Sunday, May 13, 2001

Report faults
hospital crowding

Abusive patterns threaten safety,
says a monitor appointed by the
U.S. District Court

Kaneohe hospital addresses
problems, administrator says

By Helen Altonn

Overcrowding has affected patient and staff safety and programming at Hawaii State Hospital and resulted in high sick leave and overtime abuses, says a court-appointed monitor for the hospital.

"Failure to halt these patterns and practices of sick leave and overtime abuse virtually assures continued noncompliance with staffing, patient care and treatment requirements, low morale and waste of taxpayer-provided resources," Leland Chang said in a 70-page report filed Friday with chief U.S. District Court Judge David Ezra.

Chang described numerous staffing, safety and morale problems at the hospital related to management and closure of the old and unsafe Guensberg building in March.

He said the hospital isn't complying with many stipulations and orders under a consent degree between the state and Department of Justice. The justice department filed suit against the state in 1991 over hospital conditions.

"He does have specific concerns, but I'm not sure he has the full information," said Anita Swanson, state Department of Health deputy director for behavioral health.

She said she's asked for an opportunity to talk to Chang next week. "I'm concerned about the comment that the staff is depressed and has no morale. Did two people say it, or 100 people? We have 650 employees."

A hearing is scheduled Thursday before Ezra on the status of hospital improvements.

Chang retained Jane Ryan, immediate past president of the American Psychiatric Nurses Association, to assist with his study.

Swanson said Ryan "raised management issues that we are aware of and currently addressing. Her input is good." Ryan also was complimentary about the hospital administrator, Barbara Peterson, and her staff, Swanson said.

"I'm very proud of the fact that we are appropriately addressing clinical issues for treatment planning," Swanson said.

But Ryan said consolidation of all patients and staff from Guensberg into four units has caused overcrowding with "negative consequences."

Chang said bathing facilities are inadequate and each unit has only one telephone and one set of washer/dryers. He raised many safety issues concerning the ceilings, lights, alarms and nursing stations.

Peterson said the hospital has been making changes to improve structural safety.

Chang said a major problem in integrating the units is that 76 percent or 116 of the 153 patients admitted between July 1, 2000, and April 26 were forensic patients from the court.

He said the other 24 percent of patients should be in a separate unit because the data show "HSH is primarily a forensic hospital and it should be thought of in that manner rather than thinking of it as a traditional state psychiatric hospital.

"Reconceptualization of thinking about the hospital as forensic may change some of the thinking about programming and security."

Chang said escapes or elopements, seclusions, restraints, assaults, injuries and harassment, sick leave and ineligible overtime shifts have increased since Guensberg was closed.

He said staff dissatisfaction with the move and feeling unsafe probably explain the excessive sick leave and overtime.

Hospital employees take an average of 16 sick days off per year, according to personnel data for 2000, Chang said. "Of a work force of 458, 155 workers (34 percent) took 20 or more days of sick leave in 2000."

He said HSH is four to five times sicker than the national average for health care organizations and twice as sick as the Honolulu City-county workforce, which had a sick leave rate of 3.2 percent in 2000 and an average of 8.4 sick leave days per worker.

There appears to be a connection between the high use of sick leave and high use of overtime, Chang said.

Swanson said, "If there is an issue, we have to engage better with the staff as to why they don't want to come to work every day or truly what the medical issues are."

She said Ryan mentioned that she knows of no other state psychiatric facility that provides for 21 days of paid vacation and 21 days of sick leave on the first day of work. "That's a difficult issue to manage when you are managing for that many people to be out over a year."

Chang said the HSA administration denied him access to records and information he requested on plans to improve areas of weakness. Swanson said she would like some examples of that because the staff "made tremendous amounts of raw data available for him."

Although the hospital has no staff shortage, Chang said staffing remains a critical issue, particularly in the nursing department, due largely to "the long-term inability of management to control sick leave and overtime abuses." Nurse managers have too much responsibility and there is wide distrust of the administration by staff, he said.

Appropriate programs and treatment for a large number of patients also are still lacking, he said.

On the plus side, Chang pointed to increased funding for the adult mental health system for the next two fiscal years.

He said the adult Mental Health Division has a framework for system development for the next four years, "although many of the questions about how the division is going to carry out its plans are not answered at present."

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