Hawai'i State Hospital reports fewer escapes
By Alice Keesing
Advertiser Health Writer
The Hawai'i State Hospital has clamped down on last year's rash of patient escapes, with hundreds of thousands of dollars in beefed-up security sharply reducing the number of those who have walked away from the facility.
There were 28 escapes from the psychiatric institution in Kane'ohe in fiscal year 2001. For the nearly seven months of this fiscal year, there have been 10.
Hospital administrator Paul Guggenheim said there was a noticeable drop last year after new procedures and security were enforced.
The hospital's efforts were rewarded with a positive report yesterday from the national accrediting agency that made an unannounced inspection of the facility last year after concerns were raised about the series of escapes.
"We got a report that we have effectively addressed the issues raised when they were here six months ago," said Department of Health director Bruce Anderson of the report by the Joint Commission on Accreditation of Healthcare Organizations.
"We asked if there was anything more we can do to address the problems, and the answer was, 'No.' "
Rep. Charles Djou said he's heartened by the changes brought to the hospital by Guggenheim, who took over the helm in September.
"He has been working very hard to improve public safety. I think they have at least taken the initial steps to correct the very serious rash of escapes that were occurring all last year," said Djou, R-47th (Kahalu'u, Kane'ohe). "The jury is still out, however, as to whether or not we have a long-term fix. There's still, I think, a lot of structural problems with the operations of the state hospital that need to be addressed and examined very closely."
That includes better communication between the departments of health and public safety and better coordination over which patients are sent to the hospital rather than prison, he said.
Too many patients
Many of last year's escapes happened after the hospital closed its aging high-security Guensberg building in March, shifting about 60 patients onto the lower campus. The move put 168 patients into a space designed for 108, and officials believe it contributed to the spike in escapes.
Guggenheim stressed that those who have walked away from the hospital have not been dangerous, although some have a history of serious violence. The rate of "elopements," as the industry calls them, also is below average when compared to similar hospitals on the Mainland, he said.
Still, the escapes last year stirred community concern. The federal court also ordered a fast solution to the crowding problem. The hospital is under federal court oversight as the result of a decade-old settlement agreement resulting from alleged improper patient care and poor conditions.
"Clearly we had and we have an overcrowding issue that's important to address for the staff to feel safe and the patients to feel comfortable," said Anita Swanson, the department's deputy director for behavioral health. "To me, we've made significant strides."
Furniture in the buildings has been bolted down after one patient escaped by throwing a TV through a window, Swanson said. Heat-sensor motion detectors have been installed in ceilings. Windows have been bolted down and the glass reinforced. Next month, the hospital will add security guards to patrol the perimeter of the hospital grounds.
Staff now wear "duress alarms" that they can activate if attacked by a patient, letting security pinpoint where they are in the hospital. There also is a new card-swipe system that tracks the movement of staff around the buildings.
More than gizmos
The new measures have cost about $300,000, Guggenheim said, and were paid for from the hospital's existing budget.
Aside from adding security hardware, the hospital is paying more attention to patient treatment plans to stop patients from wanting to leave in the first place.
The hospital has tackled crowding by adding four portable buildings and converting office and staff space. It also has moved 13 patients to Kahi Mohala, an accredited psychiatric facility, and discharged others into community facilities.
But the cramped conditions that see patients doubling up in rooms will persist until a permanent solution is found. The department is asking the Legislature for $1 million in its supplemental budget to temporarily repair the Guensberg building.
Health director Anderson said the aim is "to squeeze a few more years out of" Guensberg while the hospital plans a new building that would likely house its high-security patients. Guensberg, which was built more than 50 years ago, was shut down because of electrical fires and other safety hazards caused by a leaky roof and plumbing. Anderson hopes patients will be able to move back into Guensberg by July.
Looking to future
The long-term plan, mandated by the federal court, is to create more residential and outpatient programs in the community so the mentally ill don't have to be institutionalized.
The department is asking for another $8.8 million on top of the $24 million provided in the biennium budget to increase those community resources and to provide the infrastructure to manage them.
While last year's problems prompted some to call for the privatization of the hospital, Anderson yesterday said the court's special master has indicated that is not the way he wants to go, although he may support privatizing individual services within the hospital.
The department expects the federal court to release a plan tomorrow that lays out what still needs to be done to improve the hospital.
Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014.
