Hawaii’s state-run psychiatric hospital has a new chief, whose job is to operate a facility that has come under intense scrutiny for mismanagement and safety concerns.
William J. May took over as the Hawaii State Hospital’s top administrator on July 7 after moving to the islands from Colorado, where he was in charge of a 451-bed psychiatric facility that treated both civilly and criminally committed patients.
Prior to that he worked at psychiatric facilities in New Jersey, where he served as the chief executive officer. In all he has more than 30 years experience at mental health facilities.
May sat down with Civil Beat for a 30-minute interview Monday, his second week on the job. Among the topics discussed were funding for mental health services, an ongoing Senate investigation into the Hawaii State Hospital and how best to work with the state’s public employee unions.
The hospital and its administrators have come under fire in the past eight month over conditions at the facility. Several workers came forward in November 2013 to complain of high rates of patient assaults on staff.
That spurred a legislative investigation led by Hawaii Sens. Clayton Hee and Josh Green, who over the past several months have been subpoenaing state workers to testify about the inner workings of the hospital.
Some of the individuals subpoenaed included Department of Health Director Linda Rosen, Adult Mental Health Division Administrator Mark Fridovich and Bill Elliott, who was the acting administrator of the hospital before May was hired.
Elliott is retiring at the end of the month.
Many disturbing allegations surfaced during the senators’ inquiry, including claims of nepotism, overtime abuse and retaliation against employees who decided to speak out.
The senators are also investigating whether the state has complied with a federal consent decree that spurred sweeping changes at the hospital related to the treatment of patients.
Another focal point has been the unions representing hospital staff, specifically the Hawaii Government Employees Association and the United Public Workers. Some staff have said any reform related to staffing and overtime has been blocked by the unions.
Here are excerpts from what May had to say.
Q: A lot of questions have been raised about operations at the Hawaii State Hospital, including those related to staff safety, allegations of nepotism and overtime abuse. Why take the job?
This will be the fifth hospital of which I’ve been the chief executive, three in New Jersey one in Colorado, and now the Hawaii State Hospital.
To me being the chief executive at a psychiatric hospital is by far the most fulfilling job imaginable. I couldn’t think of myself going to work in any other position than this one.
The issues, the stuff as you say, they happen. … (But) for every unfortunate incident there’s a thousand success stories.
The key is you got to have fun. There’s issues, of course there are issues, and they’ll be dealt with effectively. But at the end of the day, the patients at the Hawaii State Hospital are going to be getting treatment at the best hospital in the country.
Q: How is the Hawaii State Hospital different from other facilities you’ve worked at?
I’ve worked at six hospitals, I’ve been chief executive at five. The one that I wasn’t a chief executive but I was a high level manager was the forensic hospital in New Jersey.
The hospital I just left, the Colorado Mental Health Institute at Pueblo, is extremely complex. Every aspect of mental illness was treated at that hospital.
We had forensic, we had civil, we had adolescents we had geriatrics, we had substance abuse, we had a developmentally disabled unit, we had … state sentenced inmates who were treated there.
We also followed 200 not-guilty-by-reason-of-insanity patients once they were discharged throughout the state of Colorado. Extremely complex.
Here at the Hawaii State Hospital, as you know, it’s a forensic hospital so we deal with not guilty by reason of insanity patients.
We do (competency evaluations) with people to see if they’re fit to stand trial and then we restore people so that they can be fit to stand trial. So this is more of a specialized unit if you will.
To answer your question more directly, what’s the difference? There is no difference. There are issues. The issues are consistent across these types of things.
Usually the physical plant is an issue, as it is here, as it was (in Colorado), as it was in New Jersey.
The safety of the staff is always a concern. It’s paramount, not just for the staff but for the patients. You can’t have an unsafe situation and expect to effectively treat people through therapeutic modalities if you’re worried about getting hit, so you do have to worry about that.
There’s ways to do that. The key, in my opinion, with safety is not getting to the point where a patient is going to lash out (at) someone.
We can train the staff and we will on how to block a punch, block a kick, get out of the way, that’s great. But more important, the most important thing is to treat the staff on how to recognize indications from that patient that he may be escalating.
Something may have happened two days ago and the staff have to realize what’s going on. They may have gotten a phone call from mom. They may have gotten a phone call from their lawyer. It may be the anniversary date of the offense that got them into the hospital. It may be the anniversary date of the death of a significant other or a love one.
Whatever it is there are indications given by every patient and our staff have to be intimately trained and skilled in that art of picking up those indications.
Q: What major changes would you like to see at the Hawaii State Hospital?
I’m going to assess everything with the main things obviously being safety, the handling of the census — which is the number of patients — the staffing, and the physical plant.
They are going to be the four key focal points for me initially. But then every other aspect, every process in that hospital can probably improve through some type of change.
To me, the most important things in the success of an organization are relationships, processes and outcomes.
As far as relationships, I’ve already had an all staff meeting where I met a couple hundred of the staff. I’ve been out to most of the units. I’ve reached out to both unions to set up meetings with their leadership.
We have a meeting with some legislators set up for the end of the month. I look forward to that. I look forward to partnering with not just the union, and the staff, and the families, and the Legislature, but the judges, the public defenders, the prosecutors, anyone who was involved in the whole system which the hospital works.
Q: What is the hospital doing well today that you think should be celebrated?
We deal with, as we sit here today, 197 people on the grounds of the hospital, plus roughly 40 in a satellite overflow unit.
Now there’s constant interactions between staff and the patients, the patients and the patients, and the staff and the staff. The vast majority, 99.999 (percent), do not result in a negative thing. They result in positive things.
The patients earn their points to be able to buy something. The patients earn their way to this level of privilege or that level of privilege. It’s the success stories.
The specific example is last Wednesday. The occupational therapist, part of (the patient’s) program is to grow produce and then they sell it at a stand at a little farmers market. So I went over and introduced myself.
A couple hours later, I’m in my office there’s a knock on my door and one of the OTs — the occupational therapists — asked me to come out to the hallway. She had brought me a patient over, a young female patient, and she had this very nice basket of papaya and pineapple as a welcoming gift.
We’re talking and I’m having this great conversation with the patient. I say, “What is this fruit?” And she said, “It’s a mountain apple,” and she’s telling me how they grow, and how they pick it, and how they cultivate it and they harvest it and that you can make relish and you can do this. She’s giving me a dissertation on mountain apples.
Come to find out when the patient was admitted she was completely nonverbal … and through this compassion, and passion, and skill set of the staff on the grounds of the hospital, this young lady was able to give me a dissertation on a mountain apple.
That’s a success story.
Q: How would you convince the governor and lawmakers to provide more funding for mental health services in Hawaii?
The first thing is a master plan, which is being done and the plan is going to identify objectively and scientifically the needs going into the future of the hospital as well as the rest of the continuum of care. Based on that plan you go the Legislature.
I applaud the Legislature for their investigation, I really do. Anything that can bring the needs of that hospital out into the open, into the community, that hopefully will result in us getting the resources that we need, I think is great.
And on that same line once we identify the needs of the hospital we’ll need a new building, more staff, different types of staff, different types of training modalities, yeah we’ll probably be coming saying we need this (money) because of this.
The 200 people on the grounds of that hospital … and the 40 in the overflow unit, they’re citizens of Hawaii. They’re somebody’s’ child. They’re somebody’s’ parent. They’re somebody’s brother or sister. And they deserve the best.
It’s going to be my job to make sure that the people who work there and who live there get the best treatment in the best setting possible.
Q: The unions have been a topic of this investigation. What sort of experience do you have working with public employee unions?
I spent 30 years in the state of New Jersey, which is a very strong unionized state. Each hospital, when I was there dealt with three unions, now it’s actually four unions, the managers unionized under the United Electrical workers for some reason.
But I always got along very very well with the unions. In fact, it’s common for me to use a union president, various union presidents for references, as I moved through my career.
I have absolutely no problem dealing with unions. It’s a partnership. At the end of the day we’re all there for the same purpose to provide fair, safe working conditions for their staff so that the patients can get the best care possible.
I look forward to meeting with the two unions, with the hierarchy with the presidents and then with the local union staff also. I have absolutely no doubt that we’ll have a great working relationship.
Colorado was not unionized they didn’t have unions in Colorado so that was a little bit different, but in Jersey they did. They were strong, they were very strong, and I always got along great with the union leadership.