State Hospital tries
to fill medical
staff vacancies

Low salaries and nationwide
shortages make a search difficult

By Helen Altonn

The Hawaii State Hospital for the mentally ill is flying in psychiatrists and nurses and recruiting to fill vacancies for those and other critical positions, says administrator Paul Guggenheim.

Meanwhile, he said, the Kaneohe facility's population has been steadily increasing. "We have a few too many patients ... We just don't have enough beds. As we get one out, we bring one in."

He said the hospital has vacancies for psychiatrists and nurses -- both in short supply nationally -- social workers, occupational therapists and a psychologist.

"We're covering things and the level of care is good," he said. But the "rental doctors" are here only six months, he said, pointing out permanent full-time doctors are able to develop better teamwork and coordination with the staff.

"We call them 'enduring treatment teams' that will stick around and be there solidly."

The hospital also has trouble holding onto professional staff because of the pay levels, Guggenheim said, noting salaries for psychiatrists are $30,000 to $40,000 a year behind mainland standards.

"We're losing a doctor now for a $35,000 difference in pay."

The Adult Mental Health Division is working with the University of Hawaii Department of Psychiatry to try and improve the salary structure for psychiatrists, which it provides for the hospital, Guggenheim said.

Dr. Thomas Hester, division chief, said the parties have had "some very good talks" about ways to improve recruitment and retention.

"We'd like to have more competitive salaries. We're also looking within the state system to see if we can get some salary ranges that can be attractive to psychiatrists to work at Hawaii State Hospital."

Another possibility is to recruit graduating medical students, Hester said.

The Kaneohe hospital has been operated under federal court oversight since the Department of Justice filed a lawsuit against the state in 1991 alleging federal violations.

He said the hospital must meet federal staffing requirements, and the court and Department of Justice are closely monitoring the situation.

The hospital needs to have 13 or 14 psychiatrists available. It has five vacant positions, including a chief of psychiatry. It has four fly-in doctors.

It is recruiting to fill vacancies for 14 registered nurses, three social workers, three occupational therapists and one psychologist.

Exceptions should be made to help resolve the staffing problems because of the court order, Guggenheim said, explaining it takes "exceptional" people to work there because the jobs are demanding and patients are difficult. "Some require the most chronic care in the system."

The court has demanded that the hospital look at alternatives to hold the patient numbers down. An analysis is underway to determine why there are delays transferring patients to community-based resources, Guggenheim said.

The hospital is licensed for 168 beds and recently had 171 patients, Guggenheim said. "We call it an 'emergency bed plan' if we go over licensed capacity."

He said the hospital has filed a petition with the Department of Health to increase the capacity to 177. "Certain (court-assigned) patients we have to take."

The hospital also has 50 beds that don't turn over because of long-term patients, he said.

One solution to overcrowding was to renovate and reopen the old Guensberg building, closed in March last year. It is being used for 60 patients diagnosed with both mental illness and substance abuse.

Two small patient units were converted for all male forensic patients and admissions.

The hospital acquired additional beds recently by expanding a contract with Kahi Mohala from 16 to 24 beds for state patients.

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