Federal safety inspectors investigating violence at Hawaii State Hospital

by Malia Zimmerman, Watchdog.org, December 5, 2013

KANEOHE, Hawaii — The feds are looking into workplace violence at the state’s hospital for the criminally insane after allegations of abuse of staff by patients recently surfaced.

The Occupational Safety and Health Administration is investigating  the Hawaii State Hospital, hospital administrators have confirmed. That study, launched just before Thanksgiving, began after four staff members publicly accused the hospital administration on Nov. 20 of perpetuating an unsafe environment for workers and patients.

Assaults on them by violent patients have increased to an average of one every three days and in some cases have caused serious injuries.

The OSHA investigation could take months, and the hospital could face fines or be compelled to make changes. State Hospital Administrator Bill Elliott said the hospital will have 30 days to respond to OSHA’s report.

State senators also have planned a series of investigative hearings to look into allegations by staff that the administration isn’t doing enough to prevent attacks, employee training is insufficient, the hospital is overcrowded and understaffed and the most deranged patients aren’t properly managed.

The most recent serious attack, officials confirmed, happened on Thanksgiving. Three workers were reportedly injured after a patient attacked a worker and two others intervened.

‘On its last legs’

Set at the foot of the Koolau Mountains in Kaneohe, the facility was established in the 1930s, with buildings designed in the 1950s and 1980s resemble a college campus. Administrators argue the facility wasn’t designed to handle violent offenders.

 A building known as Goddard condemned 10 years ago still waits, thanks to state bureaucracy, to be demolished and replaced

A building condemned 10 years ago still waits, thanks to state bureaucracy, to be demolished and replaced. Another, where 75 people are located, is, according to Elliot, “on its last legs” and also needs to come down.

Patients and staff intentionally wear no uniforms — the only way to tell the difference between patient, staff and guests are their badges. There are 314 cameras installed throughout the facility, but not in patient rooms or restrooms.

The facility is licensed for 202 people, but admissions have climbed to just under 350 per year.

Overflow is directed to a neighboring private facility, Kahi Mohala, which has accepted 40 patients and charged the state $4 million in 2013, pushing the state hospital into a deficit of $4.8 million, Eilliot said.

Kahi Mohala charges $750 per patient per day, more than the $723 per person per day that taxpayers fund at the state hospital, where the annual budget is about $52 million.

The number of patients continues to rise because of a shortage of facilities in the state to address various mental illnesses that may not be treatable. Some patients have organic brain syndromes, cognitive impairment and concurrent physical health problems. Most don’t need inpatient psychiatric treatment for very long, if at all. Most stay for months or even years, even if they don’t need inpatient treatment, Elliot said, because of legal process and lack of discharge alternatives.

 State Hospital Administrator Bill Elliott shows the security control center at the Hawaii State Hospital where video from 314 security cameras are directed.

“The Hawaii State Hospital rate of admission and census remains higher than the system can manage; arguably worse than two years ago,” stated a Nov. 14 report issued by the Governor’s Special Action Team, set up to address trouble as the hospital.

“When the Hawaii State Hospital operates in excess of licensed capacity, patient care may be compromised, program integrity may be lost, staffing costs rise and the exposure to review by other agencies, such as the U.S. Justice Department and state of Hawaii Office of Healthcare Assurance, increases,” the report said.

Improving staff safety

Sixteen employees were so seriously injured in the last three years that they were put on leave and workers compensation for weeks, months or even years.

“Our goal is zero assaults,” Dr. William Sheehan, chief of the Department of Health’s Adult Mental Health Division, told Watchdog.

Elliot said the state would like to see the most violent criminals housed in a separate treatment center, but the plan to build one was scrapped a decade ago because of funding.

 The PICU unit for the state’s most violent mentally ill patients was closed after one week because of an assault on a staff member

The Psychiatric Intensive Care Unit, a four-bedroom unit in the existing hospital, was designed to house the most violent patients, but the $500,000 facility was only used for one week in 2011. After a patient beat a staff member, resulting in a broken eye socket, the administration used the PICU for non-violent female patients.

Employees who are assaulted by patients — and those who intervene — are often injured because staff members have no weapons or protective gear, and little self-defense training. The administration maintains there are no armed guards because it is a hospital and not a prison.

Nurse Josh Akeo said staff members are sometimes bitten, spit upon, punched, kicked or body slammed. He spoke recently about suffering a concussion and memory loss after he tried to separate two fighting patients.

 Hawaii State Hospital workers Ryan Oyama, Josh Akeo and Kalfred Keanu with Dr. Scott Miscovich standing behind them, talk about the assaults they endured while working at the Hawaii State Hospital

Sheehan and Elliot met with staff Monday, soliciting ideas to improve safety.

Right now, if a patient attacks another patient or staff member, staff witnessing the attack are told to press a beacon they carry for help, and wait until five employees are there to intervene as a team. However, back-up can take minutes to arrive.

Elliot said the hospital is considering revamping training for the staff to teach them other methods to deal with violent patients.

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