The decision to furlough Hawaii government workers could result in an increase in overtime costs at facilities operated 24 hours a day.

At the Hawaii State Hospital in Käne'ohe, the only state-run psychiatric hospital in the Islands, some are questioning whether overtime costs to cover for furloughed workers will exceed what the state saves.

The concerns are spurring the Health Department to take another look at staffing at the State Hospital, including whether the Käneohe facility could be exempted from furloughs.

The Hawaii Government Employees Association represents 114 nurses at the State Hospital whose positions are staffed around the clock.

Those nurses are on a staggered furlough schedule, and their supervisors are trying to keep overtime to a minimum, Health Department officials said.

"It doesn't make sense to me," said state Sen. David Ige, D-16th (Pearl City, Aiea), the chairman of the Senate Health Committee. "It has got to cost more money in the long run."

He added he is doubly worried at the prospect of more furloughs at other 24-hour facilities, including prisons.

The HGEA ratified a contract with the state last month, under which most members will take 42 furlough days over two fiscal years, amounting to an 8 percent pay cut.

Those not subject to the furloughs include 1,985 employees at Hawaii Health Systems Corporation, which operates 14 state medical facilities. Instead, the hospital workers took a 5 percent pay cut because so many are in positions that require 24-hour staffing.

Health Department officials said it's not clear why furloughs weren't also taken off the table for State Hospital workers.

Another union — the United Public Workers — is also considering furloughs for government workers as part of ongoing contract negotiations, which could put other state facilities that require 24-hour coverage — including prisons — in a bind.

There are about 3,000 workers in UPW's Bargaining Unit 10, which includes prison guards and health care and emergency medical service workers, many of whom work in jobs that need 24-hour staffing.

FURLOUGHS ON TABLE

State Department of Public Safety Director Clayton Frank said last week it would be difficult to implement furloughs for prison guards, and added it wasn't clear if they would be exempted.

UPW officials, though, disagree that furloughs have to result in more overtime or will mean understaffing at 24-hour facilities.

"The furloughs are still a subject that we are willing to discuss for Unit 10," said Dayton Nakanelua, UPW state director. "Our view is that the furloughs, regardless of whether it's in a 24/7 facility or operation, through proper planning and scheduling, we could work (it out) where it would not impair or adversely impact on patient care."

About 1,500 Hawaii Health Systems Corporation employees are represented by UPW, said Miles Takaaze, public affairs officer for the corporation.

Speaking about the decision to have HGEA employees at the corporation take pay cuts instead of furloughs, Takaaze said: "All of the major players in the negotiations recognized that hospital care is very much unique."

At the State Hospital in Käne'ohe, the UPW union represents 252 workers, including psychiatric technicians, whose positions require 24-hour staffing.

The State Hospital would be "really hard-pressed" to comply with an additional furlough agreement for UPW workers whose positions are staffed 24 hours, said Dr. Bill Sheehan, acting chief and medical director of the Health Department's Adult Mental Health Division.

"We can probably manage for the time being. Should you put a UPW furlough on top of (the HGEA furloughs) it would be a big challenge. That is the looming sort of concern," he said.

STAFFING COMPLAINTS

HGEA officials said they are getting complaints from State Hospital workers over staffing.

"We continue to hear from members who are concerned that inadequate staffing levels will compromise the health and safety for staff, as well as other patients and the public," said Nora Nomura, HGEA deputy executive director.

Most of the patients at the hospital are "forensic admissions," which means they have been ordered there by the courts.

As of last week, there were 195 patients at the hospital. At the start of the year, there were about 168 people at the facility.

Officials say it's not clear what's causing the increase, though advocates point to cuts to community-based mental health services, which are meant to keep the severely mentally ill stable through treatment plans and by ensuring they are taking medication.

The state Office of Health Care Assurance has licensed the State Hospital for up to 202 beds. However, a patient census over 168, according to a Health Department report to the Legislature, requires the hospital to use rooms that are "substandard with respect to total area," access to a bathroom or the lack of an exterior window.

In 1991, the U.S. Justice Department's civil rights branch filed a lawsuit over conditions at the hospital.

The suit resulted in a consent decree that kicked off 15 years of federal oversight of the state's delivery of mental health services and treatment. Federal oversight of the state's mental health services ended in 2006.

Mental health advocates say the hospital is still far better than it was in 1991. But, they argue, compounding cuts and mounting staff problems could throw the facility back into turmoil.

"We know that in the past there have been incidents of violence that, certainly, adversely impacted staff and impacted other patients of the hospital as well," said Marya Grambs, executive director of Mental Health America of Hawaii. "I don't know how they can handle reduced staffing."

VACATIONS, SICK DAYS

Sheehan, from the Health Department, said it's possible the furloughs will increase overtime costs.

"The risk we run with the furlough is that we're going to have to incrementally increase that overtime" as schedules get tighter or people take vacation, he said. "We're trying to schedule people in such a way that we won't worsen our problem. But again, that's the risk. The problem over time will be how to make it even out. It will be harder and harder as time goes on."

Sheehan pointed out that about $30 million of the hospital's $50 million budget goes to salaries.

And the hospital, even before the furloughs, had significant overtime costs to cover for people in 24-hour positions who call in sick or are on vacation. In August, for example, the hospital spent $170,000 on overtime, $58,000 of which was spent to cover overtime shifts on Statehood Day, a state holiday.

"It's a substantial amount of money," Sheehan said.

Dr. Chiyome Fukino, director of the Health Department, said last week that the state is looking at the State Hospital situation to determine whether other options are available.

"We have to have savings," she added. "We have to do the best we can in the context of our severely restricted budget."