New State Hospital The first question everybody asks him is how long is he going to be here, says Paul Guggenheim, new administrator of the Hawaii State Hospital in Kaneohe.
administrator eager
to tackle challenge
Paul Guggenheim brings to the
job a long career of running
psychiatric hospitalsBy Helen Altonn
haltonn@starbulletin.comHe responds: "It would be a little silly" to sell a new ranch home in Loveland, Ohio, near an Arnold Palmer-designed golf course where he's a member, give up a solid job that includes a new company car and move his family to come here just for a short time.
"It's not my intention to come blowing in here for a year, 5,000 miles. No, no," he says with characteristic good humor.
Guggenheim, 55, is the fifth administrator of the beleaguered hospital since the U.S. Justice Department sued the state 10 years ago over its conditions.
Why would he want to give up "a nice lifestyle" to tackle the Hawaii mental health facility's nagging problems?
One reason is the challenge, he says, and the other is developing a system of care from the hospital into the community, planned by the state Health Department. "They're starting to do that here and I'm excited about that."
Also, he says, the time was right. His wife, Lynda, will retire as a kindergarten teacher at the end of January, and their daughter, Laura, has graduated from college.
Guggenheim has had a long career running psychiatric hospitals and community health agencies. He is a former colleague of Barbara Peterson, his predecessor at the state hospital the past year.
He was previously executive director of Core Behavioral Health Centers, a private non-profit company in Cincinnati that he said he took from bankruptcy to $1.5 million in cash in the bank.
He says he was aware of the Hawaii State Hospital's troubles but while he "saw the iceberg" and tried to look at the waters beneath it, "I just didn't go deep enough."
A self-described "direct kind of guy" who "doesn't mince words," Guggenheim says the consent decree has put heavy pressure on the staff and patients.
"I think the hospital has been bum-rapped on some things. It has been under so much barrage of criticism it hasn't really been able to deal with it. That's why administrators don't stay. This is not the greatest, ideal position to be in."
But Guggenheim points to "a lot of great things" going on to improve patient programs, tighten security, reinforce the medical staff's role in control of treatment and move patients into the least restrictive community settings with "wrap-around" services.
Since starting his job in September, he has worked 12 to 14 hours a day, reading reports and talking to patients, staff, union representatives, legislators and others concerned with the hospital.
Marion Poirier, executive director of the Oahu Alliance for the Mentally Ill, met Guggenheim at a legislative briefing on a state audit of the hospital.
"I found him very refreshing," she says. "He had a spirit about him that I think is very healthy. ... I was very impressed with his political, people and analytical skills."
Guggenheim's first act on the job was to walk through the hospital's units "because I happen to like patients." He says he attended the best community meeting of his career with doctors, staff, patients and others at the hospital discussing issues.
He's starting labor-management meetings to get union input. "If they have a better way to slice the bread, hey, I'm willing to listen," he says.
"It's encouraging to hear that," says Nora Nomura, Hawaii Government Employees Association field services officer. "He says all the right things. We'll see what happens."
Guggenheim recognizes people are frustrated about the hospital's problems and asks that they give the administrative team a chance to fix them before going to outsiders.
"I understand frustration and I am, too, in the short time I've been here," he says. "This is one big bureaucracy and it's incredible. Again, we can work within that structure to make this thing work."
Guggenheim's goal is to meet standards of the Joint Commission on Accreditation of Healthcare Agencies and move the hospital out of the lawsuit. The hospital is accredited but not in full compliance, he says, noting performance improvement is a major issue.
"We're not going to get there today," he says. "This is not a speed boat; this is turning the Queen Mary.
"I want to run this place like a business. I want top-quality patient care based on returning to the community. ... We can't afford to not do good care.
"We don't want people coming here and figure they're going to be here 20 years," he says, adding that his view of "long term" is one year. Patients should be hospitalized only as long as needed to accomplish treatment goals and be restored to the community, he says.
He says it's "probably the fault of the system" that some patients have been at the hospital for many years. "We're going to try to divert people who don't need to be here."
Guggenheim stresses, however, that he is not going to release dangerous people. "I'm concerned about patient safety, staff safety, community safety."
Safety has been an issue since the hospital closed the Guensberg building in March and consolidated patients and staff in four units.
The HGEA filed a grievance alleging patient units were "dangerously overcrowded, unsafe and not a therapeutic milieu."
A rash of patient escapes, or "elopements" in hospital parlance, aroused community and legislative concerns.
Guggenheim, who reviewed all the records, says none of the patients leaving the grounds "was seriously dangerous" and elopements have been reduced significantly.
Security windows, devices, fencing and lighting have been installed and "we're looking at more of those things," he says. He's also looking into hiring private security staff to supplement public safety officers.
The hospital must maintain "reasonable security" but he has no intention of turning it into a prison, Guggenheim says, explaining patients need to move around to psychosocial rehabilitation and therapy programs.
He is having mobile modular units installed, one per unit, to provide additional interviewing or program space for the crowded living areas. He says Guensberg should have been closed because it is unsafe but he is looking into possibly repairing it for temporary use until another building can be constructed.
With a large number of court-ordered criminal patients at the hospital, a building is needed to provide increased security for forensic services, he says, adding that the facility has some good forensic talent, including students in the University of Hawaii forensic residency program.
He says the Kaneohe site "has got to be the prettiest spot for a psychiatric hospital in the nation," but the working environment is difficult because of legal restrictions and the federal lawsuit.
Rather than drastic changes, however, Guggenheim talks mostly in terms of "refinement," emphasizing, "It's a flat tire, not a broken axle."
When he gets time, he wants to visit the other islands and learn how to scuba dive. "I like being in the middle of a picture, not looking at it," he says.