Mental unit in chaos, some say
By Johnny Brannon
Advertiser Staff Writer
Closing the most secure section of the Hawai'i State Hospital forced a volatile mix of mental patients into crowded quarters and sent altercations with hospital staff skyrocketing, according to front-line workers and a court-commissioned psychiatric expert.
Bruce Asato • The Honolulu Advertiser
But hospital administrator Barbara Peterson said such reports are overblown and that her decision to shut down the 50-year-old Guensberg building last month will provide a safer environment with improved patient care.
The hospital administrator says her decision to shut down the 50-year-old Guensberg building will provide a safer environment with improved care. She said the building was leaking, crumbling and had problems related to asbestos and electrical fires.
Peterson, who took charge of the hospital six months ago, is under heavy pressure to improve it, but she may not remain long enough to do so. Her $88,500 employment contract expires in November, and she has yet to decide whether she wants the job any longer.
In the meantime, the hospital will be one step away from a federal court seizure because of its failure to comply with improvement goals set after the U.S. Justice Department filed suit 10 years ago challenging inhumane conditions.
The Guensberg building included the hospital's intake and transition units, and it housed some of the state's most difficult mental patients.
Peterson said it had to be closed because it was simply crumbling and had not only a leaky roof but also asbestos problems. In addition, it had experienced three electrical fires in a month.
"The infrastructure could no longer support living in humane conditions," Peterson said.
But she conceded that asbestos in patient areas had been isolated years earlier, and that she had never obtained cost estimates for other repairs. And more than a month after some patients were moved into makeshift rooms that are smaller than state regulations require, she said she has yet to obtain a waiver to make that legal.
Peterson points out that the national Joint Commission on Accreditation of Healthcare Organizations conducted an unannounced inspection of the hospital and found no serious licensing violations. Though the visit occurred before patients were transferred out of the Guensberg building, Peterson said she was confident the hospital would pass such an inspection if it were conducted today.
The hospital's four remaining units now combine newly admitted patients — often acutely psychotic and referred by the criminal justice system — with others who are more stable.
Many hospital workers say the result has been bedlam.
"If one patient goes off, we're trying to do crowd control," psychiatric technician Penny Purvis said Friday. "Safety for the staff? There is none."
Many staffers have little experience working with the type of patients formerly housed at the Guensberg building, who often require much more attention, she said.
"The ones who are able and willing to receive therapy are being neglected now, and to me that's the biggest problem here," another psychiatric technician, Dee Sayers, said before a supervisor ordered both women not to speak to a reporter while on their break.
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Other staffers expressed similar concerns in telephone interviews but said they feared retaliation if they spoke out publicly. An internal survey of nursing staff found that nearly two-thirds feel unsafe now.
Barbara Peterson says mixed environment helps patients.
According to the survey obtained by The Advertiser, nurses described concerns about psychotic patients being mixed with higher functioning patients, unmedicated patients in units with glass surroundings, overcrowding, the physical facility too flimsy to contain the patients and difficulty in monitoring hidden areas.
Jane Ryan, immediate past president of the American Psychiatric Nurses Association, was commissioned to inspect the hospital for the federal court. She arrived at this conclusion: "The integrated units have patients who will get into altercations very easily and these patients are housed with patients who are considered rehabilitation patients. Some of these rehabilitation patients may by very vulnerable to being harmed ... ."
Ryan also determined that the hospital's units were dangerously crowded as a result of the Guensberg closure. The desired size of a unit is about 25 beds, she wrote, but up to 46 patients are now housed in one.
"Code 200" calls, in which a hospital staffer needs assistance to control a patient, more than tripled after the closure, she found, and cases in which patients had to be restrained more than doubled.
"The increase in the number of code 200 calls is definitely related to the mixture of patients and the number of patients on the units," Ryan wrote.
But Peterson said mixing acute patients with stable ones is better than using an intake unit and transferring patients out after their behavior has been assessed.
"I believe that if you bring patients into a relatively stable environment they stabilize more quickly," she said, stressing that the hospital is not a prison.
There were 22 escapes — called "elopements" by health officials — from the hospital last year; 12 have occurred this year.
One man, accused car thief Leonard Moore, 35, escaped twice by throwing furniture through glass windows. Many windows have since been reinforced with plastic, but the last broken by Moore, on April 7, remains covered with plywood.
Peterson said she believed the hospital's four remaining units are as secure as the Guensberg building's intake unit.
But Ryan and many hospital staffers say Peterson ignored their warnings before the building was closed and the hospital is now scrambling to make improvements.
