KANE'OHE — A tour of Hawai'i State Hospital by lawmakers and other officials yesterday reinforced claims that overcrowding and understaffing at the mental hospital is putting workers and patients at risk, state Sen. Clayton Hee said.

Some hospital staff members added that with 95 percent of the clients sent by the court system, the hospital's focus on rehabilitation is overwhelmed by criminal admittees that include some violent offenders.

Hee, D-23rd (Kane'ohe, Kahuku), and state Sen. Jill Tokuda, D-24th (Kailua, Kane'ohe), toured the facility with state Department of Health officials, hospital administrators and employees.

At the end of the tour, Hee said he was impressed with the pride employees display in providing interesting and meaningful programs for the patients. But Hee said he was disappointed to learn about the recent staff cutbacks.

"I think his challenges are great but I don't agree with his remedy to cut staff in a facility that this year has over 100 assaults and, by everyone's admission, is overcrowded," Hee said of hospital administrator Mark Fridovich.

The Hawai'i State Hospital is licensed to have 178 patients. Today, it will have 201, nurse manager Candace Sullivan said.

The hospital has 550 employees and hires 55 to 60 additional workers through an agency. Last November, there were 110 agency hires, but half of them were released in an effort to address a $6.5 million deficit, Fridovich said.

"We succeeded in reducing our deficit to $5 million," he said. "We still have a big deficit. It's about 10 percent of our operating budget."

An effort is being made to replace workers who were let go, Fridovich said.

Hee said the move was shortsighted and that it contributed to the more than 100 attacks on staff and patients so far this year. Fridovich disagreed.

"Most of the very serious assaults are due to an extremely small number of patients and they don't appear to be directly related to either the census (number of patients) or the staffing," Fridovich said.

Hee asked for the tour in part because of the recent resignation of hospital psychiatrist Dr. Karen Ritchie, who said four doctors were assaulted in the past several months. Hee also had met with several employees to discuss the state's decision to not pay new hires a bonus for signing up. The differential pay is expected to be reinstated soon.

Fridovich said a person admitted into the hospital is supposed to go through an evaluation process that could take 30 days. But with the growing number of referrals — 31 in the past 30 days — the hospital is forced to send some of the new referrals into the general population early, he said.

Dr. Michael Chang, a psychiatrist at the hospital, said the facility is not set up to handle patients referred by the courts. "To me, the biggest problem here is we're a forensic hospital that's not playing by forensic rules," Chang said. "Sometimes 95 percent of our patients have broken the law and have a long history of criminal activity."

The hospital is a rehabilitative facility but it also needs cells when safety becomes an issue, Chang said.

Because the hospital is short-staffed, employees must work overtime, said Annalyn Simon, a nurse manager.

"Sometimes nobody wants overtime and we just run our unit short," Simon said. "It matters when one less staff (member) is in the unit."

Nurse manager Grace Pakele said there are times when not enough staff members are available for programs, or that too many patients crowd classrooms like at the "mall" that can accommodate 165 people but where 180 were there yesterday.

"Our programs become ineffective because we just end up housing patients," Pakele said.

Sullivan noted that clients sent by courts can refuse mental-health treatment. It is then up to the hospital staff to petition the courts and they must have justifiable reasons to get permission, which can take three weeks to obtain, Sullivan said.

The courts also decide when a patient leaves, Fridovich said. There are 80 patients who are eligible for release but because there's nowhere to place them or because of legal obstacles, they remain at the hospital, Fridovich said.

Reach Eloise Aguiar at eaguiar@honoluluadvertiser.com.