State hospital
shows progress

A report expresses confidence
that the state will comply
with many court standards

Dramatic improvements have occurred at Hawaii State Hospital since 1991 when patients were living in crowded, unsafe conditions, sleeping on mats and deprived of necessities, says a report filed in federal court.

Because of the changes and a "can do" attitude by state mental health officials, U.S. Magistrate Kevin Chang said he believes they can comply substantially with a court-ordered remedial plan by a Sept. 30 deadline.

Chang, special master appointed by Chief U.S. District Judge David Ezra in 2001 to oversee an overhaul of the state mental health system, said in a report filed in court yesterday that more work is needed.

But he cited significant progress since the U.S. Justice Department sued the state 13 years ago alleging unconstitutional conditions at the state Health Department's hospital for the mentally ill.

"I'm not surprised but I'm very encouraged," Dr. Thomas Hester, state Adult Mental Health Division chief, said of Chang's report, which he had not yet seen.

"People have been doing a tremendous amount of work," he said, noting that it is "not just focused on compliance. It's really internally driven and focused on improving care for patients, and I believe that's going to lead to a sustaining good system after the court is no longer involved."

Chang said an evaluation team in March found the hospital continuing to improve in key areas. However, it reported slow or stalled progress in patient treatment planning, forensic services and some other areas.

The most serious finding, Chang said, was extended use of wrist-waist restraints, which the staff had used on four forensic patients with violent histories to protect other patients and staff.

Deficiencies in identifying and caring for patients with developmental disabilities and mental issues remained a lingering problem cited by the evaluation team in June. But the evaluators reported significant improvement in a number of areas and decreased use of the wrist-waist restraints with no increase in assaults.

"Importantly, it is the opinion of each member of the special master's evaluation team that Hawaii State Hospital has made significant overall progress," Chang reported to the court.

He said Kris McLoughlin, court-appointed special monitor in the case, observed "more enthusiasm, a greater commitment to purpose and a positive 'can do' attitude among Hawaii State Hospital management and staff."

Chang said clinical consultants for the Justice Department and the state will visit the hospital before Sept. 30, and the evaluation team will return to the hospital Sept. 13-17. He recommended taking no action until they submit reports.

Chang said in a report to the court in December that with continued progress a joint motion to dismiss the case could be presented to Ezra in January.