State hospital expansion might be needed for court referrals

THE ISSUE Assaults on staff at the Hawaii State Hospital have been trending higher this year.

IF the current pace continues, the incidence of assaults of staff members at the Hawaii State Hospital could exceed numbers in previous years. While some of the events are considered minor, neither employees nor other patients should be placed at risk at the facility that has recently been released from federal oversight after 15 years of court supervision.

The rise in assaults has been attributed to an increase in the hospital's population, largely because of a greater number of so-called "forensic" patients, those associated with criminal activities such as drug abuse, who are sent to the hospital by the courts.

A separate unit for patients with criminal connections should be considered. Though the state administration and lawmakers have not been receptive to building correctional facilities such as prisons because of community objections, expansion on the hospital grounds in Kaneohe might be less of a hurdle.

Whether for court-referred patients or others, the hospital has long struggled with space problems and needs enlargement. The hospital currently has one less patient than its licensed 196-patient capacity, but the optimal level is between 168 and 178.

In the first six months of this year, the state Department of Health reported 107 staff assaults by patients at the hospital. There were 187 last year, 133 in 2005 and 170 in 2004, indicating a general upward trend.

Assaults can run from a simple shove, but more serious incidents do occur. In January, a nurse suffered severe injuries and has been unable to return to her job. She intends to sue the hospital for what she maintains are unsafe working conditions. In addition, a staff psychiatrist has resigned, contending she doesn't feel safe working there. She says the hospital needs more staff, better training and better pay.

Hospital officials say staff-to-patient ratios have been unchanged since the facility was released from federal supervision, but acknowledge there are concerns.

Though administrators face shifting challenges at the hospital, staffing and related issues have continually been difficult to manage. A task force reviewing training and recruitment is close to reporting its findings and recommendations, and could identify if systemic changes are required.

In any case, legislators and Gov. Linda Lingle should be looking at expanding the hospital to fit growing needs.