Court report to suggest
State Hospital fixes

A panel of experts drafts steps
to meet a federal consent decree

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By Helen Altonn
haltonn@starbulletin.com

U.S. Magistrate Kevin Chang is expected to file a report tomorrow in federal court with recommendations to move the Hawaii State Hospital into compliance with federal laws.

"Overall, it is a good professional report," State Hospital Administrator Paul Guggenheim said. "It is current state-of-the-art practice. There are some things that are very difficult, but overall it is a very reasonable document and something we think we'll be able to live with and achieve."

Chang was appointed last May by Chief U.S. District Judge David Ezra to assist the state Health Department in meeting consent decree requirements at the Kaneohe hospital.

The consent decree stems from a lawsuit filed by the U.S. Justice Department in 1991 alleging federal violations at the hospital for the mentally ill.

When Ezra announced Chang's appointment, he said the court was only "one half-step away" from running the hospital.

At Chang's suggestion, eight mental health experts chosen by the Justice Department and the state Health Department from Hawaii and across the country were brought together in October to identify and address remaining issues.

Michael Broderick, former Judiciary administrative director now with the Hawaii Justice Foundation, was the facilitator.

The group's report was submitted to Chang with comments from concerned agencies. He could submit it as it is to the court or modify it.

State Health Director Bruce Anderson said Chang felt the expert summit was a way to draft a comprehensive plan quickly.

The Health Department also developed a plan and presented it to the group to get the process going, he said.

"There isn't a large disconnect between the two," although there are different approaches, he said.

Guggenheim said he and the hospital's executive committee reviewed and commented on the experts' report and discussed it with Chang.

Anita Swanson, deputy health director for behavioral health, said there is some concern about meeting "ambitious time lines." But she said, "We need to get into the doing stage."

Anderson said planning and implementation of treatment programs for patients in the hospital and upon discharge are among major issues.

"There is no question that patients are getting high-quality care," he said. "We need to refocus to make sure they are treated, ultimately, in less restrictive environments."

Hospital discharges have increased, totaling 168 in the 2000-2001 fiscal year and 99 from July to date, Swanson said. But admissions also have increased.

The hospital as of yesterday had 140 patients, plus five beds for patients away from the facility for various reasons, Guggenheim said.

Kahi Mohala has 13 patients under a contract with the hospital to help with an overflow.

Closing of the hospital's old Guensberg building last spring for safety reasons caused an uproar among staff and patient advocates, with complaints about overcrowding of four units with 168 patients.

The numbers have been reduced, and sensors, alarm systems and other devices have been installed to tighten security, the officials said.

The Health Department now plans to fix Guensberg's leaky roof, plumbing and other problems for temporary use for up to 60 patients until a secure new building is constructed on the grounds.

The department is asking the Legislature for $1 million for the repairs and $250,000 to design the new unit.

Anderson said the department is ready to advertise for bids for the repair project, which he hopes will be done by July for less than $1 million.

Meanwhile, Swanson said, the department has agreements with the Queen's Medical Center and major community hospitals on the neighbor islands to provide acute care for clients who meet certain criteria.

The department also is entering its first contracts in a four-year plan to develop community-based mental health services for patients who do not need hospitalization.

Anderson cited "tremendous progress" in the adult mental health system with hospital improvements and buildup of community programs.

"I believe we will have an outstanding program in two to three years -- comparable to any in other states," he said.