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Over the past 11 years, workers at the Hawaii State Hospital have been assaulted by patients at a rate of about three times per week, or once every other day, according to data from the Hawaii Department of Health. 

The data shows that between fiscal years 2013 and 2023 there have been at least 1,207 assaults on staff and another 507 attempted assaults. 

The attacks have ranged in severity — from kicking, hitting and spitting that requires little in the way of treatment to other more serious affronts that require outside medical intervention. 

Kalford Keanu is among those who experienced the violence while working at the psychiatric hospital. He was a psychiatric technician there for 17 years, but quit in July after the birth of his daughter because he was worried that one day he might not come home to see her. 

Keanu said he had worked with patients who had been arrested for rape and murder. 

He’d lost count of how many times he’d been assaulted, but knew that it was in the dozens. At least twice he missed work for months at a time due to injuries, including one instance in which he suffered a concussion after being punched in the back of the head. 

“Ultimately, it just wasn’t safe,” Keanu said. “I didn’t want to put my family through it anymore.”

The Hawaii State Hospital has a long history of troubles that have included poor living conditions for patients, short-staffing and lax security that has resulted in a dangerous work environment for employees and high-profile escapes. 

In November the hospital came under renewed scrutiny after a nurse there, Justin Bautista, was stabbed to death by a patient inside a transitional housing unit located on the hospital campus. 

Tommy Kekoa Carvalho has been charged with Bautista’s death, and questions have been raised about whether officials should have kept Carvalho in a more secure part of the hospital given his history of aggressive behavior. Carvalho has pleaded not guilty to second-degree murder. 

Keanu said it was only a matter of time before someone at the state hospital was killed. 

In 2013, he was one of several employees who spoke out about safety concerns at the hospital. Then, as now, the rate of assaults on staff was about once every three days. 

The state Senate had launched a special committee to investigate the attacks. That committee, which was co-chaired by then Sens. Clayton Hee and Josh Green, who is now Hawaii’s governor, ultimately found that the hospital was not properly equipped to handle a new breed of patient, one that had been committed there by the criminal courts and that comprised almost the entire population. 

Like Keanu, the committee warned in its final report of the potential for danger if the situation did not improve.

“The paramount workplace safety issue appears to be violent and unstable patients attacking staff and causing injuries,” the report said. “Your Committee is concerned that if this problem is not immediately addressed, a fatality will occur at the Hospital.”

The state eventually decided to build a new $160 million state hospital, one that was designed to treat forensic patients in a more secure environment.

While that facility opened in 2021, many of the same problems continue to persist, whether it’s understaffing and overcrowding or the constant threat of violence due to faulty equipment, poor training and lax security protocols. 

“It’s crazy to  think that that’s what they thought would fix it,” Keanu said. “You can buy a new car, but if you have the same reckless driver you’re going to crash that car too.” 

‘Assaults Are Going To Happen’

Each year, the health department submits a report to the Legislature detailing how many assaults take place within the state hospital. The most recent report available is from February and includes figures through fiscal year 2022. 

According to that report, an assault can be described as any physical contact that results in injury or emotional distress and can include everything from hits, spits, kicks and sexual assaults. 

In fiscal year 2022, there were 154 assaults and attempted assaults at the state hospital, which was a decline from the year before when there were 234, which was the highest total over the past 10 years.

The report notes that most of the 535 patients who were treated at at the state hospital in fiscal year 2022 — about 90% — were not involved in any acts of violence targeting the staff, and that 79 of the 154 assaults were committed by eight individuals. The remaining 75 assaults were attributed to 49 other patients, meaning there were a total of 57 individuals who were responsible for all of the recorded assaults that year. 

The health department reported 33 injuries to staff in fiscal year 2022, most of which did not require treatment. The report did not detail what types of injuries workers suffered, but noted that only one required first aid and seven involved “outside medical intervention.” 

Hawaii State Hospital Administrator Kenneth Luke declined Civil Beat’s requests for an interview to discuss the assaults that have occurred on hospital grounds or what has been done to address the violence. 

In an email, DOH communications staff tried to distance the state hospital and the new patient facility from the transitional housing unit where Bautista was killed, saying that is “not part of the hospital” and instead is a “group home on HSH grounds.”

According to DOH, the only assault to occur within the home in its nearly 15-year existence was the one that resulted in Bautista’s death. There was an attempted assault in 2021, DOH said, but that attack did not result in any physical contact with hospital staff working in the home. 

The agency provided figures showing there were 119 assaults and attempted assaults at the Hawaii State Hospital in 2023, which was a 22% decrease from the previous year. 

The agency also provided figures showing assault rates at other psychiatric hospitals located throughout the Western U.S. The data was collected by the , or WPSHA, of which the Hawaii State Hospital is a member, and only included figures from fiscal year 2023.  

The WPSHA comparison showed that the Hawaii State Hospital ranked 16th out of 22 hospitals surveyed in terms of the rate of “patient-to-staff aggression events” and 20th for injuries. 

Mike Sheldon, president of the WPSHA and chief executive officer of the Arizona State Hospital, said that any accounting of assaults taking place inside of psychiatric facilities need to be placed into the proper context. 

Not all assaults result in injury, he said, and even some of the slightest touches, such as a patient pushing another patient on the shoulder to move them out of the way, could be counted in the data. 

It’s also important to note that many patients, including those held in forensic facilities, are non-violent, Sheldon said, and that research has shown that people with mental illness are more likely to be victims of violent crime than the perpetrators of it. 

“Assaults are going to happen and it's unfortunate,” Sheldon said. “People think that just because someone is in the state hospital they should be locked up. But technically that’s a civil rights violation. We’re always trying to balance safety versus promoting patient rights.”

Sheldon said that part of his job is pushing back against the perception about what goes on inside of his hospital. Many people still think of psychiatric institutions as with padded cells and overly medicated patients wearing straight jackets. 

Sheldon said that stigma can be hard to shake, especially after high-profile incidents, such as Bautista’s death, that can send “shockwaves” into the community.

Public messaging is important, he said, and it’s critical that hospital administrators constantly remind people that the purpose of a psychiatric facility, such as the Hawaii State Hospital, is not to keep patients locked away for the rest of their lives. 

“A state hospital is not a prison, it's a hospital,” Sheldon said. “Our job is to treat individuals with the intention to eventually discharge them to a lower level of care so that they can reintegrate into society safely and be worthwhile contributors to society.”

Civil Beat’s community health coverage is supported by , Swayne Family Fund of Hawaii Community Foundation, the Cooke Foundation and .