More than two days after a man who is likened to a serial killer by prosecutors escaped from the state’s psychiatric hospital and triggered a multi-state manhunt, the Hawaii Department of Health is refusing to say how he managed to walk out of the Kaneohe facility.

The department operates the Hawaii State Hospital, where Randall Saito, 59, has been ordered to stay since 1981 — two years after he was acquitted of a murder of a 29-year-old woman by reason of insanity.

This undated photo provided by the Maui Police Department shows Randall Toshio Saito. Hawaii authorities are searching for Saito, who was found not guilty of murder by reason of insanity, after he escaped from Hawaii State Hospital in Honolulu on Sunday, Nov. 12, 2017, and flew to Maui. (Maui Police Department via AP)
Randall Toshio Saito AP

Citing privacy laws and a pending criminal investigation, Mark Fridovich, administrator of the Adult Mental Health Division, told reporters Tuesday that the department can’t release any details about the circumstances surrounding Saito’s escape.

William May, the State Hospital’s administrator, did acknowledge that Saito failed to check back in from unsupervised release within the hospital grounds at 11 a.m. Sunday. But it wasn’t until after 7 p.m. before employees realized that Saito had escaped and notified the Hawaii Department of Public Safety.

“Once we determined there was an escape, we called (the Department of Public Safety) immediately,” May said.

But, according to the police, Saito was out of the islands by then — taking a taxi to a chartered plane to Maui before boarding a second flight to San Jose, where some of his family members live.

The FBI and U.S. Marshals Service have reviewed security footage from the San Jose International Airport in connection with the manhunt, airport spokesman Jon Vaden said.

“Saito is considered extremely dangerous and should not be approached,” police said in a statement late Tuesday.

Hawaii Attorney General Doug Chin announced Wednesday that his office charged Saito with felony escape. A bench warrant has been issued for Saito’s arrest in the amount of $500,000.

“This is a dangerous individual. We need him off the streets,” Chin said. “The State is in close contact with law enforcement to make this happen.”

Citing privacy laws and a pending criminal investigation, the Hawaii Department of Health is refusing to release any details about the circumstances surrounding Randall Saito’s escape from the Hawaii State Hospital in Kaneohe. PF Bentley/Civil Beat

Saito was committed to the State Hospital 36 years ago — after being found not guilty of killing Sandra Yamashiro, who was shot and repeatedly stabbed before her body was found in her car at the Ala Moana Center parking lot.

Saito filed for conditional release in 1993, but the court denied his request, saying he suffered from necrophilia and sexual sadism.

A second attempt by defense attorneys to win Saito’s release in 2000 was also blocked after deputy prosecutor Jeff Albert objected, saying he “fills all the criteria of a classic serial killer.”

“He is a very dangerous individual,” said Wayne Tashima, a deputy prosecutor who argued in 2015 against Saito receiving passes to leave the hospital grounds without an escort.

Tashima warned people to not approach Saito, saying there’s a concern that he could commit the same “very heinous and violent offense” again.

Saito was the impetus for a rule change in 2003, when the Hawaii Attorney General’s office decided that patients at the State Hospital have no legal right to conjugal visits.

The issue came to light when the State Hospital’s administrator learned that Saito had been escorted home for weekend conjugal visits over two years.

Across the country, dangerous patients have also escaped recently from other psychiatric facilities.

In 2016, a man in Washington state accused of torturing a woman to death broke out of the state’s largest mental hospital. Anthony Garver crawled out of a window of his ground-floor room at Western State Hospital, rode a bus 300 miles to Spokane and was captured days later without incident.

After the escape Washington Gov. Jay Inslee fired the hospital’s CEO and brought in the Corrections Department to inspect the building for security improvements.

A review of police reports by The Associated Press found 185 instances in the 3 ½ years before Garver’s escape in which Western State patients escaped or walked away.

In Hawaii, the State Hospital came under fire in 2013 for its high rates of patient assaults on employees. The issue led to a legislative investigation, which also looked into overtime abuse, nepotism and threats of retaliation against whistleblowers.

A Senate committee eventually produced a 87-page report, whose wide-ranging recommendations called for, among other things, building a new state hospital to reduce overcrowding.

According to the Department of Health’s annual report, the State Hospital admitted 349 patients in fiscal year 2016 — all but one of whom were criminally committed.

Last year, the Legislature signed off on a plan to more than double the State Hospital’s capacity, approving $160.5 million in bonds to fund the construction.

According to the annual report, the number of assaults on employees has seen a steady decline, going from 145 in fiscal year 2013 to 76 three years later.

But some say the State Hospital still has a long way to go in fixing its problems.

“There is a serious lack of information for the public,” said Nicholas Iwamoto, who was stabbed 18 times on a popular Hawaii hiking trail in 2009. His attacker was found legally insane and sent to the State Hospital. He was later granted conditional release to attend community college, a decision about which Iwamoto wasn’t notified.

“Public safety has certainly been compromised,” Iwamoto said. “It’s extremely alarming. But nothing from the state surprises me anymore.”

The Associated Press contributed to this report.

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