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A federal judge once likened the conditions at the Hawaii State Hospital to those of a 19th century insane asylum.
Today that same judge could say it’s more like the Roman coliseum.
Hospital staff report being assaulted at an alarming rate, about once every three days. They believe increased staffing and better training could reduce violence.
But state senators are now questioning why this is still a problem in light of a decades-old consent decree that highlighted staffing shortages as a major cause of dangerous conditions at the hospital.
That legal agreement, which took 15 years to satisfy, was supposed to have brought Hawaii’s state-run mental health system into the 21st century.
While it solved some problems — many related to hygiene, medication and the use of restraints — it didn’t fix everything.
“We’ve known for a long time that we have serious concerns with caring of people with mental illness,” said Sen. Josh Green, who chairs the Senate Health Committee. “It’s very visible, and a lot of times problems have to be highlighted in broad daylight to prove to my colleagues and others that we have to invest our resources.”
Green joined Sen. Clayton Hee, chair of the Senate Judiciary Committee, to form an investigative panel to explore what’s behind the spate of assaults at the Hawaii State Hospital as well as other issues related to alleged mismanagement, corruption and nepotism.
That committee meets Thursday, and senators are expected to question top hospital administrators about some of the same issues raised during the federal government’s investigation into the facility in the late 1980s and early 1990s.
The U.S. Department of Justice sued Hawaii in 1991 over deplorable conditions at the State Hospital, where investigators found patients were suffering various forms of abuse and neglect, records from that time show.
Puddles of urine stagnated on hospital floors, cockroaches scurried throughout the kitchen and patients sometimes shared the same toothbrush.
New admissions were lucky if there was enough food for them, and clothing was in such high demand that many wrapped themselves in sheets and blankets.
The ‘Welcome’ sign outside of the Hawaii State Hospital in Kaneohe.
Suicide hazards were everywhere, even inside the solitary confinement rooms. Exposed metal pipes and nails protruded throughout the facility, and loose electrical cords that could be fashioned into a noose were commonplace.
The hospital also faced staffing shortages that caused workers to rely on restraints and medication to sedate unruly patients.
Hawaii settled the case with the federal government by promising to clean up the facilities, hire more staff and improve patient care. But the state struggled for 15 years to meet the demands of the federal government, and was found in contempt.
By the time U.S. District Court Judge David Ezra dismissed the case in 2004, he said the state had made an “astonishing” turnaround at the State Hospital.
“It was like a scene from a 19th century insane asylum,’ Ezra was quoted as saying in media reports from the time. “It was a horrible experience.”
But Ezra didn’t let the state off the hook completely. Part of the agreement between Hawaii and the federal government required the state to implement a community mental health plan to provide housing and treatment for mentally ill patients living outside the hospital.
Even then the state struggled to comply with the court’s orders. A special magistrate appointed by Ezra blasted the state for being too sluggish in providing services, and even partially attributed the suicide of 16 mentally ill patients in two months to slow response and lack of dedication.
The case was finally resolved in 2006, putting an end to 15 years of federal oversight. While it was a major achievement for the state, it didn’t take long for conditions to backslide, at least in certain areas.
“Immediately, everything started getting cut back,” said Marya Grambs, executive director of Mental Health America of Hawaii. “All those services they put in place to meet the court decree were eliminated. It was sort of a charade.”
Grambs’ nonprofit provides mental health education and advocacy services, including those related to anti-bullying and suicide intervention for teens.
She said that under former Gov. Linda LIngle, who was in office from 2002 to 2010, mental health services saw large cuts. Grambs said that created an imbalance between the number of patients and the amount of staff available to care for them.
This was of particular concern at the State Hospital, Grambs said, but also when it came to providing services to children and adolescents.
“I’ve been in this job eight years and as long as I’ve been here it’s been overcrowded,” Grambs said of the State Hospital. “It’s always been over census so there’s obviously a bigger problem than it’s not being run right.”
Assaults on staff have been a recurring issue at the State Hospital for the past several years, so much so that the Legislature passed a bill in 2008 to make an attack on mental health workers a felony.
When Hee launched the Senate investigation into violence at the hospital in November, he expressed frustration that he again had to address the assaults taking place at the facility.
“From my perspective this is like a rerun,” Hee said at the time. “Unless there’s a more tangible response … there’s no reason to believe that we won’t be here five years from now if not sooner.”
The Senate investigative panel intends to use the 1991 consent decree as a roadmap to see where the state is now falling short.
Lawmakers came forward in similar fashion in 2001 when the House and Senate formed a joint investigative committee to look into how the state was complying with the so-called Felix consent decree, which stemmed from a 1993 lawsuit that alleged the state was not providing proper educational and mental health services to developmentally disabled children.
The Hawaii State Hospital has come under scrutiny for mismanagement and assaults on staff.
In his opening statement to the 1993 committee, Rep. Scott Saiki, now House Majority Leader, noted how unusual it is for lawmakers to step in to an oversight role.
But he also pointed out that it was the duty of the Legislature to act because the state had spent more than $1 billion on efforts to comply with the consent decree yet still found itself held in contempt by the federal government.
“At this junction the question must be asked, ‘Why are we not in compliance after we have spent over $1 billion?’” Saiki said. “We owe it to our taxpayers and special education students to find the answer to this question.”
U.S. Rep. Colleen Hanabusa, who was then in the Hawaii Senate, was the other co-chair of the committee.
Today, Saiki believes the committee’s investigation was instrumental in forcing then-Department of Education Superintendent Paul LeMahieu to resign.
Among other things, the committee raised questions about DOE spending patterns and LaMahieu’s relationship to a contractor. Saiki said the panel also exerted pressure on the state to comply with the consent decree.
“My view is that the investigative committee ties into the Legislature’s oversight role,” Saiki said. “We were able to obtain information that we would not have otherwise obtained through the normal legislative process.”
Both Hee and Green have promised to demand changes in how the State Hospital is run. That’s one of the reasons why they took specific measures to give their committee subpoena powers. Those testifying will also be under oath.
Hee did not return phone calls seeking comment, but Green told Civil Beat that committee leaders plan to place “intense pressure” on the officials who are running the hospital as well as the administrators who have the ability to make changes.
Green made clear that some people’s jobs will be on the line.
“I’m expecting results,” Green said. “When you look in the faces of those people who got hurt and it seems clear that there are some irregularities that have been uncovered, it needs to get fixed or people are going to get fired.”