need to be cautious about. ... Closing the State Hospital does nothing to eliminate state responsibility to provide that care," Behenna emphasized.The State Hospital has been under court order to make treatment and other improvements by Dec. 20 or a special master will be appointed to take control of the state mental health system.
To avoid that and lower costs and improve patient care, the Health Department is proposing a "comprehensive community-based program of mental health treatment, rehabilitation and housing services, including appropriately secure settings for those who remain a danger to others but do not require inpatient psychiatric care."
Heath and Justice Department representatives are working on a detailed plan to be presented to U.S. District Judge David Ezra on June 15.
Some changes will be needed in the law to allow resources to go to community-based programs, House Human Services Chairman Dennis Arakaki said.
He said everyone who attended a briefing in the governor's office Tuesday "agreed they're not going to flatly reject the proposal, especially with a court order hanging over our heads."
But he said legislators want as much input as possible. "There are also major concerns about forensic patients (80 percent of the State Hospital population), and we have patients in the state prison who couldn't get into the hospital because there's no room," Arakaki said.
Nowhere to go
State Health Director Bruce Anderson said the court in many cases is sending patients to the hospital because there is nowhere else to put them."We want to shift resources so the court can assign patients to an appropriate secure facility in the community where they can get care they need," he said.
State Public Safety Director Ted Sakai said everything is still preliminary and his department will work with the health agency "to make sure that the patients' needs and the community's needs are satisfied."
Farstrup said nobody would be in favor of closing the hospital until they know it's not needed anymore.
He doubts that the transition could be completed in 18 months because facilities must be expanded and developed, and people must be trained and services coordinated.
Marion Poirier, executive director of the Oahu Alliance for the Mentally Ill, said the entire mental health system, not just the State Hospital, needs change.
"The notion that this is being explored seems perfectly reasonable to me," she said. "How the details flesh out would determine how happy a lot of us would be with it."
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