The Hawaii State Hospital would more than double its capacity while improving employee safety under an updated master plan unveiled Tuesday, health officials said.

But state lawmakers and Gov. David Ige will first have to sign off on millions of dollars for the plan to become reality.

It calls for a two-hospital model that serves high-risk patients in one facility and those who constitute less of a threat to patients and staff in the other.

This diagram shows the Hawaii State Hospital's expansion plans.

This diagram shows the Hawaii State Hospital’s expansion plans.

Department of Health

The chronically overcrowded Kaneohe facility has been the site of hundreds of assaults on staff by patients and a host of other problems over the past 20 years.

“Almost every day, new forensic patients are admitted and this creates a ‘wide open front door’ with a ‘narrow back door,’” state Health Director Dr. Virginia Pressler said in a statement. “These patients can only be discharged after a complex, comprehensive evaluation process and a judge’s written authorization.”

The hospital has become the go-to place for the courts to send patients with mental illness, including those charged with violent crime, for evaluation, care and custody. The hospital is mandated to accept them regardless of the number of available licensed hospital beds, health officials said.

In 2014, state Sens. Josh Green and Clayton Hee headed an investigation into the hospital. That effort resulted in a 93-page report to the Legislature last October that outlined recommendations on how to improve the hospital’s problems, ranging from curbing overtime abuse to maintaining a safe work environment.

Green, as well as Pressler and others, have said a new facility is critical. Pressler has made it one of her top priorities.

Hawaii State Hospital Administrator William May is seen here durng a press conference Tuesday unveiling the updated plans for the Hawaii State Hospital.

Hawaii State Hospital Administrator William May during a press conference Tuesday unveiling the updated plans for the Hawaii State Hospital.

Cory Lum/Civil Beat

Under the updated master plan, the dilapidated Goddard Building — one of several buildings on the 103-acre state property — would be replaced with a $160 million, 144-bed patient care facility.

It would feature a rehabilitation mall and dining room exclusively for high-risk patients, and a secure exterior wall and high-security fencing system to reduce the risk of patients escaping, according to health officials.

A later phase of the master plan calls for building a second 144-bed patient care facility. The Guensberg Building, adjacent to the Goddard Building, would be demolished and the new facility built in its place.

The State Hospital was built to hold 178 beds, but is licensed for 202. Its budget is based on 168 patients staying there. There were 205 patients there Tuesday, plus 42 in overflow units at Kahi Mohala Behavioral Health in Ewa Beach.

The replacement patient facility for the Guensberg Building would allow the patients at Kahi Mohala to be relocated to the Kaneohe campus. Kahi Mohala is a non-profit psychiatric hospital owned by Sutter Health that contracts with the state to provide overflow beds.

Environmental assessments must be conducted prior to building the new facilities, and the public would be allowed to provide input.

The Goddard Building, seen here Tuesday, will be demolished and replaced with a $160 million facility under the new master plan for the Hawaii State Hospital.

The Goddard Building, seen here Tuesday, would be demolished and replaced with a $160 million facility under the new master plan for the Hawaii State Hospital in Kaneohe.

Cory Lum/Civil Beat

The updated master plan also calls for demolishing the Bishop Building on the hospital’s lower campus and replacing it with a skilled nursing facility that would be independently operated.

The state is considering a partnership with Avalon Health Care, which is based in Utah and operates three nursing homes in Hawaii. This would be a 150-bed residential facility for people whose mental illnesses are less severe than those staying at the main hospital.

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.

Tokuda has said it’s a complicated issue and all options need to be on the table.

State Rep. Della Au Belatti, left, Sen. Jill Tokuda listen during a press conference unveiling the updated master plan for the Hawaii State Hospital, Tuesday.

State Rep. Della Au Belatti, left, Sen. Jill Tokuda listen during a press conference unveiling the updated master plan for the Hawaii State Hospital on Tuesday.

Cory Lum/Civil Beat

The new patient care facility would be modeled after the design used by the Colorado Mental Health Institute at Pueblo, a 451-bed psychiatric hospital that provides treatment for patients at different risk levels, according to the release.

Hawaii State Hospital Administrator William May previously served as director of the Colorado facility, which health officials said provides clear lines of sight from a central nursing station.

“This same design in the new building will help reduce the risk of patients harming themselves or each other and assaulting hospital staff,” the release says.

The federal government sued Hawaii in 1991 for violating the constitutional rights of patients staying at the hospital. Substandard care, over-prescribing medicine, leaky buildings and unsafe conditions were all reported.

Efforts to right those wrongs have proceeded ever since. Federal court oversight was lifted in 2004 after substantial progress was made, but reports of frequent patient assaults on staff and other problems have continued.

Here’s a summary of the updated master plan.

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