Posted on: Sunday, May 15, 2005
Better monitoring of patients sought
| • | Mentally ill caught in system |
By Ken Kobayashi
Advertiser Courts Writer
State health officials are striving to comply with a federal mandate to better treat and monitor patients released from the Hawai'i State Hospital rather than putting them on planes and sending them to the Mainland.
That's what happened to Lloyd Vasquez in 1979.
Vasquez was diagnosed as a schizophrenic, acquitted by reason of insanity for driving a van without permission and committed to the state hospital.
Within a year, at the request of his lawyer and recommendation of a state hospital psychiatrist, Circuit Judge Toshimi Sodetani ruled that he was satisfied Vasquez could be adequately treated in New York City, his hometown.
The order did not require him to seek treatment in New York.
Four years later, Vasquez was back in Hawai'i. He was recommitted to the hospital.
The practice of sending patients away without setting up treatment plans was known in mental-health circles on the Mainland as "Greyhound therapy," where patients would be put on a bus instead of a plane.
Today, the only state-run mental-health facility for adults no longer releases patients without trying to ensure that they get the required services and programs that are being developed under the federal mandate.
A federal judge in December lifted federal oversight of the hospital imposed as a result of a Justice Department lawsuit from the early 1990s alleging substandard treatment of the patients.
But the federal courts still maintain jurisdiction over the state Department of Health's efforts to serve an estimated 7,000 people with seriously mentally illnesses living in the community. Vasquez would fall under those services if he is released.
The state has fallen behind in implementing a two-year-old plan to improve services ranging from residential treatment to individualized case management.
Federal Magistrate Kevin Chang who oversees the state's efforts, issued a report in February saying although the state is providing services, the progress has been "slow and not remarkable."
"We think we've made a good start, but we know we have a lot of work ahead of us," said Dr. Thomas Hester, chief of the adult mental-health division for the state Health Department.
Hester said the health department envisions better monitoring of patients such as Vasquez if they are conditionally released from the hospital.
The department has already named a state forensic mental director and forensic coordinators at five of the eight community health centers to help monitor the former patients. The forensic specialists deal with issues related to mental health and the criminal courts.
Other hospital improvements include a better assessment of the patients before their release and a better "hand-off" to community providers so they can treat former hospital patients when they run into problems such drugs and alcohol or if they refuse to take medication, he said.
The department also will consider a plan for a secured residential facility, Hester said. Currently, the state has supervised and specialized housing, but no secured housing.
"It's very important with us to work on avoiding unnecessary hospitalization," he said.
Vasquez is one of about 170 patients at the Hawai'i State Hospital. Its annual budget is about $38 million, which translates to about $600 for each patient each day, according to hospital officials.
On a day last month, the hospital housed 173 patients, the overwhelming majority there because of criminal cases. Those patients include 58 who, like Vasquez, were acquitted by reason of insanity of criminal charges and committed.
