The perpetually overcrowded Hawaii State Hospital in Kaneohe, site of hundreds of assaults on staff by patients and a host of other problems over the past 20 years, has won the support of a key advocate for change — the new state health director, Dr. Ginny Pressler.

She plans to ask the Legislature for $150 million next session to build a state-of-the-art forensic facility at the hospital to add more beds, specialized care and better equipment. Right now virtually every patient is in the hospital on a court order, but with the expansion, mentally ill people who aren’t in trouble with the law could also be served.

Pressler recognizes it’s a big request, and it’s unclear how much it will cost to operate the facility once it’s built, but she said the state can’t afford to wait.

“This is one of my top priorities,” Pressler told Civil Beat. “If we don’t build a new forensic state hospital like right away, we are going to have another crisis. I want to prevent that.”

24 april 2015. photograph Cory Lum/Civil Beat

Hawaii Department of Health Director Ginny Pressler wants to build a new forensic facility at the state hospital.

Cory Lum/Civil Beat

The hospital has been plagued by crises for more than two decades.

In 1991, the U.S. Department of Justice sued the state for violating the constitutional rights of patients. Substandard care, over-prescribing medicine, leaky buildings and unsafe conditions were all reported.

The state went under federal court oversight after failing to turn things around. That lasted until 2004 when the state was credited with having achieved substantial progress.

“We need to get moving on it. This is already late in the game.” — Hawaii Department of Health Director Ginny Pressler

But problems persisted. Two governors got directly involved and a task force found that Hawaii used its hospital for criminal cases at a far higher rate than other states. Recently, no patient has been there voluntarily.

In November 2013, several employees complained of frequent patient assaults on staff. This was an issue hospital workers had reported in 2007 when there were more than 107 assaults during the first six months of that year.

The Senate created a special investigative committee in 2014. Chaired by Sens. Clayton Hee and Josh Green, it held 10 hearings over the course of several months, culminating in a report to the Legislature last October.

The 93-page report outlined recommendations on how to improve the hospital. It covered everything from curbing overtime abuse to maintaining a safe work environment, something experts said a well-designed facility would help accomplish.

‘There’s No Shortcut to Health Care’

“Everything emanates from a new facility,” Green told Civil Beat on Monday. “If we do this, we’ll be able to treat people in a very professional, dignified way. If we don’t, we’re going to be back with the violence.”

The Big Island emergency room physician plans to introduce legislation seeking the appropriation for the new hospital next session, which starts in January. Like Pressler, he says he’s making it a top priority.

“It’s long overdue,” Green said. “It’s a big ask, but it’s for all the districts in the state and all the families in the state. There’s no shortcut to health care.”

The state hospital originally was intended to be a treatment facility for people with mental illness in general, but has become the place for the courts to send individuals with a mental illness. Many are schizophrenic, others are bipolar or depressed and some are there for substance abuse.

Hawaii State Hospital in Kaneohe, HI

The state health director has made it a priority to expand the Hawaii State Hospital.

PF Bentley/Civil Beat

The Senate investigative committee found that many of the individuals hospitalized there did not require inpatient psychiatric services, did not have a bona fide mental illness or remained in the hospital much longer than clinically necessary, according to the legislative report.

“Individuals are committed to the Hospital due to problems, including dementia, acquired and traumatic brain injuries, developmental delays, substance abuse, and general medical conditions, primarily because the court cannot require or identify a more appropriate placement,” the report stated.

The current hospital was built to hold 178 beds, but is licensed for 202. Its budget is based on 168 patients staying there. On Monday, there were 203 patients there, plus 42 in the overflow units at Kahi Mohala Behavioral Health, according to DOH spokeswoman Janice Okubo.

Kahi Mohala is a non-profit psychiatric hospital in Ewa Beach owned by Sutter Health. The state has a contract with the company to provide overflow beds.

The Department of Health is proposing to build a 144-bed facility at the site of the deteriorated and long-vacant Goddard Building on the state hospital campus, Okubo said.

Right, Special Investigative Committee on the Hawaii State Hospital Senator Josh Green, Co-Chair speaks to left Co-Chair Senator Clayton Hee during  a meeting on October 22, 2014. 12pm.  photograph by Cory Lum.

Hawaii Sens. Clayton Hee, left, and Josh Green co-chaired a special investigative committee that looked into violence at the Hawaii State Hospital.

Cory Lum/Civil Beat

Green anticipates making a request next session for $165 million in general obligation bonds — $15 million for design/planning and $150 million for construction. That’s calculated by taking an average of $1 million per bed, plus 10 percent for planning and design.

“The new facility will provide the staff with clear lines of sight to improve patient supervision and create a safer and more secure hospital environment,” Okubo said.

The Department of Accounting and General Services and the Department of Health are currently reviewing a master plan draft proposal from Architects Hawaii to determine if the state will accept the final draft, she said.

Pressler is pushing to hire a single company to design and build the facility instead of the traditional practice of hiring a separate designer and contractor. She hopes this will slash the amount of time it takes to construct a new facility.

“We need to get moving on it,” Pressler said. “This is already late in the game.”

The Department of Education used the same design-build criteria for a new elementary school in Kapolei, which broke ground in April 2013 and opened to students last month. School officials said the approach saved time and money.

Partnership Could Add More Beds

The state is also planning to tear down the vacant Bishop building to make room for an additional expansion.

The plan is to partner with a private company to build a long-term care facility there for behavioral health. This would be a 150-bed residential facility for people whose mental illnesses are less severe than those staying at the main hospital. The state is considering a partnership with Avalon Health Care, which is based in Utah and operates two nursing homes in Hawaii.

“We are just finishing up some loose ends and will be able to make an announcement soon about this private partnership where they would build the facility and we would have our patients there,” Pressler said.

Hawaii State Hospital hallway in patient area

As of Monday, there were 203 patients at the Hawaii State Hospital.

PF Bentley/Civil Beat

There would be room there for some current state hospital patients and those housed in other hospitals in the community, she said. Queen’s Medical Center, for instance, could discharge some of its long-term care patients who need psychiatric help.

Pressler, whom Gov. David Ige appointed in December, said she wants to focus on the behavioral health area “because it’s been neglected so long.”

As director of the Department of Health, Pressler also oversees environmental health administration, the developmental disabilities division, community mental health centers and the alcohol and drug abuse division.

She said behavioral health accounts for problems not only at the state hospital, but also with public safety and homelessness.

“It’s all related,” Pressler said.

‘All Options on the Table’

Sen. Jill Tokuda, who chairs the Ways and Means Committee, will be balancing the request for a new forensic facility against all the other demands on the state’s $26 billion biennial budget.

Last session, she helped secure funding for the state hospital to cover $3 million in projected deficits in each of the next two fiscal years and $1.75 million for additional security guards to deter violence. The hospital’s overall budget for the current fiscal year, which started July 1, is $66 million.

“It’s a complicated issue,” Tokuda said. “How do you build a $150 million true forensic facility and sustain it? There’s no easy solution but it’s definitely something that we’ve got to take a look at and figure out how we come up with those resources.”

She has worked for years to resolve issues at the hospital, which is in her Windward Oahu district.

“All options have to be on the table,” Tokuda said. “It’s such an important public need. I don’t think we can push this down the road.”

Jill Tokuda press conference

Sen. Jill Tokuda has worked for years to resolve problems at the state hospital.

Nathan Eagle/Civil Beat

Even the process of tearing down the Goddard Building, which has been vacant since the early 1990s, has proven expensive and time-consuming.

Demolition work has cost nearly $5 million over the past few years because it’s a historic building and has asbestos — and it’s still not done. The historic nature of the building requires extra state approvals and a slower demolition process to ensure certain parts are appropriately preserved.

Tokuda said the first key is getting the Goddard Building leveled.

“How do you build a $150 million true forensic facility and sustain it? There’s no easy solution but it’s definitely something that we’ve got to take a look at and figure out how we come up with those resources.” — Sen. Jill Tokuda

The Senate investigative committee found that the hospital had three main challenges: maintaining a safe work environment for staff; meeting the current needs of the patients and staff due to inefficient use of facilities and safety practices; and providing efficient and effective human resources practices.

“We can pay for it in the facility, or we are going to pay for it cleaning up the human mess,” Green said, noting examples of crime and tragedies in Hawaii stemming from unaddressed mental health problems. 

For instance, Matthew Higa, 23, was convicted of murder after throwing a toddler off the Miller Street overpass onto the H-1 Freeway in January 2008. A month prior, police said, Higa was a patient in Queen’s psychiatric ward.

The Department of Health testified at a legislative hearing in March that the state had started implementing several of the Senate investigative committee’s recommendations, including sending dangerous patients to mainland facilities for mental health treatment, improving the hospital’s staff training program and addressing sick leave abuse.

But stopping the progress now is not an option for the health director.

“It’s like deciding to not put money into your house,” Pressler said. “At some point, it falls down. And it’s like, OK, that was the choice you made.”

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