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Monitor: State hospital
making progress under
U.S. consent decree

By Helen Altonn
Star-Bulletin

A court-appointed special monitor says a federal master needn't be appointed to take charge of Hawaii State Hospital at this time.

U.S. District Judge David Ezra in February gave the state until June 15 to correct problems in its mental health system. Otherwise, he said he'd appoint a special master to take it over.

Ezra appointed Leland Chang to monitor the state's progress in meeting conditions required under a consent decree with the U.S. Department of Justice. Chang officially began monitoring the state hospital consent decree March 20.

In a report to Ezra on Monday, Chang said court-mandated activities are under way in the mental health system and resources have been provided "to move the state toward compliance."

"We are moving forward," agreed Anita Swanson, deputy director for behavioral health administration at the state Department of Health. "And there were very few times in the past when someone independently as a monitor would be able to say the state is moving forward."

She said Ezra could call a status conference whenever he feels it's necessary, but health officials don't expect to return to court until late in the summer.

Chang's interim report covers the period from Jan. 31 to April 30. His costs during that time totaled $36,615.

His report points to increased funding for the Adult Mental Health Division from $49 million in the past fiscal year to $70.4 million for 2000-2001.

He said costs will be shifted from the hospital to the community as the hospital is downsized and patients moved into community settings.

The lawmakers approved budget requests to meet court mandates but delayed approval for about a month of an emergency appropriation to cover advance spending by the division in the fourth quarter of 1999-2000.

Chang said this raised concerns that the hospital couldn't meet its payroll, and expansion of programs would be delayed.

He said Ezra "emphatically reiterated his interest in seeing immediate action by the Legislature." Chang said he conveyed this message to legislative leaders, who quickly responded.

Boston-based Technical Assistance Collaborative consultants has been retained by the Health Department for a statewide mental-health needs assessment.

Chang said they "point to a lack of sufficient management infrastructure at the division to plan, implement, manage and monitor all of the elements that will be part of the emerging system."

Pressure to solve many problems and make major changes "have led to rapidly changing priorities and changes of direction, which at times causes confusion," he said.

"Staff morale at HSH is slowly recovering from the early 1999 proposal to close the hospital and the subsequent decision to downsize."

Swanson said the hospital is continuing to place patients in the community as resources become available. The population now totals about 140.

It was planned to reduce patients there to about 108. Now, Swanson says the population will be reduced to "the appropriate number that need acute care."

Chang cites loss of experienced nurses as one of the major problems at the hospital. He said 58.5 positions were lost from the units from August 1998, through this month, with an offsetting gain of 15.5 positions.

Swanson said many staff members have moved into hospital management positions. Others left because of changes to move from custodial care to patient rehabilitation, she said.

Chang said patient abuse and neglect reports have increased at the hospital, largely because of two patients.

He said he would support efforts to determine if staffing practices are hurting patient care and progress toward implementation of treatment activities.

"Assurance is needed that for whatever the size of the patient population, there will be a stable cadre of qualified nursing personnel."

Chang joined health officials in a telephone conference with Department of Justice officials about five weeks ago.

Robin Sue Frohboese, deputy chief of the federal agency, said she's "very pleased with the approach we're taking," Swanson said. "That's about the most positive statement I ever heard out of the DOJ.

"The staff is pulling it together," Swanson said. "We had the right idea last year. We didn't have the money. Now we have the idea, the money and energy and we can make it happen."