Secured facility
may hold patients

The Health Department wants
a new building at the state
hospital for criminal patients

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By Helen Altonn
haltonn@starbulletin.com

Funding will be requested during the next Legislature to build a secure, fenced facility at the Hawaii State Hospital to house 40 or 50 criminal patients.

State Health Director Bruce Anderson said he doesn't know what the building would cost but it would relieve space and security problems at the Kaneohe hospital.

The hospital has been trying to improve patient care for the last 10 years since the state entered into a consent decree to settle a U.S. Justice Department lawsuit. In recent months there have also been a number of highly publicized escapes from the facility which has raised concern in nearby residential areas.

Rep. Dennis Arakaki (D, Kalihi Valley), House Health Committee chairman, said he believes the Health Department would get legislative backing to build a forensic facility.

Patients with the highest security risk in the present population would be moved to the new building, Anderson said, stressing, "We're not making the state hospital into a prison." The proposed forensic unit would not be a substitute for a treatment program needed in the prison system, Anderson pointed out.

He said he submitted two reports Friday to U.S. Magistrate Kevin Chang, appointed by Chief U.S. District Judge David Ezra in May to oversee compliance with the federal consent decree.

One is a plan to address space problems with short and long-term remedies, including continuing development of community resources for treatment options.

The other plan deals with outstanding issues -- primarily patient treatment -- to comply with the consent decree.

Anderson, who disagreed in the past with those complaining that the hospital was overcrowded, said, "Until recently, I was reassured by hospital administrators that the move did not result in any significant problems regarding patient care and treatment."

He said he was told for the first time Friday, in the process of compiling data for the past six months for the court, that "patient care has been compromised."

To deal with immediate space problems at the hospital, some patients will be transferred to Queen's and Castle Medical Centers, which already take state patients for treatment. Some patients also may be transferred to Kahi Mohala and some geriatrics cases to Kahuku Hospital, although no discussions have occurred yet with those facilities, Anderson said.

Some patients who qualify would be moved to less restrictive settings, and the DOH is working with the Judiciary to speed up hearings for patients found to be fit and awaiting trial or discharge.

The department is also working with the Department of Public Safety to ensure only appropriate people are admitted to the hospital. An agreement was reached recently with public safety officials that all fitness evaluations will be done at Oahu Community Correctional Center unless a person needs hospital-level care.

It's hoped with all of those actions to reduce the hospital population from 168 to 140 by January, Anderson said.

In the long term, with a new secure unit, the population would be lowered to 108 or less in the current four units, he said.

Anderson said he will ask for special authority so construction can begin immediately on a new unit. Otherwise, it would take two or three years, he said.

Arakaki said the new unit would offset closure of the deteriorating Guensberg building in March, when all the patients and staff were moved to the present four units.

Although staff and patient advocates said the units were overcrowded and safety was jeopardized by the mix of high-risk patients with others, DOH administrators "were in denial," Arakaki said.

"Maybe it's because they realized, after the fact, that they shouldn't have acted so quickly in closing down Guensberg. Some parts of the building are pretty bad, but I can see where they could have phased out the population there."

The Hawaii Government Employees Association filed several grievances for nurses alleging the units were "dangerously overcrowded, unsafe and not a therapeutic milieu."

HGEA officials met with Anderson and hospital representatives Thursday to discuss their concerns and learned of the DOH's new proposals to deal with space and security problems, said Nora Nomura, HGEA field services officer.

"Since Guensberg closed, not much has happened to resolve those issues. For the first time, we heard they're working on it, and they feel it is a temporary situation."

The HGEA asked for a cooperative relationship, Nomura said, and Anderson agreed to consider a staff plan to make one unit more secure for difficult patients and convert one unit for admissions.

Rep. Charles Kong Djou (R, Kaneohe) said he welcomes any effort to increase security at the hospital. He believes area residents would support it.

Djou added that he is frustrated with both the DOH and the Department of Public Safety because they've never developed a long-term plan to deal with violent, psychotic patients.

Regarding outstanding compliance issues in the consent decree, Anderson said failure to provide adequate treatment plans and monitor them is an ongoing problem.

Low staff morale and staff turnover may affect performance, he said. But with 600 staff members for 168 patients and available resources, he said: "It's difficult to imagine why we're not able to consistently provide appropriate treatment plans.

"The staff are very caring. We've got a good cadre of qualified professionals in positions at the hospital. There is no excuse for not having adequate plans."

A major problem appears to be lack of supervision of clinical treatment of patients, Anderson said, adding that he will be looking into this and make changes if necessary.

"I'm hopeful in two or three months we will have a strategic plan in place to address remaining issues at the hospital and within a year or so, hopefully we will be in compliance."