Subject: State Hospital Group Says Facility is Safer

By Helen Altonn

A former Hawaii State Hospital patient who serves on the facility’s Patient Protection Committee says she would have no qualms returning there for therapy.

"It’s not the way it used to be," said Sharon Yokote, 58.

The Kaneohe hospital "is no longer a holding cell," but provides treatment and skills to help people improve their lives, she said.

But workplace violence at the hospital was identified as a major problem in a recent court report by U.S. Magistrate Kevin Chang, the court-appointed special master for the hospital.

Chang said a lawsuit filed against the state by the U.S. Justice Department in 1991 over hospital conditions will not end until a "culture of fear" is addressed. The hospital is working to fulfill the requirements of a consent decree.

Chief U.S. District Judge David Ezra has tentatively scheduled a hearing on Chang’s report at 9 a.m. tomorrow.

One workplace violence act has officials worried. An employee’s car was destroyed by fire Jan. 20 in the hospital staff parking area. Investigators said the blaze was deliberately set with gasoline.

"We’d like to know why that happened and who did it," said hospital Administrator Paul Guggenheim, explaining the case still is under police investigation. "It intimidates me and everybody in the hospital. It’s an unresolved concern. There are no good answers."

The fire was set about 10:15 p.m., 15 minutes after the owner had left the car.

"Patients aren’t out, so we don’t know if it was somebody connected to a patient or walking through the campus who shouldn’t be there," he said, adding the hospital has stepped up its security.

Other than knowing it was arson, he said, the hospital has no information to tell the staff, "and that’s really unnerving people."

However, Patient Protection Committee members and others say incidents of violence, abuse and neglect have decreased significantly at the hospital in recent years. They say program, policy and procedural changes have made it a much more professional operation.

The patient population is more difficult, they say, with more admitted patients having substance abuse problems and psychoses.

The Rev. Michael Young, of the First Unitarian Church, another committee community member, cited "major, major changes to the whole atmosphere. ... We now have professional people willing to hold each other responsible for behaving like professionals.

"It was a madhouse, literally, 10 years ago," Young said. "From what I know about the way things used to be, the consent order was absolutely necessary and appropriate."

Yokote and Young have served about six years on the committee with three other community representatives and six hospital staff members. Yokote is one of two former patients in the group.

Young said that in the past, staff members would threaten colleagues who had reported incidents of workers not performing their jobs.

He said the Patient Protection Committee has had to document inappropriate behavior for "a handful of employees over and over again" until the administrator can justify firing them through the union process.

"The attitude, three directors back, was the union is so strong, we can’t fight ‘em, and our current director will fight ‘em on every little thing. He won’t win every time, but will establish a track record and get rid of unprofessional folk.

"We aren’t seeing serious kinds of incidents we were seeing six years ago," Young added. "It’s not tolerated."

Donald Wong, chief investigator for the Investigations Division in the attorney general’s office, confirmed that the volume of cases from the hospital "certainly has decreased."

A questionnaire circulated among nurses earlier this year indicated many staff members did not feel safe in some instances, said Dr. Rupert Goetz, the hospital’s new medical director.

He said the staff understands that severely ill patients can become angry and assaultive. "What was disconcerting, committee members were starting to talk about experiences with fellow staff where there was subtle intimidation," Goetz said. "That’s just something that shouldn’t happen, period.

He said he believes "violence has subsided." Most reports to the Patient Protection Committee involve neglect, such as a staff member walking away from a patient or nursing station, he said.

Young said the staff has learned "it’s important for their own mutual safety that they turn people in who are behaving unprofessionally, whereas before it was the old ‘let’s cover each other’s behind’ either by coercion or mutual agreement."

An exhaustive investigative process is followed for every serious allegation, Yokote said.

She said every unit has locked boxes for complaints, which are cleared daily by Catherine Davis, the hospital’s patient-rights adviser. She screens them and generates a report for each case describing what allegedly happened. All potential abuse or neglect incidents are referred to the attorney general’s office for investigation.

The investigators’ reports go to the Patient Protection Committee.

"What we’re looking for in an incident is, ‘Were any policies or procedures violated?’" Yokote said. The committee makes recommendations to Guggenheim, who decides remedial or disciplinary action.

Yokote, a member of state and national councils on mental health services, said the hospital used to be the only place to send teenagers who had to be separated from their families.

She was "just baby-sat" when she was there, she said, but with the consent decree the staff has gone through retraining to be part of treatment teams. "The staff are no longer jailers."

One of the newest changes has been creation of a Psychosocial and Rehabilitation Treatment Mall. Patients are taken from their units five hours a day for academic, vocational, recreational and other activities. They say it is one of the best things to happen there in years.

One of Goetz’s goals is to link programming in the mall more closely with the patients’ needs and make it "even more explicit that we want a culture of safety and mutual respect."

A total of 313 alleged incidents of abuse and neglect were investigated at Hawaii State Hospital from Jan. 1, 2000, to June 30, 2003.

Of those, 94 were substantiated; 202 were not verified. Others were withdrawn by the complainant, administration or an investigator from the attorney general’s office. Nine are pending.

Allegations ranged from 27 to 43 per quarter in 2000. The number dropped to 12 and 17, respectively, during the first two quarters of this year.

The largest number of substantiated complaints involved staff neglect -- 29 adversely affecting patients, and 29 with no negative outcome.

A breakdown of other substantiated allegations includes five for excessive force; five, physical abuse; one, physical threatening; three, psychological abuse; and 18, verbal abuse.

Unsubstantiated allegations included 53 for physical abuse, 19 for sexual abuse, one for sexual threatening, 34 for staff neglect harming patients, 18 for staff neglect with no adverse patient results, seven uses of excessive force, one financial exploitation, seven instances of physical threatening and 17 allegations of psychological abuse.