Patients crowding State Hospital

An unusual increase in the population puts the facility over its limit

Hawaii State Hospital has received an "extraordinarily high" number of court-ordered mentally ill patients in recent months, leading to increased assaults and safety concerns, mental health officials say.

The hospital's daily population dropped from 196 in December 2005 to an average of about 172 in January and February, then rose rapidly the past two months, said Dr. Thomas Hester, chief of the state Health Department's Adult Mental Health Division.

A surge in forensic or court-assigned patients drove the increases, he said. "We're all trying to understand it."

PATIENT INFLUX Here are the patient counts at the Hawaii State Hospital: » January and February: 172 average » May: 191 » Licensed for: 190 » Target population: 168-178 Source: State Mental Health Division

Marsha Kitagawa, state Judiciary spokeswoman, said, "There have been no procedural changes in the 1st Circuit (Honolulu) to account for the increase in court referrals. As usual, judges view each case individually."

The hospital's patient census reached 191 this week, slipping over the licensed capacity of 190. More than half of the cases involve substance abuse (largely crystal methamphetamine) as well as mental illness, Hester said. "It is a huge problem."

"The census adds to the anxiety at the hospital," he said, with assaults occurring against patients and staff. "Some are very minor and don't result in injury, but all are treated as a serious event.

"The ones of most concern to me were four more serious assaults against the staff," Hester said, adding that a nurse was seriously injured in January.

Every violent or aggressive incident is an individual case with different circumstances that must be analyzed and treated differently, he said. "Obviously, we're all very concerned about this. We go through a whole variety of in-depth analysis to see how we can reduce this, how to keep this from happening, if at all possible."

Some unrest also has occurred at the facility because two psychiatrists are making career moves, Hester said. However, the staffing level has remained the same, he said.

"Safety is our biggest issue," said Mark Fridovich, administrator of the Kaneohe hospital. "We are working with staff at the hospital and the division to increase our safety for patients, the staff and public.

"There are too many patients," he said. "The challenge of admissions is felt by me and the rest of the staff. Our target range is closer to 168 to 178."

The number shot up with 19 forensic patients admitted in March and 22 in April, he said. The high population "requires adjustments in environment and staffing to safely address needs of the patients," he said.

Another big change, the officials said, is an increasing number of court-ordered people being evaluated for fitness to stand trial on misdemeanor charges -- 14 since January.

Fridovich emphasized that the Kaneohe hospital "is here to try to take care of seriously mentally ill people who require hospital-level treatment and arrange for appropriate discharge for patients who no longer require that level of care."

Hawaii State Hospital was operated under federal court oversight for overcrowding and unconstitutional conditions from 1991 until December 2004.

Capacity for discharges has been expanded, but legal and transition issues take time, Fridovich said.

Four cottages on the hospital grounds formerly occupied by staff have been converted into 24 beds for conditional release patients. The program, Hale Imua, is operated by Steadfast Housing Corp. and Windward Community Mental Health Center and now has 16 patients.

The hospital also has 22 beds in four other cottages on the grounds in a specialized residential program operated by Care Hawaii.