7 changes this hospital plans to make after a staff stabbing

The Hawaii Health Department implemented security and patient changes to the State Operated Specialized Residential Program and Hawaii State Hospital facilities following the death of a nurse.

On Nov.13, Tommy Kekoa Carvalho, 25, a former patient at Hawaii State Hospital who was discharged in August, returned to the facility and was accused of stabbing former nurse, Justin Bautista, RN, multiple times in the head and neck. Mr. Carvalho was charged with murder in the second degree. 

Following the incident, state residential facilities increased security patrols, increased staff-to-patient ratios from 1:5 to 1:3, and all residents are now subject to screening including pat searches, metal detector wands and urine drug screenings upon return to the facility if they go off grounds, according to a Feb. 29 department news release. Additionally, a four-day safety stand-down was instituted for both facilities to review and improve safety policies and procedures. 

Additional recommendations from the review also include:

  • Organizational structure changes, including establishing a standing safety and security committee, establishing an assistant administrator for safety and operations, and having reports given directly to the health department's deputy director of behavioral health.

  • Improvements to operations and facility, including enhanced contracted security personnel and a rapid response team, relocating the guard shack, repair and addition of cameras with remote monitoring capabilities, and integration of PA systems to the grounds.

  • Reducing state hospital census by increasing service provider rates, the number of community-based group homes and the number of certified court examiners to expand services to at-risk individuals.

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