JOHN R. DUNNE ARTHUR E. PEABODY, JR. MELLIE H. NELSON VERLIN HUGHES ROBINSUE FRpHBOESE U.S. Department of Justice Civil Rights Division 320 First Street, N.W. Washington, Q.C. 20530
(202) 514-6260

DANIEL BENT United States Attorney P.O. Box 50183 Room 6100 PJKK Federal Building 300 Ala Hoana Blvd. . Honolulu, HI 96850 (808) 541-2850

U.S. v. Hawaii

•• V

HH

•••£•• HHtH* • •»»

MH-HI-001-003

Attorneys for the United States of America UNITED STATES DISTRICT COURT FOR THE

DISTRICT OF HAWAII

UNITED STATES OF AMERICA,

CIVIL NO.

37 DAE

Plaintiff,
V.

COMPLAINT; CERTIFICATE OF THE ATTORNEY GENERAL; ) SUMMONS

STATE OF HAWAII; JOHN WAIHEE, Governor; )

JOHN LEWIN, Director, Department of )

Health; HENRY FOLEY, Deputy Director, )

Behavioral Health Services of the

)

Department of Health; NALEEN

)

N. ANDRADE, Acting Superintendent,

)

Hawaii State Hospital,

)

)

Defendants.

)

THE UNITED STATES OF AMERICA alleges: 1. This action is brought by the Attorney General, on
behalf of the United States, pursuant to the Civil Rights of Institutionalized Persons Act of 1980, 42 U.S.C. S 1997 •_£ sea., to enjoin the named defendants from depriving persons residing at the Hawaii State Hospital ("HSH"), of rights, privileges or

Copy C

Deputy

immunities secured or protected by the Constitution of the United state*.

JURISDICTION

2. This Court has jurisdiction over this action under 28

U.S.C. § 1345.

3. The United States has standing to maintain this action

pursuant to 42 U.S.C. § 1997a.

~

4. The Attorney General has certified that all the pre-

filing requirements specified in 42 U.S.C. § 1997b have been met.

The certificate of the*Attorney General is appended to this

Complaint and is incorporated herein.

5. Venue in the District of Hawaii is proper pursuant to 28

U.S.C. § 1391. All claims set forth in the Complaint arose in

said District.

DEFENDANTS

6. Defendant STATE OF HAWAII owns and operates HSH, which

is a state mental health facility, located in Kaneohe, Hawaii,

with a Children's Unit in Honolulu, Hawaii.

7. Defendant JOHN WAIHEE is the Governor of Hawaii, and, in

this capacity, heads the Executive Branch of the State government

and, among other duties, reviews and approves budget requests

submitted by Executive Branch agencies. He selects and appoints

the Director of the Hawaii Department of Health ("DOH").

8. Defendant JOHN C. LEWIN is the Director of DOH,

and, in this capacity, exercises administrative control of,

and responsibility for, HSH.

- 2-

• r
9. Defendant HENRY FOLEY is the Deputy Director of Behavioral Health Services in DOH. He is responsible for administration of the mental health divisions of DOH.
10. Defendant NALEEN N. ANDRADE is the.Acting Superintendent of HSH and is" responsible for the day-to-day
'7
operations of HSH. 11. The individual Defendants named in paragraphs 7, 8, 9,
and 10 above are officers of the executive branch of the State of Hawaii and are sued in their official capacities.
12. HSH, a state mental health facility administered and operated by DOH, is an institution as that term is defined in 42 U.S.C. S 1997(1)(A) and (l)(B)(i).
13. Defendants are legally responsible, in whole or in part, for the operation of and conditions at HSH, as well as for the care and treatment of persons residing at that institution.
14. At all relevant times, defendants have acted or failed to act, as alleged herein, under color of state law.
FACTUAL ALLEGATIONS 15. Defendants have failed and are continuing to fail to provide patients residing at HSH with that level of psychiatric treatment and programming necessary to ensure that patients are free from undue bodily restraint, including chemical restraint, or unreasonable risks to their personal safety. 16. Defendants have failed and are continuing to fail to ensure that medications are prescribed and administered to
- 3-

persons confined at HSH pursuant to the exercise of professional judgment by appropriately qualified staff.
17. Defendants have failed and are continuing to fail to ensure that there is an adequate number of sufficiently trained staff, at all. levels of HSH operation, to render and implement professional judgments regarding adequate care and treatment of HSH patients and to ensure adequate patient safety.
18. ".Defendants have failed and are continuing to fail to employ staff and practices needed to maintain professionally based recordkeeping and record review systems to ensure that patient records contain accurate, up-to-date and relevant information as is necessary to enable staff to exercise professional judgment regarding medical and psychiatric treatment and training decisions.
19. Defendants have failed and are continuing to fail to maintain the physical environment of HSH in such a manner that it does not expose persons confined at HSH to unreasonable risks, including fire-safety risks, to their health and safety.
20. Defendants have failed and are continuing to fail to ensure that bodily restraint and seclusion are administered to persons confined at HSH only pursuant to the exercise of professional judgment by appropriately qualified professionals and are not used as punishment, in lieu of treatment, or for the convenience of staff.
21. The acts and omissions alleged in paragraphs 15 through 20 constitute patterns or practices of resistance to the full
- 4-

enjoyment of rights, privileges or immunities secured or protected by the Constitution of the United States, and deprive patients who reside at HSH of such rights, privileges or immunities.
22. Unless restrained by this Court, Defendants will continue to engage in the conduct and practices set forth in paragraphs 15 through 20 that deprive residents of HSH of rights, privileges,' or immunities secured or protected by the Constitution of the United States, and cause irreparable harm to HSH residents. . *
23. The Attorney General is authorized under 42 U.S.C. I 1997 to seek only equitable relief.
PRAYER FOR RELIEF WHEREFORE, the United States prays that this Court enter an order permanently enjoining Defendants, their agents, employees, subordinates, successors in office, and all those acting in concert or participation with them from continuing the acts, practices and omissions at HSH set forth in paragraphs 15 through 20 above, and to require Defendants to take such action as will provide constitutional conditions of care to persons who reside at HSH. The United States further prays that this Court grant
- 5-

such other and further equitable relief as it nay deem just and

proper.

Respectfully submitted,

DXNlEL BENT United States Attorney' District of Hawaii

DICK THORNI JRGS ' Attorney Gl meral oj
the Unit* Stj
J
JOHN R. DUNNE Assistant Attorney General Civil Rights Division

Is
ARTHUR E. PEABOD/^JR. Chief Special Litigation Section

.;. ft :\ i

MELLIE H. NELSON

Deputy Chief

Specia

Section

VERLIN HUGHES ROBINSUE FROHBOESE Attorneys U.S. Department of Justice Civil Rights Division Special Litigation Section 320 First Street, NW Washington, D.C. 20530 (202) 514-6260 (202) 514-6259

- 6-

Civ
jfluiteh

SUMMONS IN A CIVIL ACTION

gUtrict (Court

Ol STRICT
Hawaii
DOCKET NO.

UNITED STATES OF AMEBICA,

TO: (NAME ANO AOORESS OF DEFENDANT)

V. .

A l l Named D e f e n d a n t s

STATE OF HAWAII; JOHN WAIHEE, Governor

JOHN LEWIN, Director, Department of

Health; HENRY FOLEY, Deputy Director,

Behavioral Health Services of the Department of Health; NALEEN

W. AHDRADE, Acting Superintendent, Hawaii S t a t e H o s p i t a l • ...

YOU ARE HEREBY SUMMONED and required to serve upon

PLAINTIFF'S ATTORNEY (NAME AND AOORESS)

JOHN R. DUNNE

••!"

DANIEL BENT

ARTHUR E. PEABODY, JR. '

United States Attorney

1ELLIE H. NELSON BERLIN HUGHES

and

P.O. Box 50183 Room 6100 PJKK Fed. Bldg.

IOBINSUE FROHBOESE

300 Ala Moana Blvd.

I.S. Dept. of Justice

Honolulu, HI 96850

:ivil Rights Division

320 First Street, N.W.

Washington, D.C. 20530

an answer to the complaint which is herewith served upon you, within 20 days after service of this summons upon you, exclusive of the day of service. If you fail to do so, judgment by default will be taken against you for the relief demanded in the complaint

CLERK

Walter A.Y.H. Chinn
CWK
(s) Laila M. Qeronlmo

OATC
MAR 0 7

©fltoflftipAttnrn^c lateral
- <fl. 20530

- CERTIFICATE OF THE ATTORNEY GENERAL

. I, Dick Thornburgh, Attorney General of the United States,

certify that with regard to the foregoing Complaint, I have

complied'with -the provisions of 42 U.S.C. § 1997b(a)(l). I

certify as well that I have complied with all subsections of

42 U.S.C. § 1997b(a)(2). I further certify pursuant to 42 U.S.C.

S 1997b(a)(3) my belief that this action by the United States is

of general public importance and will materially further the

vindication of rights, privileges or immunities secured or

protected by the Constitution of the United States.

I further certify that I have the 'reasonable cause to

believe* set forth in 42 U.S.C. § 1997a(a) to initiate this

action. I finally certify that all prerequisites to the

initiation of suit under 42 U.S.C. SS 1997a and 1997b have

been met.

Pursuant to 42 U.S.C. S 1997a(c), I have personally signed

the foregoing Complaint. Pursuant to 42 U.S.C. § 1997b(b), I

am personally signing this Certificate.

Signed this 4th

day of M a r c h

, 1991,

at Washington, D.C.

DICK Attorn
the

 
 /7

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF HAWAII

UNITED STATES OF AMERICA.

) Civ. No. 91-00137 DAE

vs

j

STATE OF K.-.V.-.-.II, e t a l . ,

)

)

Defendants.

)

_

vmm sfATa DISTRICT
eisft\a OF H
W M T S A. Y. H. CHINN.

ORDER HOLDING DEFENDANTS IN CONTEMPT

The court heard Plaintiff's petition on January 10,

1995. United States Attorney Steven S. Aim, Esq., and Department

of Justice Attorneys Verlin Hughes, Esq., and Robinsue Frohboese,

Esq., appeared on behalf of Plaintiff; Sonia Faust, Esq., and

Keidi Riar., Esq., Deputy Attorney Generals, State of Hawaii,

appeared or. behalf of Defendants. After reviewing the petition

and the supporting and opposing memoranda, receiving evidence,

and hearing argument from counsel, the court GRANTS Plaintiff's

Petition ar.d Hereby Holds the Defendants in Contempt of this

court's Septe~iber IS, 1991 Order.

BACKGROUND

Plaintiff United States of America initiated this

action on March 7, 1991, pursuant to the Civil Rights of

Institutionalized Persons Act, 42 U.S.C. § 1997 et sea. The

Complaint alleged that conditions at Hawaii State Hospital

("HSH") deprived patients of their constitutional rights and

sought injur.ctive relief against the State of Hawaii to correct

the deficiencies. A Settlerr.ent Agreement was signed as an order

U.S. v. Hawaii
•niiiiniiii MH-Hl-001-004

of this court on September 19, 1991 ("1991 Order") . See Exhibit 1 to Plaintiff's Petition.
Plaintiff has monitored compliance with the 1991 Order through Defendants' required monthly and quarterly reports ar.d four tours of HSH by Plaintiff and its expert consultants. These tours occurred in April 1992, January 1993, March 1994, and, most recently, November 1994. Two of the experts, Dr. Jeffrey Geller, a psychiatrist, and Miriam Kile, a psychiatric nurse, have collectively spent over 300 hours during the course of 40 cays to observe conditions at HSH, review patient records and other documents, and interview staff and patients. Plaintiff attaches the exhaustive declarations of Dr. Geller and Ms. Kile as Exhibits 2 and 3, respectively.1
According to Plaintiff, the experts and other acents of the United States have repeatedly communicated to Defendants that they have never fully complied with the 1991 Order. Plaintiff's agents have met with Defendants on numerous occasions and have engaged in many discussions aimed at correcting violations of the 1991 Order.
Plaintiff alleges the failure of two key requirements of the 1991 Order which in turn result in the failure to satisfy other critical requirements. First, Plaintiff alleges that Defendants have failed to adequately staff the hospital with,
xPrior to the hearing on January 10, 1995, the parties entered into a stipulation admitting into evidence the affidavits and declarations submitted by both sides and waiving crossexamination .

among others, nurses and therapists. Second, Plaintiff alleges that Defendants have failed to implement an effective organizations! structure at KSK. Plaintiff contends that these failures result in a lack of protection fro- harm, seclusicr., and undue restraint, as well as inadequate treatment.
On December 14, 19S4, Plaintiff filed the instant: Petition for an Order to Show Cause Why Defendants Should not be Held in Contempt. On January 3, 1995, this court denied Defendants' request for a continuance of the evidentiary hearing because of the grave nature of the issues presented by the petition. In its petition, Plaintiff seeks a finding of.contempt against Defendants. "Plaintiff also seeks relief that includes: a moratorium on further non-emergency admissions, full staffing within four months, procedures for monitoring abuse and the use of seclusion and restraint, the appointment of an external monitor, and a protective order for all HSH employees who have assisted or may later assist Plaintiff.
Aside from one or two specific case histories, Defendants do not dispute the facts alleged by Plaintiff. They admit that they have not complied with nurse staffing and other requirements. They state, however, that the picture painted by Plaintiff is "the product of selective vision." Defendants' Response at 3. "It fails to give this court a full understanding of the situation at the hospital and the tremendous efforts that have been rr.ade there." Id. Defendants state that they have provided full information to Plaintiff.

Defendants also contend that the Plaintiff has not
"confer [ed] with Hawaii officials in a good faith effort to
attempt tc resolve any alleged deficiencies . . ."as required bv
the 19S1 Order because it has not waited to confer with the r.ew
administration. However, this court's 1991 Order bound the Scate
of Hawaii, not an individual administration. The Defendants
cannot escape a contempt order by alleging that the Plaintiff
failed to cor.fer with the new administration, particularly when
the Defendants' noncorr.pliance is so longstanding.
The Defendants summarize their current efforts:
Efforts to control the census are in place, though under constraints imposed by the lack of alternative placements and the requirements of the criminal justice system. Salaries are being raised to competitive levels and screening and recruitment processes will soon be implemented. Thirty uniformed security guards will be on the wards beginning February 1995 to deter violence and patent abuse. Increased monitoring of existing policies on seclusion and restraint has been ordered. The clinical director's position has been filled and an offer for the position of hospital superintendent is outstanding. Management policies which will resolve supervision issues are close to completion and should be in effect bv the end of January. Finally, Dr. Miike will request that Governor Cayetano appoint a compliance officer to work in the office of the governor who will coordinate and facilitate the compliance process.
Id. at 4-5 (emphasis added). It is significant that most of
these efforts seem to have begun only recently, presumably as a
result of this petition.
The Defendants also describe the obstacles they have
faced in corr.piying with the 1991 Order. These include the
discovery of architectural safety hazards in the new patient care

buildings which necessitated extensive rep;. :s;2 the finding of
asbestos in a building where the forensic L. .its are housed; the rapid turnover among top administrative staff;3 and the
d i f f i c u l t i e s in f i l l i n g nursing positions in competition wic'r. the
increasing salaries offered by the private sector.
The Defendants l i s t the following accomplishments: The
hospital budget has nearly doubled since the year before the
agreement was signed, from $13.2 million in 1S89-90 to $26.3
million for the current fiscal year. Many nursing positions have
been added since 1991. Collaboration with the University of
Hawaii Schools of Medicine, Nursing, Social Work and Psychology
have increased the number of highly qualified physicians and
o t h e r s . Defendants c i t e to the praise for these efforts by the
P l a i n t i f f ' s experts, who noted in a l e t t e r ro P l a i n t i f f ' s
counsel:
tremendous strides during the past fev years. Remarkable achievements have been made by the disciplines of psychiatry and nursing. The quality manaoeraent office has become s t a t e of the a r t .
Exhibit A to Defendants' Response, at 15. Defendants contend
t h a t these past efforts and t h e i r current efforts preclude a
finding of contempt.
2"The design faults in the new buildi-.gs included many l i f e safety hazards and an irregular architectural design that prevented visual contact with p a t i e n t s in various areas of the wards." Id. at 8. "The executive staff cf the hospital became increasingly involved in overseeing changes to the new f a c i l i t y and asbestos removal." Id.
3Since September 1991 four individuals have held the position of permanent or acting hospital administrator.

STANDARD OF REVIEW FOR CONTEMPT ORDERS A federal court has inherent power to enforce its orders by way of civil contempt. Soallone v. United States. 4 53 U.S. 265, 276 (1990) . The district court has "wide latitude" in determining whether there has been contemptuous violation of one of its orders. Stone v. City and County of San Francisco, S5S F.2d 850, 65S (9th Cir. 1992), cert, denied. 113 S. Ct. 1050 (1993) (citir.g Gifford v. Heckler, 741 F.2d 263, 266 (9th Cir. 1984)). Contempt orders are reviewed for abuse of discretion. Id. The Ninth Circuit's test with regard to contempt has Icr.g been whether the defendants have taken "all reasonable steps within their power to insure compliance" with the court's orders. Sekaauaptewa v. MacDonald, 544 F.2d 396, 404 (9th Cir. 1976), cert, denied. 430 U.S. 931 (1977); see also General Sicmal Corp. v. Donallco. Inc.• 787 F.2d 1376, 1379 (9th Cir. 1986).* In Stone, the district court considered two factors in determining that the defendant had not taken every reasonable step: (1) the City's history of noncompliance with inmate population levels; ana, (2) the failure to comply despite the pendency of the contempt motion. 968 F.2d at 857.
The party moving for the contempt order has the burden of showing by clear and convincing evidence that the defendants
4The Sekaauaptewa court held that the defendants had failed to take "every reasonable step" to comply because there was "little conscientious effort on the part of the appellants to comply with those orders. . . . " 544 F.2d at 406. More recent cases have held that "technical or inadvertent violations . . . will not support a finding of civil contempt." General Signal Coro., 787 F*2d at 1379.

violated a specific and definite order of the court. Stone. SS8 F.2d at 856 (citing Balla v. Idaho St. Bd. of Corrections, £69 F.2d 461, 46£ (9th Cir. 19ES)). The burden then shifts to the defendants to demonstrate why they were unable to comply after taking every reasonable step. Id. (citing Donovan v. Mazzol(Donovan IT). 716 F.2d 1226, 1240 (9th Cir. 1983), cert, denied. 464 U.S. 1040 (1984)).
Intent is irrelevant to a finding of civil contempt and, therefore, good faith is not a defense.5 Id. at 856-57 (citing McCc-.b v. Jacksonville Paper Co.. 336 U.S. 187, 191 (1949); Donovan I. 716 F.2d at 1240.
Concerning obstacles encountered by defendants, federal courts have repeatedly held that financial constraints do net allow states to deprive persons of their constitutional rights. Id. at 858 (citation omitted); Lareau v. Manson, 651 F.2d SS, 104 (2d Cir. 19E1) ; Smith v. Sullivan, 611 F.2d 1039, 1043-44 (5th Cir. I960); Battle v. Anderson, 564 F.2d 388, 396 (10th Cir. 1977); Jackson v. Bishop. 404 F.2d 571, 5 8*0 (8th Cir. 1966)).
sIn Stone, the Ninth Circuit noted that recent Supreme Court cases concerning the deliberate indifference tests and the tuodification of consent decrees do not change this standard. Id. (distinguishing Wilson v. Seiter, 111 S. Ct. 2321, 2326-27 (1991) (holding that plaintiffs must show prison officials showed "deliberate indifference") and Rufo v. Inmates of Suffolk Ccur.tv Jail, 112 S. Ct. 748, 758 (1992) (treating modification of consent decrees)).

DISCUSSION I . Violation of a Specific and Definite Order of this Court
Plaintiff has demonstrated by clear and convincinc evidence the violation of this court's specific and definite order.6 Defendants admit that they have not complied with the order in nu-.erous respects.
Specifically, the court finds that the Defendants have failed to:
{'-) comply with minimum nursing staff requirements;" (2; comply with required ratios for rehabilitation staff;5 (3) provide mandated treatment programs;9 (4) establish a sufficient organizational and management structure in order to curb neglect and implement clinical decisions,-10 and (5) take adequate action to investigate and curb hart?., abuse and undue use of seclusion and restraint.
6Indeed, as this court indicated at the hearing, the evidence has convinced the court beyond a reasonable doubt that the State has violated the 1991 Order.
71S91 Order, Part II, H C.2.e. "Id. . at Part II, ri 2.d. 9Id., at Part II, ] E.I. " i d . , at Part II, % J (implementation required by Septerr.be: 1991) .
8

As a direct result of these failures, patients at HSH have been subjected to conditions that violate the minimum guarantees of che United States Constitution. I I . All Reasonable Steps
Because Plaintiff has shown that Defendants violated the order, Defendants must show that they have taken a l l reasonable steps to comply. The court notes above the obstacles that Defendants describe. However, the recent flurry of activity on a l l fror.:s after more than three years of slower progress demonstrates to the court that Defendants could have done substantially more. While Defendants do not l i s t financial burdens as cause of the obstacles they describe, there is no question that many of the problems described by P l a i n t i f f s , such as staff shortages, could have been solved with more funding. Financial burdens are no excuse.
Further, the fact that Defendants are only now seeking to simplify the state hiring process demonstrates to t h i s court a previous unwillingness to take this step. 'The recent design of organizational procedures and implementation of procedures to counteract abuse is also evidence that these previously available routes were not taken.
In the past, then, Defendants have not taken a l l reasonable steps. While contempt orders are not punitive but remedial, NLR3 v. Trailwavs. Inc.. 729 F.2d 1013, 1023 (5th Cir. 1984), a finding of contempt must, of course, be based upon an examination of past behavior as well as present intentions.

Moreover, while the court has no wish to penalize Defendants for recent efforts, neither can the court simply ignore their contrast with more than three years of less than satisfactory progress. The "new and improved" conduct and plans offered by Defendants are laudable, but they are also evidence of previous reasonable steps that should have been taken. Therefore, the court finds that the Defendants have not taken all reasonable steps to meet the requirements of this court's order.
Because the Defendants have been for some tirr.e and are currently in violation of this court's specific and definite 1S91 Order, and because Defendants have failed to demonstrate that they have taken all reasonable steps to comply, this court hereby finds Defendants in contempt of the order. The court will address appropriate remedial steps after a separate hearing on the matter. However, the court will at this time grant Plaintiff's request for a protective order enjoining any retaliation against any person providing information or assistance to Plaintiff in the prosecution*of this matter.
CONCLUSION For the reasons stated above, the court FINDS Defendants in CONTEMPT of its 1991 Order. In addition, the court HEREBY ENJOINS any current, former, or future HSK or State employee from retaliating in any way against any person who has
10

assisted or assists Plaintiff by reporting deficient conditions

at Hawaii State Hospital.

IT IS SO ORDERED.

DATE! : Honolulu, Hawaii,

JAN-^4 0 1990. \

ALAN EZRA7 UNITED STATES ikkTRICT Ju~

United States of America vs. State of Hawaii, et al. , Civil 91-00137 DAE; ORDER HOLDING DEFENDANTS IN CONTEMPT

 
 FilED IN THE UNITED STAT.t:S DISTRICT COURT
DISTRICT OF HAWAII

IN THE UNITED STATES DISTRICT COURT AUG 28.2006

/f _min~M £II o'clock and

FOR THE DISTRICT OF HAWAII

SUE BEITIA, CLERK/-

UNITED STATES OF AMERICA, Plaintiff,
vs. STATE OF HAWAI'I, et. al.,
Defendants.

CIVIL NO. 91-00137 DAE-KSC
TWELFTH REPORT AND RECOMMENDATION; EXHIBITS "A" - "C"

TWELFTH REPORT AND RECOMMENDAnON
This Twelfth Report and Recommendation discusses the seventh and final visit of the Special Master's Community Mental Health Services Evaluation Team on June 26-30, 2006, and presents the Special Master's findings and conclusion regarding the Defendants' efforts to achieve substantial compliance with the Special Master's Plan for Community Mental Health Services and the Special Master's closing comments related to this case.

Relevant History The relevant history of this fifteen year old lawsuit based on the Civil Rights of Institutionalized Persons Act ("CRIPA") is well known to the parties and has been set out in the preceding eleven Reports and Recommendations filed by the Special Master. The Community Plan An overview of the Special Master's Plan for Community Mental Health Services ("Community Plan") is contained in the Special Master's Tenth Report and Recommendation ("Tenth Report") filed on July 20, 2005. Reports and detailed discussion concerning Defendants' progress or lack thereof to achieve substantial compliance with the Community Plan are set out in the Fourth, Seventh, Eighth, Ninth, Tenth and Eleventh Reports and Recommendations filed by the Special Master on July 18, 2003, August 26 and November 12, 2004, February 9 and July 20, 2005, and February 10, 2006, respectively. Although entitled the Special Master's Plan for
2

Community Mental Health Services, the Community Plan was the result of a collaborative effort by counsel, representatives of the parties and Kris McLoughlin, the court appointed Special Monitor, along with Thomas Hester, M.D., Chief of the Adult Mental Health Division, Department of Health ("AMHD"). The meetings and discussions which lead to formulation of the Community Plan took place in Honolulu and Washington, D.C., during the fall of 2002.
The Community Plan was presented as part of the Special Master's Third Report and Recommendation filed on November 27, 2002, and was approved and adopted as an Order of the Court by Chief District Judge Ezra on January 23, 2003.
The deadline for Defendants' compliance with the Community Plan was originally January 23, 2005. On December 10, 2004, the twenty-four month period allowed for Defendants' compliance with the Community Plan was increased by seventeen months and Defendants' deadline was extended to June 30, 2006.
3

In the Tenth Report filed on June 20, 2005, the Special Master expressed apprehension and doubt as to whether Defendants were likely to meet the June 30, 2006 compliance deadline. Thereafter, counsel for the parties engaged in discussion and negotiation.
The Joint Stipulation On October 26, 2005, Chief District Judge Ezra approved a Joint Stipulation And Order Regarding Plan For Community Mental Health Services ("Joint Stipulation") in this case. The Joint Stipulation negotiated by the parties (1) recognized Defendants' progress and substantial compliance with the Hawaii State Hospital Remedial Plan, (2) promoted the efficient use of available resources and the provision of community based mental health services to consumers, (3) contemplated a more collaborative approach to Defendants with the Special Monitor and Evaluation Team members offering technical assistance to Defendants, (4) obligated Defendants to put forth their reasonable best efforts towards
4

achieving substantial compliance, (5) provided the best opportunity for Defendants to achieve substantial compliance with the Community Plan by June 30, 2006, and (6) ensured closure of this costly and very challenging fifteen year old lawsuit.
In pertinent part, the Joint Stipulation provided the following.
First, Defendants' deadline for compliance with the Community Plan remained June 30, 2006.
Second, Defendants were required to prepare an Action Plan with timelines which sets out the particular steps Defendants will take to achieve substantial compliance with the Community Plan. Third, the United States, Defendants, the Special Monitor and the Evaluation Team members would collaborate on the implementation of Defendants' Action Plan.
Fourth, Defendants would put forth their reasonable best efforts to achieve substantial compliance with the Community Plan and all previously entered court orders related to the Community Plan.
5

Fifth, in the event that Defendants did not achieve substantial compliance with the Community Plan by June 30, 2006, Defendants would continue their efforts to implement the Community Plan until on or before November 30, 2006. Finally, this lawsuit will terminate on November 30, 2006.
The Evaluation Team's Seventh Site Visit Kenneth Minkoff, M.D., Gail Hanson-Mayer, A.P.R.N., B.C., M.P.H. and Paul Gorman, Ed.D. comprise the Special Master's Community Evaluation Team ("Evaluation Team") . Curriculum vitae for each member of the Evaluation Team have been attached as exhibits to previously filed Reports and are a part of the record and file in this case.
The Evaluation Team and Kris McLoughlin, the court appointed Special Monitor, were instrumental in facilitating Defendants' compliance with the Hawaii State Hospital Remedial Plan for Compliance.
During the period June 2003 through June 2006, the Evaluation Team assisted the Court by (1) conducting
6

community site visits, (2) examining Defendants' efforts and progress with regard to implementation of the Community Plan, (3) measuring Defendants' compliance, if any, with various aspects of the Community Plan, (4) conferring with Kris McLoughlin, the court appointed Special Monitor and (5) preparing written progress reports.
The seventh and final community site visit by the Evaluation Team took place on June 26-30, 2006. Dr. Minkoff made visits to Kauai and Maui Counties and Ms. Hanson-Mayer visited to Hawaii County. Copies of the written reports submitted by Dr. Minkoff, Ms. HansonMayer and Dr. Gorman are attached to this Twelfth Report as Exhibits "A", "8" and "C", respectively.
In past visits, the Evaluation Team focused on certain items or areas of the Community Plan because of then existing "due-dates." During this final site visit, the Special Master asked the Evaluation Team to examine Defendants' completion and/or substantial compliance, if any, with regard to each section of the
7

Community Plan and applicable portions of the Hawaii State Hospital Remedial Plan for Compliance.
Initially, the Evaluation Team found many areas of the Community Plan complete. Most notable was Defendants' establishment of an array of services which included: (1) access to the Adult Mental Health Division ("AMHD") system, (2) psychosocial rehabilitation services, (3) crisis services, (4) support services (such as representative payee), (5) housing, (6) Mental Illness/Substance Abuse ("MI/SA") services and (7) treatment services (except as discussed hereinafter and below) .
Other areas found by the Evaluation Team to be in substantial compliance included: (1) identifying guiding principles, (2) describing and reporting on the target population, (3) developing an information management system, (4) establishing a basic framework of operations and services at the community mental health centers ("CMHCs"), (5) establishing a provider quality monitoring system, and (6) filling many of the required
8

administrative and clinical positions described in the Community Plan.
However, the Evaluation Team also found that Defendants had not made meaningful progress and/or achieved substantial compliance in critical areas of the Community Plan.
Significantly, after reviewing information and documents which included (1) AMHD's own quality improvement data, (2) target population patient charts, (3) Hawaii State Hospital discharge records, (4) Sentinel Event documentation, (5) consumer grievances and (6) engaging in discussions with AMHD mental health consumers, AMHD leadership, CMHC providers and community purchase of service providers, the Evaluation Team could not state that members of the target population were receiving appropriate community services in all of the service areas identified in the Community Plan.
Shortcomings were noted in the following multiple areas: (l) forensic services, (2) treatment planning, (3) inpatient discharge oversight, 4) ACT services, (5)
9

case management services, (6) clinical/eligibility assessments, (7) individual, group and family therapy at CMHCs and (8) consumer protection.
This Report highlights some of the key areas noted by the Evaluation Team to be deficient or requiring Defendants' additional effort. For additional information, see the reports prepared by the Evaluation Team which are incorporated herein by reference.
One such area involves the development and implementation of community-based forensic services. See HSH Remedial Plan section 1(1) (xi) and Community Plan section III.D.2.e.iv. At the time of the Evaluation Team's site visit, AMHD was without a permanent Forensic Director. Ms. Hanson-Mayer also stated, "The evidence of the development and implementation of a model for forensic practices throughout the service system was not present statewide
There was minimal evidence of a monitoring program for forensic services. This would make sense in some ways as the [forensic services] program was yet to be
10

defined and implemented." Exhibit "B" at page 57. For example, the first AMHD community-based
conditional release program (the "Hale Imua" program) opened in March 2006. While this program appears promising, at the time of the Evaluation Team's site visit, Hale Imua, programs for community fitness restoration, services for jail/prison transfers and other related programs were incomplete and still in the midst of development.
A second key area of service development found in noncompliance was treatment planning, referred to by AMHD as "Recovery Planning". See Community Plan section III.C.1-3. At the time of the Evaluation Team's site visit, AMHD had developed a plan for system-wide training and implementation of treatment planning, a Recovery Manual had been developed and training had occurred. However, the system was not fully implemented. Dr. Minkoff stated in his report:
" ... it is clear from the evaluation that compliance has not been achieved. In all the performance improvement audits conducted by AMHD,
11

there was dramatic poor performance on recovery plans. (Admittedly, these were based on last year's records, but these are still the most current audits.) Further, current self assessments were uniformly not fully compliant. In addition, I review 36 recovery plans selected by AMHD from 20 providers and over 30 charts I reviewed had deficiencies related to the recovery plan standards in one or more areas. Particular concerns include: Timeliness ... Crisis Plans ... Recovery Orientation ... Teamwork ... [and] Family [involvement] ."
Exhibit "A" at pages 23-24.
Ms. Hanson-Mayer also conducted individual record
reviews and reached the same conclusions. Ms. Hanson-
Mayer reviewed approximately 50 treatment plans. She
expressed her concern about the adequacy of treatment
plans by stating the following:
" ... this consumer made a serious suicide attempt while living in a care home. The record indicated this had also occurred at HSH. The root cause analysis at the time identified a language barrier as a precipitant. The treatment plan did not include a plan to ensure appropriate communication. There was no evidence of documentation to support an ongoing assessment of her level of risk or suicidal intent. The development of a coordinated crisis plan that included a mechanism to ensure regular communication between providers and involvement with community supports was lacking."
Exhibit "8" at page 17.
12

A third key area in service development which came
up short is development and implementation of Assertive
Community Treatment ("ACT"). See Community Plan section
III.D.a.i. Over the years, AMHD has received much
feedback about their ACT services. In essence, the
overriding concern of the Evaluation Team and the
Special Monitor was that Defendants' Assertive Community
Treatment was ACT in name only and that the Defendants'
ACT treatment teams did not follow, function or properly
apply the Assertive Community Treatment model.
Essentially, it was form without substance.
Dr. Minkoff summarized Defendant's compliance
status with regard to ACT treatment as follows:
"It is now well understood that ACT as an evidenced based practice is a comprehensive treatment approach, not a case management approach, and AMHD, in the last year, has begun to organize its implementation efforts to achieve real fidelity to the ACT model. Unfortunately, as with recovery planning, the ACT improvement efforts have begun too late in the sequence to have achieved successful implementation at this point in time. In order to make progress, AMHD has utilized consultation from Indiana effectively to provide training to ACT team on what ACT really is, have utilized the ACT fidelity scale to get real data on
13

the level of fidelity of the teams, and has begun to create new utilization management definitions ... However, at present, not one ACT team meets adequate fidelity criteria to be considered "ACT" according to the Indiana evaluations, and recent AMHD updates."
Exhibit "A" at page 29.
A fourth key area of system development found
lacking is that of consumer protection. See Community
Plan section IV.B.l.b. Dr. Gorman explained as follow.
"AMHD has developed policies and procedures that are designed to respond in a timely way to incidents of abuse, neglect, death or serious injury to members of the target population when such events occur within AMHD covered services. The continuing problem is that AMHD does not follow its own policies. The Director of Quality Assurance acknowledged that sentinel events that are not absolutely critical in nature are not being attended to in the manner in which the policy indicates."
Exhibit "C" at page 40.
Ms. Hanson-Mayer also noted the following with regard to consumer protection.
"During this review I met with several consumers on an individual basis. The concerns raised in each of these meetings focused on the lack of responsiveness to consumers who raise concerns regarding the appropriateness of care received. There was a fear that retaliation would occur if a consumer lodged a complaint against an AMHD
14

provider. Consumers reported that complaints were not responded to in a comprehensive and timely fashion. The consumer office was seen as an extension of AMBO, not representing consumer concerns." Exhibit "8" at page 49 - 50.
The Evaluation Team noted additional areas of noncompliance with the Community Plan related to AMBO system functions, organization and structure which support the provision of services. These areas of weakness and/or non-compliance included: (1) integration of recovery principles into the AMBO services system, (2) adequacy of staffing at the CMBCs, including hiring of MI/SA and case management coordinators, (3) timely completion of planning reports, (4) efficient operation of the Utilization Management department to ensure service continuity, (5) development of interorganization agreements, (6) provider relations, (7) ability and authority of Service Area Administrators to ensure access to, quality of and continuity of services within their respective counties, (8) ensuring that
15

decision making is driven by clinical needs and (9) the
establishment and maintenance of clear lines of clinical
and administrative authority and accountability.
More specifically, staffing levels at the CMHCs
affect AMHD's ability to provide adequate and
appropriate services to consumers and continue to be a
significant problem. See Community Plan sections
III.D.l.a and IV.A.4.f and g. Dr. Minkoff wrote the
following with regard to targeted case management
consumer to case manager ratios:
"Data provided regarding TCM case ratios at CMHCs indicates that the required ratio is not met in most clinics. This has been a long standing issue that has not been resolved ... Most concerning, however, was direct reports from at least two CMHC managers (one in writing, in response to performance improvement review indicating that the ratio was not met) that there is currently no expectations for meeting the ratios, nor is there a specific plan for meeting the ratios."
Exhibit "A" at page 31.
Ms. Hanson-Mayer also stated her concern about the
same issue:
"The ability of AMHD to meet the case management
16

ratios has been a consistent concern since my initial evaluation. The data provided by AMHD to review supported that this remains a concern. The problem is threefold. (1) There are caseloads that exceed these ratios consistently across providers. (2) There are waiting lists for case management services, particularly ACT and ICM, which contributes to delays in consumers receiving the appropriate level of care. (3) The lack of progress in meeting the ratios, particularly within the CMHCs has contributed to staff job dissatisfaction and morale which in turn contributes to the high turnover in case managers. It is not uncommon to see that a consumer has multiple changes in case manager within a relatively short period of time."
Exhibit "8" at page 20.
Ms. Hanson-Mayer noted "at the time of this review
the Case Manager Coordinator positions were not [all]
filled." Exhibit "8" at page 42. Dr. Minkoff noted
similar concerns about the MI/SA coordinator positions,
"I continue to be impressed with the quality of the
MI/SA coordinators, their teamwork, and their close
collaboration with the MI/SA Service Director. However,
I am concerned that there is an increase in the number
of sites which do not have a MI/SA coordinator." Exhibit
"A" at page 67.
The Evaluation Team noted areas of concern related
17

to the Service System Organization & Functions Section
of the Community Plan. See Community Plan sections
IV.A.1-2 and 3.c.ii and 3.e.iii(b)and(c)i and (c)iv.
One specific area was the positioning of the Service
Area Administrators ("SAA"). Ms. Hanson-Mayer explained
as follows:
"The positioning of the SAA within the AMHO organizational structure has recently shifted from reporting directly to the AMHO Chief to now reporting to the Chief of Clinical Operations. The effect of this change has impacted in the ability of the SAA to carry out the job description as defined in the Plan ... The role of the SAA on the Executive Team was unclear ... The SAA's lines of authority and accountability need to be clarified by the AMHO Chief in order for the SAA position to have a meaningful role within the system of care."
Exhibit "8" at page 34.
Dr. Minkoff added, "One issuers], already discussed, is
the concern by the SAAs that they have no authority in
relation to the CMHCs." Exhibit "A"at page 55.
To be consistent with the original intent of the
Community Plan, SAA's should have the responsibility and
authority in the AMHO organizational structure to
oversee all service providers in their respective
18

counties. The Evaluation Team also questioned whether AMHD
had satisfactorily established and maintained clear lines of clinical and administrative authority, accountability and the provision of supervision and guidance for administrative leaders.
As Ms. Hanson-Mayer noted, "The AMHD Chief has not adequately addressed the separation of the State's provider operations from the oversight function." Exhibit "8" at page 29. Dr. Minkoff emphasized, "[tJhe importance of the administrative infrastructure in designing and supporting all the functions of the Community Plan is so significant that adequate performance is critical." Exhibit "A" at page 44.
The Evaluation Team identified shortcomings by the Defendants and areas of the Community Plan which were incomplete.
However, and importantly, the Evaluation Team also found that Defendants had made significant progress over the past six months, and particularly, in the three
19

months preceding the June 30, 2006 compliance deadline. The Evaluation Team noted that in many areas Defendants were headed in the right direction and encouraged Defendants to continue their efforts through November 30, 2006.
Conclusion In conclusion, the Special Master is unable to say that Defendants achieved substantial compliance with the Community Plan on or before June 30, 2006. However, the Special Master can state unequivocally that the amount and level of treatment, care and services available to persons in the community with serious mental illness has improved dramatically since the filing of this lawsuit. Due to the efforts of the parties and their counsel and the work of Kris McLoughlin, the court appointed Special Monitor, the integrated hospital-based and community-based mental health system contemplated by the "omnibus plan" approved by Chief District Ezra in January 2000 is approaching reality.
20

Hawaii State Hospital is no longer subject to the jurisdiction of the Federal Court and Defendants have made noteworthy progress and achieved compliance in many areas of the Community Plan recognized by the Evaluation Team.
However, the Special Master cannot disregard Defendants' shortcomings in the Community Plan areas of Service System Organization and Functions, core service areas such as Case Management and ACT; Forensic Services, Treatment Planning, Inpatient Discharge Oversight and Consumer Protection. There is no dispute that the foregoing items are critical to the establishment of the framework for a sustainable system of community mental health services contemplated by the Community Plan.
Based on the foregoing and carefully considering the purpose and intent of the Community Plan, the findings of the Evaluation Team and giving due weight to Defendants' progress and lack thereof in all areas of the Community Plan, the Special Master finds that
21

Defendants' lack of progress and/or non-compliance by June 30, 2006 in the areas specifically discussed herein above preclude a determination by the Special Master that Defendants have achieved timely substantial compliance with the Community Plan.
Defendants' deficiencies in the above-referenced areas should not diminish Defendants' successes and achievements in other areas of the Community Plan and the extraordinary efforts being put forth on a daily basis by the individuals working at Hawaii State Hospital, the Community Mental Health Centers and other service providers, the Service Area Administrators, the Service Directors and other key individuals at AMHD and elsewhere who continue to work hard to provide quality service to consumers, to develop the system of care and to implement the Community Plan.
Indeed, counsel contemplated a possible scenario in which Defendants were unable to meet the June 30, 2006 compliance deadline and expressly provided for it in the Joint Stipulation. The Joint Stipulation requires
22

Defendants to continue their efforts to implement the Community Plan until November 30, 2006, the agreed upon dismissal date for this case.
The Evaluation Team provided suggestions to Defendants with regard to areas of Defendants' nonfulfillment in their final reports. Defendants are proceeding in good faith with the requirements of the Joint Stipulation. The Special Master understands that Defendants have reviewed the suggestions made by the Evaluation Team and are in the process of finalizing a plan which will focus their continuing efforts between now and the November 30, 2006 termination date. The Special Master and the Special Monitor urge Defendants to follow the suggestions of the Evaluation Team and to continue with their good efforts. Momentum is certainly on the Defendants' side.
Therefore, and in accordance with the terms and conditions of the Joint Stipulation approved by the Court, the Special Master recommends that no further action be taken and that this case be dismissed on
23

November 30, 2006. In closing, the Special Master recognizes and
thanks the members of the Evaluation Team for their continued assistance and service to the Court. These three individuals have at all times acted in accordance with the highest professional standards and in the best interests of mental health consumers, the public and the parties.
The same is true with regard to Kris McLoughlin, the court appointed Special Monitor. Dr. McLoughlin" has a deep and unwavering commitment to the mentally ill and her community and she demonstrated same throughout her work as the Special Monitor in this case. The Special Master thanks Dr. McLoughlin for her perseverance, extraordinary work and expertise in this case. In so doing, Dr. McLoughlin has provided exceptional service to the Federal Court.
The Special Master also thanks counsel for their
1 In May 2006, Kris McLoughlin completed her course of study and her thesis in accordance with university requirements and received a Doctor of Nursing Practice from Case Western Reserve University.
24

very professional approach and work in this case. After his appointment in 2001, the Special Master asked counsel to recognize a shared goal and to consider a collaborative approach in this case. At all times, counsel put acrimony aside and worked in the best interests of their respective clients and the public to bring this case to a negotiated conclusion and a positive outcome.
Lastly, the Special Master thanks District Judge Ezra for his support and leadership in this case. Judge Ezra identified the objective, set the tone and provided the Special Master with the opportunity to work with the parties to address the very important issues in this CRIPA based lawsuit in a collaborative way that would benefit the mentally ill and the community as a whole.
In closing, the Special Master requests that District Judge Ezra schedule a hearing on this Twelfth Report and Recommendation and allow the parties a reasonable opportunity to file comments and objections, if any, to this Twelfth Report and Recommendation. If
25

there are no objections or opposition filed by the parties to the Twelfth Report and Recommendation and its proposed approval, the Court may deem the matter appropriate for disposition without a hearing and issue an appropriate Order.
IT IS SO FOUND AND RECOMMENDED. DATED: Honolulu, Hawaii, August 28, 2006.
United States Magistrate Judge
CIVIL NO. 91-00137 DAE-KSC; UNITED STATES OF AMERICA vs. STATE OF HAWAI'I, et. al.; TWELFTH REPORT AND RECOMMENDATION
26

 
 424 F.Supp.2d 1278 (2006)
UNITED STATES of America, Plaintiff, v.
State of HAWAII, et al., Defendants.
No. Civ.91-00137 DAE-KSC.
United States District Court, D. Hawai`i.
March 24, 2006.
1279 *1279 Verlin Hughes Deerinwater, Richard J. Farano, David Deutsch, Robinsue Frohboese, U.S. Department of Justice, Washington, DC, Michael Chun, Office of the United States Attorney, Honolulu, HI, for Plaintiff.
Paul M. Aucoin, Aucoin Dupont Hetterscheidt Younkin LLC, Columbus, OH, Robert A. Marks, Office of the Attorney General, State of Hawaii, Blair A. Goto, State of Hawaii, Atty. Generals Dept., Regulatory Division, Honolulu, HI, for Defendants.
ORDER ADOPTING AND APPROING ELEVENTH REPORT AND RECOMMENDATION
DAVID ALAN EZRA, District Judge.
A hearing on the Special Master's Eleventh Report and Recommendation filed on February 10, 2006 ("Eleventh Report") was held on March 23, 2006. United States Department of Justice attorneys Judith Preston and Verlin Deerinwater and Assistant United States Attorney Harry Yee appeared on behalf of Plaintiff United States of America ("United States"). Attorney General Mark Bennett, Deputy Attorney General Ann Andreas and Special Deputy Attorney General Paul AuCoin appeared on behalf of Defendants State of Hawaii, Linda Lingle, Chiyome 1280 Fukino, Michelle Hill and William Elliott ("Defendants"). Also present was Kris *1280 McLoughlin, the court appointed Special Monitor.
After carefully reviewing the Eleventh Report and the written responses and supplemental responses filed by the parties on February 21, and March 10, 2006, respectively, and considering the arguments of counsel presented at the hearing, the Court approves and adopts the Eleventh Report.
The Court denies the United States' request for the imposition of sanctions against Defendants based on the findings presented by the Special Master in the Eleventh Report.
In pertinent part, the Joint Stipulation and Order Regarding Plan for Community Mental Health Services filed on October 25, 2005 ("Joint Stipulation"), provides that the deadline for Defendants' achieving substantial compliance with the Plan for Community Mental Health Services ("Community Plan") is June 30, 2006. The Joint Stipulation also requires, in pertinent part, that Defendants put forth their "reasonable best efforts" to achieve compliance with the Community Plan and all previously entered court orders related to the Community Plan.
In the Eleventh Report, the Special Master found that Defendants have failed to make meaningful progress to achieve substantial compliance in certain critical areas of the Community Plan and that Defendants remain far from achieving substantial compliance with the Community Plan. Defendants acknowledge that they are behind schedule and that there is much more work to be done.
Because the Court has a serious concern that Defendants are not putting forth their reasonable best efforts to achieve substantial compliance with the Community Plan by June 30, 2006, the Court directs counsel for the parties to promptly meet and confer with the Special Master for the purpose of identifying and agreeing on benchmarks with an April 30, 2006 deadline in a limited number of subject areas of the Community Plan which would prove that the Defendants are putting forth their reasonable best efforts to achieve substantial compliance

with the Community Plan by June 30, 2006. Thereafter, the Special Master, with the assistance of the court appointed Special Monitor, shall make findings and report to the Court whether or not the Defendants have met the identified benchmarks by the April 30, 2006 deadline and/or are putting forth their reasonable best efforts to achieve substantial compliance with the Community Plan. If the parties are unable to reach agreement, the Special Master shall identify the benchmarks for the parties. In the event Defendants fail to meet the aforesaid benchmarks, the Court will entertain a motion filed by the United States for the imposition of sanctions against Defendants based on Defendants' failure to put forth their reasonable best efforts to achieve substantial compliance with the Community Plan and all previously entered court order related to the Community Plan.
IT IS SO ORDERED.
ELEVENTH REPORT AND RECOMMENDATION
CHANG, United States Magistrate Judge.
This Eleventh Report and Recommendation (1) updates the status of the case related to the Special Master's Plan for Community Mental Health Services, (2) explains the Joint Stipulation and Order Regarding Plan for 1281 Community Mental Health Services and (3) discusses the sixth visit of the Special Master's Community *1281 Mental Health Services Evaluation Team on December 5-9, 2005.
The Community Plan
A detailed overview of the Special Master's Plan for Community Mental Health Services ("Community Plan") is set out in the Special Master's Tenth Report and Recommendation ("Tenth Report") filed on July 20, 2005.
Reports and detailed discussion concerning Defendants' progress or lack thereof to achieve substantial compliance with the Community Plan are set out in the Fourth, Seventh, Eight, Ninth and Tenth Reports and Recommendations filed by the Special Master on July 18, 2003, August 26 and November 12, 2004, and February 9 and July 20, 2005, respectively.
Although entitled the Special Master's Plan for Community Mental Health Services, the Community Plan was the result of a collaborative effort by counsel, representatives of the parties and Kris McLoughlin, the court appointed Special Monitor, along with Thomas Hester, M.D., Chief of the Adult Mental Health Division. The meetings and discussions which lead to formulation of the Community Plan took place in Honolulu and Washington, D.C., during the fall of 2002.
The Community Plan was presented as part of the Special Master's Third Report and Recommendation filed on November 27, 2002, and was approved and adopted as an Order of the Court by Chief District Judge Ezra on January 23, 2003.
The deadline for Defendants' compliance with the Community Plan was originally January 23, 2005. On December 10, 2004, the twenty-four month period allowed for Defendants' compliance with the Community Plan was increased by seventeen months and Defendants' deadline was extended to June 30, 2006.
In the Tenth Report filed on June 20, 2005, the Special Master expressed apprehension and doubt as to whether Defendants are likely to meet the June 30, 2006 compliance deadline.
The Joint Stipulation
On October 26, 2005, Chief District Judge Ezra approved a Joint Stipulation And Order Regarding Plan For Community Mental Health Services ("Joint Stipulation") in this case.
The Special Master and Kris McLoughlin, the court appointed Special Monitor, encouraged and supported the proposed Joint Stipulation reached by the parties because it (1) recognizes Defendants' progress and substantial compliance with the Hawaii State Hospital Remedial Plan, (2) promotes the efficient use of available resources and the provision of community based mental health services to consumers, (3) contemplates a more collaborative approach to Defendants with the Special Monitor and Evaluation Team members offering technical

assistance to Defendants, (4) obligates Defendants to put forth their reasonable best efforts towards achieving substantial compliance, (5) provides the best opportunity for Defendants to achieve substantial compliance with the Community Plan by June 30, 2006, and (6) brings closure to this costly and very challenging fifteen year old lawsuit based on the Civil Rights of Institutionalized Persons Act ("CRIPA").
In pertinent part, the Joint Stipulation provides the following.
First, Defendants' deadline for compliance with the Community Plan remains June 30, 2006.
Second, Defendants shall prepare an Action Plan with timelines which sets out the particular steps Defendants will take to achieve substantial compliance with the Community Plan.
1282 *1282 Third, the United States, Defendants, the Special Monitor and the Evaluation Team members shall collaborate on the implementation of Defendants' Action Plan.
Fourth, Defendants shall put forth their reasonable best efforts to achieve substantial compliance with the Community Plan and all previously entered court orders related to the Community Plan.
Fifth, in the event that Defendants have not achieved substantial compliance with the Community Plan by June 30, 2006, Defendants shall continue their efforts to implement the Community Plan until on or before November 30, 2006. Finally, this lawsuit will terminate on November 30, 2006.
The Evaluation Team's Sixth Site Visit
Kenneth Minkoff, M.D., Gail Hanson-Mayer, A.P.R.N., B.C., M.P.H. and Paul Gorman, Ed.D. comprise the Special Master's Community Evaluation Team ("Evaluation Team").
The sixth community site visit by the Evaluation Team took place on December 5-9, 2005. Copies of the written reports submitted by Dr. Minkoff, Ms. Hanson-Mayer and Dr. Gorman are attached to this Eleventh Report as Exhibits "A", "B" and "C", respectively.
Overall, the Evaluation Team noted "promise" and "potential" based on recent personnel and other changes made at the Adult Mental Health Division, Department of Health ("AMHD"). During their sixth visit, the Evaluation Team encountered a different organizational structure at AMHD, new staff hired to fill vacant AMHD positions, a changed internal AMHD action plan, and as of November 30, 2005, a new Community Plan implementation extension time line.
The Evaluation Team also described areas of the Community Plan in which Defendants showed significant progress. These areas included: (1) describing and reporting on the target population, (2) implementation of an array of community housing services, (3) implementation of psychosocial rehabilitation services, and (4) implementation of a service research and evaluation system.
However, the Evaluation Team also found that Defendants have still not made meaningful progress to achieve substantial compliance in the following critical areas of the Community Plan: (1) development and implementation of community-based forensic services, (2) AMHD inpatient discharge oversight, and (3) development of an AMHD functional organizational chart as described in the Community Plan. The subject of community based forensic services and programs is discussed in detail herein below.
Defendants have also failed to make appreciable progress in several other significant areas. They are: (1) AMHD system infrastructure, (2) implementation of crisis services, (3) treatment planning, (4) medication algorithm implementation, and (5) Community Mental Health Center (CMHC) functioning with regard to center leadership structure and staff supervision.
Overall, Defendants remain far from achieving substantial compliance with the Community Plan and it appears unlikely that they will meet the June 30, 2006 deadline. Some progress has been made but much more work needs to be done. The reports prepared by the Evaluation Team should be reviewed for additional information.

Finally, Defendants' lack of progress with the Community Plan is adversely affecting conditions at Hawaii State 1283 Hospital and threatens to reverse the progress achieved as a result of Defendants' substantial *1283 compliance
with the Hawaii State Hospital Remedial Plan in 2004.
Community Based Forensic Services and Programs
Forensic services and programming is an area which has become one of critical need and importance to the mental health system in Hawaii.
November 30, 2005 was the deadline applicable to the majority of tasks related to forensic services and programs required by the Community Plan and Hawaii State Hospital related court orders. Defendants are more than sixty days past this deadline.
However, Defendants' failure with regard to implementation of forensic services and programs is egregious because the majority of forensic related requirements come from the Hawaii State Hospital Remedial Plan ("HSH Remedial Plan") filed on February 21, 2002. Thus, Defendants, and specifically AMHD leadership, have had four years to address the issues and requirements related to forensic services and programs, and they have little to show for the past four years.
For example, after interviewing the AMHD leadership team, the AMHD Forensic Director and several community providers in December 2005, and completing a thorough document review, Ms. Hanson-Mayer found no evidence of Defendants' progress since the Evaluation Team's June 2005 visit in the following areas of forensic services and programs: (1) model court orders, involuntary treatment and medication orders, (2) proposed legislation to separate fitness from responsibility, (3) evaluation of jail diversion, forensic ACT teams, community crisis teams and (4) the location, level and timeliness of forensic services. Additionally, Ms. Hanson-Mayer found the following three forensic program areas lacking in development: (1) outpatient fitness restoration, (2) jail diversion, and (3) conditional release. See Page 13 of Exhibit "B".
The need for the forensic services and programs set out in the HSH Remedial Plan and the Community Plan is unmistakable and has never been clearer.
Significantly, AMHD reported that, for fiscal year 2005, 507-570 or 48%-54% of the 996 persons in the target population for the Community Plan who are currently receiving AMHD services had a forensic encumbrance of some kind. Additionally, a study conducted in October 2005 by the AMHD Forensic Director found that approximately one-third of the target population for the Community Plan referred to above is on Conditional Release status. Based on the foregoing, a high percentage of the target population for the Community Plan is susceptible to community forensic services and programs.
Establishment of adequate forensic services and programs, and specifically, successful conditional release programming is vital to Defendants achieving timely substantial compliance with the Community Plan and to patient and public safety.
In her June 2005 report, Ms. Hanson-Mayer described how the absence of conditional release programming potentially contributed to a death and a serious assault. Pages 16-17 to Exhibit "E" of the Tenth Report.
In her current report, Ms. Hanson-Mayer noted another clinical case review of a target population member in which the lack of conditional release programming contributed to his disappearance within 90 days of discharge from Hawaii State Hospital. Pages 9-11 of Exhibit "B".
Dr. Minkoff concurs with the above, identified three specific cases in his report and stated, "Most concerning 1284 however is the total lack of progress in the development *1284 of conditional release programming . . . Most
important, lack of CR [conditional release] programming is a major contributor to sentinel events and to HSH [Hawaii State Hospital] readmission." Page 29 of Exhibit "A".
Dr. Minkoff wrote the following.

The seriousness of this issue cannot be overstated. AMHD is most significantly past (or about to be past) the due dates for compliance in an area of increasing clinical relevance to the provision of successful community based care in the entire system, the lack of which is contributing to a significant percentage of early readmissions to HSH, which is dramatically over census. Further, there was no evidence at this visit that this problem is being meaningfully addressed. At this point, it is not clear whether even dramatic action can assure compliance by June 30, 2006.

Pages 29-30 of Exhibit "A".

The Special Master and the Special Monitor agree with Dr. Minkoff and Ms. Hanson-Mayer that the need for adequate forensic services and programs is critical and immediate. As stated by Dr. Minkoff, Defendants' noncompliance in the area of forensic services and programs has a direct effect on readmissions and the patient census at Hawaii State Hospital.

Hawaii State Hospital Census

More than seven months ago, the Special Master pointed to the increasing census at Hawaii State Hospital as proof of Defendants' lack of progress in developing the system of community-based mental health services required under the Community Plan.

The patient census at Hawaii State Hospital has risen steadily from an average daily census of 155 in 2002 to an average daily census of 172 in 2005. This disturbing trend has continued to the present with an average daily census of 191 in December 2005, and an average daily census of 193 in January 2006.

In the Tenth Report, the Special Master wrote the following.

It should be recalled that nearly three years ago, in the Second Report and Recommendation filed on August 9, 2002, the Special Master wrote the following (after the reopening of the Guensberg Building) regarding overcrowding at Hawaii State Hospital.

In the event the patient census at Hawaii State Hospital continues to hover at or beyond 168, and patients continue to be placed at Kahi Mohala or with other providers to receive necessary hospital care, Defendants should promptly develop and evaluate alternatives which will assure that there are an adequate number of hospital and community-based residential beds to serve the population of mentally ill persons in need of hospitalization or residential care.

[cite omitted]

It is reasonable to conclude that the increasing census at Hawaii State Hospital is due, in part, to "back door" and "front door" issues related to Defendants' slow implementation of the Community Plan.

1285

Simply put, Hawaii State Hospital is unable to efficiently transfer patients from the hospital setting into the community because the system of community-based mental health services is not adequate or fully prepared to receive, treat and follow the patients. This is the "back door" issue at Hawaii State Hospital, that is, because patients are not leaving the hospital, the census at Hawaii State Hospital is increasing and remains high. Because patients who have completed their hospital treatment are not being efficiently transferred from Hawaii State Hospital into the *1285 community, persons in the community with serious mental illness who are in need of hospital services cannot be admitted to Hawaii State Hospital due to the unavailability of bed space. Further, patients discharged from Hawaii State Hospital with less than adequate community placement and programming promptly decompensate and require readmission to the hospital.

The "front door" issue which exists at Hawaii State Hospital is that persons with serious mental illness in need of hospital based services are unable to receive them in a timely manner and are stacked up waiting to be admitted. This circumstance contributes to an increasing and elevated census.

Pages 36-38 of the Tenth Report (emphasis added).

Little has changed since July 2005 when the census began routinely topping 180. The "back door" and "front door" issues described seven months ago in the Tenth Report continue to exist today and are persistent reminders of Defendants' lack of progress with regard to the Community Plan, and the failure of AMHD leadership to achieve substantial compliance.

In the Tenth Report, the Special Master wrote the following regarding AMHD contracting with Kahi Mohala.

Beginning in or about September 2001, Defendants contracted with Kahi Mohala for additional bed space to address the overcrowded situation at Hawaii State Hospital. As of July 1, 2005, AMHD has contracted with Kahi Mohala for 8 acute beds and 32 intermediate stay beds for a total of 40 contracted beds. The contracted rates for each of the acute and intermediate stay beds are $730 and $680 per day, respectively. Thus, the approximate total cost per day for the 40 beds is $27,600, the approximate total cost per month for the 40 beds is $828,000, and the approximate total annual cost for the 40 beds is $10,074,000.

Significantly, the average daily census at Kahi Mohala for the AMHD contracted beds in the last three months was as follows: April 2005-39 beds; May 2005 42 0907 beds; and June 2005 45 0907 beds. Kahi Mohala charges AMHD the lower rate of $680 per day for the over-flow number in excess of 40 beds. Thus, for the past three months alone, AMHD has incurred more than $2.5 million for the contracted beds at Kahi Mohala. The total amount paid to Kahi Mohala for contracted beds to address overcrowding at Hawaii State Hospital since September 2001 is not known.

Pages 38-39 of the Tenth Report (emphasis added).

This item has worsened. Defendants continue to contract with Kahi Mohala for additional bed space. The average daily census at Kahi Mohala for AMHD contracted beds in the last 3 months was at the contract maximum of 42. Thus, the extraordinary cost of having to pay for Kahi Mohala beds continues unabated and has increased since the Tenth Report.

Finally, in the Tenth Report, the Special Master wrote the following regarding the negative effects of overcrowding.

Further, the budgeted capacity of Hawaii State Hospital is 168 patients, which means that staff, services and supplies are budgeted for a population of 168 patients. When the hospital census exceeds 168, Hawaii State Hospital incurs additional costs and expenses such as staff overtime, supplies, services and operational expenses for the number of patients above 168.

1286

Based on historical events, we know that overcrowding has a negative effect on the quality of treatment provided to patients *1286 at Hawaii State Hospital. Hospital clinical staff is strained and overburdened. Hospital facilities and resources are stretched beyond their limits. Overcrowding represents a step backwards in the progress made at Hawaii State Hospital. This very serious issue was discussed with defense counsel months ago as the census at Hawaii State Hospital began to rise.

Pages 39-40 of the Tenth Report (emphasis added).

There is no dispute that overcrowding has adversely affected the quantity and quality of treatment provided to patients at Hawaii State Hospital.

Several times in the last quarter of 2005, classes and services provided to patients at the HSH rehabilitation treatment mall were curtailed or cancelled because the mall could not accommodate the increased number of patients at Hawaii State Hospital. Very simply, there was not enough staff to safely and effectively teach classes and supervise patients.

The treatment mall was then closed in January 2006 due to an outbreak of chicken pox. The plan was to reopen February 6, 2006, but this was postponed due to a lack of space and staff. HSH staff has reportedly resisted pressure from AMHD leadership to re-open the treatment mall on an "as is" basis citing safety, hygiene, and clinical reasons. As of February 8, 2006, the treatment mall at Hawaii State Hospital remained closed to patients.
In December 2005, some patients had to sleep on mattresses placed on floors in conference or activity rooms because there were no available patient rooms and some patients did not have access to proper bathroom and shower facilities due to the increased number of patients at Hawaii State Hospital. These patients now have beds but must continue to walk through communal areas in order to get to the bathroom or shower. On one HSH unit, patients shower in staff areas.
It was reported to the Special Monitor that Hawaii State Hospital was seeking licensing waivers because existing conditions may place the hospital in violation of applicable state licensing rules and requirements. Waivers or relief from licensing requirements alone will not improve the existing health and safety conditions at Hawaii State Hospital. For example, on one HSH unit, twenty or more male patients have only 2 showers and 3 toilets available for their use.
It has also been reported by HSH staff that the number of patient to patient assaults increased in December 2005, and that staff are reluctant to accept overtime shifts. As a result, the frequency of daily staff-patient ratio shortages is increasing.
Some of the above issues and concerns were presented to the Director of the Department of Health and defense counsel by the Special Master and the Special Monitor at a meeting on January 6, 2006.
The Director of the Department of Health responded to the Special Master in a letter dated February 3, 2006, which is attached as Exhibit "D" to this Report.
The Special Master appreciates the commitment and extraordinary efforts being made by HSH staff to sustain the progress made at Hawaii State Hospital in 2004.
The Special Master also recognizes the recently commenced and ongoing work by Defendants to address census related issues at Hawaii State Hospital.
The personal commitment of the Director of the Department of Health and her direct involvement with the problems and very troubling facts and circumstances at Hawaii State Hospital is appreciated because there is a 1287 concern that the situation at Hawaii State Hospital may get *1287 worse before it gets better. Hopefully, this will not be the case but after receiving the Director's correspondence, the Special Master learned that Connie Mitchell, the highly regarded Director of Nursing at Hawaii State Hospital, had submitted her resignation. Ms. Mitchell, along with former HSH administrator Paul Guggenheim, HSH medical director, Rupert Goetz, M.D., Kris McLoughlin, the court appointed Special Monitor and the dedicated HSH staff were instrumental in helping Hawaii State Hospital to achieve substantial compliance with the HSH Remedial Plan in 2004.
Conclusion
The Joint Stipulation presents Defendants, and specifically, the Adult Mental Health Division, Department of Health ("AMHD") with an extraordinary opportunity to complete the work that needs to be done to establish the framework for a sustainable system of community mental health services.
The Joint Stipulation came about, in large measure, because there was recognition of the remarkable change and progress made at Hawaii State Hospital in 2004 and a concomitant willingness to provide AMHD with the best chance possible to achieve timely substantial compliance with the Community Plan under the circumstances. Simply put, it was understood by all involved that if AMHD and Defendants achieved substantial compliance with the Community Plan, the immediate and long term benefits to Hawaii State Hospital, mental health consumers and the public would be great, and the integrated hospital-based and community-based mental health system contemplated by the "omnibus plan" would be a step closer to reality. This "big picture" goal was shared by the parties, counsel, the Special Monitor and the Special Master. The foregoing, and not the fact that this lawsuit would end in November 2006, was the primary driver to the Joint Stipulation.

The Joint Stipulation requires Defendants to continue their efforts to implement the Community Plan under supervision of the Court, even after June 30, 2006, and until November 30, 2006.
Therefore, based on the plain language and the spirit underlying the Joint Stipulation, it would be wrong for AMHD leadership to not urge or put forth their reasonable best efforts to achieve timely substantial compliance with the Community Plan.
AMHD leadership should seize the opportunity, follow the "road map" previously provided by the Evaluation Team and utilize the technical assistance offered by the Evaluation Team and the Special Monitor to achieve a positive outcome in this case. While the June 30, 2006 deadline for Defendants' substantial compliance with the Community Plan is only five months away, there is still an additional five months to the November 30, 2006 dismissal date of this lawsuit. Thus, AMHD and Defendants have ample opportunity, a total of ten months, in which they can fully and forcefully demonstrate their stated commitment to persons in the community with serious mental illness and the public at large.
Anything less than a full and complete effort by AMHD and Defendants to achieve substantial compliance over the next ten months depreciates the extraordinary efforts being put forth on a daily basis by the individuals working at Hawaii State Hospital, the Community Mental Health Centers and other service providers, the Service Area Administrators, the Service Directors and other key individuals at AMHD and elsewhere who are working 1288 hard to respond to earlier recommendations, to provide quality service to *1288 consumers, to develop the system of care and to implement the Community Plan.
Finally, there is an immediate need for Defendants to achieve substantial compliance with Community Plan items, such as community based forensic services and programs, which directly affect the patient census at Hawaii State Hospital. AMHD's past inability to make substantial progress with regard to the Community Plan and failure to take prompt action at Hawaii State Hospital in 2005 to address overcrowding issues may have the catastrophic effect of undoing all that was achieved at Hawaii State Hospital in 2004.
Frankly, AMHD's time for discussion and planning for the overcrowding at Hawaii State Hospital occurred in the past seven months0907what is required now is focused action by AMHD. Considering AMHD's apparent confusion and lack of direction in the past, the Special Master appreciates the Director of Health's assistance and involvement in this regard. The Director's February 3, 2006 letter response was timely, on point and conveyed an understanding of the urgency, analysis and action needed at this time.
The Evaluation Team's final community site visit is scheduled for June 26-30, 2006. The Special Master recognizes and thanks the members of the Evaluation Team for their continued assistance and service to the Court. These three individuals have at all times acted in accordance with the highest professional standards and in the best interests of mental health consumers, the public and the parties.
The same is true with regard to Kris McLoughlin, the court appointed Special Monitor. Pursuant to the terms of the Joint Stipulation, Ms. McLoughlin will continue to assist the Court until the termination of the case on or before November 30, 2006.
After their final site visit, the members of the Evaluation Team will submit written reports which will present their respective findings and conclusions with regard to whether Defendants have achieved substantial compliance with the Community Plan by June 30, 2006, and other matters which they deem appropriate to the case.
The Special Master will continue to monitor conditions and developments at Hawaii State Hospital, confer with Kris McLoughlin, the court appointed Special Monitor, communicate with counsel and prepare a closing report for this fifteen year old CRIPA lawsuit upon receipt of the Evaluation Team's final reports.
In closing, the Special Master requests that District Judge Ezra schedule a hearing on this Eleventh Report and Recommendation and allow the parties a reasonable opportunity to file comments and objections, if any, to this Eleventh Report and Recommendation. If there are no objections or opposition filed by the parties to the Eleventh Report and Recommendation and its proposed approval, the Court may deem the matter appropriate for disposition without a hearing and issue an appropriate Order.

IT IS SO FOUND AND RECOMMENDED. Feb. 10, 2006.
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 United States v. Hawaii
United States District Court for the District of Hawaii May 30, 2006, Decided CV 91-00137DAE-KSC

Reporter: 2006 U.S. Dist. LEXIS 35207

UNITED STATES OF AMERICA, Plaintiff(s), vs. State of

Hawaii, et al., Defendant(s).

Judges: David Alan Ezra, United States District Judge.

Prior History: United States v. Hawaii, 424 F. Supp. 2d 1278, 2006 U.S. Dist. LEXIS 18629 (D. Haw., 2006)
Counsel: [*1] spmr Kris A. McLoughlin, Special Master, Pro se, Honolulu, HI.
For USA, Plaintiff: David Deutsch, Richard J. Farano, U S Department of Justice, Civil Rights Div, Special Litigation Sec, Washington, DC.; Harry Yee, Office of the United States Attorney, Honolulu, HI.; Robinsue Frohboese, U.S. Department of Justice, Civil Rights Division, Washington, DC.; Verlin Hughes Deerinwater, US Department of Justice, Special Litigation, Washington, DC.
For State of Hawaii, Defendant: Ann V. Andreas, Office of the Attorney General-Hawaii, Honolulu, HI.; Blair A. Goto, Office of the Attorney General-State of Hawaii, Honolulu, HI.; Paul M. AuCoin, AuCoin DuPont Hetterscheidt & Younkin LLC, Columbus, OH.
For John Waihee, Governor, John Lewin, Director, Department of Health, Henry Foley, Deputy Director, Bahavioral Health Services of the Department of Health, Naleen N. Andrade, Acting Superintendent, Hawaii State Hospital, Defendants: Blair A. Goto, Office of the Attorney General-State of Hawaii, Honolulu, HI.

Opinion by: David Alan Ezra
Opinion
ORDER ADOPTING SPECIAL MASTER'S REPORT REGARDING BENCHMARKS
A Report of Special Master having been [*2] filed and served on all parties on May 3, 2006 and no objections having been filed by any party,
IT IS HEREBY ORDERED AND ADJUDGED that pursuant to Title 28, United States Code, Section 636 (b)(2) and Local Rule 53.1, the Special Master's Report Regarding Benchmarks, document no. 403, is adopted as the opinion and order of this court.
IT IS SO ORDERED.
DATED: Honolulu, Hawaii, May 30, 2006.
David Alan Ezra
United States District Judge

 
 U.S. Dep; lent of Justice Civil Rights Division

Office of the Assistant Attorney General
BY OVERNIGHT AND REGISTERED MAIL RETURN RECEIPT REQUESTED

Washington, DC. 20530

NOV

U.S. v. Hawaii

1989

Honorable John Waihee Governor of Hawaii Hawaii State Capitol Honolulu, HI 96813

MH-HI-001-001

Re: Investigation of Hawaii State Hospital, Kaneohe and Honolulu. Hawaii

Dear Governor Waihee:

I arc writing to let you know of our intention to investigate conditions within the Hawaii State Hospital, Kanehoe and Honolulu, Hawaii. This investigation is pursuant to the Civil Rights of Institutionalized Persons Act, 42 U.S.C. Sections 19971997j.

The purpose of the investigation will be to determine whether there exists any violations of the statutory and federal constitutional rights of patients residing at the facility. The investigation will focus on allegations related to an 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. The initiation of this investigation in no way evidences any prejudgment on our part that patient federal rights have been violated. If any violations are found, we look forward to conferring with you and your staff concerning corrective actions that might be appropriate.

As a means of commencing this investigation, I wish to propose an initial meeting in the near future between our attorneys and representatives of your office. It has been our experience that such a preliminary conference can substantially expedite the process. We also wish to arrange for our attorneys, consultants, and perhaps agents of the Federal Bureau of Investigation to visit the Hawaii State Hospital. We shall be in touch with your staff to work out the specifics of our meeting and later visits.

- 2-
Your cooperation in this matter is greatly appreciated.
Sincerely,
Janes P. Turner Acting Assistant Attorney General
Civil Rights Division
cc: Honorable Warren Price Attorney General State of Hawaii
Dr. Howard Gudeman Superintendent, Hawaii State Hospital Daniel A. Bent, Esquire United States Attorney

 
 JPT:AEP:MHN:VH:RF:CA:drb DJ 168-21-10

MAR 1 1890

BY OVERNIGHT AND
REGISTERED MAIL
RETURN RECEIPT REQUESTED
Honorable John Waihee
Governor of Hawaii Hawaii State Capitol Honolulu, HI 96813

..«
..„. ... ... ... " f IIIII II I III I I I II II
• '' "' '1,[JJO

Re: Notice of Findings Regarding Hawaii State Hospital, Kaneohe and Honolulu, Hawaii, 42 U.S.C. S1997bfa)(1)

Dear Governor Waihee:

On November 6, 1989, we informed you that, pursuant to the Civil Rights of Institutionalized Persons Act (CRIPA), 42 U.S.C. §1997, we were commencing an investigation into conditions at Hawaii State Hospital (HSH), in Kaneohe and Honolulu, Hawaii. On December 11-14, 1989, attorneys and consultants from the Department of Justice toured HSH. Our touring team examined patient records, interviewed the facility superintendent and numerous staff and spoke with patients. We also reviewed numerous documents provided by the facility concerning a wide range of procedures and activities. During the investigation, our people were treated graciously by HSH staff and attorneys from the Hawaii Attorney General's office.

On the basis of our investigation we have concluded that HSH subjects patients to conditions that deprive them of certain of their constitutional rights. Institutionalized mentally ill persons are constitutionally entitled to adequate food, clothing, shelter, medical and nursing care, a reasonably safe environment and such treatment programs as an appropriate professional would consider reasonable to ensure a patient's safety and freedom from undue bodily and chemical restraint. Cf. Younabera v. Romeo. 4 57 U.S. 307, 324 (1982). Set forth below are those conditions which violate the constitutional rights of HSH patients.

cc: Records Chrono Peabodv Nelson Frohboesei NNJJiughes Alford Hold

- 2-
Hawaii State Hospital at Kaneohe
1. Inadequate Food. Clothing, and Shelter
Our investigation disclosed that HSH fails to afford its patients basic elements of life's necessities. Specifically, patients are not provided adequate amounts of food, sufficient clothing, essential personal hygiene supplies, and an environment which is free from unreasonable risks to their personal health and safety.
The amount of food served to patients is highly questionable in terms of nutritional adequacy. Staff on the Pali Unit advised our consultants that the amount of food available to serve patients was consistently inadequate. Specific reference was made to the unavailability of adequate food for newly admitted patients. Finally, food served to outlying units is transported and served in styrofoam food containers. This method of food distribution presents a serious health risk because the containers do not keep the food sufficiently hot or cold from the time it is put into the containers in the central kitchen until actually served to patients on the various living units.
There is also inadequate clean clothing and essential personal hygiene materials at HSH for use by patients. Staff reported that patients are often wrapped in blankets or sheets due to the absence of adequate clothing. Our consultants observed what appeared to be communal use of soap, shampoo, and toothbrushes due to the lack of adequate personal hygiene items. The communal use of such personal hygiene materials represents an unreasonable risk to the health of residents since germs and bacteria are easily passed in this manner. Moreover, staff indicated that there were shortages of towels, clean linens and other items necessary to employ basic personal hygiene measures.
While we were apprised of plans to build new hospital facilities to house a substantial number of HSH patients, the environment at the present facility is so inadequate that living conditions pose serious risks to the health and safety of patients. While the plan to close many current buildings and replace them with new facilities is commendable, new construction will not necessarily solve all of the environmental problems identified below. Indeed, new facilities will be of little assistance to forensic and adolescent patients who will continue to be housed in their current buildings.
First, the facility is dangerous. Suicide hazards abound throughout the facility. Exposed metal pipes, electrical cords
wrapped loosely around ceiling fans, non-bendable and non-
breakable curtain rods, and exposed containers of cleaning fluids

- 3-
and other hazardous materials are ubiquitous throughout the facility. Seclusion rooms are especially dangerous. Such rooms have blind spots, holes in their walls, exposed jagged edges, peeling paint and protruding nails. Beds are kept in seclusion rooms with restraint straps attached. These conditions pose serious risks to suicide prone patients. Due to crowding on the Pali Patio Unit, two beds are placed in rooms built to house only one, leaving only a few inches of space between beds used to serve newly admitted acutely psychotic patients. Moreover, since the beds are not bolted to the floors, staff advised our consultants that patients frequently use the beds to barricade themselves inside the room, requiring staff to break down the door to gain access. Finally, the facility contains numerous fire hazards, including inadequate fire evacuation routes, insufficient smoke compartmentalization, and lack of sprinklers.
Second, sanitation is grossly inadequate. During a tour of the Rehab A unit of HSH, our consultants had to walk around numerous puddles of urine. Staff appeared to treat the incident as not atypical and it was a significant length of time before the area was cleaned. Kitchen facilities exhibited signs of serious cockroach infestation and other unsanitary practices. Basic and fundamental infection control procedures were consistently violated at the facility.
Third, the facility is poorly maintained. Our consultants were in universal agreement that the facility was poorly maintained and in a general state of disrepair and dilapidation. Indeed, our consultant psychologist opined that the current environment at HSH is, in brief, "unsafe;" our consultant psychiatrist described HSH, in a word, as an "abomination.*'
In sum, the lack of adequate food, clothing, basic personal hygiene measures, and an environment free from unreasonable risks to the personal safety of patients violates their constitutional rights. The lack of adequate food and clothing are especially flagrant or egregious conditions requiring immediate correction.
2. Unsafe Psvchopharmacoloaical Practices
It is our consultant psychiatrist's opinion that drug practices at HSH are seriously deficient and represent significant departures from generally accepted medical standards. There are essentially no policies and procedures in effect at the hospital for the use of psychotropic medications. There are no policies with respect to monitoring maximal dosage, polypharmacy, dosage schedule, dosage form, or laboratory requirements. The absence of policies and procedures in these areas represents so great a departure from accepted medical judgment as to demonstrate that professional judgment was not, in fact, exercised in the provision of care to institutionalized mentally ill persons.

- 4-
Many patients at HSH are administered powerful, mind altering medications which exceed the recommended maximal dosage. The patient records we reviewed did not contain justifications for such dosage levels, nor were there indications in the records that physicians attempt to treat patients at the lowest effective dosage or that physicians are striving to wean patients off these drugs, as appropriate. Antipsychotic medication is being prescribed for patients without a psychotic condition and two or more medications of the same chemical class (polypharmacy) are routinely administered to hospital patients absent any justification. Specific drugs are being administered to patients absent a diagnosis which would warrant the use of such drugs. Since there is no policy regarding dosage schedule, patients are receiving medication at various inappropriate intervals with no rationale. Moreover, patients are receiving simultaneously, both oral and intramuscular depot forms of medication, again, absent any justification. Further, our consultant noted that routine but crucial laboratory tests were not being conducted for patients and that screening of patients for tardive dyskinesia is inadequate. Finally, and most significantly, our consultant psychiatrist noted the "remarkably ubiquitous use" of PRN or "as needed" medication. Such usage places the decision to medicate in the hands of nurses who do not have sufficient expertise to medicate patients and exposes patients to significant risks, including the risk of overmedication. To compound the problem at HSH, physician review, monitoring, and examination of patients receiving medications on this basis is inadequate.
These medication deficiencies are due, in part, to both an inadequate number of psychiatrists, registered nurses, and psychologists as well as the absence of any organizational structure at HSH which places responsibility for various clinical functions and individual patients in specifically designated persons. HSH does not have a permanent Clinical Director. As such, there is no one at HSH with the ultimate responsibility for the clinical care of patients. Moreover, the deficiencies caused by inadequate patient coverage by psychiatrists is exacerbated by the fact that psychiatrists attending patients are often retained from the community on a part-time, fee for service, basis. As administered at HSH, this system of providing psychiatric care to patients has proved inadequate and has harmed patients. Further, the number of registered nurses at HSH is grossly deficient; nearly 42% of all nursing positions at the hospital are currently vacant. One-half of the psychologist positions are also vacant. Such vacancies compromise the delivery of patient care, including the failure to monitor patients for the effects of psychotropic medication, inadequate basic and essential nursing services, and the failure to address the behavioral problems exhibited by many patients which are now addressed by the excessive use of physical and chemical restraint.

- 5-
In sum, psychophannacological practices at HSH are so deficient as to violate the constitutional rights of HSH patients by exposing them to unreasonable risks to their health and safety. Lack of adequate professional staff to prescribe and monitor the usage of the medications is largely responsible for the problem.
3. Inadequate General Medical Care
HSH operates no on-grounds infirmary for physically ill patients. As a result, general medical services are provided by off-grounds care providers. HSH medical staff informed us that the absence of adequate procedures to insure the timely transfer of physically ill patients to the community health care facility results in protracted delays in actually transferring patients to the community hospital, thereby placing patients in severe jeopardy. While the use of community resources is unobjectionable, there is no justification for the failure to ensure that patients are referred and transported to such services in a timely manner once facility professionals have determined the need to provide services outside HSH.
Medical staff likewise advised us that the number of ongrounds physicians is inadequate to care for the medical care needs of patients who do not, or cannot, receive medical services outside HSH. The shortage of medical staff at the facility results in inadequate monitoring of sick patients, and, in some instances, the failure to implement a physician's orders. Moreover, the current medical staff is inadequate to meet the medical needs of physically handicapped patients who present a host of specialized needs, including the need for individually adapted wheelchairs and other equipment requiring some degree of medical involvement. Finally, there is no physician of any kind at the facility at night and on weekends. It is unacceptable for a facility of the size and nature of HSH to function absent the presence of a physician on grounds at all times.
Medical care at HSH requires significant improvement to insure that HSH patients receive adequate medical care.
4. Lack of Adequate Treatment Programs Results in Undue Bodily Restraint
In view of serious, chronic and facility-wide staffing shortages, HSH staff employ bodily restraints — physical restraints, seclusion, and chemical restraints — at an unjustifiably high level solely for their own convenience or in lieu of professionally designed treatment programs. The use of bodily restraints at HSH currently exposes patients to unreasonable risks to their personal safety. Patients are routinely placed in seclusion rooms or physical restraint based on the telephone order of a physician. While these procedures

- 6-
may be appropriate in an emergency where no doctor is readily available, there is no justification — as is the practice at HSH — for physicians to fail to examine the secluded patient within a reasonable period of time and for the patient to be monitored by professional staff at reasonable intervals. Moreover, staff were so unfamiliar with HSH rules and procedures for the placement of patients in bodily restraints that they almost universally were unable to state how long a specific restraint order could remain in effect before requiring renewal. This deficiency is especially severe because it means that patients are routinely left in bodily restraint, especially seclusion, for periods of time in excess of that necessary to restore them to a controlled state. Indeed, records reviewed indicated that many patients were secluded for periods of time far longer than that recognized by any known standard. In addition, direct care staff are not adequately trained to place patients in seclusion rooms or to administer other physical restraints. It is the view of our consultant psychiatrist that patients are routinely secluded and placed in physical restraints at HSH absent adequate justification and without proper documentation. In view of the absence of full documentation, it was his further view that it is impossible to determine precisely the exact amount of bodily restraint used at the hospital.
Treatment programs for patients at HSH exhibiting dangerous behaviors and other maladaptive behaviors exposing them to unreasonable risks of harm are inadequate. To the extent that "programs" have been developed for patients, they are not professionally based because the current psychology staff is inadequate to properly assess patient behavior, develop and monitor behavior management programs, and to revise them, as necessary. Moreover, the direct care staff is insufficient in number, is not trained, and is otherwise ill-equipped to implement the programs. Further, data is not maintained at the facility regarding patient behavior necessary to properly monitor and revise behavior management programs. The absence of behavior management programs subjects patients to undue bodily restraint and a wide array of unreasonable risks to their personal safety.
5. Inadequate Recordkeepincr Practices
Our consultants found documentation at HSH to be grossly inadequate. Documentation is insufficient to permit staff to exercise professional judgment in the provision of patient care. As described above, documentation regarding the use of medication is deficient in all respects. Moreover, our review of patient records revealed that months go by without physicians making notes in patients records and that chronic patients seldom, if ever, see a psychiatrist. The lack of notes in patient records by these professionals and those associated with other disciplines regarding an individual's care and treatment leaves

- 7-
professionals without basic information necessary for the exercise of professional judgment.
Children's Unit at Honolulu
Our investigation indicated many of the physical plant deficiencies existing at the Kaneohe facility likewise exist at the Children's Unit (Leahi A and B). Suicide hazards are present throughout the units; seclusion rooms are unsafe. Indeed, it was our psychologist consultant's opinion that the use of the "pink" seclusion room be halted immediately due to its especially hazardous condition for children. Finally, fire hazards are prevalent throughout.
Minimally Necessary Remedies
The conditions described above constitute a pattern and practice that results in deprivation of certain constitutional rights of Hawaii State Hospital patients. To eliminate these violations and to ensure that constitutionally adequate conditions are maintained in the future, the following minimum remedial measures are required:
1. HSH must immediately provide all patients with adequate clothing and essential personal hygiene items;
2. HSH must immediately provide patients with sufficient food that is nutritionally adequate and served in a manner that does not pose risks to patients' health;
3. Environmental, sanitation, infection control, and fire-safety deficiencies that pose a risk to patients' safety must be corrected immediately;
4. Improvements in medication practices, including medication monitoring, must be effected where necessary to conform practices to accepted medical standards;
5. HSH must ensure that patients have timely access to adequate medical care.
6. HSH must hire and deploy sufficient qualified direct care and professional staff, including psychiatrists, psychologists, physicians, and registered nurses, to ensure that patients receive adequate medical and psychiatric care, including treatment plans and behavior management plans and follow-up treatment sufficient to reduce or eliminate unreasonable risks of harm to their personal safety;

- 8-
7. HSH must recruit and hire a permanent Clinical Director, and HSH's table of organization must be revised in order to establish clear lines of responsibility and authority between and among HSH staff;
8. Seclusion and restraint practices must be employed only pursuant to the exercise of professional judgment by a qualified professional. The practice of using seclusion and restraint for the convenience of staff or in lieu of treatment or training programs must cease immediately. Seclusion rooms roust be modified to allow full vision of patients, leather straps must be removed when a patient is in seclusion and the rooms must be properly and safely maintained;
9. HSH must institute and implement recordkeeping practices sufficient to ensure treatment documentation adequate to enable staff to provide essential psychiatric, psychological and nursing care and treatment services to patients;
We would be pleased to consult with you regarding financial, technical, or other assistance which might be available from the United States to assist you in correcting the deficiencies described. You may wish to consult with the Department of Health and Human Services (HHS) to inquire about the possibility of assistance through programs it administers. Please contact Dean Dana, Regional Director, Department of Health and Human Services, Federal Office Building, 50 United Nations Plaza, San Francisco, California, 94102 (telephone 415-556-6746) for information regarding HHS programs.
We appreciate the cooperation extended to us during our CRIPA investigation by the superintendent and staff of Hawaii State Hospital, officials of the Hawaii Department of Mental Health, and counsel for the State.
We hope that a cooperative spirit will prevail so that this matter can be concluded promptly and amicably. Indeed, we hope and trust this information will assist you in developing appropriate remedies while the Hawaii legislature is in session. My staff will contact the Attorney General's office shortly to discuss this matter further. In the meantime, if you or your staff have any questions regarding this matter, please contact Arthur E. Peabody, Jr., Chief, Special Litigation Section, at

- 9202-272-6060. I hope and trust that we will be able to resolve this matter in an amicable and reasonable manner.
Sincerely,
James P. Turner Acting Assistant Attorney General
Civil Rights Division
cc: Honorable Warren Price Attorney General State of Hawaii
Dr. Howard Gudeman Superintendent, Hawaii State Hospital Daniel A. Bent, Esquire United States Attorney

 
 U.S. District Court District of Hawaii (Hawaii) CIVIL DOCKET FOR CASE #: 1:91−cv−00137−DAE−KSC

CLOSED

USA v. State of Hawaii, et al Assigned to: JUDGE DAVID ALAN EZRA Referred to: JUDGE KEVIN S.C. CHANG Demand: $0 Cause: 42:1981 Civil Rights Special Master Leland Chang TERMINATED: 02/28/2002
Special Master spmr Kris A. McLoughlin
Plaintiff USA

Date Filed: 03/07/1991 Date Terminated: 12/01/2006 Jury Demand: None Nature of Suit: 440 Civil Rights: Other Jurisdiction: U.S. Government Plaintiff
represented by Kris A. McLoughlin 1212 Nuuanu Ave Honolulu, HI 96815 524−2031 PRO SE
represented by David Deutsch U S Department of Justice Civil Rights Div Special Litigation Sec P O Box 66400 Washington, DC 20035−6400 202 307−3116 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Harry Yee Office of the United States Attorney Prince Kuhio Federal Building 300 Ala Moana Blvd Ste 6100 Honolulu, HI 96850 541−2850 Email: harry.yee@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
Michael Chun Office of the United States Attorney Prince Kuhio Federal Building 300 Ala Moana Blvd Ste 6100 Honolulu, HI 96850 541−2850 TERMINATED: 01/31/2006 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Richard J. Farano U S Department of Justice Civil Rights Div Special Litigation Sec P O Box 66400 Washington, DC 20035−6400 202 307−3116 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robinsue Frohboese

V. Defendant State of Hawaii
Defendant John Waihee Governor

U.S. Department of Justice Civil Rights Division 320 First St. N.W. Washington, DC 20530 (202) 514−6260 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Verlin Hughes Deerinwater US Department of Justice Special Litigation 950 Pennsylvania Ave NW Washington, DC 20530−0001 202 307−3116 Email: verlin.deerinwater@usdoj.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Ann V. Andreas Office of the Attorney General−Hawaii 425 Queen St Honolulu, HI 96813 586−1500 Email: ann.b.andreas@hawaii.gov LEAD ATTORNEY ATTORNEY TO BE NOTICED
Blair A. Goto Office of the Attorney General−State of Hawaii Kekuanao'a Building 465 S King St Rm 200 Honolulu, HI 96813 587−3050 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Paul M. AuCoin AuCoin DuPont Hetterscheidt &Younkin LLC 495 South High St Ste 250 Columbus, OH 43215 (614)464−4100 LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert A. Marks Price Okamoto Himeno &Lum Ocean View Center 707 Richards St Ste 728 Honolulu, Hi 96813 538−1113 Email: ram@pohlhawaii.com TERMINATED: 01/31/2006 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Blair A. Goto (See above for address)

Defendant
John Lewin Director, Department of Health

Defendant
Henry Foley Deputy Director, Bahavioral Health Services of the Department of Health

Defendant
Naleen N. Andrade Acting Superintendent, Hawaii State Hospital

Receiver Michael F. Broderick
Receiver M.D. Jeffrey Akaka

Date Filed

#

Docket Text

LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert A. Marks (See above for address) TERMINATED: 01/31/2006 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Blair A. Goto (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert A. Marks (See above for address) TERMINATED: 01/31/2006 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Blair A. Goto (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert A. Marks (See above for address) TERMINATED: 01/31/2006 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Blair A. Goto (See above for address) LEAD ATTORNEY ATTORNEY TO BE NOTICED
Robert A. Marks (See above for address) TERMINATED: 01/31/2006 LEAD ATTORNEY ATTORNEY TO BE NOTICED
represented by Michael F. Broderick 220 Ilihau Kailua, HI 96734 254−6392 PRO SE
represented by Jeffrey Akaka PO Box 11780 Honolulu, HI 96828 733−9260 PRO SE

03/07/1991 03/07/1991 12/14/1994 12/14/1994 12/14/1994 12/29/1994 12/29/1994
01/03/1995 01/03/1995 01/04/1995 01/10/1995
01/10/1995 01/10/1995

422 CIVIL CASE DOCKET SHEET reflecting docket text entry number 1 through 17 (afc)
(Entered: 08/07/2007)
1 COMPLAINT; Certificate of the Attorney General; Summons. (Attachments: # 1 Civil Cover Sheet)(afc) (Entered: 08/07/2007)
18 PETITION by plaintiff USA for Order to Show Cause why defendants should not be held in contempt; memorandum in support of petition; exhibits 1−44 (wnn) (Entered: 12/14/1994)
19 RETURN OF SERVICE executed petition for osc and osc on Cheryl DeMello for Sonia Faust on 2/14/94 (tbf) (Entered: 12/20/1994)
20 ORDER TO SHOW CAUSE why defts should not be held in contempt: by Judge David A. Ezra − on behalf of USA set for 9:00 1/10/95 to Judge David A. Ezra (tbf) (Entered: 12/20/1994)
21 RETURN OF SERVICE of OSC executed upon defendant State of Hawaii on 12/23/94 (wnn) (Entered: 12/29/1994)
22 MEMORANDUM by defendant in opposition to United States' petition for an order to show cause why defendants should not be held in contempt [18−1]; declaration of Sherry K. Harrison, exhibit "A"; declaration of Lawrence Miike, M.D.; declaration of Paula E. Ayers; declaration of Antonia S. Austria, M.D.; certificate of service (wnn) (Entered: 12/30/1994)
23 EX PARTE MOTION by plaintiff USA for an expedited ruling on defendants' request for continuance of contempt hearing (wnn) (Entered: 01/18/1995)
24 MEMORANDUM by plaintiff USA in opposition to defendants' request for a continuance of the 1/10/95 contempt hearing (wnn) (Entered: 01/18/1995)
25 ORDER denying defendants' request for continuance by Judge David A. Ezra − on behalf of plaintiff (wnn) (Entered: 01/18/1995)
26 EP : Order to Show Caue Why defendant Should Not be Held In Contempt: stipulation regarding admissibility of documents in United States' memorandum in support of petition to show cause why defendants should not be held in contempt; order signed and filed. defendants stipulate to the qualification of pltf's experts witnesses, Dr. Jeffrey Geller and Miriam Kile; their declarations and waives cross examination. opening statement by the plaintiff. no evidence submitted by the defts in defense of violations alleged by the plaintiff. the court finds defendants in violation of the Court's order. the cCourt will allow the exceutive and legislative branch of the State of Hawaii prepare a remedial plan in accordance with the remedial measure suggested by the pltf. the submission and approval of such a plan is set for 9:00 1/18/95. the defendants are enjoined from taking any retribution against the "whistle−blowers" and ordered to investigate any threats made thereof.(Ct Rptr : SP) JUDGE Judge David A. Ezra (wnn) (Entered: 01/18/1995)
27 STIPULATION and ORDER by Judge David A. Ezra : regarding admissibility of documents in United States' memorandum in support of petition to show cause why defendants should not be held in contempt − on behalf of USA (wnn) (Entered: 01/18/1995)
28 ORDER by Judge David A. Ezra holding defendants in contempt − [Court finds defendants in contempt of its 1991 Order; court hereby enjoins any current, former or future HSH or State employee from retaliating in any way against any person who has assisted or

01/18/1995 01/19/1995 01/19/1995 02/13/1995 03/01/1995 03/30/1995 05/01/1995 06/01/1995 07/03/1995 07/31/1995 09/01/1995 10/02/1995 11/01/1995 11/15/1995
12/01/1995 01/05/1996 02/01/1996

assists plaintiff by reporting deficient conditions at Hawaii State Hospital − (cc: all counsel) (wnn) (Entered: 01/18/1995)
29 EO : the hearing on the submission and approval of the remedial plan is continued to 3:00 1/19/95. ( Ct Rptr : ) JUDGE Judge David A. Ezra (wnn) (Entered: 01/23/1995)
30 EP : stipulation and order to remedy defendants' contempt of settlement agreement; attachment 1 signed and filed. ( Ct Rptr : YI) JUDGE Judge David A. Ezra (wnn) (Entered: 01/23/1995)
31 STIPULATION and ORDER by Judge David A. Ezra : to remedy defendants' contempt of settlement agreement; attachment "1" − on behalf of plaintiff USA (wnn) (Entered: 01/24/1995)
32 STIPULATION and ORDER regrding reporting requirements − by Judge David A. Ezra : on behalf of USA (tbf) (Entered: 02/21/1995)
33 FIRST STATUS REPORT by plaintiff USA regarding defendants' compliance with remedial plan (wnn) (Entered: 03/01/1995)
34 SECOND STATUS REPORT by plaintiff USA regarding defendants' compliance with remedial plan; attachments 1−2 (attachment 2 filed under seal) (wnn) (Entered: 04/05/1995)
35 THIRD STATUS REPORT by plaintiff USA regarding defendants' compliance with remedial plan; attachments 1−3 (attachment 2 &3 filed under SEAL) (wnn) (Entered: 05/02/1995)
36 United States' fourth STATUS REPORT regarding defendants' compliance with remedial plan; attachment (fe) (Entered: 06/09/1995)
37 United States' FIFTH STATUS REPORT regarding defendants' compliance with remedial plan; attachment (fe) (Entered: 07/05/1995)
38 SIXTH STATUS REPORT by plaintiff USA regarding defendants' compliance with remedial plan; attachment a; attachment b (wnn) (Entered: 08/01/1995)
39 Seventh STATUS REPORT by plaintiff USA regarding defendants' compliance with remedial plan; attachment a (wnn) (Entered: 09/12/1995)
40 United States' eighth STATUS REPORT regarding defendants' compiance with remedial plan; attachment a (fe) (Entered: 10/02/1995)
41 Ninth STATUS REPORT regarding defts' compliance with remedial plan; attachment a − by plaintiff (tbf) (Entered: 11/03/1995)
42 STIPULATION and ORDER by Judge David A. Ezra : regarding procedures for reporting and investigating allegations of abuse and neglect at Hawaii State Hospital − on behalf of USA (wnn) (Entered: 11/16/1995)
43 TENTH STATUS REPORT by plaintiff USA regarding defendants' compliance with remedial plan; attachment a (wnn) (Entered: 12/04/1995)
44 Eleventh STATUS report regarding defendants' compliance with court's orders; attachment a; attachment b − by plaintiff USA (tbf) (Entered: 01/09/1996)
45 TWELFTH STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a;

03/01/1996 04/01/1996 05/01/1996 05/07/1996 05/22/1996
06/28/1996
07/01/1996 08/01/1996 08/30/1996 10/01/1996 11/01/1996 12/02/1996 01/02/1997 02/04/1997

attachment b (wnn) (Entered: 02/01/1996)
46 Thirteenth Status REPORT regarding defts' compliance with court's orders; attachment a; attachment b − by plaintiff USA (tbf) (Entered: 03/05/1996)
47 United States' Fourteenth STATUS REPORT regarding defendants' compliance with court's orders; attachment a − on behalf of pltf (fe) (Entered: 04/11/1996)
48 Fifteenth STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a; attachment b; attachment c (wnn) Modified on 05/06/1996 (Entered: 05/06/1996)
49 JOINT MOTION by plaintiff USA for status conference − set for 8:00 5/22/96 before Judge David Alan Ezra (wnn) (Entered: 05/07/1996)
50 EP : Status conference held 5/22/96 before Judge David A. Ezra ; pltf's counsel Verlin Hughes recited on the record to this court the update on conditions at the State Hospital; the next written status report from the plaintiff's to this court is due by 7/1/96 ( Ct Rptr : SP) JUDGE Judge David A. Ezra (wnn) (Entered: 05/28/1996)
51 STIPULATION and ORDER − [re progress regarding implementation of certain provisions of stip and order to remedy defts' contempt of settlement agreement and remedial plant entered as an order on 01/19/95, and to address areas in continuing need of correction at Hawaii State Hospital; all provisions of (1) order entered 9/19/91, (2) stip and order entered 1/19/95, and (3) stip and order entered 11/15/95 that do not otherwise conflict with the terms of this order shall remain in full force and effect] − by Judge David A. Ezra − on behalf of pltf (fe) Modified on 07/02/1996 (Entered: 07/02/1996)
52 Sixteenth STATUS REPORT regarding defendants' compliance with court's orders by plaintiff USA; attachment a (wnn) (Entered: 07/02/1996)
53 Seventeenth STATUS REPORT regarding defts' compliance with court's orders; attachment a − by plaintiff USA (tbf) (Entered: 08/05/1996)
54 Eighteenth STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a; attachment b; attachment c; attachment d (wnn) (Entered: 08/30/1996)
55 Ninteenth STATUS REPORT regarding defts' complaince with court's orders; attachment a; attachment b; attachment c; attachment d − plaintiff USA (tbf) (Entered: 10/03/1996)
56 United States' Twentieth STATUS REPORT regarding defts' compliance with court's orders; attachment a (fe) (Entered: 11/04/1996)
57 Twenty First STATUS REPORT by plaintiff USA regarding defendants' compliance with court orders; attachment a; attachment b; attachment c (wnn) (Entered: 12/03/1996)
58 United States' Twenty−Second STATUS REPORT regarding defts' compliance with court's orders; attachment a − on behalf of pltf (fe) (Entered: 01/06/1997)
59 Twenty−Third STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a (wnn) (Entered: 02/07/1997)

03/03/1997 03/28/1997 05/05/1997 06/04/1997 07/01/1997 07/01/1997 08/04/1997 08/22/1997 10/01/1997 10/17/1997 10/28/1997 10/28/1997 11/03/1997 11/18/1997
12/03/1997 12/15/1997

60 Twenty−Fourth STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a (wnn) (Entered: 03/03/1997)
61 Twenty−Fifth STATUS REPORT regarding defendants' compliance with court's orders by plaintiff USA; attachment a (wnn) (Entered: 04/02/1997)
62 Twenty−Sixth STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a; attachment b; attachment c; attachment d (fe) (Entered: 05/06/1997)
63 Twenty Seventh STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a; attachment b; attachment c (wnn) (Entered: 06/05/1997)
64 NOTIFICATION by plaintiff USA of name change of counsel − [Verlin Hughes' name changed to Verlin Hughes Deerinwater] (fe) (Entered: 07/09/1997)
65 TWENTY−EIGHTH STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a; attachment b (fe) (Entered: 07/09/1997)
66 Twenty−Ninth STATUS REPORT regarding defts' compliance with court's orders; attachment a; attachment b; attachment c − by plaintiff USA (tbf) (Entered: 08/07/1997)
67 THIRTIETH STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a (fe) (Entered: 08/26/1997)
68 Thirty−First STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a; attachment b (fe) (Entered: 10/06/1997)
69 SUPPLEMENT by plaintiff USA to 31st status report regarding defts' compliance with court's order [68−1]; attachment a; attachment b (fe) (Entered: 10/21/1997)
70 Joint MOTION for status conference − referred to Judge David A. Ezra − on behalf of USA (fe) (Entered: 10/29/1997)
71 EO : status conference set for 3:00 11/18/97 before Judge David A. Ezra ( Ct Rptr : ) JUDGE Judge David A. Ezra (fe) (Entered: 10/29/1997)
72 Thirty−second STATUS REPORT by plaintiff USA regarding deft' compliance with court's orders; attachment a (fe) (Entered: 11/05/1997)
73 EP : Status conference on the consent decree held 11/18/97 before Judge David A. Ezra ; an updated report was presented to the court by pltf's counsel as to the compliance or non−compliance by the State of Hawai'i to the consent decree the parties were ordered by the court to do the following: 1) the parties are to meet again to discuss and resolve the areas of non compliance as outlined by pltf; 2) submit another status report by 12/15/97( Ct Rptr : Debra Chun) JUDGE Judge David A. Ezra (wnn) Modified on 11/24/1997 (Entered: 11/24/1997)
74 Thirty−Third STATUS REPORT regarding defts' compliance with court's orders; attachment a; attachment b − by plaintiff USA (tbf) (Entered: 12/04/1997)
75 STATEMENT by defendant State of Hawaii re: joint status report pursuant to 11/18/97 order [parties intend to complete their discussions by the end of this week; hope plan to be submitted to the court by that time] (wnn) (Entered: 12/15/1997)

12/24/1997 02/02/1998 02/11/1998 02/11/1998
02/12/1998
02/13/1998 02/13/1998
02/13/1998 02/26/1998 03/05/1998 04/01/1998 05/04/1998 06/01/1998 06/17/1998 07/01/1998

76 Thirty−Fourth STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a (wnn) (Entered: 01/02/1998)
77 STATUS REPORT regarding defts' compliance with court's orders; attachment a − by plaintiff USA (tbf) (Entered: 02/03/1998)
78 EX PARTE MOTION to shorten time; declaration of Michael Chun; Order − as to pltf's m/appt of an independent expert, etc − set for 2/13/98 @ 9:00 a.m. DAE − by Judge David A. Ezra by plaintiff (tbf) (Entered: 02/11/1998)
79 NOTICE OF MOTION and motion by plaintiff for the appointment of an independent expert to assist with and monitor compliance in the child and adolescent mental health programs ; memorandum in support; attachments 1−8; certificate of service − set for 9:00 2/13/98 before Judge David A. Ezra (tbf) (Entered: 02/11/1998)
80 MEMORANDUM by defendant in opposition to motion for the appointment of an independent expert to assist with and monitor compliance in the child and adolescent mental health programs [79−1]; declaration of counsel; exhibit "a"; declaration of Howard R. Weiner, Ph.d.; exhibits "a"−"b"; declaration of Carol Matsuoka; exhibit "a"; certificate of service (tbf) (Entered: 02/13/1998)
81 STIPULATION and ORDER; attachments a − e − re non compliance of the court's orders − by Judge David A. Ezra : on behalf of USA (tbf) (Entered: 02/17/1998)
82 ORDER by Judge David A. Ezra denying the United States' motion for the appointment of an independent expert to assist with and monitor compliance in the child and adolescent mental health programs [79−1] − denied without prejudice (cc: all counsel) (tbf) (Entered: 02/17/1998)
83 EP :denying motion for the appointment of an independent expert to assist with and monitor compliance in the child and adolescent mental health programs [79−1] ( Ct Rptr : Yukie Ichikawa) JUDGE Judge David A. Ezra (tbf) (Entered: 02/17/1998)
84 DECLARATION by defendant of Ann V. Andreas; exhibit "a"; certificate of service (tbf) Modified on 02/27/1998 (Entered: 02/27/1998)
85 Thirty−Sixth STATUS REPORT by plaintiff United States regarding defts' compliance with court's orders; attachment a (fe) (Entered: 03/06/1998)
86 Thirty−Seventh STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a; attachment b (fe) (Entered: 04/02/1998)
87 Thirty−eighth STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a; attachment b; attachment c; attachment d (fe) (Entered: 05/04/1998)
88 Thirty−Ninth STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a; attachment b (fe) (Entered: 06/02/1998)
89 Thirty−Ninth STATUS REPORT re defts' compliance with court's orders; attachment a; attachment b − by plaintiff USA (tbf) (Entered: 06/19/1998)
90 Fourtieth STATUS REPORT regarding defendants' compliance with court's orders by plaintiff USA; attachment a; attachment b (wnn) (Entered: 07/01/1998)

08/10/1998 08/31/1998 10/01/1998 10/05/1998 11/03/1998 11/19/1998 11/30/1998 12/02/1998 12/03/1998 12/23/1998 12/23/1998 12/29/1998 02/01/1999
02/17/1999

91 Forty−First STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a; attachment b; attachment c; attachment d; attachment e (fe) (Entered: 08/10/1998)
92 42nd STATUS REPORT re defts' compliance with court's orders; attachment a; attachment b − by plaintiff (tbf) (Entered: 09/01/1998)
93 Forty−Third STATUS report regarding defts' compliance with court's orders; attachment a; attachment b; attachment c; attachment d − by plaintiff (tbf) (Entered: 10/02/1998)
TRANSCRIPT of proceedings for the following date(s): 9/16/91 − original − Terrence Chun (Re: ) (tbf) (Entered: 10/05/1998)
94 Forty−Fourth STATUS REPORT by plaintiff USA regarding defendant's compliance with court's orders; attachment a; attachment b (sealed) (Entered: 11/03/1998)
95 Motion to Enter STIPULATION and ORDER regarding children and adolescent residential services − by Judge David A. Ezra − on behalf of pltf (fe) (Entered: 11/30/1998)
96 Forty−Fifth STATUS REPORT by plaintiff USA regarding defts' compliance with court's orders; attachment a; attachment b (fe) (Entered: 12/09/1998)
97 JOINT MOTION for status conference − referred to Judge David A. Ezra − on behalf of pltf &defts (fe) (Entered: 12/09/1998)
98 ORDER granting joint motion for status conference [97−1] − [ status conference set for 9:00 2/1/99 before Judge David A. Ezra ] − by Judge David A. Ezra (cc: all counsel) (fe) (Entered: 12/09/1998)
TRANSCRIPT of proceedings for the following date(s): 2/13/98 − original − Yukie Ichikawa (Re: ) (lyc) (Entered: 12/28/1998)
TRANSCRIPT of proceedings for the following date(s): 1/19/94 − original − Yukie Ichikawa (Re: ) (lyc) (Entered: 12/28/1998)
99 Forty−Sixth STATUS REPORT by plaintiff USA regarding defendants' compliance with court's orders; attachment a; attachment b; attachment c; attachment d; attachment e (wnn) (Entered: 12/30/1998)
100 EP : status conference held 2/1/99 ; oral report and recommendations made by the Verlin Derinwater for the government; the state of HI was mandated by the court to do the following: 1. the state of HI will assemble a compliance team of 5 members; the Dept of Health will appoint 3 members and the Dept of Justice will select the remaining two members; the goal of the team is to study, identify and seek a solution to each outstanding issues in compliance with federal law; the study will be completed and submitted to the court by 6/1/99; 2. pursuant to findings and recommendations of the compliance team, the state of HI will set in place programs to rectify these problems by 6/15/99; 3. if the state of HI fails or does not materially comply with the findings of the compliance team, the court will appoint a special master to run the Dept of Health pursuant to federal law; 4. the state of HI is ordered to submit to the court for public review the members of the compliance team by 3/15/99; further status conference set for 9:00 12/20/99 before Judge David A. Ezra ( Ct Rptr : Lisa Groulx) JUDGE Judge David A. Ezra (tbf) (Entered: 02/03/1999)
101 MOTION by plaintiff USA to enter order establishing compliance committee, reporting schedule, and setting status conference −

03/15/1999 03/18/1999 06/10/1999 07/02/1999 12/15/1999 12/20/1999 12/20/1999
12/30/1999 01/05/2000 01/07/2000 01/18/2000
01/18/2000 01/20/2000 01/31/2000

before Judge David A. Ezra (tbf) (Entered: 02/18/1999)
102 REPORT on compliance committee; and certificate of service − by defendant (tbf) (Entered: 03/16/1999)
103 ORDER by Judge David A. Ezra establishing compliance committee, reporting schedule, and setting status conference − status conference set for 9:00 12/20/99 before Judge David A. Ezra (cc: all counsel) (tbf) (Entered: 03/19/1999)
104 Joint MOTION for extension of time for filing status report ; ORDER granting extension − [parties shall have until 07/02/99 to file status rpt] − by Judge David A. Ezra (fe) (Entered: 06/15/1999)
105 STATUS REPORT; exhibits 1 and 2 − by plaintiff USA (lmg) (Entered: 07/06/1999)
106 Defendant's STATUS Conference REPORT by defendant State of Hawaii; Appendices 1 and 2; Certificate of Service (3 Volumes) (gab) (Entered: 12/15/1999)
107 STATUS REPORT of the United States; attachements (sic) a−d − by plaintiff (lmg) (Entered: 12/23/1999)
108 EP : Status Report held; plaintiff's summary of findings of the State Hospital's compliance to the consent decree and defendant's response were presented to the court; pursuant to the reports submitted, the court orders the appointment of a special court monitor to oversee the operations of the Adult State Facility; in the event the defendant does not comply with the conditions of the consent decree within six months, the court will appoint a special master; the defendant have 10 days in which to file their response as to the duties of the special court monitor ( Ct Rptr : T.C.) JUDGE Judge David A. Ezra (lmg) (Entered: 12/27/1999)
109 RESPONSE by defendant to status report of the United States concerning powers of monitor; certificate of service [107−1], to [105−1] (tbf) (Entered: 01/04/2000)
PARTIAL TRANSCRIPT filed ( Ct Rptr Terrence Chun) taken on 12/20/99 (fe) (Entered: 01/05/2000)
110 ORDER Setting powers of special monitor − by Judge David A. Ezra − [court appointed a special mointor to be in place within 30 days of December 20, 1999] (cc: all counsel) (lmg) (Entered: 01/10/2000)
111 MOTION by defendant Naleen N. Andrade, defendant Henry Foley, defendant John Lewin, defendant John Waihee, defendant State of Hawaii for reconsideration, or amendment of order setting powers of special monitor ; memorandum in support of motion for reconsideration, or amendment of powers of special monitor; certificate of service − reffered to Judge David A. Ezra (eps) (Entered: 01/21/2000)
112 MOTION by plaintiff USA to appoint Leland K.W. Chang as special monitor ; attachment a; attachment b; proposed order; certificate of service − referred to Judge David A. Ezra (eps) (Entered: 01/21/2000)
113 Defendants' OPPOSITION to nomination of Leland K.W. Chang as special monitor [112−1]; declaration of Linda C. Fox; exhibits "a" and "b"; certificate of service (lmg) (Entered: 01/24/2000)
114 ORDER by Judge David Alan Ezra appointing Leland Chang as special monitor − [all duties, authorities, responsibilities and compensation as set forth in this court's order setting powers of special monitor filed 01/07/00] [112−1] (cc: all counsel) (lmg)

02/01/2000 02/01/2000 02/22/2000 02/29/2000 03/06/2000
03/17/2000 03/20/2000 04/05/2000 04/10/2000 07/31/2000 07/31/2000 02/09/2001
03/05/2001 03/13/2001

(Entered: 01/31/2000)
115 RESPONSE by plaintiff USA to defendants' opposition to nomination of Leland K.W. Chang as special monitor [113−1] − referred to Judge David Ezra (fe) (Entered: 02/09/2000)
116 MEMORANDUM by plaintiff USA in opposition to motion for reconsideration, or amendment of order setting powers of special monitor [111−1]; attachment A; certificate of service (fe) (Entered: 02/09/2000)
117 OBJECTIONS by defendants to special monitor's proposed budget; exhibit "a"; certificate of service (wnn) (Entered: 02/25/2000)
118 OBJECTIONS to defendants' objection to monitor's proposed budget; attachment a; certificate of service − by plaintiff USA to [117−1] (eps) (Entered: 03/03/2000)
119 ORDER by Judge David A. Ezra granting defendants' motion for reconsideration, or amendment of order setting powers of special monitor [111−1] − the power of the special monito to consider individuals who have never been institutionalized but who are seriously mentally ill, e.g. potential patients is inconsistent; court grants motion for recons and amends paragraph 3.a.(1); since the court has amended such order, it denies defts' request for interlocutory appeal (cc: all counsel) (eps) (Entered: 03/10/2000)
120 MOTION by plaintiff USA for clariffication and expedited ruling ; memorandum in support; proposed order; certificate of service − referred to Judge David A. Ezra (fe) (Entered: 03/20/2000)
121 ORDER setting special monitor's budget − by Judge David A. Ezra re [120−1] (cc: all counsel) (fe) (Entered: 03/20/2000)
122 STATEMENT of position by defendant concerning United States' motion for clariffication and expedited ruling [120−1] (fe) (Entered: 04/11/2000)
123 ORDER Amending Order setting powers of special monitor by Judge David A. Ezra − granting motion for clariffication and expedited ruling [120−1] (cc: all counsel) (fe) (Entered: 04/11/2000)
124 Joint MOTION to extend term of appointment of special monitor ; declaration of Ann V. Andreas; exhibits a−c; referred to Judge David A. Ezra (fe) (Entered: 08/01/2000)
124 ORDER by Judge David A. Ezra granting motion to extend term of appointment of special monitor [124−1]; certificate of service − by defendants (fe) (Entered: 08/01/2000)
125 JOINT MOTION to further extend the term of appointment of special monitor ; declaration of Elizabeth A. Schaller; exhibits a and b; ORDER − by Judge David A. Ezra − granting joint motion for extension of appointment of special monitor; certificate of service [124−1] − by defts and plaintiff − it is hereby ordered that the term of appt of Leland Chang as special monitor is extended from 01/31/01 through 03/31/01 (lmg) (Entered: 02/12/2001)
126 NOTICE by defendant Naleen N. Andrade, defendant Henry Foley, defendant John Lewin, defendant John Waihee, defendant State of Hawaii of hearing ; status conference set for 9:45 5/7/01 before Judge David A. Ezra (gab) (Entered: 03/07/2001)
127 NOTICE of hearing ; status conference continued from 05/07/01 to 9:45 5/16/01 ; (cc:Ann Andreas) (lmg) (Entered: 03/15/2001)

04/10/2001
05/15/2001 05/15/2001 05/15/2001 05/15/2001 05/16/2001
05/17/2001
05/24/2001 05/29/2001 05/30/2001 05/31/2001 05/31/2001 06/05/2001 06/05/2001

128 Joint motion to further extend the term of appointment of special montitor; declaration of Ann V. Andreas; exhibits a and b; ORDER; certificate of service by Judge David A. Ezra extending the appointment of special monitor Leland Chang from 3/31/01 through 5/31/01 subject to review of the special monitor's supporting documentation showing expenditure of the funds on behalf of defts (eps) (Entered: 04/10/2001)
129 STATUS CONFERENCE REPORT by defendants'; exhibits I. 1−16, II. 1−7, III. 1−3; certificate of service − re vol 1 of 2 (lmg) (Entered: 05/16/2001)
129 STATUS CONFERENCE REPORT by defendants'; exhibits I. 1−16, II. 1−7, III. 1−3; certificate of service re vol 2 of 2 (lmg) (Entered: 05/16/2001)
130 NOTICE of submission by defendants of the original signed copy of the declaration in support of pro hac vice application; declaration in support of pro hac vice applcation; certificate of service (lmg) (Entered: 05/16/2001)
131 SUPPLEMENTAL exhibits to status conference report by defendants; exhibit I.17 and exhibit II.8; certificate of service − re report [129−1], re report [129−1a] (lmg) (Entered: 05/16/2001)
132 Defendants' EX PARTE APPLICATION for admission of Paul M. Aucoin pro hac vice ; declaration of Barbara A. Fabrey; exhibit a; designation and consent of Heidi M. Rian as associate counsel; ORDER by Judge David Ezra − granting ex parte application to appear pro hac vice; certificate of service (lmg) (Entered: 05/21/2001)
133 EP :Status Conference: Discussion held regarding special masters report. Pursuant to the agreement of the parties, Court hereby Orders that Pursuant to Rule 53 of the Federal Rules of Civil Procedure that the Honorable Kevin S. C. Chang, United States Magistrate Judge be appointed herewith until further order of this Court as a special master in this matter. Mr. Deerinwater to prepare Order. ;Status conference held 5/17/01 before Judge David A. Ezra ( Ct Rptr : Terry Chun) JUDGE Judge David A. Ezra (lmg) (Entered: 05/22/2001)
134 NOTICE of submission by plaintiff the United States of proposed order of reference; certificate of service (lmg) (Entered: 05/30/2001)
135 NOTICE of hearing ;status conference set for 1:30 6/8/01 before Mag Judge Kevin S. Chang ; Ann Andreas to notify all parties (lmg) (Entered: 05/31/2001)
136 NOTICE by defendants of status conference; certificate of service (lmg) Modified on 05/31/2001 (Entered: 05/31/2001)
137 NOTICE of submission of defendants' substitute proposed draft order of reference; certificate of service − by defendants (lmg) (Entered: 06/01/2001)
138 Statement of OBJECTIONS by defendants to proposed draft order of reference; exhibit 1; certificate of service [134−1] (lmg) (Entered: 06/01/2001)
139 RESPONSE by plaintiff United States' to defendants' statement of objections to proposed draft order of reference and to defendants' proposed order of reference; certificate of service [138−1] (lmg) (Entered: 06/07/2001)
146 EP : ;Further status conference held; next conference set for 11:30 6/7/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang

06/07/2001 06/08/2001 06/11/2001 06/14/2001 06/19/2001
06/26/2001 06/27/2001 06/28/2001 06/29/2001 07/03/2001 07/05/2001 07/06/2001 07/09/2001 07/10/2001 07/12/2001 07/16/2001 07/18/2001

(lmg) (Entered: 08/06/2001)
147 EP : ;Further status conference held; next conference set 10:00 at 6/11/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
140 EP :status conference held; ;next conference at 10:00 7/26/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 06/15/2001)
148 EP : ;Further status conference held; next conference on call ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
145 EP : ;Further status conference held; next conference set for 1:30 6/5/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
141 ORDER OF REFERENCE by Judge David A. Ezra − [appointment and mandate: Honorable Kevin S.C. Chang is appointed Special Master beginning on date of this order and shall continue until further order of this court; refer to order] (cc: all counsel) (afc) (Entered: 06/20/2001)
149 EP : ;Further status conference held; next conference 6/27/01 at 12:30 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
150 EP : ;Further status conference held; next conference set for 9:30 6/28/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
151 EP : ;Further status conference held; next conference set for 8:00 6/29/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
152 EP : ;Further status conference held; next conference set for 1:30 7/3/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
153 EP : ;Further status conference held; next conference set for 10:00 7/5/01 KSC ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) Modified on 08/06/2001 (Entered: 08/06/2001)
154 EP : ;Further status conference held; next conference set for 10:00 7/10/01 KSC ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) Modified on 08/06/2001 (Entered: 08/06/2001)
Original TRANSCRIPT filed ( Ct Rptr Terrence Chun) taken on 05/17/01 (lmg) (Entered: 07/09/2001)
142 ORDER by Mag Judge Kevin S. Chang regarding special master's employment of Kris A. McLoughlin (cc: all counsel/parties) (lmg) (Entered: 07/12/2001)
155 EP : ;Further status conference held; next conference set for 1:00 7/12/01 KSC ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
156 EP : ;Further status conference held; next conference set for 3:30 7/16/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
157 EP : ;Further status conference held; next conference set for 3:30 7/18/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
158 EP : ;Further status conference held; next conference set for 8:30 7/19/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record)

07/19/2001 07/20/2001 07/23/2001 07/24/2001
07/25/2001 07/26/2001
07/27/2001 07/30/2001
07/30/2001 07/31/2001 08/03/2001 08/06/2001 08/08/2001 08/10/2001 08/10/2001 08/13/2001 08/14/2001

JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
159 EP : ;Further status conference held; next conference set for 2:00 7/20/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
160 EP : ;Further status conference held; next conference is set for 3:30 7/23/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
161 EP : ; Further status conference held; next conference set for 10:30 7/24/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
162 EP : ;Further status conference held; next conference is set for 10:30 7/25/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
163 EP : ;Further status conference held; next conference set for 6:45 7/26/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
164 EP : ;Further status conference held; next conference is set for 10:30 7/27/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
165 EP : ;Further status conference held; next conference is set for 3:30 7/30/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
143 ORDER regarding status conference and deadlines − by Mag Judge Kevin S. Chang ; status conference set for 10:30 8/30/01 before Mag Judge Kevin S. Chang (cc: all counsel/parties) (lmg) (Entered: 08/01/2001)
166 EP : ;Further status conference held; next conference set for 3:30 7/31/01 before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
144 EP : ;Further status conference held; next conference on call ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/03/2001)
167 EP : ;Status conference held 8/3/01 ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/06/2001)
168 EP : Further status conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/13/2001)
169 ORDER approving special monitor's budget − by Mag Judge Kevin S. Chang (cc: all counsel) (lmg) (Entered: 08/13/2001)
170 MEMORANDUM by defendants' concerning compliance status; exhibit 1a; exhibit 1b; certificate of service (Two volumes of said exhibits) (lmg) Modified on 08/14/2001 (Entered: 08/14/2001)
171 MEMORANDUM by defendants concerning space utilization at Hawaii State Hospital; certificate of service (lmg) (Entered: 08/15/2001)
172 EP : Further status conference held ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/21/2001)
173 EP : Further status held ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 08/21/2001)

08/15/2001 08/15/2001 08/16/2001
08/16/2001 08/28/2001 08/28/2001 08/30/2001 09/20/2001 09/25/2001 09/25/2001 09/25/2001 09/26/2001 10/01/2001 10/05/2001 10/05/2001 10/09/2001

174 RESPONSE by defendants' to the special master's framework and scope of services questions dated August 1, 2001; exhibits a through h [169−1] (lmg) (Entered: 08/22/2001)
175 CERTIFICATE of service (lmg) (Entered: 08/22/2001)
176 EX PARTE MOTION to conform special master's working copies of exhibits 1a and 1b to original and service copy and to withdraw defendants' memorandum concerning compliance status filed on August 10, 2001 and to file in its place a corrected defendants' memorandum concerning compliance status; declaration of Ann V. Andreas; declaration of Barbara A. Fabrey; corrected exhibits 1a, 1b and 2; ORDER − by Mag Judge Kevin S. Chang − granting ex parte motion to conform special master's working copies of exhibits 1a and 1b to original and service copy and to withraw defendants' memorandum concerning compliance status filed on August 10, 2001 and to filed in its place a corrected defendants' memorandum concerning compliance status; certificate of service − by defendants [174−1][169−1] (lmg) (Entered: 08/22/2001)
177 MEMORANDUM by defendants' concerning compliance status; exhibit 1a; exhibit 1b; certificate of service [171−1] (lmg) (Entered: 08/22/2001)
178 RESPONSE by plaintiff USA to defendants' memorandum concerning space utilization at Hawaii State Hospital [171−1] (eps) (Entered: 08/30/2001)
179 RESPONSE by plaintiff USA to defendants' memorandum concerning compliance status [177−1] (eps) (Entered: 08/30/2001)
180 EP : further status conf held before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 09/05/2001)
181 STIPULATION and ORDER regarding space utilization for patients of the Hawaii State Hospital − by Judge David A. Ezra − on behalf of plaintiff (lmg) (Entered: 09/23/2001)
182 ORDER regarding special master's employment of Richard T. Kozuma − by Mag Judge Kevin S. Chang − [141−2] (cc: all counsel) (lmg) (Entered: 09/25/2001)
183 ORDER regarding special master's employment of Glenn M. Murata − by Mag Judge Kevin S. Chang − re [141−1] (cc: all counsel) (lmg) (Entered: 09/25/2001)
184 ORDER regarding special master's employment of Michael F. Broderick − by Mag Judge Kevin S. Chang − re [141−1] (cc: all counsel) (lmg) (Entered: 09/25/2001)
185 EP : Further status conference held ; next conference on call ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 10/03/2001)
186 ORDER regarding special master's employment of Chad Y. Koyanagi, MD by Mag Judge Kevin S. Chang re [141−1] (cc: all counsel) (eps) Modified on 10/03/2001 (Entered: 10/02/2001)
187 Amended ORDER regarding special master's employment of Richard T. Kozuma − by Mag Judge Kevin S. Chang − re [182−1] (cc: all counsel) (lmg) (Entered: 10/09/2001)
188 Amended ORDER regarding special master's employment of Michael F. Brokerick − by Mag Judge Kevin S. Chang − re [184−1] (cc: all counsel) (lmg) (Entered: 10/09/2001)
189 EP : Further settlement conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 10/09/2001)

10/10/2001 10/15/2001
10/16/2001 10/26/2001 10/29/2001 10/30/2001 11/01/2001 11/14/2001 11/23/2001 11/30/2001 11/30/2001 12/03/2001 12/07/2001 12/10/2001 01/04/2002 01/11/2002 01/18/2002 01/18/2002 01/22/2002

190 Amended ORDER regarding special master's employment of Glenn M. Murata − by Mag Judge Kevin S. Chang − re [183−1] (cc: all counsel) (lmg) (Entered: 10/12/2001)
191 NOTICE OF APPEARANCE for USA by David Deutsch, Richard J. Farano of DOJ, Civil Rights Division; Elizabeth Johnson &Verlin H. Deerinwater will continue as counsel for USA (eps) (Entered: 10/17/2001)
192 ATTORNEY APPEARANCE for plaintiff USA by counsel, David Deutsch and Richard J. Farano (lmg) (Entered: 10/17/2001)
193 EP : further status conference held ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 10/29/2001)
194 EP :Status conference held; ;status conference set 8:00 10/30/01 before Mag Judge Kevin S. Chang ( Ct Rptr : tape C6 1183) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 11/02/2001)
195 EP : ;Further status conference held Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 11/02/2001)
196 EP : Further status conference held before Mag Judge Kevin S. Chang ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 11/02/2001)
197 CERTIFICATE of service (lmg) (Entered: 11/15/2001)
198 EP : Further status conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 11/27/2001)
199 EP : further status conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 12/03/2001)
200 RESPONSE to experts consensus plan in the United States v. State of Hawaii, November 9, 2001 by defendant State of Hawaii (eps) (Entered: 12/05/2001)
201 RESPONSE to experts' consensu plan of November 9, 2001 by plaintiff USA (eps) (Entered: 12/05/2001)
202 RESPONSE by defendant State of Hawai'i's comments on The United States' to the experts' consensus plan, filed on November 30, 2001 [200−1] (lmg) (Entered: 12/10/2001)
203 REPLY by plaintiff USA re State of Hawaii's response to the experts' Consensus Plan [202−1] (fe) (Entered: 12/12/2001)
204 EP : ;Further status conference held; next conference set for 10:00 1/11/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 01/07/2002)
205 EP :Further status conference held; ;next conference set for 10:00 1/18/02 before Mag Judge Kevin S. Chang ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 01/17/2002)
206 EP :Further status conference held; ; next conference set for 10:00 1/22/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 01/22/2002)
207 EO : ;further status conference from 1/18/02 10:00 AM to 10:00 1/22/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 01/22/2002)
209 EP: status conference held 1/22/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (tbf) (Entered: 01/29/2002)

01/25/2002 01/25/2002 01/25/2002
02/19/2002
02/19/2002 02/20/2002 02/21/2002
02/21/2002
02/22/2002 03/12/2002 03/29/2002 03/29/2002 04/16/2002 04/16/2002 04/16/2002

208 REPORT AND RECOMMENDATION ; exhibits a−c by Mag Judge Kevin S. Chang (cc: all counsel) (eps) (Entered: 01/25/2002)
210 EO :setting hearing on special master's report and recommendation [208−1] 9:00 2/19/02 ( Ct Rptr : ) JUDGE Judge David A. Ezra (tbf) (Entered: 01/29/2002)
211 EP : Status Conference − Parties were advised that a hearing on Special Master's Report and Recommendation has been scheduled before DAE on 2−19−02 at 9:00. Written comments or objections to R &R to be filed by 2−8−02. [208−1] ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 02/04/2002)
212 EP : hearing on special master's report and recommendation ; the court approves the special master's REPORT AND RECOMMENDATION [208−1] ( Ct Rptr : Lisa Groulx) JUDGE Judge David A. Ezra, Magistrate Kevin Chang (eps) (Entered: 02/21/2002)
213 Second ORDER regarding special master's employment of Michael F. Broderick by Mag Judge Kevin S. Chang − for appointment of receiver Michael F. Broderick [212−1] (cc: all counsel) (lmg) (Entered: 02/22/2002)
214 EP : status conference held ; next conference of call ( Ct Rptr : No record) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 02/22/2002)
215 Parties' joint RESPONSE to the special master's reprt and recommendationfiled January 25, 2002; order entering Hawaii State Hospital remedial plan; certificate of service − on behalf of defendants [211−1] (lmg) Modified on 02/22/2002 (Entered: 02/22/2002)
216 ORDER regarding special master's report and recommendation by Judge David A. Ezra − adopting report and recommendation motion REPORT AND RECOMMENDATION [208−1] − Leland Chang's appointment as special monitor is terminated on 2/28/02 and that Kris A. McLounglin is appointed to replace Leland Chang (cc: all counsel) (lmg) Additional attachment(s) added on 8/7/2007 (afc). (Entered: 02/25/2002)
217 ORDER regarding special master's employment of Jeffrey Akaka, M.D. by Judge David A. Ezra − for appointment of receiver Jeffrey Akaka (cc: all counsel) (lmg) (Entered: 02/27/2002)
218 EP : conference re community summit held ( Ct Rptr : C5 tape 868) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 03/13/2002)
219 EO : status conference set for 8:30 4/2/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 04/01/2002)
220 EO : status conference set for 10:30 4/2/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 04/01/2002)
221 ORDER regarding special master's employment of Nirbhay N. Singh, PH.D by Mag Judge Kevin S. Chang (copies mailed to counsel/parties by chambers) (bbb) (Entered: 04/18/2002)
222 ORDER regarding special master's employment of Paul G. Gornman, ED.D by Mag Judge Kevin S. Chang (copies mailed to counsel/parties by chambers) (bbb) (Entered: 04/18/2002)
223 ORDER regarding special master's employment of Kenneth Minkoff, M.D by Mag Judge Kevin S. Chang (copies mailed to counsel/parties by chambers) (bbb) (Entered: 04/18/2002)

04/16/2002 04/18/2002 04/26/2002 05/03/2002 05/07/2002 05/08/2002 05/10/2002 05/17/2002 06/07/2002 06/14/2002
06/20/2002 06/25/2002 06/26/2002 06/28/2002 07/12/2002

224 ORDER regarding special master's employment of Gail Hanson−Mayer, RN, CS, MPH by Mag Judge Kevin S. Chang (copies mailed to counsel/parties by chambers) (bbb) (Entered: 04/18/2002)
225 EO : status conference set for 10:00 4/19/02 before Mag Judge Kevin S. Chang ( Ct Rptr : IC) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 04/19/2002)
226 EO :Further status conference set for 05/03/2002 10:00 AM KSC; ; status conference set for 10:00 5/3/02 before Mag Judge Kevin S. Chang ( Ct Rptr : IC) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 04/29/2002)
227 EP : further status conference held 5/3/02 before Mag Judge Kevin S. Chang ( Ct Rptr : No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 05/06/2002)
228 EO : status conference set for 9:00 5/8/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 05/08/2002)
229 EP : further status conference held 5/8/02 before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 05/09/2002)
230 ORDER regarding special master's employment of Peter Lloyd Forster, M.D. by Mag Judge Kevin S. Chang (copies mailed to counsel/parties by chambers) (bbb) (Entered: 05/15/2002)
231 EP : STATUS CONFERENCE − Further status conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 05/22/2002)
232 EP :Status Conference held. Next conference on call. before Mag Judge Kevin S. Chang ( Ct Rptr No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 06/10/2002)
233 EP :Further Status Conference set for 06/14/2002 10:00:00 AM KSC held. Next conference set 6−21−02 at 10:00 KSC. status conference set for 10:00 6/21/02 before Mag Judge Kevin S. Chang ( Ct Rptr : No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 06/17/2002)
234 EP : status conference held 6/20/02 before Mag Judge Kevin S. Chang , next status conference set for 10:00 6/28/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 06/20/2002)
235 EO :Further Status Conference set for 06/26/2002 08:00:00 AM KSC. status conference set for 8:00 6/26/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 06/26/2002)
236 STIPULATION and ORDER by Mag Judge Kevin S. Chang : regarding Hawaii State Hospital patient L.M. (fe) (Entered: 06/27/2002)
237 EP : further status conference held; next status conference set for 10:00 7/5/02 before Mag Judge Kevin S. Chang ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 07/01/2002)
238 EO :Further Status Conference moved from 7−19−02 to 07/22/2002 10:00:00 AM KSC. Parties notified. status conference set for 10:00 7/22/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 07/15/2002)

07/12/2002
07/22/2002 07/26/2002 08/09/2002 08/09/2002 08/15/2002 08/23/2002 08/29/2002 09/11/2002 09/11/2002 09/11/2002 09/12/2002 09/13/2002 09/13/2002 09/19/2002
09/20/2002 09/23/2002 09/23/2002

239 EP : further status conference held 7/12/02 before Mag Judge Kevin S. Chang , next conference set for 10:00 7/22/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 07/16/2002)
240 EP : further status conference held 7/22/02 before Mag Judge Kevin S. Chang ( Ct Rptr : No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 07/24/2002)
241 EP :Status Conference held. ( Ct Rptr : No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 07/29/2002)
242 SECOND REPORT AND RECOMMENDATION ; exhibits a−c by Mag Judge Kevin S. Chang (cc: DAE, all counsel) (bbb) (Entered: 08/09/2002)
243 EP :Further Status Conference set 8−9−02 at 10:00 KSC held. before Mag Judge Barry M. Kurren ( Ct Rptr : no record) JUDGE Mag Judge Barry M. Kurren (fe) (Entered: 08/12/2002)
244 EO :Further Status Conference that was set for August 15, 2002 was taken off calendar and not held. ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 08/19/2002)
245 EP : further status conference held ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 08/30/2002)
246 EP : further status conference held ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 08/30/2002)
247 EO : status conference set for 11:00 9/12/02 before Mag Judge Kevin S. Chang ; parties notified; () JUDGE Judge Kevin S. Chang (bbb) (Entered: 09/13/2002)
248 EO : status conference set for 8:00 9/23/02 before Mag Judge Kevin S. Chang () JUDGE Judge Kevin S. Chang (bbb) (Entered: 09/13/2002)
249 EO : status conference set for 10:00 9/26/02 before Mag Judge Kevin S. Chang ; parties notified () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 09/13/2002)
250 EP : status conference held 9/12/02 before Mag Judge Kevin S. Chang ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 09/13/2002)
251 ORDER by Judge David A. Ezra adopting SECOND REPORT of Special Master [242−1] (cc: all counsel) (eps) (Entered: 09/16/2002)
252 EP : Further status conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (lmg) (Entered: 09/16/2002)
253 STATEMENT by defendants Naleen N. Andrade, Henry Foley, John Lewin, John Waihee, State of Hawaii of no opposition to adoption of special master's SECOND REPORT AND RECOMMENDATION [242−1] dated August 9, 2002; certificate of service (bbb) (Entered: 09/23/2002)
254 RESPONSE by plaintiff USA to the second report and recommendation of the special master [242−1]; certificate of service (bbb) (Entered: 09/23/2002)
255 EP: Status Conference held. (Ct Rptr: In Chambers − No Record) JUDGE Mag Judge Kevin S. Chang (afc) (Entered: 09/25/2002)
256 EP : Hearing on Master's Second Report. Honorable Kevin S.C. Chang, U.S. Magistrate Judge present. Brian Garner, Anita Swanson, and Dr, Bruce Anderson present. Comments made by Court. Comments heard from both sides. Hearing on Master's

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11/20/2002
11/22/2002
11/22/2002 11/25/2002 11/27/2002

Second Report−ADOPTED. [242−1] ( Ct Rptr : Cynthia Fazio) JUDGE Judge David A. Ezra (bbb) (Entered: 09/27/2002)
257 EP : status conference held 09/26/02 before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (sealed) (Entered: 10/01/2002)
TRANSCRIPT of Proceedings − 09/23/2002 − ORIG − ( Cynthia Fazio ) − pp 9 (bbb) (Entered: 10/01/2002)
258 EP : further status conference held before Mag Judge Kevin S. Chang ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 10/16/2002)
259 EP :Status Conference held. before Mag Judge Kevin S. Chang ( Ct Rptr : No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 11/04/2002)
260 EP : Status Conference held before Mag Judge Kevin S. Chang ( Ct Rptr : Chambers) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 11/12/2002)
261 MOTION by plaintiff USA regarding the plan for community adult mental health services referred to Mag Judge Kevin S. Chang (bbb) Modified on 03/03/2003 (Entered: 11/19/2002)
262 MEMORANDUM by plaintiff USA in support of motion regarding the plan for community adult mental health services [261−1] (bbb) (Entered: 11/19/2002)
263 EX PARTE MOTION and Order by Mag Judge Kevin S. Chang by defendants Naleen N. Andrade, Henry Foley, John Lewin, John Waihee, State of Hawaii shorten time for hearing on motion for consent to hire three doctors with limited and temporary licenses for employment at Hawaii State Hospital ; affidavit of Barbara A. Fabrey; Order granting ex parte motion to shorten time for hearing of state defendants' motion for consent to hire three doctors with limited and temporary licenses for employment at Hawaii State Hospital; certificat of service (cc: all counsel) (bbb) (Entered: 11/22/2002)
264 NOTICE OF MOTION and motion by defendants Naleen N. Andrade, Henry Foley, John Lewin, John Waihee, State of Hawaii for the court's consent to hire three doctors with limited and temporary licenses ; memorandum in support of motion; declaration of Barbara A. Fabrey; exhibits a−m; certificate of service; motio set for 9:30 11/27/02 before Mag Judge Kevin S. Chang (bbb) (Entered: 11/22/2002)
266 EO :State Defendants' Motion for Consent to Hire Three (3) Doctors with Limited and Temporary LIcenses for Employment at Hawaii State Hospital set on 11−27−02 vacated. Court to rule without a hearing. Parties notified. − that the motion for the court's consent to hire three doctors with limited and temporary licenses [264−1] is submitted ( Ct Rptr : ) JUDGE Mag Judge S. Chang (fe) (Entered: 11/26/2002)
267 EP : status conference held before Mag Judge Kevin S. Chang ( Ct Rptr : No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 11/26/2002)
265 ORDER by Mag Judge Kevin S. Chang granting State defendants' motion for consent to hire three doctors with limited and temporary licenses for employment at Hawaii State Hospital [264−1] − on behalf of defendants (fe) (Entered: 11/25/2002)
268 THIRD REPORT AND RECOMMENDATION]; exhibits a−e − by Judge Kevin S. Chang (cc: DAE, all counsel) (fe) Modified on

11/27/2002 12/06/2002
12/20/2002 01/03/2003 01/06/2003
01/07/2003 01/07/2003 01/14/2003 01/16/2003 01/17/2003 01/21/2003 01/23/2003 01/31/2003 01/31/2003 02/14/2003 02/28/2003

01/24/2003 (Entered: 11/27/2002)
269 Joint STIPULATION re November 15, 2002 filing of the United States [261−1] (fe) (Entered: 11/29/2002)
270 EO :Hearing on the Master's 3rd Report. Hearing on the Master's 3rd Report−SET for 1/21/2003 @3:45pmDAE. Responses due 1/7/2003. Copies faxed to Ann Andreas, Verlin Deerinwater, and Paul Aucion. status conference set for 3:45 1/21/03 before Judge David A. Ezra ( Ct Rptr : ) JUDGE Judge David A. Ezra (fe) (Entered: 12/13/2002)
271 EP :Status Conference set for 12/20/2002 10:00:00 AM before KSC held. status conference held 12/20/02 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 12/24/2002)
272 EP : status conference held before Mag Judge Kevin S. Chang ( Ct Rptr : InChambers−No Record) JUDGE Mag Judge Kevin S. (bbb) (Entered: 01/08/2003)
275 ORDER amending order regarding Speicial Master's employment of Kris A. McGloughlin and order regarding Special Master's employment of Chad Y. Koyanahi, M.D. by Mag Judge Kevin S. Chang re [142−1], re [216−1] (cc: all counsel) (bbb) (Entered: 01/10/2003)
273 STATEMENT of no opposition to third REPORT AND RECOMMENDATION [268−1]; certificate of service (bbb) (Entered: 01/09/2003)
274 United State's RESPONSE to the third report and recommendation of the special master; certificate of service [268−1] (bbb) (Entered: 01/09/2003)
276 EO : Hearing on the Master's 3rd Report. Hearing on the Master's 3rd Report set for 1/21/2003 @3:45pmDAE has been changed to 1/21/2003 @2:15pmDAE. All parties notified by fax. () JUDGE Judge David A. Ezra (bbb) (Entered: 01/15/2003)
277 REPLY by defendants' to plaintiff's response to special master's third report and recommendation re [274−1]; certificate of service (fe) (Entered: 01/16/2003)
278 EP :Status Conference held. before Mag Judge Kevin S. Chang ( Ct Rptr No Record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 01/21/2003)
280 EP :Hearing on the Master's 3rd Report. Hearing on the Master's 3rd Report−ADOPTED. [268−1] ( Ct Rptr : Cynthia Fazio) JUDGE Judge David A. Ezra (fe) (Entered: 01/24/2003)
279 ORDER by Judge David A. Ezra adopting report of Special Master [268−1] (cc: all counsel, Judge Chang) (fe) (Entered: 01/24/2003)
TRANSCRIPT of Proceedings − 1/21/03 − ORIG − ( Cynthia Tando Fazio ) − pp 12 − hearing on Master's Third report (fe) (Entered: 01/31/2003)
281 EP :Status Conference held. before Mag Judge Kevin S. Chang ( Ct Rptr : no record) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 02/04/2003)
282 EP :Status Conference held. before Mag Judge Kevin S. Chang ( Ct Rptr None) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 02/19/2003)
283 EP : Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 03/03/2003)

03/14/2003 04/10/2003 04/25/2003 05/09/2003 05/22/2003
05/30/2003 06/05/2003 06/05/2003
06/27/2003 07/11/2003 07/18/2003 07/25/2003 07/31/2003
08/08/2003 08/15/2003 08/18/2003 08/18/2003

284 EP :Status Conference. Status Conference held via telephone. before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 04/18/2003)
285 EP : Status Conference. Status Conference held via telephone. ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 04/18/2003)
286 EP : Status Conference. Status Conference held via telephone. , ( Ct Rptr : none) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 04/25/2003)
287 EP: Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 05/12/2003)
288 Joint motion for order allowing access to confidential protected health information, including medical, mental, health, alcohol and drug abuse treatment records; memorandum in support of joint motion; ORDER granting motion by Mag Judge Kevin S. Chang; certificate of service (fe) (Entered: 05/22/2003)
289 EP : status conference held before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 06/02/2003)
290 EP : status conference held before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 06/05/2003)
291 Joint STIPULATION for partial dismissal without prejudice of claims regarding children and adolescent residential services and ORDER by Judge David A. Ezra :; certificate of service dismissing Children and Adolescent Residential Services − on behalf of plaintiffs USA (fe) (Entered: 06/09/2003)
292 EP : status conference held before Mag Judge Kevin S. Chang ( Ct Rptr ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 06/27/2003)
293 EP : Status conference held before Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 07/14/2003)
294 Fourth REPORT AND RECOMMENDATION ; exhibits a−g − by Mag Judge Kevin S. Chang (cc: all counsel) (fe) Modified on 07/18/2003 (Entered: 07/18/2003)
295 EP : Status conference held before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 07/28/2003)
296 EO :Hearing on Master's Fourth Report and Recommendation is set for 9/10/2003 09:00:00 AM before DAE status conference set for 9:00 9/10/03 before Judge David A. Ezra ( Ct Rptr : ) JUDGE Judge David A. Ezra (fe) (Entered: 07/31/2003)
297 EP : status conference held 8/8/03 before Mag Judge Kevin S. Chang ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (fe) (Entered: 08/11/2003)
298 RESPONSE by defendants to Special Master's fourth report and recommendation [294−1]; appendix a; certificate of service (fe) (Entered: 08/18/2003)
299 RESPONSE by plaintiff USA to the fourth Report and Recommendation of the Special Master [294−1]; certificate of service (fe) (Entered: 08/19/2003)
300 RESPONSE by plaintiff USA to the fourth report and recommendation of the special master [294−1]; certificate of

09/10/2003 09/10/2003
09/11/2003 10/01/2003 10/24/2003 11/07/2003 11/21/2003 12/04/2003 12/12/2003 01/07/2004
01/12/2004 01/14/2004
01/22/2004 01/23/2004 01/30/2004
02/19/2004

service (fe) (Entered: 08/19/2003)
301 EP: Hearing on Master's Fourth Report and Recommendation. Hearing held before Judge David Alan Ezra. () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 09/11/2003)
302 EP: Hearing on Master's Fourth Report and Recommendation. Hearing on Master's Fourth Report and Recommendation − ACCEPTED. [294−1] ( Ct Rptr : Steve Platt) JUDGE Judge David A. Ezra (bbb) (Entered: 09/11/2003)
303 EP: Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 09/12/2003)
304 ORDER adopting report of master [294−1] by Judge David A. Ezra (bbb) (Entered: 10/02/2003)
305 EP: Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 10/27/2003)
306 EP: Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 11/10/2003)
307 EP: Status Conference Held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 11/24/2003)
308 EP: Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 12/04/2003)
309 Fifth FINDINGS AND RECOMMENDATION ; exhibits a−d by Mag Judge Kevin S. Chang (cc: all counsel) (bbb) (Entered: 12/12/2003)
310 EO: Hearing on the Master's 5th Report. Hearing on the Master's 5th Report is set for 1/28/2004 @9:00amDAE. All parties notified by fax. ; in court hearing set for 9:00 1/28/04 before Judge David A. Ezra () JUDGE Judge David A. Ezra (bbb) (Entered: 01/08/2004)
311 United States' RESPONSE to the Fifth Report and Recommendation of the Special Master [309−1] (bbb) (Entered: 01/13/2004)
312 EO: Hearing on Master's Fifth Report and Recommendation set for 01/28/2004 09:00:00 AM before DAE− WILL BE DECIDED ON THE PAPERS WITHOUT A HEARING. All responses to be due by 1/22/2004. Counsel notified via fax . [309−2] () JUDGE Judge David A. Ezra (bbb) (Entered: 01/15/2004)
313 Defendants' RESPONSE to special master's fifth report and recommendation [309−1]; certificate of service (bbb) (Entered: 01/26/2004)
314 EP: Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 01/26/2004)
315 EP: Defendant shall deliver a complete and detailed response to Mr. Deerinwater's letter (and items listed therein) dated December 10, 2003 by February 13, 2004. If Defendants do not comply in a timely manner, this court will issue an Order to Show Cause and schedule a hearing date. ( Ct Rptr : In Chambers−no record) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 02/02/2004)
316 ORDER ADOPTING REPORT OF SPECIAL MASTER by Judge David A. Ezra [309−1][309−2] [02/21/04 deadline for defendants' compliance with Hawaii State Hospital Remedial Plan for Compliance is extended to 09/30/04] (cc: all counsel) (afc) (Entered: 02/19/2004)

02/19/2004 02/27/2004 03/18/2004 04/15/2004 04/16/2004
04/23/2004 04/29/2004 05/28/2004
06/17/2004 07/07/2004 07/30/2004 08/05/2004 08/26/2004 08/27/2004 09/08/2004 09/08/2004 09/13/2004 09/15/2004 09/16/2004

317 EP: Status Conference. Status Conference held via telephone. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 02/20/2004)
318 EP :Status Conference − Status Conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 02/27/2004)
319 EP : Status Conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 03/18/2004)
320 EO: status conference (all counsel by phone) set for 11:00 4/16/04 before Mag Judge Kevin S. Chang () JUDGE Judge Kevin S. Chang (bbb) (Entered: 04/16/2004)
321 EP: Status Conference−(All Counsel by Phone)−This Status Conference was held. ; settlement/status conference held 4/16/04 before Mag Judge Kevin S. Chang ( Ct Rptr : None) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 04/19/2004)
322 ORDER regarding deadlines and schedule applicable to Hawaii State Hospital Remedial Plan for Compliance Experts by Mag Judge Kevin S. Chang (cc: all counsel) (bbb) (Entered: 04/26/2004)
323 EP: Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 04/29/2004)
324 EP: Status Conference: Status conference held. Next status conference scheduled on 6/17/04 at 10:00 a.m. ; settlement/status conference set for 10:00 6/17/04 before Mag Judge Kevin S. Chang ( Ct Rptr : no record (chambers)) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 06/01/2004)
325 EP: Status Conference. Status Conference held. ; settlement/status conference held 6/17/04 before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 06/17/2004)
326 EP :Status Conference. Status Conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 07/08/2004)
327 EP: Status Conference − Status Conference held. () JUDGE Mag Judge Kevin S. Chang (afc) (Entered: 08/03/2004)
328 Sixth REPORT AND RECOMMENDATION; exhibits a−h by Mag Judge Kevin S. Chang (cc: all counsel) (bbb) (Entered: 08/05/2004)
329 Seventh REPORT AND RECOMMENDATION; exhibits a−d by Mag Judge Kevin S. Chang (bbb) (Entered: 08/26/2004)
330 EP : Status Conference. Status Conference held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 08/30/2004)
331 ORDER by Judge David A. Ezra adopting SIXTH report and recommendation [328−1] (cc: all counsel) (eps) (Entered: 09/13/2004)
332 ORDER by Judge David A. Ezra adopting SEVENTH report and recommendation [329−1] (cc: all counsel) (eps) (Entered: 09/13/2004)
333 EP : Site Visit. Site visit held ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 09/14/2004)
334 EP : Status Conference. Status conference held. ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (eps) (Entered: 09/16/2004)
335 EP: Status Conference. Status conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 09/20/2004)

10/22/2004 11/12/2004 11/12/2004 11/19/2004 11/30/2004
12/09/2004 12/09/2004 12/09/2004 12/10/2004
12/10/2004 12/10/2004 12/10/2004
12/10/2004 12/22/2004 01/04/2005 01/28/2005 02/09/2005

336 EP: Status Conference. Status conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 10/26/2004)
337 Eighth REPORT AND RECOMMENDATION; exhibits a−c; by Mag Judge Kevin S. Chang (bbb) (Entered: 11/16/2004)
338 EO: Hearing on Special Master's 8th Report set for 12/10/2004 09:45:00 AM before DAE [337−1] ( Ct Rptr: ) JUDGE Judge David A. Ezra (bbb) (Entered: 11/16/2004)
339 EP: Status Conference. Status conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 11/22/2004)
340 ORDER regarding special master's employment of Kenneth Minkoff, M.D., Gail Hanson−Mayer, R.N., C.S., M.P.H. and Paul G. Gorman, Ed.D. by Mag Judge Kevin S. Chang (cc: all counsel) (bbb) (Entered: 12/06/2004)
341 CERTIFICATE of service by defendants Naleen N. Andrade, Henry Foley, John Lewin, John Waihee and State of Hawaii (bbb) (Entered: 12/10/2004)
342 EP: Status Conference. Status conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 12/10/2004)
343 EP: Site Visit. Site visit held. () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 12/10/2004)
344 EP: Hearing on Special Master's 8th Report. Paul Guggeheim present. Dr. Chiyome Fukino present. Michelle Hill present. Hearing on Special Master's 8th Report held. Stipulations signed and filed. [337−1] ( Ct Rptr : Stephen Platt) JUDGE Judge David A. Ezra and Kevin S. Chang (bbb) (Entered: 12/10/2004)
345 STIPULATION for dismissal of Hawaii State Hospital remedial plan for compliance; ORDER referred to Judge David A. Ezra (bbb) (Entered: 12/10/2004)
346 ORDER by Judge David A. Ezra re: the Hawaii State Hospital Remedial Plan [345−1] submitted by the Attorney General's Office (bbb) Modified on 12/10/2004 (Entered: 12/10/2004)
347 ORDER by Judge David A. Ezra extending deadline for the State's compliance with the Plan for Community Mental Health Services submitted by the Attorney General's Office (bbb) (Entered: 12/10/2004)
348 STIPULATION for extension of deadline for plan for community mental health services ; and ORDER − referred to Judge David A. Ezra : re [347−2] by plaintiff (bbb) (Entered: 12/16/2004)
ORIGINAL TRANSCRIPT filed ( Ct Rptr Stephen Platt) taken on 12/10/2004 pp. 24 (bbb) (Entered: 12/27/2004)
349 EP : Status Conference. Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (sm) (Entered: 01/06/2005)
350 EP: Status Conference. Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 01/28/2005)
351 Ninth REPORT AND RECOMMENDATION; exhibits a−c by Mag Judge Kevin S. Chang (cc: all counsel) (bbb) (Entered: 02/10/2005)

02/25/2005 02/28/2005 03/18/2005 05/27/2005 06/09/2005 07/15/2005 07/20/2005 07/27/2005
07/27/2005 08/22/2005 08/22/2005 08/24/2005
08/26/2005 09/08/2005 09/19/2005

352 EP : EP: Status Conference. Status Conference held before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (ecs) (Entered: 02/25/2005)
353 ORDER adopting ninth report and recommendation [351−1] by Judge David A. Ezra (cc: all counsel) (bbb) (Entered: 03/01/2005)
354 EP: Status Conference. Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 03/21/2005)
355 EP: Status Conference. Status Conference held before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 06/01/2005)
356 EP: Stats Conference. Status Conference held before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 06/13/2005)
357 EP: Status Conference. Court read statement on the record. (Ct Rptr: FTR−C5; Time: 10:01−10:15) JUDGE Mag Judge Kevin S. Chang (afc) (Entered: 07/18/2005)
358 TENTH REPORT AND RECOMMENDATION; exhibits a−f [351−1] by Mag Judge Kevin S. Chang (cc: all counsel by chambers) (bbb) (Entered: 07/21/2005)
359 EO: Hearing on Special Master's 10th Report set for 9/22/2005 at 9:00 AM before Judge Ezra. Parties shall file simultaneous submissions in response to the Tenth Report by August 22, 2005. cc: all counsel via mail [358−1] ( Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 07/27/2005)
360 EO: Hearing on Special Master's 10th Report set for 09/22/2005 09:00:00 AM before DAE [358−1] () JUDGE Judge David A. Ezra (bbb) (Entered: 07/29/2005)
361 United States' RESPONSE to the tenth report and recommendation of the special master [358−1]; certificate of service (bbb) (Entered: 08/23/2005)
362 Defendants response to Special Master's Tenth Report and Recommendation [358−1]; exhibits a to k; certificate of service (bbb) (Entered: 08/25/2005)
363 Defendants' EX PARTE MOTION for leave to filed defendants' response to special master's tenth report and recommendation exceeding limitations set forth in Local Rule 7.5 [362−1]; declaration of Ann V. Andreas; exhibit a; Order granting Defendants' ex parte motion for leave to file Defendants response to special master's tenth report and recommendation exceeding limitations set forth in Local Rule 7.5 by Judge David A. Ezra (bbb) (Entered: 08/26/2005)
364 EP: Stats Conference. Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 08/29/2005)
365 EO: Settlement Conference set for 9/20/2005 at 1:30PM before Judge Chang. cc: all parties via mail ; settlement/status conference set for 1:30 9/20/05 before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 09/09/2005)
366 EO: Hearing on Special Master's 10th Report has been continued from 09/22/2005 09:00:00 AM to 09/23/2005 11:15:00 AM before DAE. All counsel cc'd via fax [358−1] 11:15 9/23/05 JUDGE Judge David A. Ezra (afc) (Entered: 09/20/2005)

09/20/2005 09/23/2005
10/26/2005 10/28/2005 10/31/2005 11/14/2005 11/18/2005 11/30/2005 12/02/2005 12/07/2005 12/08/2005 01/06/2006 01/09/2006 02/10/2006
02/10/2006 02/21/2006 02/21/2006 02/22/2006

367 EP : Status Conference. Status Conference held. ( Ct Rptr : C5−no record) JUDGE Mag Judge Kevin S. Chang (ecs) (Entered: 09/23/2005)
368 EP: Hearing on Special Master's 10th Report. Hearing on Special Master's 10th Report held. [358−1] before Judge David A. Ezra ( Ct Rptr : Cynthia T. Fazio) JUDGE Judge David A. Ezra (bbb) (Entered: 09/27/2005)
369 JOINT STIPULATION and ORDER regarding plan for community mental health services by Judge David A. Ezra (bbb) (Entered: 10/26/2005)
370 EP: Status Conference held. before Mag Judge Kevin S. Chang ( Ct Rptr : In chambers) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 10/28/2005)
ORIGINAL TRANSCRIPT filed ( Ct Rptr Cynthia T. Fazio) taken on 09/23/2005 17 pages (bbb) (Entered: 10/31/2005)
371 EP : Meeting with Department of Health and AMHD. Meeting held. (Ct Rptr : ) JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 11/16/2005)
372 EP: Status Conference. Status Conference held. before Mag Judge Kevin S. Chang () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 11/21/2005)
373 JOINT STIPULATION and ORDER regarding timelines for plan for community mental health services by Judge David A. Ezra [369−1] (bbb) (Entered: 11/30/2005)
374 EP: Status Conference. Status Conference held. () JUDGE Mag Judge Kevin S. Chang (bbb) (Entered: 12/02/2005)
375 CERTIFICATE OF SERVICE by State of Hawaii, John Waihee, John Lewin, Henry Foley, Naleen N. Andrade re 373 Stipulation and Order (bbb, ) (Entered: 12/12/2005)
376 EP: Minute Entryfor proceedings held before Judge #KEVIN S CHANG: Status Conference held on 12/8/2005. (bbb, ) (Entered: 12/14/2005)
377 EP: Status Conference held on 1/6/2006. (Court Reporter no record.) (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 01/06/2006)
378 EP: Status Conference held on 1/9/2006. (Court Reporter no record.) (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 01/10/2006)
380 ELEVENTH REPORT AND RECOMMENDATION; # 1 Exhibit A;# 2 Exhibit B (part 1 of 2) pages 1−21;# 3 Exhibit B (part 2 of 2) pages 22−43# 4 Exhibit C;# 5 Exhibit D. (bbb, ) (Entered: 02/10/2006)
381 EP: Status Conference held on 2/10/2006. (In Chambers − no record, 10:00−10:35am) (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 02/10/2006)
383 Mail Returned as Undeliverable 380 . Mail sent to David Deutsch and Richard J. Farano (bbb, ) (Entered: 02/22/2006)
384 State Defendants' RESPONSE to Special Master's 380 Eleventh Report and Recommendation; # 1 Exhibit A;# 2 certificate of service.(bbb, ) (Entered: 02/22/2006)
385 United States' RESPONSE to the 380 Eleventh Report and Recommendation of the Special Master. (bbb, ) (Entered: 02/24/2006)

02/27/2006 03/10/2006 03/13/2006 03/23/2006 03/23/2006 03/23/2006 03/24/2006 03/24/2006
03/24/2006 03/28/2006 04/10/2006
04/10/2006 04/10/2006
04/21/2006 05/03/2006

387 NOTICE of Hearing: Status Conference on Hearing on the Eleventh Report 380 set for 3/23/2006 10:00 AM before JUDGE DAVID ALAN EZRA. (tl, ) (Entered: 02/27/2006)
388 State Defendant's REPLY 385 United States' RESPONSE to the Eleventh Report and Recommendation of the Special Master; certificate of service. (cc: KSC) (bbb, ) (Entered: 03/15/2006)
389 United States' SUPPLEMENTAL 385 Response to the Eleventh Report and Recommendation of the Special Master. (cc: KSC) (bbb, ) (Entered: 03/15/2006)
390 EP: Status Conference held on 3/23/2006. (Court Reporter Cynthia Fazio.) (Judge DAVID ALAN EZRA )(tl, ) (Entered: 03/23/2006)
391 EP: Status Conference held on 3/23/2006. (Court Reporter Cynthia Fazio.) (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 03/24/2006)
392 EP: Status Conference held on 3/23/2006. (In Chambers − no record, 11:00−11:50am, 4:30−5:30pm.) (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 03/24/2006)
393 ORDER ADOPTING and Approving 380 ELEVENTH REPORT AND RECOMMENDATIONS . Signed by Judge DAVID ALAN EZRA on 03/24/2006. (bbb, ) (Entered: 03/24/2006)
COURT'S CERTIFICATE of Service − a copy of 393 "ORDER ADOPTING and Approving 380 ELEVENTH REPORT AND RECOMMENDATIONS" has been served by First Class Mail to the addresses of record on 03/24/2006. Registered Participants of CM/ECF received the document electronically at the e−mail address listed on the Notice of Electronic Filing (NEF). (bbb, ) (Entered: 03/24/2006)
394 TRANSCRIPT of Proceedings (HEARING ON THE ELEVENTH REPORT) held on 3/23/06 before Judge DAVID ALAN EZRA and Judge KEVIN S. C. CHANG. Court Reporter: Cynthia Fazio. (cf@hid.uscourts.gov) CF (Entered: 03/24/2006)
396 JOINT STIPULATION AND ORDER regarding plan for community mental health services; # 1 Exhibit A;# 2 Exhibit B. Signed by Judge DAVID ALAN EZRA on 03/28/2006. (cc: DAE, KSC) (bbb, ) (Entered: 03/29/2006)
398 EP: Status Conference held on 4/10/2006. Counsel have agreed to the 12 benchmarks identified in Ann Andreas' memorandum. Court to issue Findings and Recommendation today. (FTR C5 − 10:31−10:37:06am.) (Judge KEVIN S.C. CHANG )(sna, ) Modified on 4/10/2006 (sna, ). (Entered: 04/10/2006)
399 FINDINGS AND RECOMMENDATION regarding benchmarks. Objections to RRdue by 4/30/2006. Signed by Judge KEVIN S.C. CHANG on April 10, 2006. (bbb, ) (Entered: 04/10/2006)
COURT'S CERTIFICATE of Service − a copy of 399 "FINDINGS AND RECOMMENDATION regarding benchmarks" has been served by First Class Mail to the addresses of record on 04/10/2006. Registered Participants of CM/ECF received the document electronically at the e−mail address listed on the Notice of Electronic Filing (NEF). (bbb, ) (Entered: 04/10/2006)
401 EO: Status Conference set 4/21/06 before Judge Chang was not held due to a family emergency of counsel. Status Conference to be reset. (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 04/24/2006)
403 SPECIAL MASTER'S REPORT REGARDING 399 BENCHMARKS; # 1 Exhibit A.; "Based on the foregoing, the Special Master recommends that no further action be taken by the Court with regard to the Order Adopting and Approving Eleventh

05/03/2006
05/12/2006 05/15/2006 05/26/2006 05/30/2006 05/30/2006
06/29/2006 08/28/2006 08/28/2006
09/07/2006 09/11/2006 09/12/2006

Report and Recommendation. IT IS SO FOUND AND RECOMMENDED."; Objections to RRdue by 5/17/2006. Signed by Judge KEVIN S.C. CHANG on May 3, 2006. (bbb, ) (Entered: 05/03/2006)
COURT'S CERTIFICATE of Service − a copy of 403 "SPECIAL MASTER'S REPORT REGARDING BENCHMARKS" has been served by First Class Mail to the addresses of record on 05/03/2006. Registered Participants of CM/ECF received the document electronically at the e−mail address listed on the Notice of Electronic Filing (NEF). (bbb, ) (Entered: 05/03/2006)
405 Defendants State of Hawaii, John Waihee, John Lewin, Henry Foley, Naleen N. Andrade's STATEMENT OF NO OPPOSITION in response to 403 SPECIAL MASTER'S REPORT REGARDING BENCHMARKS; and certificate of service. (cc: DAE, KSC) (bbb, ) (Entered: 05/15/2006)
407 United States' RESPONSE to 403 SPECIAL MASTER'S REPORT REGARDING BENCHMARKS. (cc: KSC) (bbb, ) (Entered: 05/16/2006)
409 EP: Status Conference held on 5/26/2006. (In Chambers − no record, 10:00−10:15am.) (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 05/26/2006)
410 ORDER adopting 399 , 403 Special Master's Report Rearding Benchmarks. Signed by Judge DAVID ALAN EZRA on May 30, 2006. (bbb, ) (Entered: 05/30/2006)
COURT'S CERTIFICATE of Service − a copy of 410 "ORDER adopting Special Master's Report Rearding Benchmarks" has been served by First Class Mail to the addresses of record on 05/30/2006. Registered Participants of CM/ECF received the document electronically at the e−mail address listed on the Notice of Electronic Filing (NEF). (bbb, ) (Entered: 05/30/2006)
412 EP: Status Conference held on 6/29/2006. (In Chambers − no record, 10:00−10:30am.) (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 06/30/2006)
413 Twelfth REPORT and Recommendation. Signed by Judge KEVIN S.C. CHANG on 8/28/2006. (Attachments: # 1 Exhibit A part 1# 2 Exhibit A part 2# 3 Exhibit B part 1# 4 Exhibit B part 2# 5 Exhibit C part 1# 6 Exhibit C part 2)(gab, ) (Entered: 08/29/2006)
COURT'S CERTIFICATE of Service − a copy of 413 Status Report Order has been served by First Class Mail to the addresses of record on 8/28/2006. Registered Participants of CM/ECF received the document electronically at the e−mail address listed on the Notice of Electronic Filing (NEF). (gab, ) (Entered: 08/29/2006)
414 EO: Hearing on Special Master's 12th Report set for 10/2/2006 02:15 PM before JUDGE DAVID ALAN EZRA. All parties to be notified. (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 09/07/2006)
415 State Defendants' RESPONSE to 413 Special Master's Twelfth Report and Recommendation; (Attachments: # 1 Exhibit A# 2 Exhibit B# 3 Exhibit C# 4 Certificate of Service)(gab, ) (Entered: 09/12/2006)
416 United States' RESPONSE to the 413 Twelfth Report and Recommendation of the Special Master (gab, ) (Entered: 09/14/2006)

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417 Correspondence re: Cover Letter from Verlin Hughes Deerinwater. (gab, ) (Entered: 09/14/2006)
418 EO: Hearing on Special Master's 12th Report set 10/2/06 has been continued to 10/27/2006 09:00 AM before JUDGE DAVID ALAN EZRA. (Judge KEVIN S.C. CHANG )(sna, ) (Entered: 09/21/2006)
419 EP: Status Conference held on 10/24/2006. (Court Reporter cynthia fazio.) (Judge DAVID ALAN EZRA )(tl, ) (Entered: 10/31/2006)
420 ORDER DISMISSING ACTION WITH PREJUDICE. Signed by Judge DAVID ALAN EZRA on 12/01/06. (afc) (Entered: 12/04/2006)
421 TRANSCRIPT of Proceedings (HEARING ON SPECIAL MASTER'S 12TH REPORT) held on 10/24/06 before Judge DAVID ALAN EZRA. Court Reporter: Cynthia Fazio. (20 pp.) (cf@hid.uscourts.gov) (Entered: 12/21/2006)