Officials say they have been urgently trying to reduce the patient population after the killing of a nurse last year drew new attention to problems at the hospital.

A doctor treating four employees said the decision is “unconscionable” and will delay their ability to address the trauma they experienced.

The push to protect health care workers comes in response to an increase in violence at facilities around the county.

Hawaii officials have struggled to address the problem despite building a $160 million forensic hospital designed to improve safety.

Construction of a state-of-the-art psychiatric hospital was supposed to mark a new era in worker and patient safety. Instead, a familiar set of problems emerged.

The licensed practical nurse role is being phased out in favor of more specialization.

The judge ordered Tommy Carvalho to continue to be held without bail because he poses a “serious risk of danger to the community.”

The killing of a nurse last week happened outside the main secure facility, but it cast a spotlight on concerns about staff safety.

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.

Tommy Carvalho is scheduled to be arraigned in First Circuit Court on Monday.