Hospital needs better strategies

Two weeks have passed since killer Randall Saito slipped away from the Hawaii State Hospital in Kaneohe, made his way to Maui and then to California, where he was apprehended.

Six investigators from the state Attorney General’s Office are now tasked with piecing together how the escape occurred, and seven hospital employees tied to the incident have been suspended without pay. State officials did the right thing with those initial responses; now the public is due a candid, timely accounting of what went wrong and a strategy for avoiding future screw-ups.

The suspensions, however, are touching off workplace concerns that underscore long-standing problems at Hawaii’s only publicly funded, state psychiatric hospital.

The Hawaii Government Employees Association is rightly worried about an emerging situation that has forced employees to work double shifts to compensate for tight staffing already in place before the suspensions. Unless the state finds relief, HGEA executive director Randy Perreira said, matters are likely to get worse at the facility that struggles with overcrowded patient conditions; an increasing number of high-risk, potentially violent patients; and ever-present concerns about employee safety.

The union had filed a complaint about mandatory overtime to the Hawaii Labor Relations Board before Saito walked off the grounds. He was committed in 1981 after being acquitted by reason of insanity in the shooting and stabbing of a 29-year-old woman who was in a car parked next to his at Ala Moana Center.

Given the substandard conditions at the aging hospital, which was built for 178 beds but consistently has more than 200 patients, Perreira has said staff are more likely at risk for physical assault. That’s distressing, as it is a valid concern.

Two years ago, when the state Department of Health, which runs the hospital, announced plans for a $160 million facility expansion — a master plan calls for more than doubling the number of beds and installing tighter security — records showed that there had been nearly 330 assaults or attempted assaults on staff in the previous 2-1/2 years.

In 2014, a state Senate committee investigating work conditions conducted 10 hearings; a final report warned that ongoing assaults could eventually end in a fatality if safety problems weren’t quickly addressed.

Last week, while acknowledging the impact the suspensions are having, Gov. David Ige said: “We are required to provide services 24/7, 365 days, so, yes, we needed to make some adjustments and that may include some overtime.” But overtime imposed upon an already stress-ridden staff seems ill-advised. Surely, the state is seeking ways to reduce the risk of further trouble by bringing in temporary staff or redirecting admissions of new patients.

Ige’s office has said security guards have been “reposted,” and all staff are being retrained on existing policies, which are being reviewed. The public must be apprised of findings and improvements. Security personnel, in particular, needs scrutiny. Many of the patients are inmates from the state prison system — including those charged with violent crimes — who have been referred for mental evaluation, care and custody.

Saito is one of 17 people who have escaped in the past eight years. Most of the escapes occurred when a patient broke “curfew,” failing to return to the grounds after being allowed to leave for a period of time. The Health Department told the Associated Press last year that most escapees returned within a few days. One exception: David True Seal bolted in 2009 and wasn’t found until 2013, when authorities said he confessed to killing a man on Hawaii island. Seal is now serving a 20-year prison sentence.

The mother of a patient currently on the loose contacted the Star-Advertiser the day before Saito’s escape, saying she was worried that her son, Gregory LaBar — a suspected felon diagnosed with paranoid schizophrenia and bipolar disorder— could be a danger to others and to himself. Two months have passed since LaBar had escaped from Kahi Mohala, a mental health facility in Ewa Beach where the DOH contracts for 40 beds.

Little had been done to alert the public. On Nov. 12, when Saito escaped, hospital officials notified authorities 10 hours later. Any delay is unacceptable, of course.

The public has a right to prompt information about any escape from state custody and should be advised on how to assist authorities. That’s the standard corrections system protocol when, for example, a community custody inmate fails to meet a check-in time at a work furlough center. The state must develop a system that swiftly relays a hospital escapee bulletin to the media and other transit sources. Had taxi services and airport facilities been on the lookout for Saito, promptly, his capture might have occurred on-island.

This current focus on the State Hospital must prod the state to complete its facility overhaul, as scheduled, by 2021. The current master plan is a revision of one drafted more than a decade ago. That plan was never funded or implemented — and, not surprisingly, we’re witnessing the spilling of consequences.