Court gives state 2 years
to fix mental health care

A state official on an expert panel thinks
a "national class" facility is in the making

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By Helen Altonn
haltonn@starbulletin.com

The Hawaii State Hospital has up to two years to meet federal requirements to correct deficiencies, under a plan designed to end a federal court's oversight of the mental health facility.

The psychiatric hospital has been under a federal consent decree for 11 years to improve treatment for patients. Yesterday, U.S. Magistrate Kevin Chang, special master overseeing hospital compliance of the decree for Chief U.S. District Judge David Ezra, filed a compliance plan created by a panel of eight experts.

The only Hawaii expert on the panel said yesterday that the state is on its way to having a "national class mental health system."

"I'm confident we're on the right track to achieve this plan," said Dr. Thomas Hester, medical-clinical director in the state health Department's Adult Mental Health Division.

Chang recommended adoption of the plan, with minor modifications. He termed the plan "empowering," giving health officials flexibility to develop and choose the most appropriate strategies for the State Hospital and its patients.

State Health Director Bruce Anderson said he was "very pleased" with the plan and Chang's thorough effort to understand issues at the hospital and in the community. "It (the plan) wouldn't have happened without his leadership.

"I'm optimistic that we're going to be out from under court oversight, at least active oversight, in two years," Anderson said.

The U.S. Department of Justice sued the state in 1991 over federal violations at the mental health facility in Kaneohe. A settlement was reached to make improvements.

But Anderson said: "Up until now, part of the problem is, we've been chasing a moving target. ... It has been frustrating for us because we haven't been clear on what we need to do to get through this lawsuit. Now I think we've got a clear road map for the future."

Chang not only talked to hospital administrators and staff, but met with advocacy and union representatives and visited mental health centers and community mental health programs.

The experts recommended some new positions, such as a forensic director, but said they assume existing positions will be redeployed.

Anderson said staff can be reassigned, and he does not anticipate a need for new positions or funding to comply with the order.

He said the biggest single issue at the hospital has to do with staffing ratios, which have been imposed under court orders up to now regardless of a patient's needs. The new plan proposes a team approach tailored to the needs of each patient, he said.

He said he appreciates the flexibility allowed to adjust to changing conditions and needs at the hospital because "some stipulations and orders are so prescriptive, they have tied our hands."

Some patients are unnecessarily hospitalized because community-based programs are lacking, and they must be developed to comply with state law, Anderson said.

Chang has recommended a community mental health conference in March to plan services to meet "clinical and social needs" of patients transferred or diverted from the State Hospital.

Hester said that within 30 days the Health Department must develop benchmarks to measure progress of compliance.