Posted on: Saturday, November 13, 2004
Feds to end oversight of state mental hospital
| • | Advocates praise changes |
By Ken Kobayashi
Advertiser Courts Writer
In 1991, the Hawai'i State Hospital was in shambles.
The care for patients was substandard, the buildings leaked, and some patients got too much medication, according to a federal magistrate.
Patients were left unattended lying on concrete floors. They were routinely restrained. Staffing was inadequate. Conditions were unsafe and unsanitary. One patient was seen eating paint chips; another was lying in his own urine.
But today, 13 years later, Magistrate Kevin Chang, who originally provided that grim view of the hospital, says conditions have improved, and now he recommends dismissing a federal civil rights lawsuit against the hospital. He's also ready to terminate federal court oversight of the only state-run mental institution in Hawai'i.
Chang also is recommending that the state embark on a plan to set up a system to provide mental relief to those leaving the hospital.
State officials, he says, have made "substantial progress and dramatic change" at the hospital, with patients now being treated in "a different and successful way."
The recommendations are part of a 44-page report issued yesterday that signals the end to the federal court oversight, which has lasted even longer than the 11-year-old Felix consent decree governing the Department of Education's services to mentally and emotionally disabled students.
Chang's recommendations go to U. S. District Judge David Ezra for approval at a Dec. 10 hearing.
Dr. Thomas Hester, chief of the adult mental health division for the state Health Department, said Chang's report recognizes that the state's mental health system is no longer "the worst in the nation," as it was once ranked.
"Now, there's a hospital that Hawai'i can be proud of," he said. "It's a historic achievement for the state of Hawai'i and it is an achievement that was the result of a great deal of dedicated work by the staff at the Hawai'i State Hospital and the administration."
Assistant U. S. Attorney Harry Yee said he's pleased with the progress made by the state. "We feel that this is a very solid foundation on which we can build a strong state mental health system in Hawai'i," he said.
Attorney General Mark Bennett also applauded the recommendations. "This report brings truly welcome news to the patients, staff and administration of the Hawai'i State Hospital, the Adult Mental Health Division of the Department of Health and to all citizens of our state whose lives are affected by serious mental illness.
"All of the hard work that has brought Hawai'i State Hospital to this point is truly appreciated and has set the stage for continuous improvement of the services offered at the state hospital."
Paul Guggenheim, the hospital administrator for the past three years, applauded the staff, which he said worked hard to improve the care, management and treatment of the patients. "We accomplished a lot, but it's not over," he said.
The hospital currently has 167 patients, including those committed to the hospital after they were acquitted of crimes by reason of insanity.
Scrutiny of the hospital began in 1991, when the U.S. Department of Justice filed a lawsuit alleging that the patients' civil rights were being violated at the Kane'ohe facility. The federal government and the state reached an agreement to remedy the problems, but in 1995, Ezra held the state officials in contempt of violating that order. In response, the state officials agreed to a "remedial plan."
Chang was appointed by Ezra in 2001 to be a special master to oversee the state's compliance. In his report yesterday, Chang said he agreed with an evaluation team that concluded the state was in "substantial compliance" with the plan.
"The hospital has a different atmosphere that is more amenable to fostering a treatment environment that guards the rights and privileges of patients and staff at the facility," evaluation team member Gail Hanson-Mayer wrote.
Chang said the team found the hospital met the requirements of the plan in areas that include clinical leadership; reduction in the use of seclusion and restraints, and nursing and psychiatric services.
"To say that circumstances at Hawai'i State Hospital have changed is a gross understatement and fails to comprehend the severity of the problem and the magnitude of the change brought about by (state officials)," Chang said.
Chang said the state must still come up with a community plan for people with serious mental illnesses who are former patients or who will be released from the hospital. He recommended a June 30, 2006 deadline for implementation, which the federal court will continue to monitor.
Hester said some of the major areas of the plan are refining and integrating crisis services; developing forensic services in the community to work with people under court supervision such as probation; and jail diversion programs that shift people who have been arrested —usually for non-violent misdemeanor offenses — out of jails and into treatment programs.
Advertiser staff writer Robbie Dingeman contributed to this report. Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com or 525-8030.
