Public sector collective bargaining is at least partly to blame for unsafe conditions at the Hawaii State Hospital, according to the tearful testimony of a top nurse who works at the facility.

On Wednesday, Associate Chief Nurse Emma Evans told a state Senate panel investigating violence at the hospital that she’s been handcuffed by the unions when it comes to controlling how many hours her staff works, particularly as it relates to overtime.

She said putting in too many hours can lead to fatigue, and even admitted that employees who work too much overtime have fallen asleep on the job, putting both hospital staff and their patients in danger.

But she also told lawmakers there’s little she can do when a staffer insists on working overtime because of provisions in their union contracts that guarantee the right to overtime.

“It hurts because I care for the place I work,” Evans said through tears and a quivering voice. “As nurses we are there for the patients and the safety of the patients.”

When clinical judgment is cast aside due to collective bargaining, she said it can be “demoralizing.” Evans noted that the hospital used to have caps on overtime when the state was under a federal consent decree, but that employees filed a grievance to get those caps removed.

“The staff grieved and they won,” Evans said. “Where does that leave us? Whatever we have done before is lost.”

Sen. Clayton Hee — who is leading the investigative panel along with Sen. Josh Green — spent much of Wednesday’s hearing quizzing Evans on what he believes to be excessive overtime at the Hawaii State Hospital.

He focused on three hospital employees who worked more than 1,000 hours of overtime each in fiscal year 2013. Those employees, Hee said, earned anywhere from $32,000 to $48,000 more than their base salaries.

Total staffing costs at the hospital in FY 2013 were $35 million, with about $2 million spent on overtime.

Hee also asked Evans about sick time use in which employees would take four days off — the threshold before having to provide a doctor’s note — and then work a double shift on their fifth day, giving them eight hours of overtime.

“Here’s my concern,” Hee told Evans. “Based on your description it sounds to me like the employees are gaming the system.”

Hee was also worried that certain employees were getting more overtime opportunities than others, something Evans denied was the case.

After the hearing, Hee told Civil Beat he intends to dig deeper into the overtime issue. He also plans to subpoena representatives from the Hawaii Government Employees Association and United Public Workers unions to testify under oath. Both unions represent hospital workers.

Department of Health Director Linda Rosen said it’s difficult to get a handle on sick leave and overtime issues at a 24-hour facility like the State Hospital, especially when there are staffing shortages.

“For health and safety reasons you want to limit overtime,” Rosen said. “But you have to fill your shifts.”

Both Honolulu’s Emergency Medical Services Division and the Hawaii Department of Public Safety, which runs the state’s jails, face similar problems to those encountered at the hospital.

Honolulu’s EMS has come under fire for high overtime rates, and most recently had to suspend service at some units around the island because too many people called in sick. And overtime has long been an issue in Hawaii’s jails as has the sick leave, which has led DPS to cancel family visitations at its facilities.

Rosen said that upping the staff levels at the hospital could solve many of the problems the facility faces as they relate to safety and overtime use. But she also said any chances in overtime or sick leave policy will have to be negotiated through the collective bargaining process.

“Am I willing to challenge the unions? Absolutely,” Rosen said. “But history shows that hasn’t worked out very well.”

While the senators seemed sympathetic with the staffing challenges Evans faces at the state hospital, they didn’t give her long to dry her tears.

Evans is one of several employees who have large numbers of family members working at the hospital. Senators have said they are worried about nepotism, and focused much of their last hearing on the topic.

On Wednesday, Hee confronted Evans about her family ties. Among the family members she said work with her are three sister-in-laws all married to different brothers, two sisters and a daughter.

The senators peppered Evans about these family ties and asked whether the family members received any special treatment.

At every turn she said that each applicant — regardless of whether they are a relative to an employee — goes through the same hiring process.

That doesn’t mean people don’t make recommendations, she said. In fact, she said, prior administrators encouraged employees to invite friends and families to work at the facility, but that they still had to be properly vetted.

“We have vacancies because not so many people would like to work at the Hawaii State Hospital,” Evans said. “Our concern is that we have people to work at the hospital … If we know of any referrals we entertain them, so not (just) limited to our families.”

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