In May, the state Department of Health unveiled a long-awaited $160 million psychiatric facility at the Hawaii State Hospital to help improve safety and alleviate overcrowding.
The gleaming, 144-bed building in Kaneohe is equipped with state-of-the-art security along with hundreds of digital cameras, clear lines of sight, elevators that separate staff and potentially dangerous patients, and padded rooms where unstable patients can be constrained or confined to prevent self-injury.
The prison-like atmosphere is tempered by outdoor areas where patients can relax, athletic courts, a game room and an open dining room — all amid a stunning landscape that provides expansive views of Kaneohe and Kailua bays.
The new facility took years to develop, but five months after state officials opened the building to media tours, it remains empty as DOH continues to develop policies to govern its operations and struggles to fill staff positions.
A state health official declined to speculate on when it would start accepting patients.
The union representing many of the staff says a fundamental dispute over the vision for the facility has caused months of delays. Rather than a new hospital designed to treat mental illness, the Hawaii Government Employees Association says the state has essentially built a prison, and it’s taken time for state health officials to fully recognize that.
“It is truly going to be a correctional facility for individuals who have mental illness,” said HGEA Executive Director Randy Perreira. “If you started from that premise, then you would realize policies and procedures needed to be developed that addressed the security for both the patients and the staff.”
Perreira said that Run Heidelberg, the administrator at the Hawaii State Hospital, had wrongly viewed the building more as a hospital with elevated security.
“From the get-go, the Hawaii State Hospital administration just didn’t plan adequately for how this new building would be staffed and opened,” Perreira said.
He said security at the facility should be akin to what’s found at the state’s Oahu Community Correctional Center and Halawa Correctional Facility, where there are trained correctional officers.
According to Perreira, planning has since been transferred to DOH’s Behavioral Health Services Administration, and that in a promising sign, Ted Sakai, a former director of the Department of Public Safety, which oversees the state’s jails and prisons, has been brought on as a consultant.
Sakai confirmed he is assisting the project but said he was not at liberty to comment.
DOH did not respond to Honolulu Star-Advertiser requests to interview Heidelberg, who holds a master’s degree in psychiatric mental health nursing and a doctorate degree of nursing practice. He has worked at the Hawaii State Hospital since the mid-1990s and took over as administrator in 2019.
Heidelberg led a media tour of the facility in May, showcasing its new security features and classrooms set up for therapy and anger-management sessions with patients. He said the majority of patients at the facility at any given time are homeless and more than 90% suffer from substance abuse on top of their mental health issues.
Many patients also are suffering from severe trauma, he said.
At the time, Heidelberg said the new facility was set to begin housing patients in August.
Marian Tsuji, deputy director of DOH’s Behavioral Health Services Administration, didn’t directly address Perreira’s characterization of past conflicts between the union and hospital administration, but said the department and HGEA are now “on the same page.”
“I think we are all headed in the same direction,” she said. “We are all anxious about getting into this new facility, but at the same time we want to do it right.”
The Hawaii State Hospital has been plagued with problems for decades, including lax security and hundreds of assaults by patients against staff. In one high-profile example of security failures, Randall Saito, a patient who was sent to the hospital in 1981 after being acquitted of murder by reason of insanity, walked out of the facility in November 2017, called a taxi that took him to the airport, boarded a chartered flight to Maui and then took a commercial flight to San Jose, Calif.
He was eventually caught and sentenced to five years in prison for the escape.
This year, the hospital again made headlines after it was revealed that Honolulu police wrongly arrested a homeless man for a crime committed by someone else. Joshua Spriestersbach was locked up in the Hawaii State Hospital for more than two years and forced to take psychiatric drugs.
State health officials have long emphasized the new building would go far to assist with reform efforts, including improving security and alleviating overcrowding. The hospital is licensed for 202 beds, but with waivers has held as many as 238 patients in other buildings on campus and at a contracted facility in Ewa.
As of Friday, there were 220 patients, according to DOH. Hospital officials have said the crowding has reduced classroom space and the ability to focus on therapy.
Nearly all of the patients at the Hawaii State Hospital, which is the only publicly funded psychiatric hospital in the state, were ordered there by the courts. But 69% of the current patients have not been convicted of any crimes, according to DOH. Of those patients, 16% were acquitted but committed to the hospital by the courts. Many of the patients were deemed unfit to proceed at trial or are awaiting such a determination.
Patients end up at the hospital after being charged with a wide mix of offenses. Between fiscal years 2015 to 2019, 40% of patients committed to the hospital had been charged with misdemeanors or petty misdemeanors, according to the Hawaii State Hospital’s most recent annual report to the Legislature.
About 1 in 5 patients were charged with Class A and B felonies and 38% were charged with Class C felonies. The average stay at the hospital during the 2019 fiscal year was about eight months.
DOH hoped to build a new psychiatric facility as far back as 2005, but funding was slow to come. Gov. David Ige’s administration was able to secure the funding in 2016 and the Legislature later provided funding in the 2021 fiscal year for 127 new positions.
The state is currently recruiting registered nurses, psychiatric technicians, social workers and phone operators, and is also evaluating the need for security personnel, a patient rights adviser and kitchen helpers.
But out of the 127 funded positions, just 31 have been filled as of September, according to DOH, while an additional 25 applicants have been selected but haven’t yet begun work.
State health officials say recruitment didn’t start until after a statewide hiring freeze was lifted in April, and emphasized in emailed responses that “there have been challenges to hiring hospital personnel throughout the country and Hawaii is no exception.”
Tsuji said she was reluctant to provide a timeline for when the new facility will start accepting patients. She said an internal committee within DOH has been meeting regularly to develop policies and procedures for the new building, which also needs to be licensed by the department’s Office of Health Care Assurance.
She said the COVID-19 pandemic also has complicated matters.
“I’m reluctant to say anything just because we’re still in a pandemic,” Tsuji said. “And I’m just really reluctant to commit to a solid timeline in light of that.”
She said that when the draft polices and procedures are ready, DOH will provide them to HGEA for review.
