Hospital monitor
says state needs timeHe backs extending a deadline
to meet federal requirements,
citing progress made
U.S. Magistrate Kevin Chang, special master overseeing court-ordered improvements in Hawaii's mental health system, says the state needs more time to meet federal requirements despite "noteworthy progress."
In a report filed in court Friday, Chang recommended extending the deadline from Feb. 21 to Sept. 30 next year for state compliance with a consent degree.
The agreement stems from a U.S. Justice Department lawsuit against the state in 1991 alleging unconstitutional conditions at Hawaii State Hospital. Chief U.S. District Judge David Ezra appointed Chang in 2001 as special master in the case.
Chang asked Ezra to schedule a hearing on his recommendation, which he said is based on the state's "efforts and past performance, established momentum, the merits and validity of the Remedial Plan, defendants' commitment to continued effort and hard work, a belief that success is achievable with defendants' continued hard work and the agreement of counsel."
If everything goes according to plan, Chang said a joint motion to dismiss the case could be presented to Ezra in January 2005.
He said hospital staff and leaders "certainly deserve special recognition. They are hereby commended for their efforts to date and encouraged to keep up the good work essential to achieving compliance and a favorable outcome in this case."
Chang and the evaluation team praised mental health officials for significant progress in addressing workplace violence, highlighted in his July report as a major problem at the Kaneohe hospital.
Gail Hanson-Mayer, psychiatric clinical nurse specialist from Lexington, Mass., observed, "The gap that existed between the administration and staff has decreased as an increased sense of trust that workplace violence will not be tolerated at HSH has developed."
She noted staff members have been fired for violating the zero-tolerance policy for violence. Hospital administrators must continue to focus on that area to maintain the progress of the last six months, she stressed.
Psychiatrist Kenneth Minkoff, a team member from Acton, Mass., asked for further "evidence of progress" in safety actions and indication that the hospital is "forcefully addressing any barriers that might emerge."
He called for "documented evidence" of regular meetings with both unions at the hospital, "taking whatever measures are necessary to document lack of participation (if any) on the part of any union so that such resistance can be addressed by the court."
Hospital administrator Paul Guggenheim said he couldn't comment on Chang's report because he hadn't seen it. Dr. Thomas Hester, Adult Mental Health Division chief, is out of town and couldn't be reached.
The team cited improvement in integration of mental illness and substance abuse services, forensic and developmental disability services, care of patients in seclusion and restraints and the performance improvement process.
But members said more work is needed to comply with the Remedial Plan in areas of treatment, psychosocial rehabilitation, forensic services, developmental disability services and programming and nurse staffing, Chang reported.
Kahi Mohala, a private psychiatric hospital where the state has some "replacement beds," also was evaluated, with some improvements recommended. Kahi's role also needs to be defined better and it needs more guidance, the team said.
But Chang reported, "Interestingly, some areas, such as community linkage and treatment planning, were found to be somewhat better at Kahi than at HSH (Hawaii State Hospital)."