The facility has been spending $2 million to $3 million per quarter on overtime since the pandemic.

Three top managers at the Hawaii State Hospital are being terminated from their jobs and were abruptly escorted off the hospital campus Thursday morning in a move to “restructure” the facility’s management team.

Dr. Bimmie Strausser, HSH associate administrator, was escorted off the property by staff from the state Attorney General’s office along with Director of Nursing Lani Tsuneishi and HSH Operations Administrator Anthony Fraiola, according to staff at the facility.

Kenneth Luke, acting administrator of the state hospital, then distributed a letter to employees explaining that “a decision has been made to restructure our hospital’s senior leadership team,” and the three are “no longer with our organization.”

Three top managers at the Hawaii State Hospital were notified that they are being terminated, and were escorted off the hospital grounds Thursday. (Anita Hofschneider/Civil Beat/2021)

“Other leaders will be asked to take on new roles to help our organization move forward,” Luke wrote.

The letter gave no further explanation for the move, and health department spokesman Shawn Hamamoto said the department cannot comment because it is a personnel matter.

Strausser and Tsuneishi have both ranked among the highest paid salaried employees in the Health Department in recent years, according to the Civil Beat Public Employees Salary Database. Strausser earned $311,628 in fiscal year 2022, while Tsuneishi was paid $172,992 that same year. Fraiola was paid $133,896 in 2022.

Tsuneishi, who has worked at the Hawaii State Hospital for more than 30 years, said in an interview she understands she is an at-will management employee who can be let go at any time, but “I feel like I’m in shock.”

Tsuneishi said she has never had any job performance issues, and “it was so unnecessary” to walk her off the grounds. “Suddenly there’s this attorney general police guy, somebody in a police uniform, and I’m thinking ‘What is this?'” she said.

Hawaii State Hospital operates 24 hours a day, seven days a week, and has long struggled to recruit and retain enough staff, Tsuneishi said.

No one has explained exactly what is happening, but she said she suspects the management terminations have to do with overtime costs and staffing issues.

The facility has been spending $2 million to $3 million per quarter on overtime since the pandemic, she said.

“I was telling people, ‘What can we do? This is ridiculous.’ We can’t continue to do this, this is not a sustainable process,” Tsuneishi said.

Nursing shortages have always been an issue, but with the arrival of the pandemic “we averaged 30 to 40 sick calls of nursing staff a day” out of a nursing staff of 300 to 400, she said. Other staffers are out on workers compensation or extended leave, she said.

“Everybody’s pulling their load and more, but it’s really hard when you have that many staff calling out sick every day,” Tsuneishi said.

The hospital uses temporary agency nurses to fill in gaps, but union rules allow hospital employees to demand overtime shifts even when temp nurses are available, she said. The nursing staff and aides are represented by the United Public Workers and Hawaii Government Employees Association unions.

The types of patients at the hospital can also aggravate staffing issues. In general the staffing ratio is supposed to be one staffer to five patients, but some patients –– such as those who present a risk of suicide –– get one-to-one staffing, Tsuneishi said.

Normally the hospital has three or four of those cases, but there are more than 30 one-to-one cases at the moment, including patients deemed to be at risk for falls or because of the medications they are taking, she said.

At one point Tsuneishi said she was juggling the responsibilities of three jobs, including administrator, her own job and nursing supervisor. “We were short, that’s what we do, we had to fill in,” she said.

Apart from the overtime issue, the hospital also struggled to resolve issues that delayed the opening of a new $160 million hospital building for more than a year.

“It was a difficult job, and I understand that the buck stops here,” she said. “That’s why were were working really hard just trying to fill the spots.”

Tsuneishi, who was director of nursing for 10 years, said her termination letter says she is now on paid leave, and technically her employment ends at the end of this month.

Strausser and Fraiola did not respond the messages requesting comment on Friday.

Civil Beat’s community health coverage is supported by the Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation, Atherton Family Foundation and Papa Ola Lokahi.

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