Improve security at State Hospital

Workplace violence should not be a way of life for any health care employee — but for those working at the Hawaii State Hospital, an assault occurs an average of every three days. Like the healing of some staffers seriously injured by patients, the process to improve safety conditions at the Kaneohe hospital is likewise slow and painful. Alarmed, state lawmakers are now delving into the situation, and hearings to be held in a couple of weeks must lead to improvements.

In a news conference Wednesday, several workers hurt on the job outlined drastic conditions, detailing injuries that have left them on workers comp for months. Psychiatric technician Emelinda Yarte has been out for four years after she was slammed into a wall, and beaten on her head and spine.

There seems to be a serious disconnect between those on the front lines dealing with the patients and the administration overseeing the State Hospital. Staffers who have been injured lament deficient training and inadequate security at the facility, which is run by the state Health Department.

But Dr. Mark Fridovich, chief of the Adult Mental Health Division who oversees the hospital, said the staff-to-patient ratio is good, that staffing is increased when needed, and that overtime and agency staffing are also employed when necessary.

A troubling contributor to the violence is the criminally insane who are committed by the courts to the hospital, too mentally incapacitated to stand trial despite involvement in violent or lethal crimes. These patients require holdings that provide adequate treatment and appropriate security, but "we don’t have such a facility in Hawaii," stated Randy Perreira, executive director of the Hawaii Government Employees Association.

As Kalford Keanu, a psychiatric technician who was out of work for 10 months after being attacked, said: "I feel that we should get more training than the ACOs (prison guards) because we’re getting the criminally insane, not just criminals."

The hospital is not a prison, so its security force is unarmed — but even so, they should be well-trained and fully prepared to deal with violent behaviors. The hospital had 196 patients as of Nov. 14. So far this year there have been 90 assaults on workers, compared with 120 last year, the Health Department reports.

Safety at the State Hospital has been a chronic concern, notably about four years ago when budget cuts dramatically dropped the number of state security guards there, a loss of about a dozen, leaving some 18 private guards.

Now, inadequate procedures to separate violent patients seem to be compounding problems. The most violent inmates are supposed to be confined to the Psychiatric Intensive Care Unit (PICU), which was renovated a few years ago for $500,000. But, the injured employees claim, the PICU has not been used for that purpose after a dangerous patient attacked a psychiatric technician and broke his eye bone. If the unit is now being used as overflow space for minimal-risk female patients, as reported, that situation must be remedied quickly.

Another volatile element that needs defusing, as detailed by employees: The most dangerous patients are housed in the same unit as new arrivals who are still being assessed.

Clearly, there are serious issues about how the hospital is operating, with differing contentions of how bad the problems are. That in itself is troublesome, so the upcoming hearings by the Senate’s Health and Judiciary committees are urgently needed to vet the troubles.

For the sake and safety of staffers, as well as patients, improvements must be made before an already risky environment turns fatal inside this state-run facility.