Plan to upgrade State Hospital shows promise

After years of chronic problems with overcrowding and staffing issues at the Hawaii State Hospital (HSH), the Kaneohe facility may finally be getting some needed relief — and it’s a development that would benefit the community at large as well.

The updated master plan for the campus calls for a new 150-bed longterm care facility to replace the unusable, 1930s Bishop Building, via a publicprivate partnership that involves the leasing of some state land to a private contractor to build and then operate the facility.

About 50 beds, or a third, of the skilled-nursing facility would be set aside for patients discharged from HSH who have complex, long-term care needs; that would free up crucial space at the hospital, which is struggling with overcapacity. The 100 remaining long-term care beds would be open to the community for those in need of complex care, possibly 50 for veterans, said Lynn Fallin, the state’s deputy health director of behavioral health.

This has the hopeful potential for leveraging private resources to meet vital needs of both an overcrowded Hawaii State Hospital and those in the general population with severe medical needs, both physical and mental.

The proposed site is adjacent to Windward Community College, away from the HSH’s main upper campus, which helps mitigate concerns of proximity to patients linked to criminality.

More details, such as property lease terms, are expected after architectural plans are submitted in July, said state health officials.

An ideal outcome for the public and private sectors is certainly achievable here. After all, the HSH campus is attractive acreage that would appeal to any number of entities seeking an idyllic Windward site. For the Hawaii State Hospital, having a nearby outlet for its longterm patients in need of complex care — some have been there more than a decade — would ease the overall space needs of the operation.

Overcrowding at the Kaneohe hospital — plus its resultant problems and dangers — came to light dramatically over the past 18 months, when four staffers publicized their serious injuries from patient assaults at the mental health facility due to lack of staff, support and training. That led to a special state Senate committee investigation, which resulted in an 88-page report last October.

Among the troubling findings: Though built for 168 patients, the hospital actually gets 25-30 over that number on a daily basis. Another 40 beds are contracted with Kahi Mohala Behavioral Health, a private psychiatric hospital, with “a high likelihood” for more overflow beds in the future.

Virtually all hospital admissions are forensic mental health patients committed there by the state courts.

The investigation found that the hospital’s design, infrastructure and technology “no longer effectively meet the therapeutic mental health needs of its patients.”

Further, it said, the hospital “is forced to admit, accommodate and treat patients with limited resources, which contributes to safety concerns for the patients, staff and surrounding community.”

Obviously, this is not a population easily addressed, and public safety must be a top consideration.

A second component of HSH’s master plan calls for another old, unusable structure — the Goddard Building — to be demolished and eventually rebuilt with a new 144-bed secured facility.

For now, the Bishop Building long-term care home offers a nearer-term, win-win prospect. A private builder/operator would offer needed capacity and services without adding unduly to a publicunionized staff. In 2014, two-thirds of the Hawaii State Hospital’s $52.9 million budget went for personnel costs, and part of the Senate investigation found questionable scheduling practices that drove overtime costs.

Progress on this project in the coming months is eagerly awaited. This public-private partnership holds promise to meet needs of the Hawaii State Hospital and its patients, as well as those in the general community who’ve not been court-committed but are in dire need of intensive long-term care.