Amid questions over the decision to discharge the psychiatric patient, the head of the union representing hospital employees calls for a thorough review of operations.

The patient accused of stabbing a nurse to death on the grounds of the state-run psychiatric hospital was in a physical confrontation with another patient weeks before he was released from the secure section of the facility, an incident that raises questions about the decision to release him.

The killing on Monday also prompted a call by the union that represents employees at the Hawaii State Hospital for a thorough review of the facility, citing longstanding concerns about staff safety there.

Tommy Kekoa Carvalho, 25, was indicted on a charge of second-degree murder Wednesday after allegedly killing 29-year-old nurse Justin Bautista with what hospital staff have described as a pocket knife.

The attack occurred in an unsecured cottage on the hospital grounds that is used for a program known as the state-operated specialized residential program. That program functions much like a halfway house to help to transition hospital patients who will soon be leaving the hospital.

Fence runs along some of the Hawaii State Hospital's bordering area with the Windward Community College campus. The fence ended on the Kahaluu side along where the road met up with the road that runs thru Windward Community College.
The Hawaii Government Employees Association, which is the largest union in the state, is calling for an “exhaustive review” of the Hawaii State Hospital in Kaneohe in the wake of the murder of a nurse in a cottage outside the main facility. (Cory Lum/Civil Beat/2017)

Brenden Whitt, a former patient who spent time in the Haiku 2 unit of the hospital with Carvalho last summer, described Carvalho as “totally aggressive.” And Whitt said staff at the hospital were aware of Carvalho’s behavior.

Whitt said he was shoved by Carvalho during a scuffle about a week before Carvalho was moved out of the secure hospital and into the cottage in August, and said the confrontation occurred in a hallway that is monitored by cameras.

Whitt said one of the nurses asked Whitt if he wanted to file charges over the incident and said staff placed placed Carvalho on “one-to-one” supervision after that altercation. That meant staff members were assigned to shadow him, a clear signal that they knew he was volatile, Whitt said.

“If you couldn’t even be trusted to interact with staff or other patients and they had to follow him all day, I don’t know how they could discharge him,” Whitt said of the decision to move Carvalho to the unsecured cottage.

He described the nurses at the facility as overworked, but said it is a “huge concern” if incidents of that type were not properly documented.

Two other staff members who spoke on condition that they not be identified agreed with Whitt’s description of Carvalho as a patient who was known for having physical altercations with other patients.

“This tragedy sadly brought these long-standing workplace safety and security issues into stark focus.”

Randy Perreira of HGEA

Whitt, who has been homeless at times and was sent to the hospital twice for treatment, said he also saw Carvalho in other confrontations, including occasions when he would “flex” on other patients to try to dominate them. Whitt said he also saw Carvalho snap at staff “for following him too close.”

Generally Carvalho would aggressively posture but would back off and comply when staff ordered him to the “quiet room” to calm down, Whitt said. He would constantly pace, became argumentative and would laugh at other patients, Whitt said, adding “we were just told to ignore him.”

State hospital Administrator Kenneth Luke said Tuesday that Carvalho had been deemed stable enough to leave the hospital’s acute care unit and move to the state-operated specialized residential program, where participants can leave the facility in the daytime.

However, hospital staff said Carvalho is a “dual-diagnosis patient” with a history of both mental illness and drug abuse, and said he tested positive for cocaine use about a month ago after moving into the cottage.

The state Department of Health declined to respond Wednesday to Whitt’s description of Carvalho’s behavior, saying the department has been deluged with media inquiries about the attack.

It was the first killing of a staff member on the campus, officials said, but the hospital has been the subject of complaints about abuse of patients and threats and violence against staff.

A new multimillion dollar patient complex was opened last year as part of efforts to address overcrowding and concerns about a lack of secure facilities for patients committed to the hospital by the courts.

Randy Perreira, executive director of the Hawaii Government Employees Association, said in a written statement Wednesday that “the state Department of Health’s launch of an exhaustive review of its facility is long overdue.”

“For years, HGEA has urged the state to address safety issues facing our members at the Hawaii State Hospital, particularly our registered professional nurses,” he wrote. “This tragedy sadly brought these long-standing workplace safety and security issues into stark focus.”

“HGEA stands ready to work with DOH to ensure the safety of our members and everyone who is employed at the state hospital,” Perreira said in his statement. HGEA is the state’s largest union, with nearly 37,000 members statewide.

The HGEA has taken its concerns about operations at the state hospital to the Hawaii Labor Relations Board, which declared in an August decision that the hospital is “understaffed.”

In fact, the state Department of Health said in a written statement Wednesday that the hospital currently has 140 vacant positions, for a vacancy rate of 20%. However, the department added that “the state contracts for additional staffing while it continues to recruit and hire into vacant positions.”

“Since COVID, there has been a nation-wide shortage of medical staff,” the department said in its statement. “The hospital is also competing with the private sector whose pay scales are more generous than the hospital can offer.”

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