A Hawaii Senate panel began its probe into safety conditions at the state mental hospital Tuesday, raising serious questions about dysfunction at the facility.

The investigation, led by Sens. Clayton Hee and Josh Green, stems from reports of severe assaults on staff members by patients housed at the Hawaii State Hospital in Kaneohe.

But Tuesday’s hearing revealed there are much deeper issues that will be explored as lawmakers grill hospital workers and administrators from the Hawaii Department of Health.

Hee said several more hospital employees have come forward since he first announced in November that there would be a Senate investigation of the hospital.

These employees, in addition to recounting personal stories of assaults they have endured, have detailed disturbing allegations of corruption, nepotism and retaliation against those who speak out.

“This thing is a can of worms that’s going to be very difficult to unravel,” Hee said. “It’s multifaceted and I think some very candid information is going to come out.”

Hee read excerpts from an email he had received from one state worker who claimed several employees at the hospital were promoted or given raises because of their “relationships” with management.

There were also allegations of off-the-books overtime pay for some workers.

Tuesday’s panel was a joint meeting of the Judiciary and Health committees, which are chaired by Hee and Green. Top administrators from several key departments were also present, including the DOH, Public Safety and the Judiciary.

But much of the attention was focused on State Hospital Administrator Bill Elliott and Medical Director Bill Sheehan, both of whom are DOH employees.

The two men offered details to show that the facility is approaching maximum capacity when it comes to housing mentally ill patients and that the number of annual admissions has nearly tripled from 100 in 1997 to 333 in 2013.

Many of the patients come to the hospital through the criminal justice system, and also suffer from severe mental illness and substance abuse problems.

“It’s 10 pounds of rice in a five-pound bag,” Sheehan said.

“Demand seems infinite.”

DOH officials admitted that they needed to do a better job of protecting their employees from patients who can become violent.

But they also said there simply isn’t a suitable facility on the islands that could act as a middle ground between jail and the State Hospital. This is especially relevant for some patients who come to the State Hospital after they are found not guilty of certain crimes by reason of insanity. At least a handful of them faced murder charges.

There are other patients who are sent to the hospital temporarily to be evaluated for mental illness after being picked up by the police or charged with a crime.

Officials said these patients could be candidates for a new type of secure mental health facility that would be more adept at handling patients who might be prone to violent outbursts.

Right now it is up to nurses and psychiatric technicians to defend themselves and other patients when an attack occurs inside the hospital.

Lynn Fallin, deputy director of the Behavioral Health Division at DOH, said the agency is contemplating building a new facility to help fill this detention gap between jail and the state hospital.

The state plans to demolish an abandoned building on the State Hospital grounds, and DOH has asked for $2.5 million in the upcoming budget to plan and design a replacement structure that could act as a secure mental facility for such patients.

It’s part of several planned changes DOH wants to pursue to update its facilities and improve overall conditions for mental health patients in Hawaii, Fallin said.

“We’re here to listen,” she told the lawmakers. “(But) we’re also here to offer what we think are improvements that can make the Hawaii State Hospital and the mental health system safer and more effective.”

But what became clear Tuesday is that senators are looking for more than just improved policies and procedures. They also want accountability.

Hee scolded Elliott for not responding to several of the senator’s questions about who closed down a psychiatric intensive care unit in 2011 after a particularly violent assault. That attack came seven days after the state completed $530,000 worth of renovations to the unit.

Hee was so frustrated by the lack of direct answers that he paused while questioning of Elliott to warn future testifiers that they should be straightforward and honest when answering his questions.

“Let me say this to everyone here, it’s going to be much more helpful if the evasiveness of this individual is not emulated by subsequent individuals appearing before this committee,” Hee said.

“I will ask specific questions because I’m looking for specific answers. That’s all we’re looking for. If you’re doing to say it was an executive decision just tell us who the executive is. If it’s you, it’s you.”

He added, “I’m really trying to help you help us.”

The lawmakers said they intend to seek subpoena powers to help with their investigation into the problems at the Hawaii State Hospital.

Both Hee and Green seemed particularly concerned about alleged retaliation against hospital workers who came forward to discuss the attacks that were occurring at the facility.

One worker, Kalford Keanu, is one of four state hospital workers who have publicly described the attacks they suffered at the hands of patients.

Keanu testified at Tuesday’s hearing that he was discouraged from reporting the assaults, and that he was the victim of reprisals after he decided to speak up.

This has prevented several workers from coming forward publicly, he said, and has become an underlying threat at the hospital.

“There is a reason why people fear retaliation,” Keanu said. “It’s there. A lot.”

The next committee hearing is scheduled for Jan. 22 at 1 p.m.

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