Case: United States v. Hawaii

On March 3, 1991, the United States filed a lawsuit under the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. § 1997, against the State of Hawaii, the Hawaii Department of Health, and Hawaii State Hospital (HSH), in the U.S. District Court for the District of Hawaii, Hawaii Division. The government asked the court for injunctive relief, alleging that the defendants were depriving HSH residents of their constitutional rights, privileges or immunities. Specifically, the government contended that the defendants (a) failed to provide patients at HSH with psychiatric care necessary to ensure patients were free form undue bodily restraint or unreasonable risks to their personal safety, (b) failed to ensure that medications were prescribed and administered by qualified staff, (c) failed to provide an adequate number of sufficiently trained staff, (d) failed to ensure professionally based recordkeeping and record review systems, (e) failed to maintain the physical environment at HSH, and (f) failed to limit bodily restraint and seclusion to instances where professional judgment indicated their use.

Previously, on November 6, 1989, the Department of Justice (DOJ) sent the Governor of Hawaii a letter indicating its intention to investigate conditions within HSH at Kanehoe and Honolulu, Hawaii. In the letter, the DOJ related allegations of inadequate number of professional and direct care staff, abuse and neglect of patients, overuse of restraints, inadequate recordkeeping practices, substandard physical conditions, and the failure to provide treatment sufficient to avoid undue risks to personal safety and unreasonable bodily restraint. After touring HSH on December 11-14, 1989, on March 1, 1990, the DOJ sent the Governor a findings letter. In the letter, the DOJ cited conditions at HSH respecting inadequate food, clothing and shelter, unsafe psychopharmacological practices, inadequate general medical care, a lack of adequate treatment programs that resulted in undue bodily restraint, and inadequate record-keeping practices. The DOJ further outlined certain remedies to stop patterns and practices at HSH that resulted in deprivations of patients' constitutional rights.

After the DOJ's findings letter apparently went unheeded, the government filed this suit.

On September 19, 1991, the District Court (Judge David Alan Ezra) approved a consent decree. Under the consent decree, the defendants were required to submit monthly and quarterly reports and to permit the DOJ to regularly tour HSH to monitor compliance. The DOJ toured HSH in April 1992, January 1993, March 1994 and November 1994. The DOJ repeatedly communicated to the defendants that they never fully complied with the consent decree.

On December 14, 1994, the government filed a petition to hold the defendants in contempt for failing to adequately staff HSH and implement an effective organizational structure. The government further sought a moratorium on further non-emergency admissions, full staffing within four months, procedures for monitoring abuse, the appointment of an external monitor and a protective order for HSH employees who assisted DOJ. Ruling on the government's contempt motion, on January 10, 1995, the District Court (Judge Ezra) found the defendants in contempt, and further granted the protective order for HSH employees who assisted the DOJ.

On November 15, 1995, and on June 28, 1996, the District Court (Judge Ezra) entered orders regarding procedures for reporting and investigating allegations of abuse and neglect at HSH, as well as implementation of certain provisions to remedy the defendants' contempt of the settlement agreement.

On February 13, 1998, the District Court (Judge Ezra) denied the government's motion for appointment of an independent expert to monitor compliance in the child and adolescent mental health programs. However, on March 18, 1999, the Court established a compliance committee.

On January 7, 2000, the District Court (Judge Ezra) ordered a special monitor to be in place within 30 days, and, on January 20, 2000, the Court appointed Leland Chang as special monitor. On February 21, 2002, the Court appointed Kris A. McLounglin to replace Leland Chang as special monitor. Significant litigation followed respecting the power, term and budget of the special monitor.

On June 19, 2001, the District Court (Judge Ezra) appointed Magistrate Judge Kevin S. Chang as special master. Significant litigation followed respecting the numerous reports and recommendations from the master. See e.g., United States v. Hawaii, 424 F.Supp.2d 1278 (D.Hawai'i 2006). On December 1, 2006, following the filing of the master's twelfth report, the district court (Judge Ezra) dismissed the case with prejudice.