Federal court puts State Hospital under the gun

By Beverly Creamer
Advertiser Staff Writer

In the wake of a blistering report that accused the Hawai'i State Hospital of withholding information about the 163 mentally ill patients in its care, federal court monitor Leland Chang has asked the hospital administration to supply missing data by April 10.

The information on hospital practices will be used in preparation for a May 16 status conference before U.S. District Judge David Ezra.

Chang's Jan. 31 report, filed with the court, states that he and his monitoring experts were told certain documents "do not exist, when in fact I have obtained copies of those documents from other sources."

In the January report, Chang accused the hospital of withholding important information regarding its compliance with U.S. Justice Department standards, and said patients are not yet participating in active treatment "to the degree required."

"I'm hoping for an improved response in the most recent request for information," said Chang, who for a year has been overseeing the hospital's compliance with a federal court consent decree.

State Hospital Administrator Barbara Peterson said the hospital has "absolutely not" tried to hide information from the court monitor.

The problems may have been created because of a change in the method of reporting in recent months, the administrator said.

The State Hospital has been monitored by the Justice Department since 1991, after the state was sued to improve conditions and staffing at the hospital for treatment of the mentally ill. Among other things, the hospital was accused of overmedicating patients and misusing restraints. In 1995, the Justice Department went back to court on contempt charges, saying the state wasn't moving fast enough to fix problems.

Former Administrator Marvin St. Clair, who served from 1995 to 1998, brought changes to the hospital, earning accreditation by the Joint Commission for the Accreditation of Health Care Organizations for the first time in 23 years. But the federal court has consistently found the state slow to comply with federal demands, although staffing levels and patient care have improved.

For the past two weeks, Department of Justice lawyers have been in Hawai'i scrutinizing the latest developments at the hospital.

"We're still concerned about the adequacy of the programming and treatment that patients are receiving," said lead Justice Department attorney Verlin Deerinwater. He said Justice will be in "discussions" with the state to continue remedying continuing problems in the weeks leading up to the May 16 conference.

Peterson agreed that there are "legitimate" questions about when services required by the consent decree will emerge. Developing treatment programs for the patients is an "ongoing process," she said.

"The presumption is that if some is good, more would be better, and we agree," she said. "You're never really there. You're always getting there, and there's no end to that path."

In moving toward the court-ordered goals, the hospital and state Mental Health Division are pushing forward to build two new "wraparound" six-person teams to provide intensive services for patients moving from the hospital back into the community.

"The teams should be in place by July 1," Peterson said.

In his most recent report, Chang said strides are being made in some important areas, including patient safety. The use of seclusion and restraint is at a relatively low rate, he said, even though the paperwork to show adequate monitoring is lacking.

Chang also said there were continuing problems, including not enough permanent staff people.

Since the report, Peterson said, 11 employees have been hired in the nursing department, and staffing levels are close to required levels.