Hospital audit A state audit of the Hawaii State Hospital citing patient safety, treatment and management problems reveals little that is new, says state Health Director Bruce Anderson, "and we're already addressing most of the issues."
covers old issues,
state says
The state health director
By Helen Altonn
says the problems are
already being addressedThe review, from last July to January, generally covers deficiencies in the mental health system that have come up already in legislative and court hearings. Some new ones also have surfaced since the audit.
The audit said patient safety is compromised by the staff's failure to follow procedures when secluding and restraining patients.
"We reviewed 20 episodes of seclusion and/or restraint and found that staff failed to follow hospital procedures in 15 percent of these cases," the report said.
The State Hospital in Kaneohe has been operated for 10 years under a consent decree between the state and U.S. Department of Justice.
At the last federal hearing in May, Chief District Judge David Ezra appointed U.S. Magistrate Kevin Chang to oversee the state's compliance with federal laws covering the hospital. Calling it a "make or break" situation, Ezra said the next step would be to appoint a special master to run the hospital.
Anderson said Auditor Marion Higa "restated a lot of historical concerns with the program, many of which have been effectively addressed in the last year."
He said some of the auditor's comments were legitimate, and others "completely off base." He sent Higa an eight-page response to the report.
The most significant issue he has with the audit, Anderson said yesterday, is that it does not recognize a comprehensive four-year plan for community mental health programs developed with community participation in the last 18 months by the Adult Mental Health Division.
The audit criticizes the division for making "quick fixes" to resolve federal court orders instead of engaging in long-range planning.
Anderson said preliminary copies of the four-year plan were given to the auditor's staff, but they told him they did not include it in the report because it was not completed.
"It is a disservice to the hundreds of people who worked on this plan over a year not to have at least acknowledged the existence of the plan," he said.
Anderson disputed an audit statement that the State Hospital is the Adult Mental Health Division's "lowest priority," pointing out its budget is $28.8 million -- the division's single largest expenditure.
The Legislature also gave the division an additional $8 million this year and another $14 million next year, which Anderson said is "an unprecedented amount of money allocated to building out our mental health programs."
He said the auditor "presents a picture that we're sitting on money" by not filling 66 positions worth $4 million in salaries as of last November.
There are some vacancies, he said, but instead of filling some civil service positions, the hospital is contracting for service providers in the community.
Transfer of staff and patients from the deteriorating Guensberg building to four units in March triggered many complaints from staff and patient advocates about safety and overcrowding.
The Hawaii Government Employees Union filed a grievance in April alleging the units are "dangerously overcrowded, unsafe and not a therapeutic milieu."
A series of escapes also aroused concern.
Anderson disagrees that the facility's 160 patients are overcrowded, and stresses that the facility is a hospital, not a prison. But security and policies and procedures are being improved, he said.
The auditor also pointed to lack of management controls at the hospital, resulting in inaccurate overtime payments to 17 percent of staff sampled.
"Of further concern," the auditor reported, "a former hospital administrator circumvented the civil service system when he allowed staff serving in the newly created unit manager positions to seek overtime to increase their base salaries.
"Two unit managers were paid a combined total of approximately $30,000 in overtime in 1999-2000 without any assurance that they actually worked the overtime reported," the audit said. "In fact, one unit manager acknowledged that he submitted inaccurate overtime claims upon the request of hospital management."
Inadequate oversight of sick and vacation leave also leads to staff misuse of leave, the audit said.
Anderson said the hospital is working with the unions to tighten up on supervision and administrative oversight and require more staff accountability.
The hospital shaved $3 million from its operating costs in the last fiscal year, mostly by reducing overtime payments, he said.
"We are running the hospital more efficiently than we ever have in the past," he added.