Union to fight state's plan for mental hospital

By Johnny Brannon and Lynda Arakawa
Advertiser Staff Writers

Gov. Ben Cayetano is renewing his efforts to turn the long-troubled state mental hospital over to private hands, but union leaders vowed to fight such a move and said they doubted it would improve patient care.

"The rules and civil service regulations we have in place tie management up into knots, and we just can't manage that place as well as we would like," Cayetano said. "Perhaps if it was under the private sector, with greater flexibility they can do a better job, and so we're looking at that right now."

Cayetano proposed in 1999 that the hospital be privatized, but the idea stalled in the Legislature after union officials threatened a lawsuit and others questioned whether private operators could provide appropriate services.

Cayetano said an oversized staff had rendered the hospital "dysfunctional" and that a state privatization law approved May 1 could strongly aid a new attempt to remedy the situation.

"We have 600 employees caring for about 160-something patients and that is not cost efficient by any stretch of the imagination," he said. "So we have to find some way to rectify the situation."

The hospital has been harshly criticized for escapes by patients accused of criminal acts, and for failing to comply with court-ordered improvement goals that resulted from a 1991 federal lawsuit.

Many hospital workers, and a court-commissioned psychiatric expert, say the recent closure of the facility's most secure wards created new crowding and security problems.

State health director Bruce Anderson said the hospital is working to address those concerns, and that its court oversight and "onerous" mandatory staffing ratios could make Cayetano's idea difficult.

"Whether services are privatized or not, those stipulations would still apply," he said. "I doubt if there would be any savings that would result from privatizing the state hospital given the constraints we work with, but it's something that should be perhaps looked into."

The state is already moving more toward private sector mental health care by contracting with community-based agencies that provide treatment and programs outside the hospital, Anderson said.

Other states, such as Arkansas, California, Connecticut, Illinois and Vermont, have also done so, but nearly all state psychiatric hospitals in the nation remain government-operated.

The 350-bed South Florida State Hospital was the first to be completely privatized, in 1998. It is now run by a subsidiary of the Wackenhut Corrections Corporation, one of the world's largest operators of private prisons.

A lawmaker who represents the area around the Hawai'i hospital said new options must be considered to address lingering problems.

"The public management of the hospital is clearly not working," said Rep. Charles Djou R-47th (Kahalu'u-Kane'ohe), who had urged Cayetano to revisit the issue. "I think it is incumbent upon the state to explore other models."

But United Public Workers head Gary Rodrigues said a privatization attempt here would likely lead to a serious court battle.

"They have the right to try, and we have the right to challenge," said Rodrigues, whose union represents nearly 300 nurses' aides, custodial workers and others at the hospital.

He said privatization would amount to "passing the buck" rather than seriously addressing the facility's problems, and he blasted Djou and Cayetano for floating the idea.

"It shows ignorance on their part, but politicians get away with that," said Rodrigues, who threatened to sue the state over the governor's 1999 proposal.

He said the state should consider turning management of the hospital — but not the entire facility — over to the private sector to spur improvements.

Randy Perreira, deputy executive director of the Hawai'i Government Employees Association, said he doubted the hospital would be of much interest to the private firms.

"These types of services are not profitable, so it's not like there are a lot of suitors out there waiting to take the work," said Perreira, whose union represents about 150 nurses, therapists and others at the hospital.

Cayetano conceded that the private sector had expressed no interest in handling the hospital, but said that was before the privatization law was put into place.

He emphasized that cost would not be the only factor in deciding whether to privatize government operations. The state needs to make sure essential services won't be lost or reduced, he said.

There were 22 escapes from the hospital last year, and 12 have occurred this year. Anderson said that reflects an improvement over previous years, and is about average for such a facility.

But Cayetano said such problems must be further minimized no matter who runs the hospital.