Federal judge appoints 'master' to oversee State Hospital
By Johnny Brannon
Advertiser Staff Writer
Following a series of scathing reports that criticize management of the Hawai'i State Hospital and its failure to comply with a federal consent decree, U.S. District Judge David Ezra yesterday boosted court authority over the troubled facility.
In a move that falls just shy of a court takeover, Ezra appointed U.S. Magistrate Judge Kevin Chang to serve as "special master" to oversee the hospital's efforts to improve conditions and services for the mentally ill.
"This is make it or break it for the state," Ezra said during a court hearing. "We've literally reached the point where if we don't have compliance in a reasonable time we will have to take that final step."
The decision came a day after police caught accused car thief Leonard Moore, who bolted from the hospital twice and eluded capture for more than a month after authorities sent him there for a psychological evaluation. Ezra said he was very troubled by Moore's escapes, the latest in a series at the hospital.
"These things happen in the best facilities, but I do know we can do better," Ezra said. "We need to provide more security and better facilities," as well as improved care for patients referred to the hospital by the criminal courts or who are admitted voluntarily.
Although a special monitor had been assigned to oversee the problems, the appointment of a special master with broader authority to correct deficiencies in the system is a more significant step to resolving the troubles at the hospital.
Chang's exact authority will be spelled out by the U.S. Justice Department within a week.
State health director Bruce Anderson said he welcomed the increased scrutiny and authority over the hospital he is responsible for.
"I think it was a very positive step and hopefully we'll be able to report to Judge Ezra in six months to a year that we are in compliance," Anderson said.
He said the hospital can safely accommodate patients who pose security problems, despite the recent closure of a building that had served as a secure intake facility. He said Moore, the escapee, would not have been housed in the building if it were still open.
But some hospital staffers say the closure has increased security problems and that they don't believe the facility is set up to safely handle patients like Moore.
Randy Perreira, deputy executive director of the Hawai'i Government Employees Association, said the union, which represents about 150 nurses, therapists and others at the hospital, is hopeful that Judge Chang can spur safety improvements.
"Given the trouble we've had at the hospital over the last couple of years, I don't think it can get any worse," Perreira said.
The state Legislature recently increased money for the hospital by $22 million over the next two years, but Anderson said more would be needed in the future.
"In the short run, I think we have enough money to make the system work," he said. "In the long run, we're going to need additional funding."
State House health committee chair Dennis Arakaki, D-28th (Kalihi Valley, Kamehameha Hts.) said he was not surprised by Ezra's decision given the hospital's history.
"It's disappointing that it had to come to this point," Arakaki said. "Probably the judge is just as frustrated as we are that there hasn't been progress even though we continue to pour resources into the programs and facilities."
He said he believed the problems were mainly because of poor management, not a lack of money.
But Ezra said fiscal neglect by lawmakers was a big cause of the hospital's woes.
"Unfortunately, in the past the Legislature has been much less responsive," he said. "I suspect that's because the mentally ill don't provide a large block of voters."
Ezra had threatened in 1999 to put the hospital under federal control soon if the state did not speed up improvements. Justice Department and state attorneys proposed just before yesterday's hearing that Ezra assign a magistrate as special master.
"Perhaps if we'd had this all along we might have moved at a quicker rate," said defense lawyer Paul Aucoin, special counsel to the attorney general.
The consent decree is a court agreement the state entered in 1991 to settle a lawsuit filed that year by the U.S. Justice Department's civil rights branch. A "special monitor" with limited powers had already been appointed to watch over the deal but had detailed the hospital's repeated failure to comply with its terms.
In a report issued May 11, monitor Leland Chang wrote that crowding and short staffing harm hospital programs and jeopardize safety.
Abuse of overtime and sick leave "appear to be reaching a critical level" among nurses there, he wrote, and "active treatment and adequate, appropriate programs for the wide range of patients in the hospital are still lacking."
Aucoin said the report exaggerated the problems.
"Our perception is that the hospital is in nowhere near as bad a shape," he said.
Leland Chang has also repeatedly complained of a lack of cooperation by hospital administrators to his requests for information about the care of patients, however, and the report said those problems had worsened.
The hospital produced just five out of 53 sets of documents he had recently requested, Leland Chang wrote.
Justice Department attorney Verlin Deerinwater said the appointment of a special master would provide "a more intensive compliance vehicle than we've had in the past."