As a staff psychiatrist at Hawaiʻi State Hospital, Brenton Yuen, said he has witnessed assaults on staff members by patients. 

Just three weeks ago, he said he saw a newly arrived intoxicated patient swing at several staff members and shove a nurse to the floor. 

“She hit her head on the floor and another staff member got struck in the head,” Yuen said. “It did take a full response from at least six people to contain him. And you know, it was a harrowing experience.”

Yuen, who says he was removed from his position as chief of psychiatry this month after raising alarms about what he calls a staffing crisis, is suing the institution, accusing administrators of retaliating against him for blowing the whistle.  

Nearly two years after a nurse was stabbed to death by a patient in a transitional housing unit at the institution, concerns about understaffing and overcrowding have persisted. Yuen spoke at a media briefing Tuesday at the office of his lawyer, Eric Seitz.

In some units, the patient-to-psychiatrist ratio is more than double the 15 patients per one psychiatrist that the Department of Justice recommends, Yuen said. This creates a dangerous working environment for staff as psychiatric patients aren’t getting the attention and care they need, he added. 

“If I’m being honest, I work there in fear,” said Yuen, who is back to working as a staff psychiatrist at the hospital after being asked to step down as chief of psychiatry. “I watch my back at all times.” 

Yuen said he felt “belittled and invalidated” when he raised concerns about understaffing in the units and was told to stop talking to recruiting agencies to try to hire more advanced practice registered nurses, or APRNS.

Adam LeFebvre, spokesman for the Department of Health, declined to comment on Yuen’s lawsuit.

Problems That Go Back Decades 

The state’s only psychiatric hospital has been the site of complaints for decades. 

In 1994, the Department of Justice asked a federal court to hold the state in contempt for failing to improve conditions at the hospital after the agency cited problems including severe understaffing, physical abuse and neglect of patients and refusal to discipline abusive employees. 

In 2013, the hospital was still experiencing issues with overcrowding and staff were being assaulted on a regular basis. At least 1,207 assaults and 507 attempted assaults on staff occurred from 2013 to 2023, according to Department of Health data reviewed by Civil Beat.  

In November 2023, a 29-year-old nurse, Justin Bautista, was stabbed to death by a patient. The patient, Tommy Carvalho, pleaded not guilty to second-degree murder. He is being held at the Oʻahu Community Correctional Center pending a July 30 hearing to determine his fitness to proceed, according to court records.  

In a telephone interview Tuesday, former nurse Jodi Fukumoto, who worked in the housing unit where the stabbing occurred from 2011 to 2019, said she experienced issues with staff members frequently calling out of work, failing to sign out for their shifts and playing on their cellphones instead of working.

She said managers were not present on the evening shift when incidents were more likely to occur and supervisors didn’t address safety concerns, such as the fact that the office where medication was kept only had a half-door that patients could reach past or jump over. Fukumoto said she also experienced retaliation when she raised concerns. 

“Everything is lax on that unit,” she said. “We were neglected by the hospital.” 

Fukumoto filed her own lawsuit against the hospital in 2012, which was settled this year for $300,000, according to Seitz, who was also her attorney. 

“We would think that the people who are leaders at the Department of Health and the hospital would address those issues seriously,” Seitz said. 

Not A Team Player

Yuen, who was first hired as a staff psychiatrist at the hospital in 2021 and appointed chief of psychiatry in 2023, said he tried to share his concerns with supervisors about severe understaffing at the hospital and the danger it posed to the workers. 

One unit had a psychiatrist-to-patient ratio of 1 to 34, he said. 

After Bautista’s death, Yuen said he tried to create more psychiatric positions at the hospital and expedite the hiring of psychiatric advanced practice registered nurses to fill gaps in coverage. 

He said he urged administrators to sign an emergency contract with Prolink, a hospital staffing agency. 

But about a year later, the hospital allowed its contract with Prolink to expire, meaning that two APRNs who were employed under the contract were unable to keep working at the hospital, Yuen said. 

“That was devastating for me because I thought one of my roles as chief of psychiatry was to work on recruitment for the department of psychiatry,” he said. 

Instead of being supported in his efforts to hire more nurses and psychiatrists, Yuen said he was told by his superiors that he was not acting like a team player and was asked to step down as chief of psychiatry earlier this month. 

“All of this is occurring within a dangerous environment of critical staffing shortages that adversely affects patient care and jeopardizes the safety of patients and staff at the hospital,” Seitz wrote in a June 9 letter to Department of Health Director Kenneth Fink. 

Seitz said he is seeking a court injunction that would prevent the state hospital from threatening or punishing employees who raise concerns. 

Yuen said he’s pursuing the lawsuit for the sake of his fellow staff members. 

“It’s not just about my particular case of being silenced,” he said. “I want everyone there to be able to voice their concerns freely without fear of being retaliated against.”

Read Yuen’s complaint: