A key Hawai'i State Hospital official who was applauded by U.S. District Judge David Ezra as one of those who helped to improve conditions and remove the facility from the purview of a federal consent decree is leaving.

Connie Ching-Mitchell, the hospital director of nursing and one of four members of the administrative committee that runs the facility, said she is resigning because she was told she must leave a rent-free two-bedroom cottage near the hospital on May 1, but would not get any compensation for losing her housing. Her resignation is effective May 1.

A critical issue at the hospital is overcrowding, and officials have said one way to deal with it was to set up cottages to provide 24-hour supervised care for patients.

Ching-Mitchell's departure could be significant for the facility, which struggled to emerge from the federal consent decree in late 2004.

More than 200 hospital workers supported Ching-Mitchell and endorsed a letter from the hospital nursing executive council to Chiyome Fukino, director of the Department of Health.

The letter said that without the housing, Ching-Mitchell, who supervises a staff of more than 350, would be paid less than other nursing directors in the U.S.

It warned that her departure represents a "crisis in the first order" and would be a "severe setback for staff morale."

Fukino responded last week that Ching-Mitchell's pay — not including the housing — totaled $105,000 last year and is in line with salaries of other nursing directors in the Hawai'i Health System Corp.'s community hospitals.

But Ching-Mitchell said the issue isn't about the money for her, but whether the hospital is fairly compensating the position. "For me, it's an issue of justice more than anything else," she said recently.

FEDERAL OVERSIGHT

Although the state hospital is no longer under the consent decree, state health officials are still under federal oversight to develop a plan to provide services to the seriously mentally ill in the community.

In February, U.S. Magistrate Judge Kevin Chang issued a blistering report saying health officials are still behind in developing the programs, resulting in overcrowding with an average number of 193 patients this year at the facility set up for 168 patients. He warned the overcrowding could jeopardize the improvements made the hospital.

At the time, Fukino said the cottages would be used to address crowding.

Ching-Mitchell said she would lose what she estimated to be about $2,000 a month for living at the cottage.

She said that when she first got the job five years ago, she had a base salary of $70,000, but was told she could live at the cottage near the hospital because she would have to be on call 24 hours seven days a week.

In late 2004, she also was given on-call pay, which allowed her to earn $105,000 last year, including carryover payments from 2004, she said.

She now earns nearly $100,000 annually, including the on-call pay, she said. But taking away the housing left her with no choice but to reluctantly resign, she said.

THE 'PRINCIPAL' OFFICER

The nursing executive council rallied to her support with a three-page letter to Fukino that included more than 200 signatures from hospital personnel. The letter, dated Feb. 12, said Ching-Mitchell would make less than her nursing subordinates and the perception is that she was forced to leave as a result of "shabby treatment" from health and hospital officials.

"In our estimation, Connie is the principal (state hospital and state adult mental health) official who makes staff and patient safety, patient care and clinical outcome the first priority," the letter said. "She does not seek recognition or approval but because of her honesty and integrity her staff deeply appreciates her as their leader. Since she has been the (director of nursing), morale has vastly improved and the competency of the staff has been enhanced."

It asked Fukino to find a way to keep Ching-Mitchell.

Ching-Mitchell later met with Fukino. "She was regretful she could not change anything, or offer me any compensation and that there were other managers that were not paid as much as people they supervise," Ching-Mitchell said.

'INHERENT LIMITATIONS'

After The Advertiser submitted questions about the resignation, Fukino last week wrote back to the council. She said "inherent limitations" in the state pay system "are known to offer woefully inadequate professional salaries when compared with industry standards for comparable positions."

The health director instead compared Ching-Mitchell's compensation with the directors of nursing in the state community hospitals who receive $78,000 to $92,220 annually, while regional chief nurse executives receive $95,058 to $109,200.

Fukino said Ching-Mitchell received $105,000 last year, has an annual base salary of $80,683 and a 25 percent standby pay compensation, and would receive pay increases through April 1, 2007.

Ching-Mitchell said she doesn't want to denigrate the community hospitals, but said officials at those facilities do not have to deal with the issues involving the mentally ill, such as violence and mandates from the courts. She said that her standby pay she received starting in late 2004 meant for the first three years she didn't get paid for her on-call status.

The council letter said Ching-Mitchell is the only female and the only person born and raised in Hawai'i who sits on the hospital administrative committee. She is a 1974 graduate of McKinley High School.

"The value of the cultural understanding and sensitivity she brings to Hawai'i State Hospital cannot be overestimated," the letter said.

In her letter, Fukino said she assumes the comments are "less a request to take race into consideration" than they are to make sure senior managers are "culturally sensitive to the vast array of people who live and work in our island state."

"We endeavor to make hiring selections based on the abilities, education and experience of interested applicants," Fukino said.

REQUEST UNANSWERED

The Health Department did not respond to a request for the salaries of the other three committee members — including acting Hospital Administrator William Elliott. But Elliott's predecessor, Paul Guggenheim, was paid about $193,000.

The other official who left the department last year was Alan Radke, medical director for the adult mental health division, who received $210,000 a year.

Ching-Mitchell said she was "stunned" to receive word that she had to leave the cottage.

She said the issue is whether the job is fairly compensated to enable the hospital to attract a qualified nursing director in the context of what other health and hospital officials earn.

"For me, I'm willing to work for less," she said, if the compensation was fair in terms of what her supervisors and subordinates earn. She said several of her nursing subordinates have salaries higher than her pay.

She said that when she submitted her resignation, she wondered whether the health officials would respond. Instead, they accepted her resignation, and began looking for a replacement, she said.

What should the director of nursing make?

She said $120,000 annually "would not be too much."

Reach Ken Kobayashi at kkobayashi@honoluluadvertiser.com.