New Hawaii State Hospital to open after lengthy delay

Officials overseeing the Hawaii State Hospital told state lawmakers Monday that their new 144-bed psychiatric facility is expected to open its doors to patients in about two weeks after more than a year of delays caused by a lack of policies and procedures, difficulty recruiting staff and flaws in shower floors, door handles and hinges.

Still, lawmakers expressed bewilderment at the reasons that were proffered for the delays during a 1-1/2-hour briefing in front of the Senate Health Committee and House Health, Human Services and Homelessness Committee, saying by the end that they still weren’t clear on what happened.

“I don’t know why it has taken so long,” said state Sen. Sharon Moriwaki. “But if you are actually opening up, that is good news.”

The gleaming $160 million facility on the Kaneohe campus was completed in early 2021 and granted a certificate of occupancy that February, following a state inspection and approval from the Honolulu Fire Department. However, it would be months before officials with the state Department of Health would create policies and procedures for operating the faci­lity and seek consultation with the unions that represent staff. New recruitment didn’t begin until May.

Marian Tsuji, DOH’s deputy director of behavioral health, conceded that this work should have begun earlier.

“We need to take responsibility for that over at DOH,” she said. “There are a number of things that we should have started while the building was still being built, like an operating plan, start drafting our policies and procedures, and we didn’t.” But she noted that DOH staff were also having to juggle the daily operations of the existing facility in the midst of a pandemic.

The building didn’t receive a license from DOH’s Office of Health Care Assurance until January.

Around that time, health officials and the state Department of Accounting and General Services determined that some aspects of the new building were not up to standard after all. Three or four of the 80 showers drain in the wrong direction and 50 of the showers aren’t sufficiently sloped to drain quickly, creating issues with ponding or even flooding, said Eric Nishimoto, public works manager for DAGS.

“We want them to work better, so we rejected them,” said Nishimoto. He said the contractor for the psychiatric facility has been told to fix them.

Nishimoto also said that there were doorknobs and door hinges that needed to be replaced to make sure that patients can’t use them to hang themselves.

DAGS also determined that the campus needs a better fire suppression system, and DOH has requested $5.3 million from the Legislature for that work, though Nishimoto said that is not holding up the opening of the building.

“There is a standard that is a very high standard,” said Nishimoto. “It is not that the facility isn’t compliant with anything or is not safe for occupancy. It is just an improvement to meet that very high standard.”

The state mental hospital primarily houses patients with significant mental health issues that have been ordered there by the courts after committing minor or serious crimes, or while awaiting evaluations on whether they are mentally fit to stand trial.

The delays have left patients housed in overcrowded and dilapidated buildings on other parts of the campus. Patients also haven’t been able to have in-person visitation with family and loved ones during the pandemic because state health officials say there hasn’t been adequate space to safely faci­litate the meetings.

The new facility was built in large part to address safety issues. In recent decades the campus has suffered from lax security contributing to numerous assaults by patients on staff. In one 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 flight to Maui and then flew to San Jose, Calif.

Another patient escaped in March, stirring frustration that the new high-security building continued to sit empty.

State health officials were expected to address the escape during Monday’s hearing but told state lawmakers that they were advised by the state Department of the Attorney General not to comment.

“That’s extremely disappointing,” said Sen. Jarrett Keohokalole, chair of the Senate Health Committee.

Opening the new building will happen in phases, Department of Health officials said, with 48 patients moving into the building’s third floor as soon as April 13. Another 48 patients are expected to move into the second floor by late this month, with patients occupying the first floor by May. By that time the showers are expected to be fixed.

Hawaii State Hospital Administrator Run Heidelberg said that the design fixes to the hospital should help when the facility is inspected by an accreditation agency after it opens. “The ponding could cause issues,” he said. “It is better for us to take the time to get it right or move in and get it wrong and lose accreditation at that point.”

Keohokalole expressed frustration with that response.

“I’m sorry. We have been at this for a year, and we’ve had multiple meetings. But it is not in the interest of the public that we take this time,” he said. “I don’t understand why prior to receiving keys from the contractor, it wasn’t established at some point that we had 50 of the 80 showers not sufficiently safe to meet joint commission accreditation standards to compel you guys to delay receiving receipt of the building.”

The delay in opening the new building has also caused delays in fixing dozens of flaws in the lower campus buildings that in 2017 were cited by the accreditation agency for posing a suicide risk. That work, supported by $8.9 million in funding, is expected to begin in May once patients are moved into the new facility.