HGEA files HAWAII STATE HOSPITAL'S four patient units are "dangerously overcrowded, unsafe and not a therapeutic milieu," the Hawaii Government Employees Association alleges in a grievance filed for hospital employees.
grievance against
state hospital
Hawaii State Hospital workers
complain of overcrowding and
unsafe conditionsGrievance issues and suggestions
By Helen Altonn
Star-BulletinComplaints have increased at the hospital since the Guensberg building was closed in March and patients and staff consolidated into four units.
Hospital Administrator Barbara Peterson said about 155 patients now occupy the units, which are designed for 108. She said problems are being addressed, patients are happy with their new quarters and she believes the staff is adjusting to the new environment.
"We recently initiated a process so everyone could decide their final work choice and there was only one request for change," she said.
"That suggests to me that people are becoming familiar with their current environment and adapting well."
A House Health Committee briefing recently was held after patient advocates and hospital employees reported serious overcrowding and increased patient altercations. Two escapes or "unauthorized leaves" occurred within a week.
State Health Director Bruce Anderson told legislators a national accrediting committee and a U.S. Department of Justice team found no health or safety problems at the hospital during recent inspections.
But Nora Nomura, HGEA field services officer, said, "The staff has a totally different picture than the administration is painting. We're just wondering why the disconnect?
"We have to go with concerns of members," she said, explaining why a grievance was filed with the health department. "We continue to get calls. There is not enough staff to handle the changes. There haven't been improvements to security and there are still concerns about safety glass and several other issues we brought up to the administration."
Nomura said members report increased incidents of violence between patients and between patients and staff.
Peterson said patients were moved from the Guensberg building because of its structural problems and patients "are satisfied with their space. They like where they are much better than where they were. I think things are beginning to even out for staff as well."
Three groups of staff members from all disciplines, including anyone who wanted to participate, were formed to deal with environmental (including safety) programming and staffing issues, she said.
"Those groups did an excellent job in a relatively short time frame (from the end of January through March)."
She said some space had to be converted for bedrooms in the new units, which may have led to a perception of overcrowding.
"The key change is everyone previously had a private room and now everyone does not. It's just part of the transition process," she said, explaining most patients in shared space are ready for discharge and will be going to places where they won't have private rooms.
She said the hospital is working on several things to try to keep the patient population somewhere in the 140s, moving patients to community settings when appropriate.
The staff is working with community providers and hospital representatives to use their resources to the maximum potential, she said.
She said work has continued to address environmental and safety issues at the state hospital, and she participates in that group.
"We have identified a number of things that have an impact both on perceptions --- what we know is going to occur -- and nuts and bolts things we can address right now, and we have been doing that."
She said action already is being taken to correct some problems cited in the grievance.
The union said alarm systems should be used to prevent patients from accessing the drop ceiling and getting into electrical wiring and crawl spaces.
Peterson said motion detectors are being installed in drop ceilings and an alarm will go off in the nursing station if someone should try to disturb the ceiling.
The union said the lack of barrel keys poses a safety hazard because they control the entry and exit doors of each unit. All nurses who work in secured areas must have appropriate keys, the grievance said.
Peterson said the facility is being rekeyed to be sure people have keys they need for their work areas.
She said anyone moving into a new work situation needs time to adjust to other staff members and patients, to the environment, policies and procedures and how they're interpreted, and that process is going on with "a lot of education" by staff.
A mix of court-assigned forensic or criminal patients with other patients has raised concern about safety of patients and staff.
But Peterson said studies show patients going into a situation with people who have established routines, who know rules and regulations and participate in things, adjust much more quickly than putting a group of acutely ill people together.
"What we really have done is try to even out the milieu and enable patients to adjust more quickly," she said, "and we really have started to concentrate on clinical competencies of staff we employ.
"So that means paying attention to the signs and symptoms exhibited by those for whom we care, and to intervene at the earliest possible moment in a nonphysical, nonthreatening, nonaggressive way."
Although hospital employees "are diligently attempting to mitigate the negative effects of the consolidation, these are by no means comprehensive and management needs to do much more than it has so far," the grievance statement says.
"For example, opening the dorm areas for extended periods is helpful to decrease tension among the patients, but it also means there are more areas for staff to monitor.
"Likewise, promoting more off-unit programming to decrease unit overcrowding creates safety problems because these buildings have no perimeter fences and some patients must be escorted for security reasons."
The Hawaii State Hospital is administered under a consent degree resulting from a Department of Justice lawsuit against the state over conditions there. A status hearing is scheduled May 16 in federal court.
Highlights of health and safety issues cited at Hawaii State Hospital and recommendations in a Hawaii Government Employees Union grievance: Grievance issues and suggestions
>> Provide enough coverage for buildings and grounds used by patients to prevent escape.
>> Eliminate glass and window spaces large enough to permit escape in strategic areas and replace with non-breakable material.
>> Protect nurses' stations with unbreakable barriers that won't restrict communication but will prevent patients from assaulting, throwing objects or reaching into a station.
>> Design care rooms and lounge areas and arrange furniture to protect patients and prevent staff from being trapped. Furniture must be heavy enough or fixed to the floor so it can't be thrown.
>> Increase the number of seclusion and de-escalation rooms and eliminate one room now used for those purposes that has "unacceptable deficiencies."
>> Improve staffing ratios in units -- a major concern because of at least 12 nursing vacancies and paramedical assistant and psychiatric technician vacancies. "A shortage of staff increases the incidence of violence in health care settings and negatively affects the delivery of patient care," the grievance says.
>> Reevaluate the practice of admitting patients to all units. "A unit specific for admissions ensures a stable, therapeutic milieu for all units."
>> Create units within units to deal with violent patients who pose a threat to the community and to help them stabilize if they become unstable. Assaultive patients should be considered for a unit with greater security.
>> The hospital safety committee must evaluate all reports and records of assaults and incidents. If it makes a recommendation, the employer must report back in a timely manner on actions taken.
>> More camera surveillance is needed in all units.
>> Sensors should be installed on all perimeter fences.
>> Bright, effective lighting systems should be installed for indoor building areas, as well as the grounds.
>> More personal alarm systems are needed, and they should be more reliable.
>> More radios (walkie-talkies) are needed for staff communication. One recent escape was made possible because the staff didn't have radios and couldn't request immediate assistance.
>> Security guards must be well trained in appropriate techniques for work with the mentally ill and they should be assigned directly to the nursing staff under the nurse manager's supervision. The classification level and qualifications for guards assigned to the hospital should be upgraded, similar to those at the University of Hawaii.
>> A hazard pay differential should be given to registered professional nurses, psychologists, social workers, ward clerks and others who work on the units or are there regularly as part of their duties.