Posted on: Saturday, December 11, 2004

State hospital passes muster

By Ken Kobayashi
Advertiser Courts Writer

Hawai'i State Hospital was removed from 13 years of federal court oversight yesterday, but state health officials must now implement services for thousands of seriously mentally ill residents in the community in the next year and a half.

U.S. District Judge David Ezra dismissed the Justice Department's 1991 civil rights lawsuit that led to the federal court oversight of the Kane'ohe facility. He applauded the hospital staff, as well as the lawyers and others who worked on the case.

Ezra also gave state officials until June 30, 2006, to implement a public community mental-health system that would provide services ranging from residential treatment to individualized case management.

The intent of the plan — like the hospital's mission — is to provide adequate services to Hawai'i's seriously mentally ill residents. Initial state estimates are that more than 6,000 people, including those discharged from the hospital, would need the services.

State health officials predicted that they will be able to meet that deadline, but the federal court will still retain oversight on the implementation of the plan.

Yesterday's hearing, however, reflected what all sides say was a significant and dramatic improvement at the hospital from the early 1990s. Ezra called the improvement "astonishing."

The judge said that when he first visited the facility in the early 1990s, he found patients lying in their own urine and feces and others running around naked. "It was a scene out of a 19th-century insane asylum," Ezra said.

But during a tour of the facility Thursday, he found patients in well-kept rooms, adequately supervised. "It really looks like a well-kept college campus," he said.

During the years of federal oversight, Ezra at one point threatened contempt-of-court citations against the state and came close, he said, to ordering the seizure of state land and assets to finance the mandated improvements. He said the state eventually "got the message" and provided the resources.

"I have every reason to believe that this will be the end of the problems as we know it," he said.

State Attorney General Mark Bennett said the hospital had failed to provide services required not only under the law, but by "common decency." He called the judge's decision a "significant milestone," but said it was not the end of the journey, only a midpoint with the state committed to doing the "fair, right, just and decent thing to do."

"This is an example of how federalism ought to work," he said.

In 18 months, he said, the state will be "ready to stand on our own."

Justice Department civil-rights lawyer Verlin Deerinwater told Ezra that department officials believe that patients are now receiving adequate services and it is time for the state to run the facility. But he said the state now needs to focus on providing the community services.

Deerinwater later said the state must have a range of services that include housing and individualized case management providing various levels of care.

State officials yesterday could not immediately provide numbers on how much the state spent on improving the hospital or how much it would cost for the community services plan, but the state hospital's annual budget was about $13 million in 1991 and is about $38 million now, according to Paul Guggenheim, who has been the hospital's administrator for three years.

Guggenheim is optimistic that state health officials will be able to meet the deadline for community services, although he acknowledged it will require more resources to meet the needs on all islands. "I think we're on target to do that," he said.

State Health Director Chiyome Fukino credited the hospital staff's dedication and hard work that "created a place of quality care and treatment, which now serves as a model to the rest of the nation."

Justice Department officials also were pleased with yesterday's decisions. "When a state accomplishes meaningful reforms for those persons it has accepted responsibility to protect from harm, we must recognize and applaud those efforts," said R. Alexander Acosta, assistant attorney general for the civil-rights division.

Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com or 525-8030.