Audit cites abuses at State Hospital
By Johnny Brannon
Advertiser Staff Writer
An audit that harshly criticizes poor planning and management of services for Hawai'i's mentally ill is itself flawed and outdated, state health chief Bruce Anderson said.
Advertiser library photo • May 25, 2001
"The auditor, it seems, went out of her way to paint a picture that may have existed years ago but is very different today," Anderson said of the report released yesterday by state auditor Marion Higa.
Bruce Anderson says audit omissions are unfair.
Her report found that poor management and faulty staff training at the Hawai'i State Hospital in Kane'ohe have jeopardized patient care and allowed unchecked abuse of overtime and sick leave.
"Patient safety is compromised by staff's failure to follow hospital procedures when secluding and restraining patients," the audit states. "... Improvements are needed to ensure patients are adequately protected from harm and provided with sufficient treatment."
The audit also faulted the Health Department's Adult Mental Health Division for addressing systemic problems with "quick fixes" instead of solid long-range planning.
Anderson agreed that overtime and sick leave abuse is indeed a problem but said it had been greatly reduced over the past year.
"There still are problems with overtime that need to be addressed, but we're making significant progress in that area," he said. "It's not an easy fix, but there's room for improvement there."
Anderson said the audit had unfairly excluded information about a comprehensive plan to expand mental health services, however.
The four-year plan, which calls for more services outside the state hospital, had not been finished by the close of the audit period in September 2000 but has since been completed and financed by the Legislature, Anderson said.
"Had she acknowledged that, I think a very different picture would have been presented," he said. "It's as complete and thorough a plan as I've ever seen for building out mental health programs in any state."
Higa could not be reached for comment. But Gov. Ben Cayetano said it had been "nonsensical" for her to omit the plan. "The state does not center its efforts around Marion Higa's audit schedule," Cayetano said through his communications director, Jackie Kido.
Creating more residential and outpatient programs in community settings should decrease the number of mentally ill people who end up in prison or the state hospital, Anderson said. The Legislature has appropriated $8 million for new programs this year and $14 million next year, he said.
"We've got the money, we've got the plan, and there's nothing I see that will stop us from developing an excellent comprehensive mental health system in Hawai'i," he said. "All we need is a little time and continued support."
The audit did not address security problems at the hospital, which have clearly continued despite any improvements in other areas.
A dozen patients have run away from the facility so far this year, including several with histories of serious violence. Thieves also stole 28 computers, worth a total of $30,000, from the hospital this month. And three patients were arrested there over the past two weeks for allegedly using illegal drugs.
"There are such a multitude of problems at that hospital; if it's not one thing it's another," said Rep. Charles Djou, (R-Kahalu'u, Kane'ohe), who represents the surrounding area. "I cannot imagine anyone arguing coherently that what going on at the hospital is acceptable. Is there any security at all here?"
He said the state should consider turning the hospital over to a private operator.
"Complete, wholesale, top-to-bottom reform is needed," said Djou. "The time for tinkering with the state hospital is over."
Most of the 160 patients there have been committed by the criminal justice system after arrests. Anderson said one problem is that the hospital must admit some patients who really belong in a more secure facility, such as a prison that is set up to handle them.
He and Department of Public Safety director Ted Sakai attended a national conference on mentally ill prisoners this month and hope to present a reform plan to Cayetano within weeks.
And a new administrator is scheduled to take charge of the hospital in mid-September. Paul Guggenheim will replace Barbara Peterson, who has run the hospital since November and did not seek to extend her one-year employment contract.
The hospital operates under a federal consent decree as a result of a decade-old lawsuit that alleged improper patient care and poor conditions. A court-appointed monitor has documented many of the problems the audit points out, such as overtime and sick leave abuse.
The audit found that the hospital allowed inaccurate overtime payments to staff and that two managers were paid a total of $30,000 in overtime without any assurance that they had earned it.
Hospital managers may have compounded the problems by failing to investigate patterns of potential sick leave abuse, auditors found.
"In fact, one unit manager acknowledged that he submitted inaccurate overtime claims upon the request of hospital management," the report states. "... staff are allowed to use sick leave for unallowable purposes."
Nora Nomura, a field services officer for the Hawai'i Government Employees Association, said the union hopes to consult with the new hospital administrator to solve any problems.
"The employees we work with don't like to see abuse any more than the public does, and we want to work with management if in fact that is a concern," she said.
Two previous state audits, in 1995 and 1997, also found chronic absenteeism and overtime problems at the hospital and determined that they were preventing it from meeting court-ordered staffing requirements.
You can reach Johnny Brannon at jbrannon@honoluluadvertiser.com.
