The Packed Hawaii State Hospital May Soon See A Surge In Patients From A Private Facility

Health officials are seeking $14 million in emergency funding to try to improve security and reduce the patient population at the Hawaii State Hospital, but the psychiatric facility may soon have to make room for an influx of even more patients from the privately run Kahi Mohala facility.

The hospital has contracted for years with the nonprofit Kahi Moha to house 40 of its patients there, and most or all of those patients are “forensic” patients. That means they were committed to Hawaii State Hospital by the courts after being arrested.

Sutter Health network is now pursuing a deal to sell Kahi Mohala to The Queen’s Health System, and “Queen’s has indicated that the forensic patients will no longer be serviced at that campus,” said Marian Tsuji, deputy director for behavioral health for the state Department of Health.

Tsuji told lawmakers Wednesday that the department is trying to reduce the number of patients at Kahi Mohala to prepare for the movement of patients from that facility back to Hawaii State Hospital. But the loss of the Kahi Mohala beds seems likely to aggravate already severe crowding at the hospital.

Kahi Mohala referred questions to a public relations firm, which said it didn’t have any information. Queen’s didn’t respond to a request for comment.

‘A Very Challenging Time’

Dr. Kenneth Luke, administrator of Hawaii State Hospital, told members of the House Health and Homelessness Committee on Wednesday the hospital is licensed for 297 beds, but as of Wednesday morning had 345 patients. That does not include the patients now at Kahi Mohala.

Public attention has focused on problems at Hawaii State Hospital since Nov. 13, when a patient stabbed to death 29-year-old nurse Justin Bautista with what hospital staff have described as a pocket knife.

The attack occurred on the hospital grounds in an unsecured cottage used for a state-operated specialized residential program, which functions much like a halfway house. Tommy Kekoa Carvalho has been charged with second-degree murder in the case and is being held at the Oahu Community Correctional Center.

The case was the first killing of a staff member on the hospital campus, but the hospital has long been the subject of complaints about abuse of patients and threats and violence against staff.

Luke said after the attack on Bautista that the hospital has been urgently trying to reduce the patient count, but the census numbers he announced Wednesday suggest the facility has made little progress on that front in recent months.

“Hawaii State Hospital is going through a very challenging time right now,” Luke told lawmakers.

“The types of patients that we’re getting are much sicker than we got maybe a decade ago. These are patients that have not only a chronic and severe mental illness, but they also have co-occurring conditions, oftentimes a substance abuse disorder, primarily methamphetamine,” Luke said.

“This really complicates their conditions, makes them much more acute, much more difficult to treat,” he said. Luke said 70% of the patients were “houseless” on the street, and are therefore less stable than patients of past years.

He described the hospital staff as “the best staff that any hospital could ask for … but I feel that we owe them what we can to make the place safer.”

Backlog In Evaluations

One problem has been the long delays in processing people sent by the courts to Hawaii State Hospital for evaluations to determine if they are mentally fit to proceed with their criminal cases, Tsuji said.

Those patients sometimes remain at the hospital for many months because of a backlog in the evaluations, which contributes to the high patient counts.

“We need to process people a whole lot quicker than what we’ve been doing,” Tsuji said. “We’re short forensic psychologists, evaluators at the courts as well as at the hospital, and so if we can get those evaluations done quicker, we can process them quicker.”

Crisis Shelters And Metal Detectors

House Health and Homelessness Committee Chairwoman Della Au Belatti questioned Luke and Tsuji about the request for an emergency appropriation to finance improvements to Hawaii State Hospital.

The original funding request in House Bill 1941 was for $5.975 million, but Gov. Josh Green is about to submit a governor’s message that will increase that request to $14.2 million, Luke said.

A consultant’s report last month recommended changes in hospital operations, and the money would be used to finance a reorganization, according to hospital staff. It would also pay for an expansion of the hospital’s existing network of community-based treatment facilities, Tsuji said.

Those facilities are used to transition patients back into the community after they have completed treatment at the hospital. But some patients cannot be placed in group homes because they are full, which contributes to overcrowding as patients remain at the hospital until a community slot opens, Tsuji said.

She said the governor’s message will ask lawmakers to fund two licensed crisis shelters for patients, and two additional houses with 24-hour supervision. The state plans to award contracts to operate those facilities, Tsuji said.

Additional money is also being requested to increase the rates the state pays for existing group homes because in some cases those payments have not been increased in a decade, she said. Tsuji said she expects those rates will go up by 20% to 25%.

The hospital reorganization would involve creating a new “safety and security team” at the facility, and improving information technology, according to Naomi Yanagishita, associate administrator for administrative and support services at the hospital.

Another $650,000 would be committed to upgrading communications and information technology within the hospital, including fixing video cameras that no longer function, Yanagishita said.

Tsuji said some of the new funding would also be used to buy wand-type metal detectors to screen patients such as Carvalho who are allowed to come and go from the hospital campus. The hospital is also requesting money for drug testing, Tsuji said.

Tsuiji said the governor’s message will request $700,000 in construction funding to relocate the hospital’s guard shack to better control access to the facility.