The hospital came under scrutiny in 1991 when the U.S. Department of Justice filed a lawsuit alleging that patients' civil rights were being violated. An agreement was reached to rectify the situation, but in 1995

Ezra held the state in contempt for not making improvements. A "remedial plan" was then established and Magistrate Kevin Chang was appointed special master to oversee the state's compliance in 2001.

When he took over, Chang said patient care was substandard, buildings leaked, staffing was inadequate and some patients got too much medication.

Last month Chang recommended dismissal of the lawsuit involving the hospital.

Among officials accompanying Ezra on yesterday's tour were Chang; state Attorney General Mark Bennett; the state's health director, Dr. Chiyome Fukino; and the court monitor for the hospital, Kris McLoughlin.

Ezra, along with Chang, declined to comment about the outcome of the visit.

Bennett said that the progress at the hospital was impressive and that the hard work and dedication by staff and employees of the Health Department have brought the facility to the point "where we believe that the judge is very likely to dismiss the portion of the case involving the state hospital."

In 12 years, the hospital has moved from being the subject of great criticism to being a model for the United States, Bennett said.

The hospital sits near the base of the Ko'olau Range on extensive grounds overlooking Windward Community College. Newer buildings and a well-cared-for landscape now house the approximately 170 patients who were seen yesterday engaged in programs, playing in the gym or walking to their classes.

The classrooms were well-lighted, with views to the outside, and pleasantly decorated. Artwork from patients hung on corridors walls.

Several people were learning to make Spam musubi, an attempt to give patients minimal skills so they are able to prepare food for themselves. In another classroom patients sat around a table to participate in a program that helped them find new meaning and purpose in life.

State health director Fukino said the judge's visit yesterday came at a time when the hospital is at its very best.

"The judge was quite pleased by the changes that he's seen," Fukino said. "He apparently visited some time ago when we were at our worst."

Fukino said that hundreds of millions of dollars have gone into the changes over the past 13 years but none of it could have been done without the staff.

"The staff, the management and the leadership at the Hawai'i State Hospital and the Adult Mental Health Division have really worked hard to make this a reality for us," she said.

Court monitor McLoughlin said the hospital has made big changes but the greatest change was moving from just caring for patients to active treatment. Even when the hospital took good care of the patients that wasn't good enough, McLoughlin said.

"The hospital has moved to active treatment and that is going to help these folks when they leave the hospital and they integrate back into the community," she said.

Paul Guggenheim, hospital administrator for three years, said the facility will continue the remedial plan for improvement after the federal oversight is lifted. The hospital will develop more programs and a 10-year plan.

"The requirements that are in the plan are still going to be expectations and requirements for us," Guggenheim said. "It makes good sense, so we'll continue."