Higa said that while the department has adequately met the medical needs of the patients, "it has been remiss in addressing non-medical needs and has exercised poor oversight of the settlement’s operations."

"Formal rulemaking has been limited and development of policies and procedures for non-medical needs were ignored, contributing to the perception of abuse and unfair treatment in several administrative practices."

Kalaupapa was established as a settlement for Hawai'i’s Hansen’s disease patients in 1865 and at one time nearly 9,000 people were quarantined there. The state’s quarantine of Han-sen’s patients was lifted in 1969 and today there are 39 patients living under the Health Department’s charge, the auditor’s report said.

Higa’s office found that the Health Department has not met with the settlement’s Patients’ Advisory Council for more than two years, despite the fact that the panel is used by the department as a conduit to help remedy complaints.

The report is particularly critical of Michael McCarten, Kalaupapa’s administrator. The report summary states that patients characterize him as "abusive, rude and lacking in compassion." It also states that McCarten lacks the proper background and experience to work with the elderly and those with special needs and that the department failed to train him adequately.

The report also criticizes McCarten for authorizing excess compensation of settlement staff, particularly in the area of travel. It also questioned an employee food credit program and why employees continue to be provided with household goods when the department ordered the practice stopped in 1999.

McCarten declined to comment.

Janice Okubo, Health Department spokeswoman, said that DOH is "actually pleased the auditor recognized that we are meeting all the medical needs of the residents as required by law."