HONOLULU (KHON2) — Keeping workers safe, and figuring out a better way for patients to re-enter society, are top concerns after a patient was arrested on suspicion of killing a nurse at the Hawaii State Hospital.

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The state’s psychiatric hospital has been under scrutiny for decades, with hundreds of millions invested in new facilities, security and beefing up staff. Yet, KHON2 found staff risks actually have increased there in recent years,

So what needs to change?

It has been nearly a decade since escalating assaults at Hawaii State Hospital landed the state administration before a panel of lawmakers investigating workplace safety at the psychiatric facility. In researching the panel’s final report, Always Investigating found this prescient conclusion: “If this problem is not immediately addressed, a fatality will occur at the Hospital.”

Yet, despite years of hiring and training, and millions invested in the facility, KHON2 found a continual and steady increase in assaults and attempted assaults on staff since then, and tragically, a murder.

That has lawmakers raising questions again.

“We do not have enough staffers,” said Sen. Joy San Buenaventura, chair of the Senate Committee on Health and Human Services. “It’s one of those things that I’m going to be asking the governor to prioritize, to task his human resources department into prioritizing.”

Keeping workers safe in a job that involves working with dangerous, mentally ill patients comes with its own set of inherent challenges.

“Mental health and substance abuse can be chronic conditions with relapses,” said Dr. Kenneth Fink, director of the state Department of Health, “and our mental health system requires continued investment and full continuum of care to ensure that individuals are able to safely reside in the community.”

But what about re-entering society? Both the regular prison system, and the state hospital, have transitional-living programs for those soon to be fully released. That was the status for the suspect in Monday’s killing.

“I was told that there was nothing that they saw that said anything other than this person should be transitioning out,” said Sen. Brenton Awa, who represents Windward Oahu and the North Shore. “So there are risks involved when it comes to operating these kinds of systems. Just like our prisons, you always hear of escapees from Laumaka. Does that mean we’re going to shut down Laumaka?”

After enormous investment in the main inpatient facility, what more needs to be done to make the transitional buildings themselves safer for worker?

“You can go to the community, you can say do you guys want to put more money into funding security for this halfway type of transitional facility? There are all those kind of talks,” Awa said. “But in reality, you have a hospital where patients go, it’s a dangerous situation, there are judgment calls whether they go to this transitional facility or not. Could better judgment have been used? I’m not sure.”

San Buenaventura said she wants to know whether the hospital has enough resources to make the right assessments for who should stay or go.

“The focus will be on why,” she said. “What decision was made that the clinicians determined that he was safe enough and normal enough to be released a community? Is it because we did not have enough eyes on him to see that he had these violent tendencies?”

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“We have well-qualified doctors, well-qualified nurses that do a clinic assessment of people who are ready,” explained Dr. Kenneth Luke, administrator of the Hawaii State Hospital. “And in this case the patient in August did appear to be ready for discharge.”