Audit slams Kalaupapa staff

By Lynda Arakawa and Gordon Y.K. Pang
Advertiser Capitol Bureau

The state Department of Health has poorly managed the Kalaupapa settlement for Hansen's disease patients on Moloka'i, according to a report released yesterday by state Auditor Marion Higa.

The critical report said that the department has met patients' medical needs but that Kalaupapa's physical isolation "has allowed settlement staff to escape departmental scrutiny and oversight." It said a lack of formal rules and policies over various nonmedical procedures contributes to the perception of abuse and unfair treatment, and that patients were frustrated with the department's "minimal response to quality of life issues."

It also said the department's "poor oversight of Kalaupapa operations resulted in mismanagement of state resources and some undue benefit to employees."

Kalaupapa was established in 1865 for people with leprosy, which is now referred to as Hansen's disease. At one time nearly 9,000 people were quarantined there. The state's quarantine of Hansen's patients was lifted in 1969 and today there are 39 patients living under the Health Department's charge, the auditor's report said.

The report is particularly critical of Michael McCarten, Kalaupapa's administrator. According to the report, patients said he "walks out of meetings when upset, uses profanity, and is perceived as being abusive, rude and lacking in compassion and respect for patients."

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.

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

Kalaupapa patient Kuulei Bell yesterday said that medical treatment is "wonderful," but that residents have complained about a lack of communication with McCarten.

"He never did that (being rude) to me, because I can talk," Bell said. "If you can't talk, he can step all over you. You have to be aggressive. So, yes, the ones that can't speak say behind him, 'This man is not good.' "

McCarten would not comment, but in a written response to the audit, health director Chiyome Fukino said McCarten, who was hired 10 years ago, met the minimum qualifications and was selected as the most qualified candidate.

But Fukino also said the "department will work with the administrator to improve the image the patients have of him" and will provide professional development opportunities "including additional knowledge and skills in communication and issues pertinent to managing a community of aging adults."

Fukino said before the audit's findings the department recognized that clear communication with the patients in deciding issues that affect them has not been achieved. She said that among other things, the department established in June quarterly meetings between the branch administrator and the patients' advisory council, and that the deputy health director has met with patients and "actively investigated some of their concerns."

The audit also said patients are bothered that they must pay for home appliances while employees living in Kalaupapa live in homes that come fully furnished, a point that patient Richard Marks said is one of the larger issues.

In some cases, he said, "things get done for (employees) that don't get done for the patients."

Fukino said that the 2000 Legislature did not approve the department's request for money to buy home appliances for patients and that a branch official had suggested that appliances for the patients be purchased with Kalaupapa Patient Donation money.

The patients could not reach consensus on the issue at the time and the matter was tabled until the audit, Fukino said.

The report also criticizes McCarten for authorizing excessive airfare reimbursements for employees, which is in conflict with collective bargaining agreements. It said a review of eight employees' reimbursement records show that four received excessive airfare reimbursements totaling $6,557 in 2002 and that one person received more than $3,000 in excess.

Also problematic, the audit said, is that it was virtually impossible to determine exactly how much the department spent on patients because the department does not distinguish between patient and non-patient costs.

Janice Okubo, Health Department spokeswoman, said: "We have had some problems in those areas and we have to take a tighter hold on and work very hard to correct them."

She said corrective actions have already begun or will begin shortly.

Reach Lynda Arakawa at larakawa@honoluluadvertiser.com or 525-8070.