The Hawaii State Hospital was not meant for patients like Randall Saito.

Saito, who was acquitted of a 1979 murder by reason of insanity, escaped the State Hospital on Sunday, triggering a three-day, multi-jurisdictional manhunt that grabbed national and international headlines.

On Tuesday morning, Saito was arrested in Stockton, California, after a taxi driver recognized him and alerted local authorities.

An investigation is now underway to find out how he managed to walk out of the Kaneohe facility, catch a taxi, and board a chartered flight to Maui and then a commercial flight to California — all before he was reported missing.

“I think it’s pretty clear … that this was premeditated, it was intentional, it was planned,” said Hawaii Attorney General Doug Chin, who is spearheading the investigation.

What’s also clear is that the State Hospital — the only state-run psychiatric facility in Hawaii — wasn’t built with security in mind for “forensic” patients like Saito.

Yet, virtually all admissions to the State Hospital are forensic — involving patients who were committed to the custody of the Hawaii Department of Health by state courts.

The Hawaii State Hospital is shown in Kaneohe, Hawaii, Tuesday, Nov. 14, 2017. The search for a dangerous man who escaped from the Hawaii psychiatric hospital moved to California after authorities said Tuesday he boarded a flight to the state from Maui two days earlier. Randall Saito, who was acquitted of a 1979 murder by reason of insanity, left the state hospital outside Honolulu on Sunday, took a taxi to a chartered plane that took him to the island of Maui and then boarded another plane to San Jose, California, Honolulu police said. (AP Photo/Caleb Jones)
Since 2014, the Hawaii Department of Health had seven patients escape from the Hawaii State Hospital — including Randall Saito, who was captured in California on Wednesday. AP

In fiscal year 2016, the State Hospital admitted 349 patients — all but one of whom were criminally committed.

Nearly 70 percent of all patients were committed either for being “unfit to proceed” in their cases or to be evaluated for their fitness. And, like Saito, 16 patients were automatically admitted after being acquitted of their charges “on the grounds of physical or mental disease, disorder or defect.”

Dr. Virginia Pressler, state health director, told reporters Wednesday that, once committed to the State Hospital, each patient is treated individually “based upon what is thought to be appropriate clinical care for them.”

That means that some patients could be locked up in their room — or held in a room with an open door that has an employee stationed outside — if they’re considered to pose danger to themselves and others.

But Mark Fridovich, administrator of the Adult Mental Health Division, says the State Hospital has “an obligation to treat individuals in the least restrictive setting.”

“It’s not a custodial environment. It’s not a prison environment where people are locked up for periods of time,” Fridovich said Tuesday. “That means, as part of their rehabilitation, affording them the opportunity to explore relative autonomy and some independence around their movement. They’re not just locked up.”

Saito, for instance, had been allowed to roam around the fenced-in areas of the State Hospital’s 103-acre campus, according to Pressler.

But the relative freedom can be risky — with Saito’s escape being an Exhibit A.

Janice Okubo, a department spokeswoman, told Civil Beat that the State Hospital used to have as many as 14 escapes a year.

At least one of the escapes had a deadly consequence: Last year, David True Seal, who fled to the Big Island after scaling the State Hospital’s 14-foot fence in 2009, was sentenced to 20 years in prison on a 2013 manslaughter charge.

But Okubo noted that the number of escapes “dramatically declined” in recent years since the State Hospital improved its protocols and procedures.

Still, seven patients — including Saito — have escaped since 2014, Okubo said.

AG Doug Chin Governor David Ige.
Dr. Virginia Pressler, director of the Hawaii Department of Health, said several hospital employees will be placed on unpaid leave for 30 days during the investigation of Randall Saito’s escape. Cory Lum/Civil Beat

Expansion Planned

If all goes according to plan, the State Hospital will have tighter security measures in place by December 2020, when a planned expansion is set to be completed.

Last year, the Legislature approved $160.5 million in bonds to fund the expansion, setting in motion a master plan that will more than double the capacity of the State Hospital, which was built for up to 178 patients and licensed to hold 202.

Under the plan, the Department of Health will expand the hospital by building two 144-bed facilities — one of which will be reserved for high-risk patients, featuring a secure exterior wall and high-security fencing system to reduce the risk of escapes.

Okubo said the department has already knocked down the long-vacant Goddard Building to make room for the facility for high-risk patients.

And the department will soon solicit proposals from vendors for the construction of the facility.

“The new facility has definite lines of sight where staff can see patients clearly,” Okubo said. “The hospital we have now is not built for forensic patients; it was built for civil patients.”

Senator Jill Tokuda flanked by left, Rep Jarrett Keohokalole and Rep Ken Ito in the Capitol Rotunda to address recent concerns about the recent Saito escape from the Kaneohe Hospital.
State Sen. Jill Tokuda, flanked by state Rep. Jarrett Keohokalole, left, and state Rep. Ken Ito, right, voiced her concerns at the Capitol on Wednesday about security at the Hawaii State Hospital. Cory Lum/Civil Beat

But some state lawmakers say the Ige administration has to step up its game to improve security until the new facility is built.

“We demand that nothing less than the Department of Health really coming forward with what exactly is going to be the response and the plan of action. What are they specifically going to do in terms of making sure this does not happen again?” asked state Sen. Jill Tokuda, whose district includes Kaneohe.

Tokuda notes that the department’s effort to improve the State Hospital’s operations has been well supported by the Legislature, pointing out that it set aside $1.7 million for an additional security just two years ago.

“We have appropriated. We have been supportive. We have done the site visits. Now it’s time for some real action and some real accountability, and that’s what we’re asking for,” Tokuda said.

Gov. David Ige told reporters Wednesday that the department has started reviewing patient privileges and public visitation policies, as well as boosting the frequency of unannounced patient searches and ordering more fencing.

The department, Ige said, will have “a complete review of the protocols that are in place at the Hawaii State Hospital — really ensuring that this incident cannot be repeated.”

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