The state Senate will form an investigative panel with subpoena power to probe whether poor management at the Hawaii State Hospital has left workers at extreme risk of assaults by patients.
The Senate will also investigate claims of nepotism among supervisors at the Kaneohe psychiatric hospital and whether workers who have spoken out about hospital conditions have been marked for retaliation.
Several hospital workers told Hawaii News Now in November that a lack of staff, inadequate training and poor management have made them vulnerable to assaults. In addition to the Senate, the state Department of Labor and Industrial Relations is investigating workplace safety at the hospital.
State hospital administrators have defended staffing levels and training but have said they will review training after hearing the workers’ complaints.
"This thing is a can of worms that is going to be very difficult to unravel," state Sen. Clayton Hee (D, Heeia-Laie-Waialua), chairman of the Senate Judiciary and Labor Committee, said at an informational briefing Tuesday. "It’s multifaceted, and I think some very candid information is going to come out."
Hee suggested that based on the evidence he has seen so far, there is a "hostile workplace environment" at the State Hospital.
Hee and state Sen. Josh Green (D, Naalehu-Kailua-Kona), chairman of the Senate Health Committee, will lead the investigation. "One of the concerns we have is that there is a vicious cycle that’s being established," Green said. "It’s a challenging workplace, with challenging patients; you end up short-staffed, the work becomes difficult and then assaults occur because the workers are overwhelmed or exhausted or we just don’t have enough staff."
State hospital administrators described the facility, which was once under a federal consent decree for violating the constitutional rights of patients, as overcrowded and outdated.
The hospital has 202 licensed beds and contracts another 40 beds with Kahi Mohala Behavioral Health, a private psychiatric hospital in Ewa Beach. Admissions at the hospital reached a high of 333 patients last year, compared with 100 in 1997, with all patients referred to the facility by court order because they are considered potentially dangerous.
Dr. William Sheehan, the hospital’s medical director, said only about 20 percent of patients meet the clinical criteria for inpatient psychiatric care at a private facility. Many patients, according to the state, do not need inpatient care, do not have an actual mental illness, and stay longer than clinically necessary.
Most patients — 73 percent — have substance abuse issues, predominantly methamphetamine, marijuana and alcohol abuse.
The state has approved 666 full-time jobs at the hospital, and administrators say 584 of the jobs are filled, a vacancy rate of 12 percent.
Because of the increasing population, Gov. Neil Abercrombie approved a special action team in 2012 to address problems at the State Hospital.
The state Department of Health, which oversees the State Hospital, is looking at alternatives so people with mental illness can get the treatment they need to help keep them out of the criminal justice system and the State Hospital. The state may also consider a crisis stabilization center so not all patients would be sent to one place.
Anecdotal accounts of staff assaulted by violent patients attracted the attention of the news media and the Senate, yet the number of assaults reported by hospital administrators has been relatively constant over the past several years. According to the State Hospital, there were 119 assaults on staff as of November of last year, 120 assaults in 2012, 132 assaults in 2011, 140 assaults in 2010, 164 assaults in 2009 and 150 assaults in 2008.
Senators, however, are disturbed by an average of one assault on staff every three days. Some workers have also said that they have been urged by their supervisors to minimize the severity of clashes with patients.
Workers on Tuesday told senators of being spat on, scratched, kicked and punched by patients. Dr. Scott Miscovich, a Kaneohe doctor who has treated many of the workers, said a frequent patient tactic is to ambush staff with a "blind-sided sucker punch to the back of the head."
Hee has taken particular interest in the case of Kalford Keanu Jr., a psychiatric technician seeking workers’ compensation after being subjected to several assaults. Keanu claims he was targeted by supervisors for retaliation for speaking out about problems at the hospital. According to Hee, an investigator for the state attorney general’s office absolved Keanu of wrongdoing in interactions with patients, yet Keanu was still admonished.
Senators have also heard from other workers who fear for their jobs if they complain about hospital conditions.
Josh Akeo, a registered nurse who works at the State Hospital, said he was severely beaten — including a soccer-style kick to the head — while attempting to break up a fight between two patients on a day when the hospital was short-staffed.
"I have a genuine fear for my job," Akeo told senators. "I sit here with a genuine feeling of fear for my job. Yes, I do. And it is very difficult to come forward to talk to you."
