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1 SENATE/HOUSE OF REPRESENTATIVES
2 THE 21ST LEGISLATURE
3 INTERIM OF 2001
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7 JOINT SENATE-HOUSE INVESTIGATIVE COMMITTEE HEARING
8 OCTOBER 13, 2001
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12 Taken at the State Capitol, 415 South Beretania,
13 Conference Room 325, Honolulu, Hawaii, commencing at
14 9:06 a.m. on Saturday, October 13, 2001.
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19 BEFORE: JESSICA R. PERRY, CSR No. 404
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1 APPEARANCES:
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3 Senate-House Investigative Committee:
4 Co-Chair Senator Colleen Hanabusa
5 Co-Chair Representative Scott Saiki
6 Vice-Chair Senator Russell Kokubun
7 Vice-Chair Representative Blake Oshiro
8 Senator Jan Yagi Buen
9 Representative Ken Ito
10 Representative Bertha Kawakami
11 Representative Bertha Leong
12 Representative Barbara Marumoto
13 Senator Norman Sakamoto
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15 Also Present:
16 Special Counsel James Kawashima
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1 I N D E X
2 WITNESS: DR. PATRICIA DUKES
3 EXAMINATION BY: PAGE
4 SPECIAL COUNSEL KAWASHIMA............. 9, 106
5 VICE-CHAIR SENATOR KOKUBUN............ 55
6 VICE-CHAIR REPRESENTATIVE OSHIRO...... 61, 116
7 SENATOR SLOM.......................... 66
8 REPRESENTATIVE KAWAKAMI............... 72
9 SENATOR SAKAMOTO...................... 80, 115
10 REPRESENTATIVE MARUMOTO............... 86
11 CO-CHAIR SENATOR HANABUSA............. 91, 118
12 CO-CHAIR REPRESENTATIVE SAIKI......... 98
13 WITNESS: DR. DAVID DREWS
14 EXAMINATION BY:
15 SPECIAL COUNSEL KAWASHIMA............. 122, 224
16 VICE-CHAIR REPRESENTATIVE OSHIRO...... 165
17 VICE-CHAIR SENATOR KOKUBUN............ 172
18 REPRESENTATIVE ITO.................... 176
19 SENATOR SLOM.......................... 178
20 REPRESENTATIVE KAWAKAMI............... 182
21 SENATOR BUEN.......................... 189
22 REPRESENTATIVE LEONG.................. 195
23 SENATOR SAKAMOTO...................... 201
24 CO-CHAIR SENATOR HANABUSA............. 209
25 CO-CHAIR REPRESENTATIVE SAIKI......... 219
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1 WITNESS: DR. MARGARET KOVEN
2 EXAMINATION BY:
3 SPECIAL COUNSEL KAWASHIMA............. 230
4 SENATOR SLOM.......................... 245
5 VICE-CHAIR REPRESENTATIVE OSHIRO...... 250
6 SENATOR SAKAMOTO...................... 253
7 REPRESENTATIVE ITO.................... 258
8 REPRESENTATIVE KAWAKAMI............... 260
9 REPRESENTATIVE LEONG.................. 263
10 CO-CHAIR REPRESENTATIVE SAIKI......... 267
11 CO-CHAIR SENATOR HANABUSA............. 268
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1 P R O C E E D I N G S
2 CO-CHAIR REPRESENTATIVE SAIKI: Good morning.
3 We'd like to convene our committee hearing to investigate the
4 state's efforts to comply with the Felix consent decree.
5 We'll begin with the roll call.
6 CO-CHAIR SENATOR HANABUSA: Co-Chair Saiki?
7 CO-CHAIR REPRESENTATIVE SAIKI: Here.
8 CO-CHAIR SENATOR HANABUSA: Vice-Chair
9 Kokubun?
10 VICE-CHAIR SENATOR KOKUBUN: Here.
11 CO-CHAIR SENATOR HANABUSA: Vice-Chair Oshiro?
12 VICE-CHAIR REPRESENTATIVE OSHIRO: Here.
13 CO-CHAIR SENATOR HANABUSA: Senator Buen is
14 excused. Representative Ito is excused. Representative
15 Kawakami?
16 REPRESENTATIVE KAWAKAMI: Present.
17 CO-CHAIR SENATOR HANABUSA: Representative
18 Leong?
19 REPRESENTATIVE LEONG: Here.
20 CO-CHAIR SENATOR HANABUSA: Representative
21 Marumoto?
22 REPRESENTATIVE MARUMOTO: Present.
23 CO-CHAIR SENATOR HANABUSA: Senator Matsuura
24 is excused. Senator Sakamoto?
25 SENATOR SAKAMOTO: Here.
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1 CO-CHAIR SENATOR HANABUSA: Senator Slom?
2 SENATOR SLOM: Here.
3 CO-CHAIR SENATOR HANABUSA: Senator Hanabusa
4 is here. We have quorum.
5 CO-CHAIR REPRESENTATIVE SAIKI: Thank you very
6 much. Members, before we proceed with testimony this
7 morning, the co-chairs would like to make a brief
8 statement -- two-fold statement. First, as to the purpose of
9 this committee, and second, as to certain privacy issues
10 which have arisen very recently. The first with respect to
11 the purpose of this committee, we would like to reiterate the
12 reason why the legislature formed this investigative
13 committee in the first place, and what we want to make loud
14 and clear is the statement that we made at our first hearing
15 when we convened this committee in June 2001, and that was
16 that each and every member of the legislature supports
17 special education programs because we know that these
18 services will give our students the opportunity to reach
19 their fullest potential, and this investigative committee is
20 evidence of our support for special education services.
21 The legislature wants to ensure that special
22 education services that are being provided to students are
23 appropriate and effective. We want to ensure that there is
24 no wrongdoing in the provision of these services, and we want
25 to ensure that the cost of these services is not inflated so
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1 that there will be adequate resources for all students in the
2 state of Hawaii.
3 CO-CHAIR SENATOR HANABUSA: Members, as you
4 know, the state auditor recently issued a subpoena to compel
5 the production of certain student records from Loveland
6 Academy. Let me reiterate that this is the auditor's
7 subpoena, not this committee's subpoena. In part, the reason
8 the auditor is seeking these records is to determine whether
9 or not the records actually reflect the progress made of the
10 students.
11 We have received generalized complaints that the
12 production of these records is unlawful and will violate
13 these students' privacy. We want to ensure the students, the
14 parents, and the public that these contentions are not true
15 for two primary reasons. First, federal law authorizes the
16 state auditor to examine these records. The FERPA, which is
17 the acronym for, in essence, the right to privacy act, states
18 an expressed provision authorizing the education audit agency
19 of each jurisdiction to access student records.
20 Second, the state law protects the student records
21 from disclosure once they are in the hands of the legislative
22 auditor. The provision is HRS Section 23-925, and this
23 provision protects notes, internal memorandum, work records,
24 and other project evidence obtained by the auditor from
25 disclosure. This statutory provision, which is known as the
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1 auditor's working papers privilege, will be complied with,
2 and again, I reiterate, it is not this committee's subpoena
3 but the subpoena of the auditor and the auditor has specific
4 confidentiality protections.
5 With that, are we ready to proceed?
6 CO-CHAIR REPRESENTATIVE SAIKI: Thank you very
7 much. The first witness this morning is Patricia Jean Dukes.
8 Would you please be seated at the witness table, and we will
9 administer the oath at this time.
10 CO-CHAIR SENATOR HANABUSA: Ms. Dukes, do you
11 solemnly swear or affirm that the testimony you're about to
12 give will be the truth, the whole truth, and nothing but the
13 truth.
14 DR. DUKES: I do.
15 CO-CHAIR SENATOR HANABUSA: Ms. Dukes, I
16 believe you are represented by counsel here?
17 DR. DUKES: No, there's a parent here who is
18 an attorney and she wanted to come and she helped me start
19 the school, but I'm really not represented by counsel.
20 CO-CHAIR SENATOR HANABUSA: We want you to
21 know that you have the right to have a counsel present if you
22 so desire.
23 DR. DUKES: If I need to use her, is that
24 okay?
25 CO-CHAIR SENATOR HANABUSA: Yes, it is okay.
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1 Just inform us.
2 DR. DUKES: Okay.
3 CO-CHAIR SENATOR HANABUSA: Members, we'll
4 follow the usual format, and again, we have instituted the
5 five-minute rule in light of the number of witnesses we have
6 here today. We will begin, of course, with the committee's
7 legal counsel, Mr. Kawashima.
8 SPECIAL COUNSEL KAWASHIMA: Thank you, Madam
9 Chair.
10 EXAMINATION
11 BY SPECIAL COUNSEL KAWASHIMA:
12 Q. Please state your name and business address, ma'am.
13 A. I'm sorry, did you say state my name and my
14 business address?
15 Q. Yes.
16 A. My name is Dr. Patricia Dukes and our school,
17 Loveland Academy, is located at 1506 Piikoi Street, and
18 that's 96822.
19 Q. And are you the owner of Loveland Academy?
20 A. Yes, it's an LLC, and I'm the managing member and
21 sole owner.
22 Q. And when you say LLC, ma'am, is it a for-profit or
23 not-for-profit organization?
24 A. I believe LLCs are all for-profit.
25 Q. All right. Now, by the way, as you asked and as
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1 Chair Hanabusa pointed out, you have the right to counsel.
2 So if at any time you would like to have your counsel with
3 you, we have no objection to that. Just go ahead and ask us.
4 You have some records with you there, ma'am. What are those
5 records?
6 A. Well, I didn't know what you were going to ask me,
7 so I just brought some things and thought maybe I might need
8 them.
9 Q. All right. We had served you with a subpoena duces
10 tecum previously and you have provided records through the
11 auditor's office, so these probably are duplications of what
12 has already been provided?
13 A. Correct, and some other things that I didn't know
14 if you needed that I brought along just that might be
15 helpful.
16 Q. I see. Like, for example, what types of things
17 that have not been turned over but we might need?
18 A. I know that there -- I've been reading the paper.
19 I haven't watched any of the hearings because I was nervous
20 about it, so I decided not to do that, but I've been reading
21 the newspaper and there were some allegations against
22 Loveland Academy, and so I thought maybe I would bring some
23 things and maybe have a chance to talk about those, and I did
24 submit a list of questions, which I know was really long,
25 things that you might want to ask me and maybe I could clear
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1 up some things.
2 Q. Well, ma'am, if we get to those areas, we may very
3 well ask you those questions. We only received them last
4 evening and the committee hasn't had an opportunity to review
5 them. They have the right to decide which ones they will and
6 will not. They are not trying to prevent any information
7 from coming out, but we have a limited amount of time, so we
8 need to focus on certain areas.
9 A. I understand.
10 Q. And by the way, the documents that were produced
11 thus far, especially insofar as treatment of students are
12 concerned, they were provided to us with student numbers, not
13 names, right?
14 A. I hope so.
15 Q. They were, I assure you. So that we have no names
16 of anyone at your institution. We only have numbers, student
17 numbers, and that's how you keep track of them also, with
18 numbers, do you not?
19 A. It just depends on what we're doing. Our records
20 that are locked, our case note records, have the children's
21 names on them. When we're doing our outcome studies and
22 statistical data for treatment ethicacy, we usually use their
23 client record numbers so they are not immediately being able
24 to -- the casual bystander would not know who that person
25 was.
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1 Q. Thank you. What are your responsibilities, ma'am,
2 at the academy?
3 A. Well, when I first started the school -- I was
4 actually approached by CAMHD to start the day treatment
5 center, and they had asked me if I would do it, and I
6 originally said no, but the parents wanted me to do it, and
7 so they helped me get the school started, and so initially I
8 did everything. I did the budgeting. I did the accounting.
9 I did everything because we started with no one except for
10 just me, and so now at this point what I try to do is I try
11 to do oversight in terms of the therapy and academics. I'm
12 basically an educator and a clinician, a therapist, and I'm
13 not a business person. So I try to concentrate my efforts on
14 the treatment, the evaluations, the diagnostics and to make
15 sure that we're doing the treatment approaches that will help
16 the children get better.
17 Q. You do not, then, render any treatment yourself of
18 any of the students?
19 A. I do daily.
20 Q. Treatment?
21 A. Daily.
22 Q. All right. Now, by the way, who at CAMHD
23 approached you to start this institution, this academy?
24 A. Beth Yano, who at that time was in the special
25 projects office. She had done day treatment before and now
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1 she still does day treatment now, and she was tying to get
2 someone to start a day treatment facility for autistic
3 children, and she had approached me several times and I had
4 turned her down several times, but I finally decided to do it
5 with the parents' support.
6 Q. At that time -- well, strike that.
7 I understand that you started Loveland Academy in
8 1999?
9 A. Correct.
10 Q. What month was that?
11 A. It opened in July. We actually got our contract I
12 think the end of -- I think I signed the contracted on May
13 30th, so we just had like one month to really get it going
14 before it opened on July 1st.
15 Q. You knew before May 30th, though, 1999 that you
16 were going to get the contract, didn't you?
17 A. A little bit before, but not much.
18 Q. If you know, ma'am, what was it about your
19 background that allowed Ms. Yano to approach you and ask you
20 to start this academy?
21 A. Well, I've spent 35 years in university teaching
22 and primarily in special education and speech pathology and
23 audiology, and I had recently gotten a master's in
24 psychology, and so I had been in private practice doing
25 autism specific treatments and evaluations with a
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1 multi-disciplinary team which consisted of two psychiatrists,
2 a few psychologists, and speech-language pathologists. So we
3 had been seeing a lot of the children who were in need of day
4 treatment services and CAMHD was aware of this.
5 Q. Now, I need to go back a bit to get some background
6 information from you, ma'am. Will you summarize for us your
7 educational background starting with institutions of higher
8 learning.
9 A. Yes.
10 Q. Take your time, please.
11 A. Thanks. I started out at Bowling Green State
12 University in Ohio with a triple major in speech pathology,
13 audiology, psychology, and education. I proceeded from there
14 to go to Kent State University where I first received a
15 master's in audiology, which is the hearing aspect of the
16 speech pathology program, and then my doctorate followed in
17 speech pathology. I proceeded after that to Indiana
18 University where I became certified to teach developmental
19 and -- developmental reading and disability-related reading
20 issues. I did post-doctoral work in learning disabilities at
21 Eastern Michigan University and became certified to teach
22 learning disabilities.
23 As far as my teaching career, I started as a
24 teaching assistant at Kent State University. I taught in a
25 program at Southern Illinois University. I taught at
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1 Washington University in St. Louis. I taught at Font Vaunt
2 College in St. Louis. I taught at Texas Tech University in
3 Lubbock, Texas. I taught at the University of Michigan Ann
4 Arbor, which was a very strong program in speech pathology
5 where I worked also at the University of Michigan Hospital
6 and did a lot of work with children with autism. I worked in
7 the public school -- I've worked in the public schools. I've
8 been a resource teacher in the public schools. I've worked
9 in clinics. I've worked in hospitals.
10 I came here to the University of Hawaii and taught
11 in the John Burns School of Medicine in the department of
12 speech pathology and audiology where I did work, again, with
13 autistic children and children with severe language
14 disabilities. I've served as the state consultant in the
15 state of Missouri to the department of mental health with all
16 of their children that had developmental disabilities and
17 have basically spent 35 years doing private practice. I've
18 never not done private practice. So when you were asking me
19 if I was still doing therapy, yes, I do, and I will do that
20 forever because that's how I learn.
21 Q. When did you receive your bachelor's from Bowling
22 Green?
23 A. In 1966.
24 Q. And then when did you receive your master's from
25 Kent State?
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1 A. In 1968.
2 Q. And where did you receive your Ph.D. from?
3 A. That was Kent State also, and I believe -- I don't
4 really remember when it was, maybe 1972.
5 Q. And you have no other advanced degrees? You've
6 testified about other areas you've taken courses in and
7 certifications you've received, but no other advanced degrees
8 in any other areas?
9 A. I have a degree in psychology -- master's in
10 psychology, which I received here through a distance learning
11 program which originally was through Honolulu University and
12 then that changed hands and was sold and so I switched to
13 Central Pacific University because that's where the professor
14 that I was working with changed to.
15 Q. David Drews?
16 A. Yes.
17 Q. And you received a master's from Central Pacific
18 University?
19 A. Yes, in psychology.
20 Q. When did you receive that, ma'am?
21 A. I'm sorry, what did you say?
22 Q. When did you receive that master's from Central
23 Pacific?
24 A. I think it was -- I want to say in the Fall of '99,
25 but it could have been 2000. I think it was the fall of '99
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1 because I think I finished the course work before I started
2 Loveland Academy, but I just didn't do the graduation
3 ceremony until afterwards because I was busy getting the
4 school started.
5 Q. What was the master's from Kent State in?
6 A. It was in speech pathology and audiology.
7 Q. What was the master's from CPU in?
8 A. Psychology.
9 Q. And when did you enter the program to obtain this
10 master's from Honolulu University?
11 A. When did I start? I think sometime in '98, but I
12 don't really remember, '97 or '98.
13 Q. Did you actually have courses, ma'am, from Honolulu
14 University --
15 A. Did I have courses?
16 Q. -- either Honolulu University or Central Pacific?
17 A. Yes, they were on the computer. They were distance
18 learning.
19 Q. Internet learning?
20 A. Uh-huh.
21 Q. No personal face-to-face type of teaching?
22 A. No. I had mentors who were on site, and they were
23 actually Dr. Koven, who is now my clinical director,
24 Dr. William Bolman, who is a psychologist -- psychiatrist who
25 worked on our team and Dr. John McCarthy, who is another
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1 psychiatrist who worked on our team.
2 Q. When you obtained this master's from -- starting at
3 Honolulu University ending at Central Pacific, you already
4 had a master's from Kent State. Why did you get this second
5 master's?
6 A. Because at that time I was working at -- I was
7 working through Hoahana Institute providing mental health
8 services to autistic children, and the department, CAMHD,
9 said that providers needed to have their graduate degrees in
10 psychology and at that time they weren't accepting degrees in
11 speech pathology or some other related area as being
12 specialists in autism, and so I wanted to go back. Even
13 though I did get a waiver, they did give me a waiver, I still
14 wanted to because I believe in higher education and I wanted
15 to have the kind of credentials that they wanted me to have.
16 So I did go back and do that.
17 Q. Would you have been able to start this academy,
18 Loveland, without the master's in psychology?
19 A. Yes, because actually to be the owner you don't
20 really have to have a degree in --
21 Q. But to render treatment, though, you would need
22 that degree, would you not?
23 A. Not to render speech pathology treatment.
24 Q. But to render psychological treatment?
25 A. Yes, but I don't do that.
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1 Q. Why did you get the degree, then?
2 A. In psychology? Well, actually, interesting that
3 you would ask. When I first started out my career I started
4 out to get my Ph.D. in psychology, and I went to Bowling
5 Green State University and got my undergraduate degree in
6 psychology. And we did mostly rat experiments and I decided
7 that that's not what I wanted to do, so I switched to speech
8 pathology. So I've always in the back of my mind wanted to
9 do it. In fact, I think I might still go on and get my Ph.D.
10 in psychology.
11 Q. From Central Pacific?
12 A. No.
13 Q. Neither Honolulu University nor Central Pacific are
14 accredited universities, are they?
15 A. I didn't know that, actually, before I got the
16 degree. Actually, they are not.
17 Q. Mr. Drews didn't tell you that?
18 A. I guess I never asked.
19 Q. You would rather have your degree from an
20 accredited university, wouldn't you?
21 A. Yes.
22 Q. Now, so -- excuse me, I'm not sure I heard you, in
23 terms of why you needed the master's degree with regard to
24 the state of Hawaii Department of Health?
25 A. Because that's in their credentialing. They've
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1 actually changed their credentialing several times. The
2 first time they didn't say that it needed to be from an
3 accredited university, and then now I think it does have to
4 be from an accredited university.
5 Q. But you needed that degree, whether it be from an
6 accredited or not accredited university to do what?
7 A. To do mental health therapy, right.
8 Q. Which is what you're doing at Loveland, right?
9 A. No.
10 Q. You don't do any mental health therapy?
11 A. I do speech pathology.
12 Q. I see. Who does the mental health therapy there at
13 Loveland?
14 A. Let me back up a second here. When we say mental
15 health therapy, I do not -- I'm not a licensed psychologist
16 and I do not do psychotherapy, but we do -- other people do
17 mental health therapy, and I guess in that sense I do mental
18 health therapy because I do individual therapy with children
19 and I do family therapy with children, and so I do do mental
20 health therapy, but I'm not a psychologist and I don't do
21 psychotherapy.
22 Q. You wouldn't be able to render those services and
23 charge for it had you not had this master's degree in
24 psychology from Central Pacific, right?
25 A. I had a -- there was a waiver from the state which
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1 allowed me to do it, but I had to work under supervision and
2 I still do have to work under supervision.
3 Q. Under whose supervision did you work while you had
4 that waiver?
5 A. Under Dr. Koven's.
6 Q. The waiver, though, that wouldn't have been for an
7 unlimited time, would it?
8 A. I don't know that. It didn't say -- they didn't
9 say.
10 Q. But the reason you got the degree from Central
11 Pacific in psychology was so that you would not have to worry
12 about having a waiver to provide mental health services?
13 A. No, that's actually not the reason. The reason is
14 because I really believe in knowledge and being able to know
15 more about what I want to be able to do, and if they were
16 saying that they thought that that was important, then I felt
17 that that was important for me to do.
18 Q. Now, I understand, ma'am, that Loveland's main
19 source of revenue is from the state of Hawaii?
20 A. Yes.
21 Q. Is it the sole source of revenue?
22 A. No.
23 Q. Do you have actual private persons paying tuition
24 or whatever you might call it to your institution?
25 A. Yes, we have actually part of Loveland Academy that
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1 is actually a school for typically developing children and
2 some of the children in that school do have forms of autism,
3 they also have forms of other problems that allow them --
4 it's difficult for them to be in large classes like the DOE
5 might have, but they can be in regular education if they are
6 in smaller classes.
7 Q. Who pays that tuition?
8 A. The parents. It's a private school.
9 Q. What is your tuition range, if you have a range, or
10 the amount?
11 A. I think it's around -- it's a Montessori school,
12 and so it's the same as the other Montessori schools in the
13 area. It's a little bit less. I think it's something like
14 $500 a month.
15 Q. So in a nine-month year, $4,500 tuition a year?
16 A. It's around -- I'm sorry, what?
17 Q. I'm sorry, I thought you said --
18 A. I think it's around $500 a month, something like
19 that, depending on how old the child is, what grade they're
20 in, but it's very similar to the other Montessori tuitions.
21 Q. I'm just saying on a nine-month school year that
22 would be $4,500 a year that parent pays?
23 A. That sounds right, if it's around 500. They
24 actually go year-round, so, yeah.
25 Q. How many students do you have there right now?
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1 A. There are probably maybe about 25 to 30.
2 Q. And that -- of course that changes from time to
3 time?
4 A. Uh-huh. They can start at two years nine months
5 and presently we're going through third grade.
6 Q. Do you have children between the years of two years
7 nine months and four?
8 A. Do we have children --
9 Q. Students who are students there.
10 A. Yes, we have a preschool program, a kindergarten,
11 and grades one through three.
12 Q. The tuition -- strike that.
13 From the records we've obtained, ma'am, for the
14 fiscal year 2001, Loveland Academy billed the state of Hawaii
15 2,308,000 -- $2,308,010 for the fiscal year 2001, does that
16 sound right to you?
17 A. I really don't know.
18 Q. Who does the financial aspects of your
19 organization?
20 A. We have an accountant.
21 Q. You oversee that accountant as the owner?
22 A. I try to.
23 Q. You say you are -- you're not a nonprofit
24 organization. Do you make a profit every year?
25 A. We have made a profit up until this year.
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1 Q. Now, getting back to where I was, does that sound
2 right to you, $2,308,010?
3 A. Truthfully, I don't know.
4 Q. I'll tell you what, ma'am, since you are the owner
5 and have access to your records, will you tonight, tomorrow
6 check to make sure we're right and you tell us if we're not
7 so that we can change the numbers, but for what we've seen,
8 that's the correct number, okay, $2,308,010 for fiscal 2001.
9 Now, our understanding also, ma'am, is that this was paid
10 through the Department of Health, not the Department of
11 Education. Does that sound right to you?
12 A. Some of our children actually are paid for by the
13 DOE on contract, so I don't know if that was --
14 Q. Sure. Isn't that of recent onset, though, where
15 DOE pays?
16 A. No, it's been a while for certain children.
17 Q. Again, will you check for us, because it appears
18 that all of the $2,308,010 was through the Department of
19 Health. If we're incorrect, please tell me, all right?
20 A. Okay.
21 Q. Now, how much more, then, in total revenues for the
22 year 2001 did Loveland Academy have from other sources other
23 than the state of Hawaii, in other words, from private
24 individuals paying private tuition, from any other source
25 over $2,308,000?
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1 A. The Lokahi Montessori School tuitions, there were
2 some people who paid privately for evaluations, but --
3 Q. Those are not large numbers, though, are they?
4 A. No.
5 Q. So would it be fair to say whatever the number is,
6 if we're correct, $2,308,010, that comprises at least 99
7 percent of your revenues?
8 A. Right.
9 Q. Now, do you receive any revenues or funding from
10 the federal government?
11 A. No.
12 Q. Now, if I may ask you, ma'am, the amount, again
13 assuming I'm right and if we're not right then these
14 questions wouldn't apply, but if we are right that the
15 academy billed the state of Hawaii for fiscal 2001
16 $2,308,010, and of that amount what we've calculated was that
17 $1,101,342 was for day treatment services provided for
18 approximately 20 students, does that sound right to you?
19 A. We've run from anywhere between 20 to I think 24,
20 which is our max.
21 Q. If I'm correct, ma'am, in terms of what we've
22 gleaned from the documents produced, over $1,100,000 for
23 approximately 20 students, that comes out to a day treatment
24 per student rate of $222 a day. Does that sound right to
25 you?
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1 A. That is the rate is $222, I do know that.
2 Q. That's the rate you contracted with the state of
3 Hawaii for them to pay you for each day a student is there?
4 A. Yes.
5 Q. And it's each day a student is there that the state
6 of Hawaii is responsible for paying for, right?
7 A. Yes.
8 Q. And how do you get your students, ma'am, the ones
9 that are paid for by the state of Hawaii?
10 A. They are referred to us through the care
11 coordinators of the individual guidance centers. After an
12 IEP team has convened and the child has been placed, the care
13 coordinator calls or faxes information and says that there is
14 a referral. We see the child and do an evaluation to see
15 whether or not we think that child is eligible for our
16 services. Some of them are found to be not eligible, some of
17 them are found to be eligible, and at that point we usually
18 take them on a trial basis and determine whether or not we
19 think that that child can make a significant enough outcome
20 so that this program which is tremendously expensive, as
21 you're pointing out, will be significant enough so that we
22 can make progress with that child. We do turn some children
23 away.
24 Q. In a general way, ma'am, is it one of the goals of
25 Loveland Academy to have the students that are there be
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1 mainstreamed into regular education, if possible?
2 A. Definitely.
3 Q. Have you done that with any of your students yet?
4 A. Yes.
5 Q. How many?
6 A. We have -- we have seven -- six, we have six
7 children who have been mainstreamed into our own regular
8 education setting who are ready to go to DOE if a proper
9 regular education setting can be found for them, and I know
10 that you're trying to look at waste of money in the system
11 and this is one area that I'd actually like to talk to you
12 about. Right now we have a tremendous, tremendous waste in
13 this area. People are still having to pay day -- based on
14 the state, still having to pay day treatment costs for
15 children who are ready and able to go into regular education
16 if the DOE will create small regular education classrooms in
17 which these children can function.
18 We've also had some children go back to DOE who are
19 in regular education. I think there are probably four of
20 those children, and they are -- three of them are working
21 well above grade level, and by the way, the children who are
22 in regular education in our setting are working at or above
23 grade level. Those are children that we were able to get
24 early in life and give intensive treatments to and they will
25 be kids who never again will have to have services, either
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1 special education services or mental health services if we
2 continue to do the right things with them, and so the cost,
3 even though it sounds very expensive initially, if we get the
4 children early enough and we do the correct treatments with
5 them, we do -- we are able to get them into regular ed with
6 no -- these children do not have TAs, they have no special ed
7 services, and they need no supports. Not to say that at some
8 point in their life they might have a stress point and we
9 would need to do some mental health services with them, but
10 this is a real area of waste and if you could make note of
11 that, that's a real way you could save some money.
12 Q. Thank you. By the way, you talked about tremendous
13 costs. With the amount that is charged per student to the
14 state of Hawaii for each of those 20 students, assuming we're
15 correct, comes out to about between 50,000 and $53,000 a year
16 that the state pays for each child. Does that sound right to
17 you?
18 A. Yes, that's a real --- keeping it with the average
19 that's pretty much published on the mainland, and if you
20 think about it, in the life of that child growing into
21 adulthood, to think that you might have to spend who knows
22 what, actually millions and millions of dollars, trying to
23 keep that child as an adult in foster care, in group homes,
24 in adult care. In fact, that's what I used to do on the
25 mainland is I would work with adults who didn't have
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1 treatment as children, and our older children who have come
2 to us late in life, we've not been able to make the kind of
3 significant gains that we have with the younger kids.
4 Q. When you say late in life, what do you mean?
5 A. I would say nine is really, really late. We need
6 to get them at age two, we need to get them at age 18 months
7 if we can get them.
8 Q. By the way, ma'am, in addition to the daily charge,
9 there are other services for which Loveland Academy charges
10 the state, for example, therapeutic aides, biopsychosocial
11 rehabilitation, things of that nature?
12 A. It depends on the child's treatment plan.
13 Q. I understand that.
14 A. So the IEP team, they basically tell us what it is
15 that they want. Some --
16 Q. You provide that service, though?
17 A. We do provide services when the IEP team requests
18 it.
19 Q. Now, you mentioned, though, a number of students --
20 you said six were ready to go into regular education if there
21 was a regular education facility prepared to accept them. Is
22 it your -- are you saying that there isn't such a facility
23 right now for those six?
24 A. Correct.
25 Q. And you say four of them went already into the
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1 education program and three of them are testing out above
2 grade level, yes?
3 A. Correct.
4 Q. Now, you go up to the third grade now, don't you?
5 A. For our regular Montessori school, yes.
6 Q. How about for Loveland Academy for the autistic
7 children, what grade do you go up to right now?
8 A. Well, initially we had written in our contract that
9 we wanted to take children only to age eleven, but --
10 Q. Fifth grade?
11 A. Yeah, I guess if you're thinking about grades. But
12 what's happened is that the state has asked us to consider
13 exceptions, and so we have considered exceptions, especially
14 in the case of children who are a little bit more aggressive,
15 and so we've been able to take children -- I think the oldest
16 child that we had was 14, and he successfully transitioned
17 into a high school placement this fall and he's doing well.
18 Q. These four students that went into the regular
19 education program, at what grades did they go into the
20 regular education program?
21 A. Early grades, these are our children that we
22 started with very early in our private practice and continued
23 to see them in school. One went -- actually, they all
24 started in kindergarten.
25 Q. And they left when, what grades?
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1 A. They were able to transition into kindergarten,
2 into the DOE regular education kindergarten classrooms.
3 Q. Within a year, then, in other words?
4 A. Yes.
5 Q. All of these four?
6 A. Yes.
7 Q. And your contract with the DOH provides for what I
8 guess I would call an all-inclusive contract. You provide
9 all the treatment that's needed per day and you charge the
10 rate of $222, don't you?
11 A. Yes.
12 Q. And the -- then also for the cost per hour that you
13 charge the state for the additional therapeutic aides is $29
14 per hour, according to your records?
15 A. That's for the children that the IEP teams have
16 requested therapeutic aides. Some of them that have
17 therapeutic aides are not -- they don't have therapeutic
18 aides through our agency. Some of them have therapeutic
19 aides that are from other agencies.
20 Q. But the ones that come to you as a result of the
21 IEP, you pay these therapeutic aides, do you not?
22 A. It depends on -- some of them come with a TA that
23 they've had in the DOE, and we let them keep that TA because
24 they've established a relationship with them, and so that TA
25 might be coming from another agency.
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1 Q. How many TAs do you have there on your staff?
2 Strike that.
3 Let me ask you, are your TAs employed by you
4 directly or are they independent contractors?
5 A. They are all employees.
6 Q. And they are paid at an hourly rate, are they not?
7 A. Some of them are salaried.
8 Q. And the hourly rate people, how much are they paid
9 per hour, what is the range?
10 A. Anywhere from around -- actually goes from about 10
11 to about 17. Most of them, I would say, are around 15. 15
12 an hour is typical. They all have bachelor's degrees in
13 psychology or human services.
14 Q. And are these typical TAs who are paid $15 an hour,
15 are they charged off at $29 an hour?
16 A. Yes.
17 Q. And what -- how do you account for the difference,
18 almost double the amount?
19 A. The difference? Training has been an absolutely
20 huge expense for us, training and supervision. When we first
21 started, there was the Felix Training Institute, and I think
22 it was around July of 2000 that stopped and the training that
23 we used to be able to get through the institute was no longer
24 available, and so we do -- we spend like lots and lots and
25 lots of money and effort for that. We also --
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1 Q. You're training your own therapeutic aides, ma'am?
2 A. Yes.
3 Q. These are your employees or people who work for you
4 at an hourly rate. Isn't that a cost you should bear?
5 A. Well, theoretically, but in Hawaii we don't have
6 any aides that are trained to do autism specific --
7 Q. That may be so, ma'am, but you have a for-profit
8 business, isn't it your cost to bear to train the people who
9 work for you who you charge out at a larger or higher rate
10 that you --
11 A. Yes.
12 Q. -- that you get from the state?
13 A. And that's what that difference -- that's one of
14 the things that contributes to that difference. Another
15 thing that contributes to it is their benefit package.
16 Almost all of them are on salary, and about a third of that
17 is benefits, which is about, what, $5 from 15, so that's $20
18 an hour right there. We also have to pay supervisors who
19 supervise the TAs. They are in meetings constantly. We had
20 not expected when we first started that there would be as
21 many meetings that our people had to go to. I thought it was
22 like one IEP meeting maybe a year and maybe a transition IEP
23 meeting. Some of our children have like 18 IEP meetings.
24 They go on for hours. So that is a huge cost which would --
25 Q. But those IEP meetings, whatever they might be, you
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1 charge out for that at $29 per hour?
2 A. No. Actually, no. We charge for one staff person
3 to be there, and it's usually Dr. Koven or myself, but at
4 that meeting is my occupational therapist, my speech
5 pathologist, the special education teacher, the one-on-one
6 TA, and sometimes other people as well, depending on -- the
7 adaptive P.E. teacher, and so that's another cost that if
8 you're taking notes on how to eliminate costs, that's one way
9 that we could definitely be cutting costs.
10 Q. When you say my therapists, in a meeting such as
11 you just described, how many of those people are employed by
12 you?
13 A. Well, that group is employed by me.
14 Q. That whole group?
15 A. Yes.
16 Q. And --
17 A. But also there's -- I'm sorry.
18 Q. No, I need to ask you this, ma'am, before I get
19 side tracked. If that whole group is employed by you, do you
20 charge the state of Hawaii anything more than that daily rate
21 for the services of these individuals?
22 A. No.
23 Q. On an hourly basis, perhaps?
24 A. No.
25 Q. And in terms of training, though, are you saying
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1 that some of the people you hired were untrained?
2 A. The TAs, because we have a shortage of therapeutic
3 aides in Hawaii who are autism specific trained, they do not
4 have training.
5 Q. How long does it take you to train a typical TA?
6 A. It's ongoing.
7 Q. Well, is there some point when they've reached
8 sufficient training that they could go to another
9 organization like yours and provide services?
10 A. Yes, if systems didn't keep changing and here's
11 another area of waste, I think. It seems like when we have
12 people trained there is a system change and we need to react
13 to that. There's -- IEP forms change, we've had transfer
14 from DOH to DOE with all different kinds of procedures and
15 things that change, so it just seems like when we do feel
16 like training has at least gotten to the point where we don't
17 feel we have to spend as much money on it, there's another
18 aspect of training --
19 Q. You mentioned a while back that Loveland has turned
20 a profit in the past. Which year was it that it had its
21 highest profit?
22 A. Probably the first year, I would guess.
23 Q. And how much was that profit, approximately?
24 A. I don't know.
25 Q. That was 1999 to 2000, right? That would have been
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1 for starting in 1999, ending last year?
2 A. Uh-huh.
3 Q. A year ago, and you say that year you turned a
4 profit?
5 A. We've always -- we've not been in the red. I know
6 that.
7 Q. I understand that, but you as the owner are
8 concerned about whether or not the business is in the red or
9 in the black, aren't you?
10 A. Yes, and that's about where I draw the line
11 basically. As I said, I'm not a business person. I do want
12 to know that we're not in the red and we have not been in the
13 red.
14 Q. And you cannot tell me how much -- give me a rough
15 estimate of how much profit --
16 A. I think you have --
17 Q. Wait. Wait a minute, ma'am, please.
18 A. I'm sorry.
19 Q. You cannot tell me or give me a rough estimate of
20 how much Loveland Academy made? You would have obtained this
21 information less than a year ago.
22 A. We have an audited financial statement that I think
23 we submitted, which it probably has in there.
24 Q. But you don't recall what it is? I'm just trying
25 to ask you that.
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1 A. Seriously, no. I am a clinician and I actually
2 don't pay attention to that. As long as we're surviving,
3 that's basically what I pay attention to, and I'm actually
4 worried right now that we won't be surviving because what's
5 happened after, actually, July of 2000 when the Felix
6 Resolution and Complaints Office folded and some other things
7 started going from DOH to DOE, we've not had referrals, we've
8 had the DOE write letters to parents saying that they were no
9 longer going to be students at Loveland Academy and that they
10 were going to be -- to go back into the system, unbeknownst
11 to us, unbeknownst to the parents, and so those children, the
12 parents did not want to send back to school and so they've
13 just stayed and so we have probably a third of our school who
14 are there and they don't pay anything at all, and so as this
15 process continues, I just want to make sure that at some
16 point I don't have more children who are there not paying
17 than I do have children there who are paying, and that's
18 basically what I'm concerned about because I think we're
19 heading in that direction.
20 Q. Ma'am, is it a form of financial aid, then, you
21 provide?
22 A. I'm sorry, what?
23 Q. Is it a form of financial aid that you provide?
24 When you say some students don't pay tuition nor are they
25 paid for by the state, is it because you have a form of
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1 financial aid there?
2 A. No.
3 Q. How is it that they don't pay you, then?
4 A. They are not able to pay.
5 Q. So it is a form of financial aid, is it not?
6 A. I don't know. If that's what the definition is,
7 yeah.
8 Q. You don't have a policy for providing financial aid
9 at Loveland?
10 A. No.
11 Q. Do you intend to?
12 A. I don't know.
13 Q. In other words, financial aid based on need, you
14 don't have such a policy?
15 A. No, not currently.
16 Q. Now, I got side tracked, but talking about
17 therapeutic aides, it appears that these aides typically work
18 about five hours a day every day; does that sound right to
19 you?
20 A. No. Most of our TAs are full-time.
21 Q. Full-time meaning eight-hour days?
22 A. Yes.
23 Q. And the state is billed $367.20 per day for each
24 therapeutic aide that you have there, is it not?
25 A. The children who have one-on-one TA services, those
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1 services are billed out at the $29 an hour rate, but
2 sometimes the children don't need TA services one on one all
3 day long, and so the IEP team will decide during the IEP
4 meeting how many hours a day that particular child needs a TA
5 and then we try to reduce that as we go along.
6 Actually, I'm usually the one in the IEP meeting
7 who is advocating that we have less TA hours because I'm very
8 big on trying to get our children independent as soon as
9 possible, and I think sometimes when children have a
10 one-on-one they tend to become more dependent and they do
11 what's called this learned helplessness where they -- if they
12 know that they have a TA available to them, they sometimes
13 rely too much on that TA, and so we try to fade that as soon
14 as possible.
15 Q. Talking about therapeutic aides, though, ma'am, it
16 appears that if a child attends your academy all day long and
17 has a TA for five hours, that instead of the $222
18 all-inclusive rate, you bill the state $367.20 cents as an
19 all-inclusive rate, do you not?
20 A. That child is -- yes, TA services are billed
21 separately, and the reason is for that -- I'm not exactly
22 sure where you're going with the question.
23 Q. Let me ask you so we don't get side tracked, ma'am.
24 It appears that the $367.20 per day rate that you charge for
25 a child that has a TA is for a five-hour day. Does that
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1 sound right to you?
2 A. No, it depends on what the child needs.
3 Q. No, ma'am, what you charge for. I understand what
4 the child may need might be different or not, but what you
5 charge the state of Hawaii for. If a child attends your
6 academy all day and has a TA for five hours, then you charge
7 367.20 as an all-inclusive rate as opposed to the $222 per
8 day that you were charging as an all-inclusive rate without
9 the TA; does that sound right to you?
10 A. Is the five hours, is that a hypothetical example?
11 Q. No. It's what appears from the records we've
12 gleaned.
13 A. I don't know what the five hours --
14 Q. That doesn't sound right to you. But you do
15 charge --
16 A. No, because some children have TA all day for day
17 treatment plus they have a TA even into their extended day
18 program.
19 Q. I see, and that you charge separate for, then?
20 A. Right.
21 Q. In addition to the daily rate, whatever it might
22 be?
23 A. Right.
24 Q. Now, your records primarily are kept in the format
25 that DOH requires, am I correct?
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1 A. Yes.
2 Q. Have you been audited by DOH --
3 A. Yes.
4 Q. -- as far as your billing records are concerned?
5 A. Yes.
6 Q. And have the problems been straightened out?
7 A. What problems?
8 Q. The problems that came out of that audit. Maybe I
9 ought to ask you this. Am I to understand that the audit
10 that was conducted by DOH resulted in a total clean bill of
11 health being given to you from a billing standpoint?
12 A. The last audit that we had was by Jerry Leong and
13 that was in April or May.
14 Q. Of this year?
15 A. Of this past year, uh-huh.
16 Q. This year or last year, I'm sorry?
17 A. 2001.
18 Q. This year?
19 A. Uh-huh.
20 Q. April or May, and was that an audit of your
21 financial operation?
22 A. That was an audit where they went -- the lady
23 went -- she had brought several people and they spent the
24 day -- actually, they spent a week and they looked at every
25 bill that we had submitted and they checked that against
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1 every document and the attendance records and they -- I think
2 there were like 5,700 something records that they looked at
3 and they found one error, which was fixed.
4 Q. There were -- there were questions raised about
5 whether or not your billings were too high, though, weren't
6 there?
7 A. No.
8 Q. You don't recall anyone complaining from the DOH
9 that your billings were too high?
10 A. No.
11 Q. Whenever you've had -- well, in this audit --
12 strike that.
13 If you have billing issues that you need to deal
14 with the DOH with, with whom do you deal?
15 A. We haven't had problems.
16 Q. Have you had instances where you've had to call
17 someone at the DOH and discuss with them Loveland bills?
18 A. Yes, because we haven't been getting the service
19 authorizations that we were supposed to be getting.
20 Q. And whom would you call for those types of issues?
21 A. His name is Matt and my biller actually does that.
22 Q. You call David Drews too from time to time, do you
23 not?
24 A. Do I call David Drews from time to time?
25 Q. Yes.
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1 A. I called him recently because I was frustrated
2 because we weren't getting any of the service authorizations
3 that we should have been getting and if you don't get it
4 within 90 days, you can't bill the service and then you have
5 to appeal it, and there were I think about $239,000 of bills
6 that we hadn't been able to even bill because we hadn't had
7 the service authorizations at all or on time and so I
8 actually did call him.
9 Q. Did he attend to that quickly?
10 A. He -- I got a couple of them, but I didn't get all
11 of them.
12 Q. And why is it you called David Drews?
13 A. Because he was the branch chief for those children.
14 Q. And you understood that he was the person in the
15 highest position of authority there at DOH relating to your
16 children who could approve such payments, right?
17 A. For --
18 Q. Or to get the service authorizations completed,
19 right?
20 A. Yes, most of the time the people in our billing
21 office, the procedure is, first of all, to try to get the
22 authorization through the care coordinator, and if they can't
23 do that they continually call and they continually fax and
24 then they send copies to the branch chiefs and then they
25 actually do call the branch chiefs as well to try --
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1 Q. People from your organization call the branch
2 chief, and the branch chief is David Drews, right?
3 A. No, it depends on the family guidance center.
4 Q. In any case, though, when you had a concern with
5 service authorizations called David Drews directly, did you
6 not?
7 A. Yes.
8 Q. And you know David Drews personally, do you not?
9 A. Yes, because he was --
10 Q. He was one of your teachers?
11 A. Uh-huh.
12 Q. In fact, when you got your master's through
13 Honolulu and Central Pacific University, he was one of your
14 instructors?
15 A. Yes.
16 Q. And did he work for your organization at any time?
17 A. No.
18 Q. He did have an agreement, though, with you, David
19 Drews did, concerning the use of classrooms at Loveland, did
20 he not?
21 A. Yes, he uses two of the classrooms for his --
22 mostly for graduation ceremonies. I think when he first
23 started his university he needed to have -- do some brochures
24 and he was supposed to have a place where students could go
25 if they needed to do that in Hawaii, but they've never needed
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1 to do that. His students I think are from like Europe and
2 Asia primarily and --
3 Q. His students from Europe and Asia, they ever come
4 to Hawaii, do they?
5 A. Three of them came for graduation ceremonies, and
6 that was all he's ever used the building for.
7 Q. I understand, but his students predominantly never
8 come to Hawaii and they get all of their education through
9 the Internet and their degree through the Internet, right?
10 A. I really don't know anything about his business.
11 Q. But you know about his brochures, though, you've
12 seen them, haven't you?
13 A. No.
14 Q. You haven't seen any of his brochures?
15 A. No.
16 Q. You haven't seen how he uses your institution in
17 his brochure?
18 A. I was told that when they did an investigation --
19 Doug Miller at CAMHD did an investigation of this and he did
20 call me and I went in and talked to him about it and he told
21 me at that time that that was the case, but --
22 Q. Did you consider what Mr. Drews was doing in terms
23 of using your institution and its buildings a proper use of
24 the institution?
25 A. I really don't know what he was doing with --
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1 Q. But you were told by Mr. Miller what he was doing?
2 A. I was told that there was something on the Website
3 that said that there was an affiliation with Loveland Academy
4 and the letter that I got back from Doug Miller basically
5 said that he found that there was no problem but that he did
6 recommend that Dr. Drews take that off of --
7 Q. Take what off?
8 A. The reference that there was an affiliation with
9 Loveland Academy.
10 Q. You do understand, though, when you learned about
11 it that it appeared that what he was doing was misuse of --
12 misappropriation of your institution in terms of the
13 buildings and how they were being used, right?
14 A. Doug Miller told me that he didn't interpret it
15 that way.
16 Q. But apparently it was enough of a problem that all
17 of those photographs were taken off the Website, right?
18 A. I know that Mr. Miller asked him to do that, but I
19 don't know -- I've never seen the Website. I don't --
20 Q. We'll talk to Mr. Drews about that more, but the
21 agreement you had, anyway, is that you provide Mr. Drews with
22 the use of two classrooms at Loveland, in exchange what does
23 he give you or do for you?
24 A. Nothing. He just fixed the classrooms. They were
25 in terrible shape. The building had been empty for ten years
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1 and there were some vacant classrooms on the third floor of
2 one building, and so he just painted them and put carpeting
3 in in exchange for that. We use them all the time. We use
4 them for our IEP meetings and adult training and staff
5 training. The community uses them. There's people who do
6 CPR classes from the community that use them. The Autism
7 Society uses those rooms for their meetings. They are used a
8 lot.
9 Q. You're at the old Island Paradise facility, are you
10 not?
11 A. Yes.
12 Q. Are you leasing that property?
13 A. Yes.
14 Q. I see. So you have no requirements to maintain it?
15 A. Yeah, we have to do all of -- basically anything
16 that needs to be done, we need to do it.
17 Q. For how long is that lease?
18 A. We just -- actually, this time I'm going month to
19 month because I have no idea what's happening with the state
20 of Hawaii's services.
21 Q. I see. You're leasing from the state of Hawaii?
22 A. No, but I have no idea what's happening, so I
23 didn't want to make a commitment.
24 Q. You have a month-to-month lease?
25 A. Yeah. Previously I had a year lease for each year
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1 of my contract, yeah.
2 Q. Oh, also, in addition to the two rooms, you have
3 allowed Mr. Drews to advertise Central Pacific University by
4 putting signs on your buildings and banners on your
5 buildings, right?
6 A. There is a sign and he wanted to put that up there
7 I guess for the picture for the Website and, again --
8 Q. Is it still there?
9 A. It is still there, and I didn't think about that
10 until recently when I was looking to prepare for this because
11 I knew this was something you were going to be asking me and
12 I realized that Doug Miller did ask him to take it down, but
13 it's still there, so I will actually ask him to do that now
14 that I'm remembering about it.
15 Q. You are in charge of those premises. You could
16 have it taken down.
17 A. Okay.
18 SPECIAL COUNSEL KAWASHIMA: Take a break.
19 CO-CHAIR REPRESENTATIVE SAIKI: Members, we'd
20 like to take a five-minute break at this point. Take a
21 recess.
22 (Recess taken.)
23 CO-CHAIR REPRESENTATIVE SAIKI: Members, we'd
24 like to reconvene our special hearing, and we'll continue
25 with questioning by our special counsel.
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1 Q. Dr. Dukes, do you actually -- as owner of the
2 academy, do you pay yourself a salary?
3 A. It's called a draw.
4 Q. And what is that draw per year?
5 A. Well, I wanted to make it similar to what I had
6 made before, and up until this year I was able to do that,
7 but this year I've only been able to take about -- I think
8 it's 30,000 or 32,000 so far this year.
9 Q. Last year your draw, how much was it?
10 A. It was probably close to a hundred.
11 Q. 100,000?
12 A. Yeah, and before when I was in private practice and
13 teaching at the university I was making -- I think it was
14 about 120.
15 Q. Now, even though you drew 100,000 that year, that's
16 not all the income you had that year, was it?
17 A. Pardon me?
18 Q. Even though you drew $100,000 last year, that was
19 not the total sum of your income?
20 A. Of the business? Of the business?
21 Q. In any way your total income.
22 A. There -- as I said before, I really don't have the
23 figures in my head, but I know that we had money that was
24 there in reserve to continue redoing our classrooms, because
25 that's what we've been basically trying to work on. There
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1 wasn't any start-up money, so I had to use my savings to get
2 started. They had actually told me there was going to be
3 start-up money, then it turned out that there wasn't. So
4 some of the money had to be in there to eventually repay me
5 for --
6 Q. How much was that that you invested in it?
7 A. I really don't know. I kept taking money out of my
8 savings.
9 Q. Is it in the realm of 10,000 or 50,000 or 100,000?
10 A. Probably more like 50.
11 Q. But the company turned a profit last year, right?
12 A. I believe it did.
13 Q. So that would be additional income that you gained
14 from that business, right?
15 A. It -- it's -- we've had money in reserve and, as I
16 said, lately we've been having to borrow. I've actually had
17 to take a couple loans, so we just actually did pay off a
18 loan, though, from last month.
19 Q. Ma'am, though, if you have a profit as a business,
20 as a for-profit business if you have a profit, then it's
21 something that you receive, do you understand?
22 A. Yes.
23 Q. So that you did receive in addition to the $100,000
24 last year an element of profit, right?
25 A. Yes.
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1 Q. How much was that, about?
2 A. That would be on my -- that would be on my income
3 taxes, right?
4 Q. Yes.
5 A. I'm really sorry. I do not know, but I can find
6 that out and let you know.
7 Q. I had asked you questions about David Drews and you
8 were providing him with two classrooms to use as a part of
9 his organization called Central Pacific University, and
10 you've described to us when he uses it and how he uses it.
11 In return you say he was going to refurbish the room?
12 A. He did that.
13 Q. He refurbished the room?
14 A. Uh-huh.
15 Q. All right. Did he pay any other consideration for
16 the use of those rooms?
17 A. No.
18 Q. Does David Drews receive any other -- other than
19 having that room for free, right, he has it for free?
20 A. Correct.
21 Q. Other than having that, does he have any other type
22 of financial gains, financial interest of any fashion,
23 whether it be exchange of services or money or whatever it
24 might be, does he have any type of interest like that or does
25 he receive it from Loveland Academy?
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1 A. No.
2 Q. How about from you personally?
3 A. No.
4 Q. So he gets those rooms free. He still does have
5 them free for now, right?
6 A. He doesn't use them, though. I mean, he hasn't
7 even used them at all this year.
8 Q. They are available for his use, are they not?
9 A. Yes.
10 Q. For free without charge?
11 A. Yes.
12 Q. And is he paying anything more than that?
13 A. No.
14 Q. Without identifying any names of your students or
15 otherwise invading these students's privacy, which frankly
16 we're not interested in doing, not invading their privacy, as
17 far as Loveland keeping records, you have a student number
18 for each student, do you not?
19 A. Yes.
20 Q. And that is how you keep records of -- well,
21 records that will allow you to bill the state, among other
22 things, right?
23 A. Yes.
24 Q. And that is how you keep your progress notes?
25 A. They have their names on them and the record
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1 number.
2 Q. Now, are these progress notes -- progress note
3 entries made -- generally made when the service is performed?
4 A. Yes.
5 Q. And are they kept in paper files or are they on a
6 computer?
7 A. They're in paper files.
8 Q. Not in a computer?
9 A. Correct.
10 Q. And if the files of students at Loveland are kept
11 in a way that the personal identification of the student is
12 protected, such as by number that you have, you would agree
13 that the confidentiality would not be broken by someone
14 looking at those files, right?
15 A. Maybe I've misled you. The records all have the
16 children's names and the record number on them. The only
17 reason that we would use just the record number is if we were
18 doing some kind of data analysis that other people might be
19 taking a look at.
20 Q. However, if we should get one of those student's
21 files, look at them -- not we. You look at them and you
22 redact out the names and just keep the student number on it,
23 that would preserve the confidentiality of the student, would
24 it not?
25 A. Yes.
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1 Q. Would you cooperate with the auditor's office,
2 doing that, allowing them to get these records, review them,
3 and if they see fit copy them, allowing you to redact the
4 names but leaving the student number on them?
5 A. Oh, definitely.
6 Q. I think we had an issue there.
7 A. The problem is we have just -- just to be visible,
8 this -- these are -- this size binder, some of our children
9 have like three and four of these, because there's a note
10 that's written by the TA, if there is one, there's a note
11 written for day treatment, there's a note written for the
12 biopsychosocial rehab program, there's a note written for
13 speech therapy usually, OT, occupational therapy, so each day
14 there's like several notes that are written for each day, and
15 so the amount of work that it would take to sanitize that
16 record -- that was the problem because we just were notified
17 Thursday night that you wanted to see the records and --
18 Q. All right. I understand what you're saying.
19 A. It's really difficult.
20 Q. Let me explain. A person employed by the state
21 auditor's office would be the person or persons, perhaps more
22 than one but no more than three, would look at the records
23 and if they are as voluminous as that we certainly don't want
24 you to have to go through the trouble of redacting all the
25 pages, but they may want to receive certain copies of certain
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1 students. As to those, then they would have to redact it,
2 leaving the student number on it and then copies could be
3 provided for them for their use. There should be no problem
4 with that, should there?
5 A. No. In fact, I would love for someone to look at
6 what we're doing.
7 Q. So I think we're in agreement as to how the
8 procedure will be. It will be kept strictly confidential, I
9 assure you. That's part of the charge to the state auditor.
10 SPECIAL COUNSEL KAWASHIMA: Madam Chair, I
11 have no further questions at this time. We may ask you
12 questions after we review your documents.
13 CO-CHAIR SENATOR HANABUSA: I think, members,
14 Co-Chair Saiki will be reading the order, and we'll have the
15 five-minute rule.
16 CO-CHAIR REPRESENTATIVE SAIKI: We'll begin
17 with Vice-Chair Kokubun, followed by Vice-Chair Oshiro.
18 VICE-CHAIR SENATOR KOKUBUN: Thank you,
19 Co-Chair Saiki.
20 EXAMINATION
21 BY VICE-CHAIR SENATOR KOKUBUN:
22 Q. I wanted to follow up on the process of referral of
23 clients to Loveland Academy. You had mentioned that they
24 were primarily referred by family guidance centers?
25 A. All the children are referred as a result of an
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1 IEP, which is an individualized educational planning meeting,
2 and it's not until the IEP team has decided on placement of a
3 child that the guidance center would get involved, and then
4 at that time the guidance center is the vehicle that sends us
5 the paperwork on that particular child. And then we look at
6 that paperwork and we decide whether or not we will allow
7 that family to bring that child for an interview and an
8 intake. If we've decided that the child does not fit our
9 criteria, then we simply call the guidance center and we put
10 in writing why we feel that child would not be a good
11 candidate for our day treatment program.
12 If we feel that the child might be a good
13 candidate, then we set up an intake and we usually do those
14 on Wednesdays. We have our whole team involved, which is
15 speech pathology, occupational therapy, psychology,
16 neuropsychology, sometimes the physician and we meet -- and
17 we take a look at that child and see whether or not that
18 child is eligible.
19 Q. And you indicated, actually, in your testimony that
20 there have been some referrals that you have refused?
21 A. Yes, several.
22 Q. Declined to accept?
23 A. Uh-huh.
24 Q. Is there a way to determine from your files and
25 from the IEPs, I assume, which family guidance centers have
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1 referred the students to you?
2 A. There probably would be, yeah, because they all
3 are -- that's listed, and I think it might be central. I
4 think it might be -- central would be my guess off the top of
5 my head. I'm not sure.
6 Q. Central?
7 A. Family guidance center.
8 Q. But there are a number of family guidance centers
9 that have referred clients?
10 A. Oh, all of them.
11 Q. Well --
12 A. We even -- we even see children from the other
13 islands. The family guidance centers from the other islands
14 have us come over and do evaluations on a student.
15 CO-CHAIR SENATOR HANABUSA: Mr. Dukes and
16 Senator Kokubun, please, the court reporter can only take one
17 of you at a time, so please afford him the opportunity to
18 finish and, Senator Kokubun, afford her the opportunity to
19 finish. Thank you. Sorry to interrupt you. And don't
20 worry, I'll give you an extra minute.
21 Q. When you talked about the students being
22 mainstreamed, is that -- mainstreamed to where, to the school
23 within your Montessori school?
24 A. Both. Some children have been successfully
25 returned to their home schools and mainstreamed within.
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1 Q. You indicated maybe six or seven students were
2 mainstreamed?
3 A. In our own Montessori school, uh-huh, and those are
4 the children who we would like to be able to find appropriate
5 DOE placements for.
6 Q. And those students that were mainstreamed would be
7 subject to the tuition, $500 a month?
8 A. It depends on what stage they are in. If they are
9 in the stage of transition, then they are still day treatment
10 clients because they receive all of the services that the
11 other children receive. The TAs go with them or their
12 educational assistant goes with them. They still receive all
13 the multi-disciplinary treatments. They receive the speech
14 therapy, the occupational therapy. Some of them are
15 receiving art therapy, some of them receive music therapy.
16 We've even done dolphin therapy. We do pet therapy. We do
17 hippo therapy, which is horseback riding kinds of things. So
18 we have a number of things that still go on, and if those
19 children are still part of the day treatment environment,
20 they are eligible to do those things, depending on their
21 individual treatment plan, and all the children are very,
22 very individualized, and that's one reason that the treatment
23 outcome does work.
24 Q. So for those students who are still under the day
25 treatment, they would not pay the tuition?
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1 A. Correct.
2 Q. So one or the other basically?
3 A. Yes.
4 Q. Six or seven students were mainstreamed to
5 Loveland's Montessori school. How many were mainstreamed to
6 regular DOE, their schools?
7 A. By mainstreamed do you mean into regular education
8 classes?
9 Q. Yes.
10 A. Into regular education, not special education?
11 Q. No, special education.
12 A. Into special education?
13 Q. Uh-huh. Let's take them both. Let's start with
14 special ed. Excuse me.
15 A. The children who have been discharged back into
16 special education, we have several who have been -- it's an
17 ongoing process throughout the year where children are going
18 back to their home placement. When the child first comes in,
19 one of the first things we do is actually start discharge
20 planning, and so we set up a list of criteria, set of goals
21 and objectives that that child has to meet in order to be a
22 successful candidate for going back into their home school,
23 and so when that starts -- when we start reaching those goals
24 and objectives, the home school comes in and visits in our
25 classrooms. We go there and visit in that classroom and then
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1 we start the transition process, and it's usually a gradual
2 process where the child might go half a day back to the home
3 school, stay with us half a day, and then transition back
4 completely.
5 Sometimes we send the educational assistant with
6 them. Sometimes we send the TA with them. Sometimes the TA
7 stays with them. We have some children who are actually able
8 to go to regular ed, they didn't have to go to special ed at
9 all from day treatment, but they've had to have a TA, a
10 therapeutic aide, with them. And that gradually has -- we
11 don't have a lot of history, because we just started a couple
12 years ago, but so far we're finding that the children that
13 we've started with early in life were able to make that
14 transition more easily and that the TA can be faded, and so
15 that we do have some children now who are in the regular
16 education classes, not in special ed at all, and we've been
17 able to fade the TA actually all the way out of the program.
18 Q. How many?
19 A. How many have we been able to do that -- that's
20 those four children that we've been able to fade the TAs out
21 and be in regular education, which is something I hadn't
22 predicted was going to happen. I didn't think that we would
23 be able to take children from day treatment and put them into
24 regular education at all. I thought they were going to have
25 to go to special ed. That's why as we learn more, we're
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1 seeing which children are able to do this more successfully.
2 VICE-CHAIR SENATOR KOKUBUN: Thank you, ma'am.
3 Thank you, Ms. Dukes.
4 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
5 Vice-Chair Kokubun.
6 Vice-Chair Oshiro, followed by Senator Slom.
7 VICE-CHAIR REPRESENTATIVE OSHIRO: Thank you,
8 Co-Chair Saiki.
9 EXAMINATION
10 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
11 Q. Ms. Dukes, I want to get some clarifications.
12 Earlier when you were talking about the service authorization
13 process and you had said that there was kind of a backlog,
14 about 230,000, can you explain that a little bit more to us?
15 What do you mean by service authorization?
16 A. Okay. When the IEP team has decided that a child
17 should receive services, whether it's through the
18 biopsychosocial rehabilitation program, which is an after
19 school program, or whether it's day treatment or whether it's
20 just individual therapy, the care coordinator is supposed to
21 send what's called a service authorization form to us before
22 the treatment starts, and I know that CAMHD would like it if
23 we don't start that treatment process before we actually get
24 the service authorization in our hand, but what happens is
25 we've had such backlogs that the children don't get services
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1 if we don't go ahead and start them. So we'll go ahead and
2 start the services that have been authorized and then the
3 care coordinator is supposed to send us that service
4 authorization. Well, sometimes they get busy and they forget
5 and they don't do it or there's a lot of transition of care
6 coordinators. Some of them leave and new ones come, and so
7 we have -- there's always -- there's always every month an
8 issue of lots of kids who don't have their service
9 authorizations.
10 Q. So does this service authorization have to go back
11 to the Department of Health for further approval?
12 A. No, but you have to take the number off of it when
13 you bill, and so the number that comes on the service
14 authorization is what has to go onto the billing, and so you
15 can't bill for that child unless you have that authorization.
16 Q. Okay. But in any event, I'm not clear, then, how
17 does the department end up having to be involved in terms of
18 the payment of it if they don't have an approval of the
19 process?
20 A. Ask me that question again, please.
21 Q. How does the department -- where is their oversight
22 in terms of the authorization of the approval of the
23 services?
24 A. I don't think I understand your question.
25 Q. When you say that there was a backlog of
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1 $239,000 not yet paid, I still am not clear on how you are
2 reporting that to the Department of Health so that they would
3 end up having to pay you?
4 A. We can't, that's the problem, because we can't bill
5 it without the service authorization, and even though the --
6 even though it's been verbally -- what happens is it's
7 verbally authorized at the IEP meeting that the Department of
8 Health care coordinator will be there at the IEP meeting,
9 will verbally authorize the service, but then for some reason
10 if they change jobs or whatever, go to someone else, we don't
11 actually get that physical piece of paper in our hand that
12 gives us the number that we can bill from.
13 Q. Okay. And who is that piece of paper supposed to
14 be coming from?
15 A. The care coordinator from the guidance center.
16 Q. From the Department of Health?
17 A. Yes.
18 Q. And then that will just depend on which care
19 coordinator at the Department of Health?
20 A. Yes.
21 Q. We had also heard previously from another
22 testifier, though, that Loveland doesn't necessarily fall
23 under this authorization process for high end services?
24 A. No, we have to have a service authorization for
25 everything we do.
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1 Q. And then I understand that when you were talking to
2 Mr. Kawashima you had said something to the effect, because
3 of this backlog after a certain period of time it got to the
4 point where you needed to call Dr. Drews; is that correct?
5 A. Yes. If you don't bill the service within 90 days,
6 you can never get paid for it.
7 Q. But, I mean, as I understand the structure of
8 Department of Health, underneath Dr. Drews there are other
9 administrators in the hierarchy or the chain. Did you try
10 and contact those people, such as Dr. Gardiner?
11 A. Several times, both in person and by fax.
12 Q. So you've tried to --
13 A. Like repeatedly for three months, because that's
14 the 90 days. We have a very detailed process by which, you
15 know, we do this. It's like if it doesn't -- if the service
16 authorization doesn't come in after five days, then we do
17 this, and so it's like after 90 days we've done a lot of
18 different things to try to get them.
19 Q. So you've tried to make repeated efforts --
20 A. Yes.
21 Q. -- with the department but they have been
22 nonresponsive?
23 A. Yes.
24 Q. I also wanted to ask you about -- in terms of the
25 supervision, you said that that was one of the aspects in
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1 terms of, I guess, the differential between the amount you
2 would pay a TA and the amount you would contract them out
3 for. Can you explain to me supervision, what does it
4 involved and how many staff people do you have to actually do
5 this kind of supervision?
6 A. Yes, I can. The people who are doing the TA work
7 are -- they have their bachelor's degree in psychology, and
8 so if they are going to be providing the mental health
9 supports for a child, they need to be supervised by someone
10 who has advanced training, and we have, I think, four or five
11 people who are -- either they already have their Ph.D.s or
12 Psy.D.s in psychology or they are at some point in their
13 doctoral program as psychologists. Some of them have worked
14 as mental health providers for several years, and they
15 actually go physically into the classroom and they observe
16 physically these people working, and they give them on-site
17 direction.
18 They have special team meetings with them. Not
19 only the psychologist, but the speech pathologist, they do
20 the same thing because children who have autism, if they
21 can't communicate, that creates a lot of frustration and
22 emotional problems for them and is a real source of their
23 acting out and having temper tantrums, things like that. The
24 same thing with the occupational therapists also, supervises
25 them because, again, autistic children have a lot of sensory
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1 needs which causes them to have behavioral issues. So they
2 need to learn how to intervene at that point in time. So we
3 have a lot of different -- our multi-disciplinary staff
4 supervising them.
5 Q. Thank you. I have just one final question. In
6 terms of the supervisors that you do have that do have
7 Ph.D.s, are any of these Ph.D.s from either Honolulu
8 University or Central Pacific University?
9 A. No.
10 CO-CHAIR REPRESENTATIVE OSHIRO: Thank you.
11 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
12 Senator Slom, followed by Representative Kawakami.
13 SENATOR SLOM: Thank you, Co-Chair.
14 EXAMINATION
15 BY SENATOR SLOM:
16 Q. Good morning, Dr. Dukes. As a business, who are
17 your primary competitors?
18 A. Well, for day treatment, unfortunately, none. And
19 I guess no one else was willing to try doing this program,
20 and hopefully there can be some other people that can be
21 talked into doing this in the future. The biopsychosocial --
22 that's not true, though, I think. I think maybe Child and
23 Family Services started a program, because I think I was
24 helping them at one time and I think they actually did it. I
25 did help them start a biopsychosocial rehabilitation program,
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1 so I know that they have one. CARE has a program, and I
2 don't really know who else has programs.
3 Q. You mentioned earlier that as a clinician you do
4 provide services on a daily basis. Are they restricted to
5 speech pathology or what kind of services do you actually
6 personally provide?
7 A. Mine are pretty much restricted to speech
8 pathology. As I was just saying to Mr. Oshiro, I would say
9 50 percent of an autistic child's problems come from
10 inability to communicate, and so that's one of the biggest
11 things that can really help that child, and so I try to
12 practice my profession and to work in that area.
13 Q. And when you discussed earlier referrals that are
14 made, you talked about eligibility. What are your
15 eligibility guidelines or what would determine who would not
16 be accepted?
17 A. It changed. We've changed our eligibility
18 guidelines as we've been working. This is very new. We're
19 actually kind of on the cutting edge of doing these kind of
20 treatments and approaches. We're finding as we go that some
21 children make a lot of progress and other children don't make
22 a lot of progress in certain areas. The DOE has excellent,
23 excellent programs for certain children and they don't need
24 to avail themselves of day treatment programs. Some of the
25 things that I personally -- and Dr. Koven will have a totally
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1 different answer for you -- but the things that I see
2 personally as important because I was a rehab director for
3 five years, I think that speech pathology and occupational
4 therapy services are absolutely critical, and there are very
5 few people in the country who know how to provide these
6 services to autistic children. We happen to be able to do
7 that.
8 If there are children who we feel would make
9 tremendous progress if they had daily intensive speech
10 pathology services from a speech pathologist who knew how to
11 teach autistic children and if we have children who have such
12 sensory issues and need sensory integration training from
13 occupational therapists that specialize in that area, those
14 children we know we can do a really good job with and can do
15 differently than what is available in the DOE.
16 Dr. Koven I think will tell you that there are some
17 psychological issues that she looks for that she knows. One
18 of them I know is a gap between nonverbal intelligence and
19 verbal intelligence. Some children have very high nonverbal
20 intelligence, if we can get their other issues under control
21 will do really well.
22 Q. Are these eligibility requirements written down
23 anywhere?
24 A. Initially -- no, not those, because we didn't know
25 that when we started. Initially our eligibility requirements
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1 were that the child fell somewhere in the autistic spectrum
2 disorder, that they were not really -- that they didn't have
3 a lot of out -- behavioral issues that would preclude our
4 staff from working with them. We are not a staff that works
5 with children who have a lot of oppositional defiant
6 disorders. We pretty much work with autism.
7 Q. I want to thank you for the four-page memo that you
8 sent all of us, and I did have an opportunity to look over it
9 and it did have one or two questions that I would ask you.
10 One you have here, who documents problems and progress at
11 Loveland Academy, who is the individual?
12 A. I'm really glad you asked that because the answer
13 is that we have lots and lots and lots of different people at
14 very different levels documenting progress, and I know that
15 one of the things that I read in the paper was that we
16 weren't showing progress with children. And one of the
17 things that I had wanted to say is that there are -- these
18 volumes -- there's like probably four of these, you know, two
19 to four volumes of these on each child, and what the family
20 guidance center gets and what the supervisor who I really
21 don't know was talking about was a very small sheet of paper
22 that they get. Originally when we were sending things to the
23 guidance centers, Dr. Koven and I tend to -- we do eight-page
24 or 15-page evaluations when some people write one page. We
25 were sending lots of information to the care coordinators.
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1 They were calling us back and saying we do not want this. We
2 want you to stay to this little paragraph that we're writing.
3 So it's impossible to show the kinds of progress that we
4 really make in that paragraph.
5 Q. Excuse me, is there one person or is it one of you
6 that is responsible?
7 A. No, that's what I'm saying. We have TAs writing
8 them, we have special education teachers writing them, we
9 have occupational therapists, speech pathologists, mental
10 health treatment providers.
11 Q. So no one person has the overall oversight to
12 comment on the programs?
13 A. Dr. Koven has the overall oversight.
14 Q. Okay, we'll talk to her. The other question that
15 you had raised here was something that was asked earlier by
16 Mr. Kawashima. Discuss -- describe practices following
17 corrected billing errors resulting from mistakes between the
18 academy or DOE or DOH. I thought you had mentioned in the
19 last audit there was only one mistake or one error that was
20 found?
21 A. Uh-huh, and it was mine. There was an IEP note
22 that had not been placed in the chart and I found it and
23 turned it in. The audit before that showed when it came back
24 they did not do an exit interview and they told us that we
25 were missing documentation for a number of bills and that we
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1 needed to send in a rejection that took those off. I found
2 out later that we were the only agency that did that. The
3 other agency said, you know, we didn't have exit interviews,
4 we want to show you where that documentation is. So I went
5 back and I looked through our records and I found that the
6 documentation was there but we were new and we were using
7 different forms. We kept changing and upgrading our forms,
8 and so they weren't seeing those. So --
9 Q. Excuse me, Dr. Dukes, I'm being gonged, so I have
10 just one final quick question I wanted to ask you. You made
11 a point several times about waste, suggestions of waste and
12 all. Did you at any time communicate in writing or otherwise
13 those specific suggestions to either the DOE, the DOH, or any
14 members of the legislature?
15 A. Yes.
16 Q. Who in the legislature did you communicate that to?
17 A. We actually sent a lot of different things. I know
18 that we sent some to Representative Saiki's office. We
19 invited the Felix task force committee to come out to the
20 school, and several people did come and I talked to them at
21 that time. I toured them around, and we did talk at that
22 time about suggestions that we thought could be done.
23 Q. Were those suggestions part of the material that
24 you turned over to the committee?
25 A. No.
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1 SENATOR SLOM: Thank you, Dr. Dukes.
2 Thank you, Co-Chair.
3 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
4 Senator Slom.
5 Representative Kawakami, followed by Senator
6 Sakamoto.
7 REPRESENTATIVE KAWAKAMI: Thank you very much,
8 Chair Saiki.
9 EXAMINATION
10 BY REPRESENTATIVE KAWAKAMI:
11 Q. I wanted to ask you, number one, I remember
12 Dr. Gardiner when he was here said you're the only show in
13 town. Okay. That stuck in my mind. Did your -- did you
14 start this academy knowing that you were going to be the
15 first one to do some -- this kind of treatment, et cetera?
16 How did you get into the business is what I'm saying?
17 A. Reluctantly. I had to be very -- I had to be just
18 pushed and pushed and pushed to do it. And --
19 Q. You were pushed by whom?
20 A. Parents primarily and, you know, we finally -- you
21 know, I did it, but no, I did not know I was going to be the
22 only show in town. It's -- I'm pretty overwhelmed, actually.
23 It's been a very overwhelming experience for me. Trying to
24 be the only show in town has been very difficult, and I would
25 hope that as part of what we're doing in this process we
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1 would, you know, get to build the capacity that I thought we
2 had as a state set out to try to do.
3 And to help that, I've -- actually, before the
4 Felix Training Institute was disbanded, I actually did a
5 training program which is now certified by the Felix Training
6 Institute and we do trainings and we provide trainings. We
7 do trainings for other agencies, we do off island trainings,
8 and we're doing our best with limited resources people-wise
9 to build this capacity, and I hope that -- I hope that we are
10 not going to chase everyone away. The people that I know
11 that I've trained that I hoped would stay in Hawaii have not
12 stayed. They've all left. Brilliant psychologists,
13 neuropsychologists, they are not here anymore because we've
14 kind of chased them away, and I hope that that doesn't
15 continue happening because we do need -- we do need to build
16 capacity here.
17 Q. When you say we chased them away, what do you mean?
18 We didn't pay them enough or there were not enough jobs?
19 A. Too much stress.
20 Q. Too much stress, and the stress was coming from
21 whom, the parents?
22 A. No, not the parents. No, the system, it just keeps
23 changing.
24 Q. The whole system?
25 A. Yeah.
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1 Q. You said a Beth Yano asked you to form this school.
2 Who is Beth Yano?
3 A. She is a lady who had worked at CAMHD at one time.
4 She's a psychologist and she had run the Windward day
5 treatment center. I think now she's on the Leeward coast.
6 She's a person who has spent her life pretty much doing day
7 treatment, and she thought that I would be a good person from
8 what she knew of me to start a day treatment program.
9 Q. You mentioned you got a waiver, and our counsel did
10 ask when is this waiver up. Does this go on and on?
11 A. I have no idea.
12 Q. You don't have any idea?
13 A. I have no idea.
14 Q. Who would you check with?
15 A. Well, this is an interesting question. These
16 things keep changing daily as well. We have a credentialing
17 process and when we go to a training, you know, we learn one
18 thing and the process changes and the credentialing changes.
19 We just successfully had hired all of our TAs who are
20 psychologists, and now that it's going to be going to DOE,
21 the RFP that just came out says that we only need to have
22 high school graduates as TAs, so where are all these -- I
23 have as many questions as you do. Where are all these
24 psychologists going to go? Where are all these TAs that we
25 just trained going to go? And how are we ever going to try
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1 to train all these other people who are high school graduates
2 to get ready for the next go-round when we have our new RFP?
3 Q. And I want to interject here, Representative Leong
4 had to leave for an important meeting, but she asked me to
5 ask this question after I asked that. If a degree is awarded
6 from an institution which is not accredited, do you consider
7 this a valid, accepted degree for a -- for your resume?
8 A. I don't need a valid degree for my resume. I have
9 more degrees than I need. I have -- I have a very, very,
10 very strong background in autism. I know as much as anyone,
11 I think, pretty much anywhere in autism and I'm not trying to
12 say that to boast. It's just that I don't need that degree.
13 It was something I had wanted to do and I did it, and for
14 what I do in the treatment of autistic children, I have more
15 degrees than what I need.
16 Q. Okay. A follow-up question now. In terms of the
17 types of services -- you mentioned autistic. What other
18 kinds do you have, post-traumatic, ADHD?
19 A. No, we are a center specifically for children who
20 have autism spectrum disorders or neurodevelopmental
21 disorders. Neurodevelopmental disorders are related in some
22 way to autism, but we're -- we do not serve children -- we
23 have children who have autism and ADHD, autism and a number
24 of different syndromes. By the time the child gets to day
25 treatment, our children are the most complex children. These
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1 are the children that no one else knows how to really treat
2 them. They may be complex because they are gifted and
3 autistic. Those are our most complex children, those are the
4 most difficult to treat, the children who are gifted and have
5 autism.
6 We have children who have central auditory process
7 disorder and autism, fetal alcohol disorder. We have
8 children who have William's syndrome and autism, bipolar
9 schizophrenia and autism, we have children who have
10 Landoff-Scholtser syndrome and autism. We have the most
11 difficult children diagnostically to treat, and that's what,
12 again, makes this program expensive because we have other
13 things to deal with.
14 Q. So if I look at it, then, you're treating really
15 the high end kids?
16 A. Yes.
17 Q. Now, our concern at one time was that too many were
18 going out of state, okay, we were paying that high cost. Is
19 this alleviating some of that?
20 A. Definitely. We have children who were destined to
21 go out of state and they were children that originally I did
22 not want to take and Dr. Koven, you know, persuaded me to do
23 that, and in most -- in most of those cases we did very well
24 with those children and they've been able to stay here and
25 not have to go out of state to residential treatment.
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1 Q. Do you know how many -- what percentage did you
2 knock off keeping them here versus still going out of state,
3 do you know?
4 A. I'm sorry, what was your question again?
5 Q. How many are still going out of state or are we
6 able to take care of all of these youngsters here?
7 A. The ones that have been referred to us who were
8 going to have to go out of state, we have been able to manage
9 all of them so far.
10 Q. So a good number percentage has been taken care of
11 is what you're saying?
12 A. I don't know what in terms of percentage. I don't
13 know what the other -- yeah.
14 Q. You had a question in your form here which I wanted
15 to follow up on. Are you getting incorrect diagnosis which
16 causes long-term expenditures on treatments? Because you
17 mentioned that in here.
18 A. Yes, definitely.
19 Q. Would you explain that?
20 A. Yeah, and this is an area that I've been trying to
21 talk to the Felix task force committee about as well. We're
22 seeing many, many, many children who have been misdiagnosed.
23 The most common misdiagnosis is mental retardation. We're
24 seeing that we -- the children that we're getting they are
25 saying have autism and mental retardation in actuality, I
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1 don't think any of the children that we got that diagnosis on
2 turned out to be mentally retarded, and so the treatments
3 that were being done with those children were inaccurate.
4 They cause the child actually to have a lot of behavior
5 problems because they were not treated as though they did
6 understand.
7 Q. So the diagnosis coming to you is incorrect is what
8 you're saying?
9 A. Yes, we've had -- we've also had a lot of children
10 that came in -- referred to us with a diagnosis of autism and
11 they didn't, and one of the children actually is a child that
12 I had been treating previously and they did put this label on
13 her. She's actually from Hilo, and the parent called me and
14 asked me to see her because they had been using autism
15 treatments, behaviorally based, and she had become
16 oppositional defiant and she now had a new diagnosis of
17 oppositional defiant disorder. And so I was actually on
18 vacation for a month this summer. I had her live at my house
19 while I was gone, the family, and I had them come to school
20 and we totally -- we redid her program. Dr. Koven went and
21 got her going in school again and she's now fine. She's in a
22 regular classroom and doing well.
23 Q. My last question, because I did get my hourglass,
24 and that is how many youngsters are coming from the neighbor
25 islands and which islands?
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1 A. The ones that we -- most of them we go over there
2 and do the evaluations on. We do have -- and most of those
3 have been the Big Island, both Kona and Hilo. We also have
4 had requests -- we've been to Molokai, we've been to Maui.
5 We've been to Maui to do evaluations. We actually could go
6 more except that we really can't be in two places at once,
7 and they have to wait forever for us, but they do. Some
8 people have waited for over a year for us to come and
9 evaluate their children. We have a child now who is -- who
10 was in Kahi Mohala and he is from Maui and he is doing great.
11 He's in our day treatment program. He goes back there at
12 night to sleep and he's in our day treatment program and I
13 think he'll be able to go back.
14 Q. So what you're saying is once you diagnose there,
15 you bring them over here?
16 A. No, no.
17 Q. How do you provide that service?
18 A. Pardon me?
19 Q. How is the service provided when you have diagnosed
20 the kid on, let's say, Molokai?
21 A. We just do the evaluations and then we try to just
22 train their staff. We actually wrote a proposal for DOE to
23 work on this. We proposed like a diagnostic treatment clinic
24 where it would bring the child over -- and that's what we
25 tried this summer with this one child -- bring the team over,
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1 we'd bring the special ed teacher over, we would train them,
2 and then they would go back to their classroom and we could
3 do some follow-up things, but they didn't like that proposal,
4 so we didn't.
5 Q. Thank you very much.
6 A. You're welcome.
7 REPRESENTATIVE KAWAKAMI: Thank you, Chair.
8 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
9 Senator Sakamoto, followed by Senator Marumoto.
10 SENATOR SAKAMOTO: Thank you, Chair.
11 EXAMINATION
12 BY SENATOR SAKAMOTO:
13 Q. Thank you that you allowed some of us to visit your
14 facility and you explained some of what you're doing as well
15 as you mentioned some of your suggestions to change.
16 Unfortunately, this time isn't the appropriate time to ask
17 some of the questions that you said relate to how waste --
18 related to waste and how it can reduce costs. Although you
19 gave us some of that information before, if possible, can you
20 please maybe put some of that, especially the waste part in
21 writing, and at the time we did have members of the DOE and
22 we did share some of your thoughts with them, and I'm sure
23 some were accepted or some were acknowledged, and my hope is
24 we can continue with that effort, but it would take five
25 hours, you know, to go over some of those. Let me just -- if
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1 you could do that, that would help.
2 A. I would be more than happy to do that.
3 Q. Going back to some of the previous discussion, one
4 was about the TAs, $29 an hour. Is that the going rate in
5 the sense of other agencies, other people charge the same
6 amount?
7 A. Yes, basically the sheet -- the rate sheet came
8 from CAMHD, and so that's basically I think where
9 everybody --
10 Q. So if it was Child and Family Service or CARE or
11 some of these other groups or DOE themselves, they would be
12 paying about --
13 A. Correct.
14 Q. -- the same amount?
15 A. Uh-huh.
16 Q. So it didn't depend on how much rent you had or how
17 many professionals you hired separate from the TAs or how
18 much training you did?
19 A. Actually, what they gave us was the maximums that
20 we could go up to in terms of our cost reporting, but
21 actually when we did our cost report, we did our budgeting
22 and everything, it was actually higher than that. So we had
23 to basically cut back on costs in order to even be able to do
24 it at that rate.
25 Q. So when your numbers people looked at rent,
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1 insurance, overhead in terms of other people's salaries that
2 are not billable, you would have --
3 A. Lost money, yes, so we had to cut back.
4 Q. Every hour it would have cost more, even if the
5 employee benefits and pay were much less than the total
6 number?
7 A. Exactly.
8 Q. And then you had a one-year contract with CAMHD and
9 then another year?
10 A. One year and renewable and it was renewed.
11 Q. So at the current time, if these are high end
12 autism services, isn't that still under CAMHD as opposed to
13 DOE?
14 A. Yes, the high end kids are. We do have some
15 children, though, who are lower end because we also have a
16 contract that allows for outpatient services and evaluations
17 and things like that, so some of our services are through the
18 DOE as well.
19 Q. So you have a current fee for service arrangement?
20 A. We had an extension of our DOE contract, but when I
21 sent in my RFP, when I did the proposal, we were not
22 accepted, and so those children who are low end children for
23 DOE, we will not be able to continue with them after the
24 extension of our contract ends, and I think that's November
25 1st. So those children we will not be able to continue with.
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1 Q. So of your 20 to 24, how many are those in that
2 group?
3 A. We have -- these are primarily children who are not
4 autistic, and I don't know how many that is, but I could --
5 would you like me to --
6 Q. No, I was just trying to get some kind of feel.
7 You know, I heard you mention some of what you're doing is
8 cutting edge, and autism isn't new and obviously for many
9 parents sooner developing something new as opposed to what's
10 not working, but my perception is from visiting you and
11 hearing other people's comments, there are sort of different
12 schools of thought in what works. And obviously, from what
13 you're saying, there's been misdiagnosis, either someone
14 diagnosed as having autism and not or someone having mental
15 retardation and diagnosed with autism. Is there a group of
16 people or individuals in the department or parents that are
17 sort of trying to undermine Loveland because they are from a
18 different school of thought?
19 A. I wasn't aware of that. I actually don't pay much
20 attention to things like that. I guess when I read that in
21 the paper I was pretty distressed. Basically I'm a professor
22 at heart and researcher. We use a lot of different kinds of
23 approaches. We use every approach that has been researched.
24 We use them with different children depending on their needs.
25 We're learning now which approaches work with different
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1 children. We're learning which ones to definitely stay away
2 from with certain children because they don't work at all and
3 they, in fact, can make the child regress.
4 Q. So if there is in round numbers 500 children with
5 autism in the zero to 20 age group, and if you say, well,
6 let's take the younger group, a third of those, or say 20
7 percent, a hundred are, you know, zero to four and of those
8 hundred you have about a fourth of the -- that group?
9 A. Do you mean like us personally working with those
10 children?
11 Q. Loveland and your Montessori school.
12 A. No, we have a very, very, very small program. We
13 have like 22, I think, children who are currently in day
14 treatment. We have another additional 12, so it's about 34
15 children in our after school program. We only do about four
16 evals a month. We have maybe eight out-patients a month.
17 Actually, we're a very small program, but we do -- what we do
18 with the children, we do very, very, very intensively and
19 that's why we're trying, you know, to get these kids in and
20 out as fast as possible. We're trying to get the kids early
21 enough and do intensive multi-disciplinary treatments and get
22 them better and get them out.
23 Q. So evidence-base wise, outcome-base wise, you feel
24 for a certain group of the population of children with
25 autism, what you're doing works for a specific group?
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1 A. It would probably work for everyone, but the DOE, I
2 think the point I was trying to make, does really well with
3 typically -- with a lot of children. What they have
4 difficulty with are certain specific approaches when the
5 child might have another diagnostic condition in addition to
6 autism or when the child might have such severe speech and
7 language problems or such severe occupational therapy issues
8 or some other psychological issues that may be related to
9 autism, may not be related to autism, when they have some
10 more neurological disorders, some syndromes, those are
11 children, I think, that take very, very specific, highly
12 trained specialists, and that's what we do and that's what we
13 have.
14 Q. Thank you.
15 SENATOR SAKAMOTO: Thank you, Chair.
16 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
17 Representative Marumoto, followed by Co-Chair Hanabusa.
18 REPRESENTATIVE MARUMOTO: Thank you,
19 Mr. Chairman.
20 EXAMINATION
21 BY REPRESENTATIVE MARUMOTO:
22 Q. I don't know whether I can get through this in five
23 minutes. Senator Kokubun was asking you about the referral
24 process through IEPs and family guidance centers. Do you
25 have students that have come through a different route?
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1 A. No. All children come through the IEP process.
2 Q. I see. One hundred percent, okay. Thank you.
3 What kind of staff do you have, your professional staff? I
4 have no idea of the number or --
5 A. We have around 50, which is actually more than the
6 children we see on an average. We see about 46 kids a month
7 and we have around 50 staff.
8 Q. Would you have special education teachers?
9 A. Yes.
10 Q. Are all of them certified to teach special ed?
11 A. All of our special ed -- we have -- we have
12 certified special education teachers to cover all of our
13 classrooms. We have some other special ed teachers who
14 actually aren't certified, but they are not the ones that
15 we're counting in terms of our certification patterns.
16 Q. What do they do?
17 A. Pardon me?
18 Q. What do the noncertified teachers do?
19 A. They teach, but they are supervised by certified
20 teachers.
21 Q. Do you employ speech-language pathologists?
22 A. Yes.
23 Q. Are they licensed in Hawaii?
24 A. That's an interesting question. They -- the speech
25 pathologists have what's called the Certificate of Clinical
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1 Competence which is issued by the American Speech and Hearing
2 Association, and that is the standard.
3 Q. How many speech pathologists do you have?
4 A. Currently two licensed speech pathologists and we
5 have three communication aides, two that have -- actually all
6 three of them have their bachelor's in speech-language
7 pathology and two are working on their master's degree in
8 speech pathology.
9 Q. Let's see. We're talking about training of the
10 staff. Does your staff, and I guess I would ask about your
11 professional staff, those with degrees in psychology. I
12 guess you said they would have bachelor's degrees. Are they
13 all trained in certain national recognized programs,
14 especially one in autism called applied behavioral analysis?
15 I guess they call it ABA. Does your -- would your
16 professional staff have training in this applied behavioral
17 analysis program?
18 A. Applied behavioral analysis is a method that --
19 actually, this is a better question for Dr. Koven. In my
20 personal opinion, and she and I sometimes disagree on
21 behavioral aspects, I think that all of our staff know how to
22 do applied behavioral analysis, and she can probably tell you
23 better if there are certifications that go along with this,
24 but it is something that is a standard practice that
25 psychologists know how to do.
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1 Q. There's another program called discrete trial
2 teaching, DTT. Have your staff had training in this
3 particular program?
4 A. Yes, they have.
5 Q. Where did they receive this training?
6 A. From us. We have a certified Felix training
7 program, and that's part of it.
8 Q. There's another program called Picture Exchange
9 System, PECS. Do you utilize this? Is your staff trained in
10 this particular --
11 A. Actually, to go back to DTT, it's really discrete
12 trial training, instead of discrete trial teaching. If
13 that's important to you, and the one that you just mentioned
14 is actually called Picture Exchange Communication System.
15 The C is for communication.
16 Q. All right, I'm missing a word in there.
17 A. Yes, and that's something that I actually
18 personally train on, in addition to the rest of our speech
19 pathologists train in that area.
20 Q. Just the speech pathologists have this training,
21 okay.
22 A. No, our speech pathologists are the ones that do
23 the training with all of our staff, and our staff use this in
24 all of our programs.
25 Q. Okay. Another test program called Teaching
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1 Autistic and Relative Communication Handicapped Children. I
2 think the acronym is TEACCH. Do you provide the training for
3 this program?
4 A. Yes.
5 Q. Again, do you provide it yourself to your staff?
6 A. Yes, we do.
7 Q. So whoever is teaching this is accredited to
8 provide this training?
9 A. Is there an accreditation process for TEACCH? I
10 wasn't sure -- I didn't know that there was an accreditation.
11 It's something that I've personally done for years. I didn't
12 realize there was an accreditation to it, but it's something
13 I've done personally for years. It's something that most
14 people who are specialists in autism do. It's a recognized,
15 common technique and procedure and approach that we use with
16 autistic children.
17 Q. I understand the DOE provides all these programs,
18 and so -- but you have not availed yourself of using the DOE
19 programs?
20 A. Pardon me? I'm not understanding the question.
21 Q. The DOE actually provides training in these
22 programs. You have not -- you or your staff have not availed
23 yourself of the DOE training in these programs?
24 A. Those particular programs are ones that we have
25 taught at the university level for years, so we've really not
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1 needed to go outside of our own on-site expertise for those
2 programs.
3 Q. That's good. I understand also the DOE does bring
4 in expert consultants into the state to provide this
5 training, but you've been doing it in-house?
6 A. Our staff also goes outside. I prefer, actually,
7 sending my staff to the mainland for the trainings directly,
8 but we do avail ourselves as much as possible. We sometimes
9 call and they say that the training is already filled up, so
10 it's been difficult, actually, for our staff to get in, but I
11 do send staff a lot to different trainings.
12 Q. Could you give me an example of the last person
13 that was sent to the mainland for training and where?
14 A. Both Dr. Koven and -- Dr. Koven went to the
15 National Autism Society, and that was just recently in
16 California. Mr. Pedro, who is one of our psychologists, he
17 went just recently to the National Psychological Association
18 conference, which I believe was just this summer. My speech
19 pathologists, one of my EAs, that's educational assistant,
20 and myself will be going next month to the American Speech
21 and Hearing conference in New Orleans. We -- my occupational
22 therapist just returned from a conference. She actually has
23 gone to three of them, I think, this year in Florida. She's
24 becoming certified to teach in the area of sensory
25 integration therapies. I believe in education. I've been a
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1 professor off and on for 35 years and I believe in training.
2 REPRESENTATIVE MARUMOTO: Thank you very much,
3 Dr. Dukes.
4 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
5 Co-Chair Hanabusa.
6 EXAMINATION
7 BY CO-CHAIR SENATOR HANABUSA:
8 Q. Dr. Dukes, let me first understand the numbers of
9 students that you are servicing. You've given the number 20
10 to 24. Is that your population of Felix children?
11 A. That's our total population of day treatment
12 children.
13 Q. At Loveland Academy?
14 A. Uh-huh.
15 Q. And that's in any given time frame?
16 A. Yes. Kids come and go, but we have actually 24
17 slots.
18 Q. 24 slots. Do you run a full 24 slots?
19 A. We usually have that many, yeah. They are not
20 all -- they are not all paid for kids, but they are kids who
21 are in our program. They are not kids that we bill -- we
22 don't always bill for all the kids that are in our program,
23 and do have capacity to take more and so sometimes we do have
24 more children who are there without coming through the state.
25 Q. What's the average number in terms of what the
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1 state is paying you for?
2 A. Around I think 22.
3 Q. 22?
4 A. Uh-huh.
5 Q. I've looked at the different types of letters,
6 memos that you've sent and I received this one, the Loveland
7 Academy. It looks like a brochure of some kind, and one of
8 the things it says in here -- you're talking about your
9 staff, and you say -- you're talking about therapeutic aides
10 and you say, all are hired with experience. Do you recall
11 that statement?
12 A. They are hired with experience, yes. It depends on
13 what kinds of experience, though. For our credentialing
14 process through CAMHD, our TAs need to be experienced, but
15 the problem is, and I believe I'm getting ahead of you, but
16 the problem is they don't have autism-specific experiences
17 and they often don't have the kinds of training that we were
18 just talking about a minute ago with the DTT, the PECS, the
19 TEACCH, and all Dr. Koven trains on different kinds of floor
20 time therapies and psychotherapies, and there's a lot of
21 different methods that they have never been exposed to.
22 Q. So when you -- so when you say all are hired with
23 experience, you're not necessarily meaning that they are all
24 experienced in terms of being therapeutic aides?
25 A. They are not experienced in terms of
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1 autism-specific training. Most of the people that we hire,
2 at least recently, have been people who have lots of
3 experience and have been coming to us from other agencies.
4 Initially when we first started we were having to do a lot
5 more training and we didn't have the pool that we have now.
6 Q. So if I read to this say all are hired with
7 experience, meaning that they are all experienced therapeutic
8 aides, I would be incorrect, from what you just said?
9 A. What did it say?
10 Q. All are hired with experience.
11 A. With experience. Yeah, I don't know. Maybe
12 Dr. Koven knows this better than I do.
13 Q. That's fine.
14 A. Most of our TAs have had experience, but experience
15 as a TA doesn't necessarily mean you have autism experience,
16 so they've been -- most of them have been hired with
17 experience as a TA.
18 Q. But not the experience you need?
19 A. Yeah, it's different issues. One is a training
20 issue and supervision issue versus experience as a TA.
21 Q. I understand, Dr. Dukes. I'm just reading your
22 brochure and telling you how I'm reading it. The other thing
23 that you say is you have the -- Loveland is a Felix Institute
24 approved training site for therapeutic aides and in-home
25 therapists and you have classroom and hands-on experiences
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1 provided through a 40-hour course. What I want to know is
2 when you do this 40-hour course, people coming in to be
3 trained as therapeutic aides or in-home therapists, is the
4 state being charged or are they paying for this training,
5 they meaning whoever is coming in for this 40-hour course?
6 A. So far we've primarily been doing that with our
7 own -- people who want to be TAs with us and we do not charge
8 them.
9 Q. This is part of what you were testifying to with
10 Senator Sakamoto about the reason why you need the $29
11 because of your training, right?
12 A. Correct.
13 Q. The other thing here, another interesting thing,
14 Loveland Academy also offers a 20-module training program
15 available in segments of bundled modules on related topics
16 for a variety of audiences, and then you go through the
17 different things, and then you say course offerings are
18 available upon request. College credit, continuing
19 education, and in-service credit may be available for some
20 courses. What I'm interested in is if someone were to come
21 in for this 20-module training, where would you give them the
22 college credit, continuing education, or in-service credit?
23 A. Currently we have students from all the colleges
24 and universities in Hawaii. Specifically we have a class
25 that comes to us from HPU. They are seniors in psychology
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1 and they are interns, and they intern with us for a semester
2 and they -- all of them receive that training. They have
3 class work, they have on-site hands-on training. We also
4 have students who come to us from ASPP, which is the American
5 School of Professional Psychology, which just changed its
6 name to Argosy University. We have doctoral students,
7 master's students from there who do, as part of their
8 training and internships and practicums, receive that
9 training. We have people from Chaminade University who are
10 in counseling psychology who, as part of their work, receive
11 that training. We've had social work students from UH.
12 We've had -- we have people from KCC, and depending on what
13 branch they want to go into can receive that training.
14 Q. But they receive college credit, that's my
15 question, they receive college credit?
16 A. Exactly.
17 Q. The ones that you said intern, like HPU students
18 intern with you for a semester, are they paid by you?
19 A. No.
20 Q. Do they do -- do they assist in the classrooms in
21 terms of like, I guess, things that therapeutic aides would
22 do? Are they placed in the classroom with the student?
23 A. They are in a training program and they are
24 students in our training program, and I've always done this
25 for, actually, my whole life. I've run other programs having
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1 been a professor and done clinical training.
2 Q. I understand. I've done internships myself, and a
3 lot of times part of it is on hands training, so my question
4 is do these interns, then, have interaction with the
5 students --
6 A. Yes.
7 Q. -- in the classroom?
8 A. Yes.
9 Q. Now, the question that concerns me is do you know
10 what the total population of autism students or people who,
11 in your opinion, are -- students, in your opinion, who would
12 qualify as autistic, what that total number is in the state
13 of Hawaii?
14 A. I think it's up to maybe about 700 now, and it's
15 increasing daily.
16 Q. So with the exception of the 22 or 20 to 24 that
17 you have, do you know who else is servicing the remainder of
18 this population base?
19 A. Hopefully DOE and DOH. What my fear is is that
20 many of them are still not identified or misidentified.
21 Q. I'll get to that. Now, the other question I have
22 that is troubling is you say you take the students up to
23 eleven. You've made an exception to someone up to 14. What
24 happens after eleven to those students that you have?
25 A. We end up usually keeping them if they need to
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1 stay.
2 Q. So after eleven till what, 20? How old?
3 A. The oldest that we've had was 14 and he was, as I
4 said, just successfully transitioned to a high school program
5 this last fall.
6 Q. So you don't know what's -- strike that.
7 You've been in existence basically for two years?
8 A. Uh-huh.
9 Q. So in that two-year period, the oldest child that
10 you've had is 14?
11 A. Right.
12 Q. And right now you intend to take the children to
13 one, two -- first, second, and third grade, correct?
14 A. No, that's in our Montessori school.
15 Q. Okay. What about in -- so it's eleven years old in
16 terms of Loveland Academy?
17 A. Well, that's what we originally put in our proposal
18 because we weren't sure that we could really handle children
19 who were beyond the age of eleven. We also weren't sure
20 whether they would make the kind of progress that would be
21 necessary for an expensive type of day treatment program.
22 Dr. Koven and I like to focus on early intervention. We
23 would like to take them as infants and work with them until
24 they were five years old and ready to go to hopefully regular
25 education as opposed to special education. So our expertise
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1 has been with younger children, but we have, interestingly,
2 made some progress with some of these children that they had
3 asked us to take who were older.
4 Q. I'm going to ask you this one last question. My
5 time is up. When you say that they come to you misdiagnosed,
6 who's done that misdiagnosis?
7 A. A variety of psychologists and psychiatrists.
8 Q. So you're saying it's from the IEP process that
9 they've been misdiagnosed?
10 A. Not necessarily. Could be outside providers.
11 CO-CHAIR SENATOR HANABUSA: Thank you very
12 much.
13 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
14 EXAMINATION
15 BY CO-CHAIR REPRESENTATIVE SAIKI:
16 Q. Dr. Dukes, I just wanted to get a better
17 understanding of the billing process that you go through when
18 you bill the state of Hawaii. I know that you mentioned day
19 treatment costs approximately $222 per day per student, but
20 does Loveland bill for services outside of that set rate?
21 A. For the day treatment children?
22 Q. Or for any children that are being billed to the
23 state of Hawaii?
24 A. Yes, we have some outpatients. We have some
25 outpatients, and those are billed hourly when they come in
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1 for treatment. Sometimes it's family therapy, and there's a
2 code number for family therapy. There's a code number for
3 individual therapy. Sometimes we see children for evaluation
4 only and there's a code number for that. We see children in
5 our after school treatment program, the biopsychosocial
6 rehabilitation program and there's a separate code number for
7 that.
8 Q. When you -- when Loveland bills the state for any
9 of these, I'll call these ancillary services outside of the
10 $222 per day, for these ancillary services, is there a
11 form -- how do you document the billing? Are your employees
12 required to complete a form that shows, for example --
13 A. Yes, there should be like a handout that was for
14 our billing.
15 Q. We haven't seen the handouts yet. Could you just
16 briefly explain?
17 A. Yes, I think so. It's pretty complicated, so I
18 don't know how brief it can be. Basically it depends on --
19 first of all, I want to back up because I'm not sure that you
20 are understanding exactly what I was saying. Our outpatient
21 services, those children do not come for day treatment
22 usually. I mean, it's not typical that they would be a child
23 in day treatment, because day treatment typically covers
24 those services. The children in the after school program,
25 some of them don't come to day treatment either. They may go
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1 to their regular DOE classroom during the day and just come
2 on the bus after school for the after school program.
3 Q. I understand that. That's why I'm calling these
4 ancillary services.
5 A. Well, they are not really ancillary because it has
6 to be ancillary to something, and those I guess --
7 Q. Let's call these non-day treatment services.
8 A. Okay.
9 Q. So for these non-day treatment services --
10 A. How are those billed, is that what your question
11 was?
12 Q. Right.
13 A. Or how do we keep track -- okay. The service
14 authorization comes in and our biller logs it into the
15 computer program that we have and it generates a service log
16 which is filled out by the provider and then it's -- that is
17 turned in weekly. And the attendance, if it's a
18 biopsychosocial rehab program or specific -- maybe it's the
19 TA that we have in the schools, they record the attendance
20 and it's recorded. When it's billed it's for each
21 five-minute unit, and so the care coordinator may have given
22 a certain number of units for the month, and if the child was
23 absent certain days or maybe their parent picked them up
24 earlier than expected from the after school program, the
25 five-minute unit is -- it's calculated down to the five
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1 minutes and that unit number is entered on the service log,
2 which is turned in weekly and put into the computer.
3 And then weekly we have an auditor that I've hired
4 who comes in and looks at all the progress notes and compares
5 them against the attendance, and then that is compared
6 against the billing. And so we're fairly sure with our
7 checks and balances in house that our attendance matches the
8 service logs and that that matches the billing that is
9 ultimately sent in. We also check after the fact to make
10 sure that it was done correctly, so that we have that same
11 person who audits -- I've hired to do audits, she then looks
12 at the entire process again after it has been billed to make
13 sure that there weren't any errors.
14 Q. Just to clarify, so that means that any of the TAs
15 or counselors or other employees on your staff who provide
16 the specific service to a student will complete -- at some
17 point will complete a log that states basically what kind of
18 service is provided and give the five-minute intervals or
19 whatever time was allotted for that student?
20 A. Yes, they will actually record the time they
21 started, the time they finished, and then calculate the unit
22 by the five-minute interval.
23 Q. When the employee completes this form, for purposes
24 of billing the state, does each of these employees have some
25 kind of an employee code number or some kind of --
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1 A. Yes, they do, and that's assigned by CAMHD, I
2 think. It might be assigned by us. It's usually their first
3 initials, the first two letters of their first name.
4 Q. So each employee has his or her own code?
5 A. Uh-huh, yes.
6 Q. Does Loveland -- does anybody at Loveland bill for
7 other employees? So, for example, is it possible that
8 services could be billed -- the work of three individuals
9 could be billed under one employee code or would you have
10 each of those employees billing under their own respective
11 code?
12 A. Would you ask me that question again?
13 Q. I'm just curious what this -- what is the technical
14 term for this code, this billing code for each employee?
15 It's your first two initials and --
16 A. There probably is --
17 Q. Let's call it an employee code.
18 A. Uh-huh.
19 Q. So each employee would bill under his or her own
20 code. What I'm asking is whether or not there's any
21 situation where one employee would use his or her code for
22 the services performed by separate employees, whether you
23 consolidate services under one employee code?
24 A. Yes, there is. Under mine. Because there wasn't a
25 way to bill the biopsychosocial rehabilitation, and so the
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1 state set it up to bill it under mine.
2 Q. So how many employees perform biopsychosocial
3 services?
4 A. I'm sorry, how many?
5 Q. How many employees perform the biopsychosocial
6 services?
7 A. It's actually like a day treatment. It's not like
8 an individual service. The children in the afternoon are
9 assigned to teams and they go to different classes and
10 throughout all the classes that they go to we work on their
11 mental health treatment goals, which may be behavioral, which
12 may be communication, whatever those treatment -- those
13 mental health goals are. We work on those as they go to
14 classes, and the kind of classes they go to there's a
15 philosophy class, there's sports, there's ceramics, there's
16 music, things like that, so there -- it's kind of like a day
17 treatment -- after school day treatment program. So for day
18 treatment, they just bill it under Loveland Academy, which I
19 think is called LAC or something like that, and so the
20 biopsychosocial is just billed under my initials, which is PA
21 something.
22 Q. How many students receive biopsychosocial services?
23 A. How many students? I think there's about -- I
24 added up about 34 right now, and then there will be extra
25 students who come during intercessions, and I think there's
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1 about seven or eight of those.
2 Q. And is it possible to quantify how many employees
3 at Loveland provide these services?
4 A. Yes. Usually what happens is that my people are
5 full-time salaried employees, and so they may work in the day
6 treatment program which goes from 8:00 to 2:00, and then they
7 may also work in the after school program, the first part of
8 it, which goes from 2:00 to 4:30, and then other staff are
9 hired just for the afternoon, and they would work from like
10 2:00 to 6:00, but it's possible to -- for us to sort it out,
11 depending on how you would want us to try to do that.
12 Q. I just want a rough idea of how many employees are
13 providing these services, the biopsychosocial services.
14 A. They are mostly the same people. It's mostly my
15 same staff. They stay for the whole day. The extra people
16 who just work in the afternoon, there are probably maybe -- I
17 don't know, maybe ten who work in the afternoon only.
18 Q. So it's ten --
19 A. I'm not really sure. I could find that out for
20 you.
21 Q. Generally, what is ten plus? What's the other
22 number?
23 A. I have some -- a lot of them are graduate students,
24 so they have strange schedules, but most of my employees are
25 full-time employees. They work from like 8:00 to 4:30 or
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1 they could work from like 9:30 to 6:00. They have different
2 shifts.
3 Q. Well, generally what is that number?
4 A. The number of -- I'm sorry, what?
5 Q. My general question is what is the number of
6 employees that provide biopsychosocial services?
7 A. I don't know that offhand, but I could figure it
8 out for you.
9 Q. Generally it's the ten who provide afternoon only
10 services plus most of your full-time. I think you said most
11 of your full-time --
12 A. No, because like the teachers, they are not
13 involved in that program, some of the therapists are not
14 involved in that program, like some of the OTs or speech
15 pathologists are not involved in that program, but I could
16 figure that out for you, like how many there are.
17 Q. Could you say whether it's between 20 or 30?
18 A. Well, I could probably -- when it's Dr. Koven's
19 turn to talk, I could figure that out for you.
20 Q. Maybe we'll ask her as well. Thank you.
21 CO-CHAIR REPRESENTATIVE SAIKI: Members, are
22 there any follow-up questions? First by special counsel?
23 SPECIAL COUNSEL KAWASHIMA: I have some
24 questions. Thank you, Chair Saiki.
25 EXAMINATION
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1 BY SPECIAL COUNSEL KAWASHIMA:
2 Q. Did I hear you testify, ma'am, that you are not at
3 full capacity?
4 A. Correct.
5 Q. And what would full capacity be for you, for your
6 academy?
7 A. It would be --
8 Q. I'm sorry, how many more could you take if you
9 wanted to?
10 A. I could take a whole school full, but we are
11 only -- when I wrote my proposal, I only wrote for 24 slots.
12 Q. I understand that, but if you had to accept
13 students, more students, you could accept more?
14 A. I could accommodate more.
15 Q. How many more?
16 A. I could -- I could take many, many, many more. I
17 have a school that originally had like hundreds of kids in
18 it. I mean, it's a regular school building, and it's not
19 being utilized, you know, to capacity.
20 Q. And the fact that you don't have many, many, many
21 more is -- what causes that? What is the reason for that?
22 A. Because we are trying to do a really good job with
23 the children that we have and I want to stay doing a small
24 number of children for right now.
25 Q. I see. Maybe I confused you, ma'am. What I'm
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1 saying is if you wanted to take more students and you would
2 accept, they were referred to you, how many could you handle?
3 A. I would grow to the capacity of what was needed.
4 Q. Which is 24?
5 A. No, I would -- however many students needed to
6 come, we could --
7 Q. So it could be hundreds, then?
8 A. It could be, but I doubt very seriously whether
9 that would be appropriate.
10 Q. No, I just -- so you really don't have a number for
11 me?
12 A. No.
13 Q. Have any -- I'm not suggesting it happened, but
14 have any parents ever withdrawn their students from Loveland?
15 A. Yes.
16 Q. How many? In other words, they voluntarily removed
17 them from your program?
18 A. Yes.
19 Q. How many?
20 A. Probably three or four.
21 Q. And am I to understand that those three or four who
22 withdrew their students or their children were unhappy with
23 the services that were being provided?
24 A. There were a couple that were unhappy with the
25 services. Their children were probably not really good
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1 candidates for the kind of treatment that we were providing
2 and it was early on so we really didn't realize that.
3 Q. So you agreed with their decision to withdraw them?
4 A. Yes.
5 Q. All four?
6 A. Yes.
7 Q. Now, you say in terms of the biopsychophysiological
8 program or whatever it is, I'm saying it wrong I'm sure, that
9 to bill that program, because the state was not set up to do
10 it, you say the state set it up to bill it under my name.
11 A. Correct.
12 Q. When you say the state set it up, who in the state
13 did that?
14 A. The fiscal -- the fiscal office at CAMHD.
15 Q. Did the division chief, Dr. Drews, have anything to
16 do with that process?
17 A. I don't think so. It's just a computer -- they
18 didn't know how to program the computer differently.
19 Q. Is that billed out at one rate, though?
20 A. It's by the hour, billed out by the hour.
21 Q. How much per hour? Let me ask you this. Is it one
22 rate per hour?
23 A. Yes, and I think there is a rate schedule somewhere
24 that's available to you. I brought copies of it.
25 Q. One rate though, you say?
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1 A. Pardon me?
2 Q. One rate per hour?
3 A. Yes.
4 Q. And is that that $29 rate or more? I have no
5 problems if you ask Dr. Koven. She's sitting right there.
6 A. I have it. Actually, there are different rates for
7 children. Unfortunately, autistic children need to stay
8 pretty much at the higher rate. We have been able to reduce
9 a couple of our children so that they didn't need the
10 intensive -- as intensive therapy services as they did.
11 Q. What is the rate?
12 A. It's $40 an hour for level 3 and $15 an hour for
13 level 2.
14 Q. I see. So depending upon the level, you charge a
15 different rate?
16 A. Right, that's the --
17 Q. Who provides these services? Who provides the
18 services we're talking about?
19 A. That program is the one that I had just explained
20 that was similar to day treatment only in the after school.
21 Q. I understand, but what level of people do you have
22 working for you providing those types of services?
23 A. The same levels as during the day.
24 Q. Which is what, therapeutic aides?
25 A. No. Well, in addition. We have speech
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1 pathologists, occupational therapists, psychologists, we have
2 specialty teachers who are -- who have their degrees, for
3 example, in fine arts. One of them teaches a murals class.
4 One of them teaches a ceramics class. We have sports, which
5 is a Special Olympics program that we've just been able to
6 offer, and that's taught by one of our TAs who now -- he's
7 actually an athlete, so he's able to do the sports program.
8 Q. And you charge him out at $40 an hour?
9 A. No, those people aren't -- the entire program that
10 the child goes through in the afternoon is billed out at $40
11 an hour.
12 Q. I see. Now, one last area. You've already
13 testified that you started operation in July of 1999; is that
14 correct?
15 A. Yes.
16 Q. And you received your contract from the DOH in May
17 of 1999?
18 A. Yes.
19 Q. And when you received that contract from the DOH in
20 May of 1999, you had no previous experience in terms of
21 opening and running a school like this, am I correct?
22 A. No.
23 Q. No track record in terms of running a school like
24 this?
25 A. Yes, I have.
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1 Q. You had?
2 A. Yes.
3 Q. Where?
4 A. In St. Louis, Missouri.
5 Q. You actually ran a school?
6 A. Yes.
7 Q. What kind of school?
8 A. It was called the Center of Learning.
9 Q. For what types of students?
10 A. Similar.
11 Q. Special education?
12 A. Yes.
13 Q. Autism?
14 A. Yes, and others, different learning disabilities,
15 speech-language impaired.
16 Q. And what was your title at the school?
17 A. I was the owner and director. It was during the
18 time that I was also teaching at Washington University in
19 St. Louis.
20 Q. And how many students did you have in that
21 institution?
22 A. Oh, it was a small school. Probably very similar.
23 Q. 20?
24 A. Probably similar to what we have now.
25 Q. I see. Now, you've already testified that Loveland
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1 is not an accredited school?
2 A. The Lokahi Montessori school --
3 Q. Is?
4 A. -- is accredited.
5 Q. Loveland Academy in and of itself is not
6 accredited, is it?
7 A. We're actually in the process of applying for
8 accreditation through the Hawaii Association of Independent
9 Schools.
10 Q. The WASC also?
11 A. The Hawaii Association of Independent Schools.
12 Q. There is also a western association that usually
13 accredits schools here in Hawaii. Are you trying to get
14 accredited through that process also?
15 A. For our day treatment center I'm not really
16 pursuing that. I might do that for our Lokahi. I think for
17 our mental health day treatment facility I want to really
18 focus on the purpose, which is mental health.
19 Q. So it is not your intent to seek WASC --
20 A. I might. I hadn't thought about it.
21 Q. Now, I understand that Loveland had submitted two
22 proposals for that contract you ultimately got in May of
23 1999?
24 A. I'm sorry, that we submitted two proposals?
25 Q. Yes, you submitted two proposals and the first
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1 proposal was rejected, do you recall that? May of 1999, in
2 that period.
3 A. No, we didn't.
4 Q. Two years ago. You don't recall the first proposal
5 being rejected and then your second proposal being accepted?
6 A. No.
7 Q. You have no recollection whatsoever of that?
8 A. No.
9 Q. Do you know whether or not Loveland obtained a --
10 I'll use the term you may not be familiar with -- Chapter 103
11 (F) waiver, which avoids the competitive process? Do you
12 know if you got that waiver so that you did not have to
13 submit to the competitive bid process?
14 A. I --
15 Q. You may not know.
16 A. Why wouldn't I know that?
17 Q. Do you know? I'm sorry. Do you know?
18 A. No, I don't even know what you're talking about.
19 Sorry.
20 Q. You did not submit a competitive bid to get this
21 contract in May of 1999, to your knowledge?
22 A. I didn't? I didn't?
23 Q. Did you compete against others?
24 A. Well, I sent in my proposal.
25 Q. I understand that, but was it your understanding
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1 that you were submitting a competitive bid with other
2 providers trying to get the same contract?
3 A. Yes. Wasn't I?
4 Q. You're asking the wrong person, ma'am. One last
5 area. You testified earlier that the system is always
6 changing and it makes it difficult for you, right?
7 A. Right.
8 Q. And the system you're talking about is a system run
9 by either the Department of Health or the Department of
10 Education or both, right?
11 A. Those are two of the systems that seem to be --
12 Q. To whom are you referring when you say -- to whom
13 do you lay the fault as far as the system always changing?
14 Is it DOE or DOH or both?
15 A. I haven't thought about fault.
16 Q. But you do agree and you have testified under oath
17 that the system is always changing?
18 A. It seems to be always changing to me.
19 SPECIAL COUNSEL KAWASHIMA: No further
20 questions. Thank you.
21 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
22 Members, are there any follow-up questions? Senator
23 Sakamoto, followed by Vice-Chair Oshiro. Members, we will
24 limit follow-ups to two minutes.
25 Senator.
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1 EXAMINATION
2 BY SENATOR SAKAMOTO:
3 Q. I wanted a clarification. When Mr. Kawashima was
4 asking about your salary and, you know, the money you put in,
5 you mentioned the term "and you take draws," which would
6 imply sort of a partnership, and I thought I remember your
7 saying in the beginning it was an LLP or are you --
8 A. It's an LLC, limited liability company, and I may
9 be using the wrong word because I'm not a business person,
10 but that's what I'm -- that's what I call it. Originally I
11 thought that I could be like paying myself a salary, but the
12 accountant who did my taxes said no, that I should be just
13 taking it out as owner's equity, a draw against the owner's
14 equity, so I basically take whatever I'm able to kind of
15 manage on each month.
16 Q. So the corporation would be a separate entity than
17 your own personal and if you did --
18 A. It's not. The LLC, it just means everything
19 runs -- everything doesn't run through my personal taxes.
20 Q. Right, it's a separate taxable entity. So I'm just
21 trying to clarify. There's yourself and if you did take a
22 salary or your 32,000 was a salary, you'd pay income taxes on
23 that. If it was return of capital which you put in to do
24 improvements, it's not a salary, just recouping what you put
25 in?
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1 A. Yes.
2 Q. And I'm just trying to clarify, and it is a limited
3 liability corporation?
4 A. Company.
5 Q. Company. Because if it was a partnership, then it
6 would be different, the monies same pot --
7 A. It's just me, and it's a limited liability company.
8 Q. I don't want to confuse it further. Thank you.
9 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
10 Senator.
11 Vice-Chair Oshiro.
12 EXAMINATION
13 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
14 Q. Just briefly. I seem to recall that when Senator
15 Kokubun was asking you a question about the progress notes,
16 you had stated something to the effect that you folks had
17 tried to give the care coordinators further detailed notes
18 but all they requested was the condensed version. Is that
19 correct?
20 A. Yes. Originally I think the care coordinators had
21 very, very, very high case loads, and it was difficult for
22 them to read lots of material, and so what they were
23 requesting was that we try to stick in -- just into the
24 little paragraph on their form that they wanted us to fill
25 out and it was narrative style, and what we were really used
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1 to doing was using like little boxes where we talked about
2 rates of progress and things like that. So now that we
3 know -- I think their case loads have been reduced, and I
4 think now they are able to maybe pay more attention to each
5 individual child.
6 So we're actually -- we redid some examples, and I
7 think Dr. Koven has examples if you want to see them of the
8 new forms that we want to submit to them to ask if it's okay
9 for us to submit them the way we feel comfortable presenting
10 our data. What we'd also like them to do is come over if
11 they have questions and talk with us and look at the other
12 records that we have, because we have volumes of information
13 on these children. We have outcome data, we have test and
14 retest data, all kinds of things.
15 Q. I'm sorry.
16 A. That's okay.
17 Q. Just for clarification, so you're not aware of any
18 instances where care coordinators have been denied access to
19 records or actually denied access to visiting your campus?
20 A. No. We actually -- we try to get them to come.
21 VICE-CHAIR REPRESENTATIVE OSHIRO: Thank you.
22 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
23 Members, any other follow-up questions? Co-Chair Hanabusa.
24 EXAMINATION
25 BY CO-CHAIR SENATOR HANABUSA:
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1 Q. Dr. Dukes, the contract that you talked about
2 submitting to -- or the proposal that you submitted to the
3 Department of Health resulting in the contract is for day
4 treatment, correct?
5 A. No. It's for all of the services on the rate
6 schedule, and I don't know if you have copies of our rate
7 schedule, but it is -- it looks like this, and --
8 Q. I've seen something like that.
9 A. And so those are all the services that we are
10 authorized to provide. One of them -- one of the codes on
11 this page is for day treatment.
12 Q. What about for intercession and extended day
13 treatment, are those on there?
14 A. Extended day isn't really something that we do.
15 That's -- I think that's a DOE word. We do intercession and
16 that is billed under the biopsychosocial rehabilitation
17 number, which is 16301.
18 Q. So the intercession is not limited to simply the 22
19 or 24 students that you have under the Department of Health?
20 A. No, intercession is for -- not for day treatment
21 kids. It's for kids who go to regular -- the DOE schools
22 because they are the ones that are on intercession. Day
23 treatment has no intercession. We work every day. We don't
24 work on Christmas and New Year's, but just about every other
25 day we are there. So they don't -- we don't have
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1 intercessions for day treatment.
2 Q. Let me just follow up with that. You gave us two
3 figures for day treatment, one is $222 and the other is $367
4 for five hours of TA.
5 A. Actually, that's what Mr. Kawashima figured out.
6 Those are -- also, those are the ones that came from CAMHD,
7 so people who would be billing these services would pretty
8 much be billing the same way.
9 Q. Let me ask you this. What does -- how many hours
10 does the $222 or the $367 dollar rate per day -- when you say
11 per day --
12 A. That's for the school day.
13 Q. And that's from what time to what time?
14 A. Like 8:00 to 2:00.
15 Q. And if these students need additional care after
16 2:00, do you get to bill them into intercession or what
17 happens?
18 A. Intercession is only for like the week off, like we
19 just had an intercession for some children, and that's when
20 their school doesn't meet, but those are children who would
21 regress if they didn't have a treatment program to go to.
22 Q. So you don't bill for the students after 2:00?
23 A. It depends. Some of them go home.
24 Q. And if they stay on?
25 A. Right, if they stay on, then they go into the
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1 biopsychosocial rehabilitation program.
2 Q. Which is a different billing?
3 A. A different billing.
4 CO-CHAIR SENATOR HANABUSA: Okay, thank you.
5 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
6 Members, any other follow-up questions?
7 If not, Dr. Dukes, thank you very much for your
8 documents and testimony this morning.
9 Members, at this point we'd like to make a motion
10 to convene in executive session, the purpose of which would
11 basically be to discuss witness testimony, the overview of
12 our investigation, and potential authorization of subpoenas.
13 Is there any discussion? If not, we'll take a roll call
14 vote.
15 CO-CHAIR SENATOR HANABUSA: Members, this is a
16 motion for executive session. Co-Chair Saiki?
17 CO-CHAIR REPRESENTATIVE SAIKI: Aye.
18 CO-CHAIR SENATOR HANABUSA: Vice-Chair
19 Kokubun?
20 VICE-CHAIR SENATOR KOKUBUN: Aye.
21 CO-CHAIR SENATOR HANABUSA: Vice-Chair Oshiro?
22 VICE-CHAIR REPRESENTATIVE OSHIRO: Aye.
23 CO-CHAIR SENATOR HANABUSA: Senator Buen?
24 SENATOR BUEN: Aye.
25 CO-CHAIR SENATOR HANABUSA: Representative
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1 Ito?
2 REPRESENTATIVE ITO: Aye.
3 CO-CHAIR SENATOR HANABUSA: Representative
4 Kawakami?
5 REPRESENTATIVE KAWAKAMI: Aye.
6 CO-CHAIR SENATOR HANABUSA: Representative
7 Leong? She's excused. Representative Marumoto?
8 REPRESENTATIVE MARUMOTO: Aye.
9 CO-CHAIR SENATOR HANABUSA: Senator Matsuura
10 is excused. Senator Sakamoto?
11 SENATOR SAKAMOTO: Aye.
12 CO-CHAIR SENATOR HANABUSA: Senator Slom is
13 excused. Co-Chair Hanabusa is aye. Motion carries.
14 CO-CHAIR REPRESENTATIVE SAIKI: Thank you,
15 members. Members, we will convene in executive session in
16 room 329 and we will reconvene our public hearing in one hour
17 at 1:10 p.m. Recess.
18 (Recess taken.)
19 CO-CHAIR REPRESENTATIVE SAIKI: Members, we'd
20 like to reconvene our hearing. We'll continue with our
21 witness testimony. Co-chairs would like to ask the
22 indulgence of the committee members. We've switched the
23 order of testimony today. We'd actually like to call
24 Dr. David Drews at this time.
25 Dr. Drews, we will administer the oath at this
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1 time.
2 CO-CHAIR SENATOR HANABUSA: Dr. Drews, do you
3 solemnly swear that the testimony you're about to give will
4 be the truth, the whole truth, and nothing but the truth?
5 DR. DREWS: I do.
6 CO-CHAIR SENATOR HANABUSA: Thank you very
7 much.
8 Members, we have the same procedure as before. We
9 begin with Mr. Kawashima.
10 EXAMINATION
11 BY SPECIAL COUNSEL KAWASHIMA:
12 Q. Please state your name and business address.
13 A. David Drews, 1227 Kilauea Avenue. I'm sorry. 3627
14 Kilauea Avenue, Honolulu, Hawaii.
15 Q. And what is that the address of, sir?
16 A. Diamond Head Family Guidance Center.
17 Q. And I understand that you are the branch chief of
18 that family guidance center?
19 A. That is true. The official title is mental health
20 supervisor 2 in the state system, but most people refer to it
21 as branch chief.
22 Q. Are you the person in the highest position of
23 authority at that family guidance center?
24 A. Yes, I am.
25 Q. And how long have you been branch chief there, if I
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1 could use that term?
2 A. Four and a half years, approximately. And actually
3 the -- it's referred to now as Honolulu Family Guidance
4 Center, which actually encompasses Diamond Head Family
5 Guidance Center, Kalihi-Palama Family Guidance Center, the
6 Adolescent Day Treatment Program, and the Children's Day
7 Treatment Program, so actually, those are all under my
8 responsibility.
9 Q. When did they change the title from Diamond Head
10 Family Guidance Center to Honolulu Family Guidance Center?
11 A. I don't know if it was official, but it sort of
12 evolved as we tried to become sort of one -- align ourselves
13 with the school districts, being Honolulu District.
14 Q. I may use the phrase Diamond Head Family Guidance
15 Center, only because relevant to the matters here I believe
16 that was the term that was used. I'll use it such that we
17 can understand that includes Honolulu Family Guidance Center.
18 Okay?
19 A. Fine with me.
20 Q. How long have you been with the Department of
21 Education, state of Hawaii, sir?
22 A. I don't work for the Department of Education.
23 Q. Thank you. Department of Health, state of Hawaii?
24 A. Four and a half years.
25 Q. I see. So you started as the branch chief?
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1 A. Yes, I was hired as the branch chief.
2 Q. Where were you before that?
3 A. The Institute for Family Enrichment, or TIFFE for
4 short.
5 Q. And that was here in Hawaii?
6 A. Yes.
7 Q. And how long were you -- how long have you been
8 employed in Hawaii, then? Let me start there.
9 A. I've been -- I've lived and worked in Hawaii for
10 coming close to 15 years now, all in the mental health and
11 education area. I was at -- I'm sorry.
12 Q. No, go ahead.
13 A. I was at TIFFE for ten years and Castle Hospital
14 prior to that on the psyche unit.
15 Q. So this position with the Diamond Head Family
16 Guidance Center was your first government position?
17 A. Yes.
18 Q. What are your duties as branch chief?
19 A. Well, pretty much responsible for all operations
20 regarding Felix and services to the kids. I have a whole
21 management team below me that goes into more detail with
22 fiscal and personnel and so forth, but I guess if you
23 compared it to a corporation, I guess I'd kind of be the CEO.
24 Q. CEO of that division?
25 A. For Honolulu.
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1 Q. For Honolulu. Would you recount for us your formal
2 education?
3 A. I have a bachelor's, master's, and doctorate in
4 psychology.
5 Q. Your BA was received when and from where?
6 A. My bachelor's degree I received in 1977 from
7 Moorehead State University in Minnesota.
8 Q. Your master's, when and where?
9 A. Master's, Honolulu University, 1996.
10 Q. And your Ph.D.?
11 A. Honolulu University, 1997.
12 Q. You are presently the owner of Central Pacific
13 University?
14 A. I am not the owner. I am the president.
15 Q. Well, is that a privately owned institution?
16 A. No, it is not.
17 Q. Is it publicly owned?
18 A. It is a nonprofit corporation.
19 Q. I'm sorry. It's a nonprofit. It has to have
20 owners, though, does it not?
21 A. It has to have officers.
22 Q. And who are the officers?
23 A. Three board of directors are myself, Nadan Drews,
24 and Gregory Knowles.
25 Q. And Nadan Drews is your wife?
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1 A. Yes.
2 Q. And Gregory Knowles, is he related to you in any
3 way?
4 A. No.
5 Q. Is he a business associate of yours?
6 A. He's one of the faculty and board members.
7 Q. Of?
8 A. CPU.
9 Q. All right. Neither CPU nor Honolulu University are
10 accredited universities, are they?
11 A. Yes and no. It depends on what kind of
12 accreditation you would be talking about. I assume you're
13 referring to a regional accreditation which is recognized by
14 the U.S. Department of Education.
15 Q. Correct.
16 A. And if that is what you're referring to, Honolulu
17 University is not. Moorehead State University is.
18 Q. How does one -- how does a university in the status
19 that Central Pacific is now become an accredited regional
20 university?
21 A. It's a long and expensive process, and there's no
22 university in the country that could be regionally accredited
23 after two years of operation, such as CPU, so I don't see
24 that as a black eye or anything. We have just now gotten two
25 years of experience under our belt, and that's when you can
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1 usually start talking to the accrediting agencies about
2 becoming eligible for candidacy of accreditation.
3 Q. You have not yet applied --
4 A. Excuse me.
5 Q. You have not yet applied for accreditation?
6 A. No, we haven't been able to. I've spoken to --
7 I've been speaking to the different accrediting bodies.
8 There are about 20 different accrediting bodies in the United
9 States that are all recognized by the United States
10 Department of Education. We're most familiar here in Hawaii
11 with WASC, but there are others, and some are more geared
12 towards distance learning and some are geared more towards
13 traditional classroom.
14 Q. As far as the state of Hawaii is concerned, if
15 there is any regulatory or statutory requirement that a
16 university or institution of higher learning be accredited
17 through the Western Association of Schools and Colleges, it
18 would have to be that type of accreditation, WASC or
19 otherwise, that type of accreditation before you could call
20 yourself an accredited organization, right?
21 A. Well, you can -- it is -- you are able to state
22 that you have other accreditations. We don't do that at CPU
23 because we have no official accreditation. Other distance
24 learning schools, though, are accredited by a variety of
25 different accrediting bodies, some are regional, some are
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1 national, some are international, some are fully legitimate,
2 some are completely bogus.
3 Q. Now, the state of Hawaii, though, when in its
4 requirements requires someone to be a graduate of an
5 accredited university, for example, they would have to be
6 accredited by someone like WASC, though, right?
7 A. Usually the wording you'll see will be regional
8 accreditation. I think that's the wording the DOH uses, for
9 instance, when we talk about what kind of degree you have to
10 have for a certain thing, they'll say regional accreditation,
11 and here that would usually mean WASC, Western Association of
12 Schools and Colleges.
13 Q. Now, you, sir, sat through the testimony of
14 Dr. Gardiner last week and Michael Stewart?
15 A. Yes, I did.
16 Q. You heard what they said about the way certain
17 providers bill their charges -- charge for services being
18 provided to special education students?
19 A. Yes, I did.
20 Q. Do you agree that there is this overbilling going
21 on generally?
22 A. I can't really say if it's overbilling. There's
23 certainly questionable billing.
24 Q. Questionable?
25 A. Yes. As a matter of fact, I recently met with
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1 Mr. Bauder and he showed me, you know, specifics of certain
2 hours billed on a certain day for a certain service and those
3 looked very suspect. I would really like to hear some
4 explanations of how one therapist could, for instance,
5 work -- bill for 23 hours in one day. That must be a very
6 super therapist.
7 Q. That must have been something that escaped your
8 review?
9 A. Yeah, we don't -- we don't do auditing or fiscal
10 audits. We're busy enough just trying to get the services
11 out to the families and kids and making sure the providers
12 get paid, but we do have an arm of the division, both a
13 contract section and a fiscal section, that would really be
14 more involved in that. We do sometimes get feedback, and
15 certainly I'm aware of concerns that have been brought up by
16 many of the agencies, where it may come from a parent, it may
17 come from a provider, it may come from one of my care
18 coordinators just saying, you know, this doesn't really fit
19 and then sometimes we'll investigate that on sort of an
20 unofficial level or bring the parties in and talk to them and
21 try to figure it out, and if we feel it's something that
22 really looks fishy, then usually I would bring in division
23 and contracts folks and the people that are trained to be
24 auditors, the numbers people, and they would go after it.
25 Q. But your people who approve services for students
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1 that come under your purview, they are supposed to review the
2 bills, do they not? I'm not suggesting they have to check
3 every one of them, but part of their responsibilities would
4 be to review those statements before they approve them for
5 payment all the way up to you?
6 A. They don't approve the bills. They never see the
7 actual bills that come in from the provider sector.
8 Q. Who sees those?
9 A. The fiscal sections of our division.
10 Q. Of your division?
11 A. Of CAMHD. Nothing with Diamond Head.
12 Q. Nothing at Diamond Head -- no one at Diamond Head
13 has any responsibility --
14 A. We're involved --
15 Q. Wait, sir.
16 A. I'm sorry.
17 Q. No one at Diamond Head has the responsibility to
18 review the statements that come in for services rendered to
19 special education students under your purview; is that a
20 correct statement?
21 A. No, I guess it would not be. I have a fiscal
22 person that looks at billings. It's not hard copy billing
23 usually, but he can bring up -- for instance, if we have a
24 question about something, he can bring up on his computer
25 screen what services were authorized and look at what got
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1 billed and make the comparison and see if it jibes together.
2 I was referring to the actual billing process and payment of
3 the providers. That part of it we don't really get involved
4 in.
5 Q. I see. Well, you mentioned that -- when I asked
6 you about overbilling, your answer incorporated the term
7 questionable, but these questionable billings are all
8 overbillings, are they not, the ones pointed out to you?
9 A. They're questionable. I mean, I've heard the term
10 double billing, triple billing, those kinds of things, and
11 I've tried to understand how some of those things can happen.
12 I was recently at an IEP and brought up that fact, and it
13 isn't that one person would be -- like, for instance, the
14 example that was given, one person billing with three
15 different kids at the same time, something like that would be
16 blatantly wrong.
17 Q. Obviously.
18 A. What more commonly I hear about is things -- there
19 may be more than one person on a kid at a time. You might
20 have your intensive home-based therapist, the therapeutic
21 aide, and they are already in a program that we're paying for
22 too, and then people sometimes call that triple billing, but
23 it's really three different services going on at the same
24 time. Is it wasteful? Is it necessary? I think I've been
25 pretty vocal sometimes at IEPs saying is this really
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1 necessary? Are we kind of tripping --
2 Q. I guess you would also say is it effective to have
3 all those three services performed at once?
4 A. In certain situations and certain kids it may be,
5 but I wouldn't want to see that as the norm. I think that
6 would be a little overkill.
7 Q. Have there been situations, sir, pointed out to you
8 where some providers were providing too many services, aside
9 from the authorization issue, too many services for special
10 education students?
11 A. You mean above and beyond what the IEP says?
12 Q. Yes, and seeking payment for that.
13 A. That happens. When you're talking about just a few
14 hours for some particular reason, that's actually quite
15 routine and it will be a provider or someone calling saying,
16 you know, I need a few more hours because Johnny had a really
17 bad day and, you know, we had to put in a few more hours, and
18 those kinds of things I don't really have a problem with and
19 we go ahead and do it because we're trying to help the kids,
20 after all.
21 When something comes in -- and I don't review TA,
22 for instance, but when something comes in and it gets bumped
23 up to me where there's a huge amount of hours being asked
24 for, of course my first question of my staff always is, what
25 does the IEP say? What has the team agreed is necessary for
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1 this child to benefit from education and what's the number?
2 Because it should state the number right in the IEP.
3 Sometimes they are very vague, and I'm not comfortable with
4 that. So I look for the number, and if it says, for
5 instance, it was supposed to be 100 hours of TA and now they
6 are asking us for another 80 this month, I'll usually say no.
7 Unless, again, if there's such a dramatic thing going on that
8 would warrant that many more hours, then the IEP team should
9 be already meeting or at least the treatment team meeting
10 finding out what in the heck is going on, why do we have to
11 pour in that many more services. There may be a good reason
12 for it, but just as a rule of thumb, if it comes across my
13 desk or one of the supervisor's desks and it's above and
14 beyond the IEP, we will not approve it.
15 Q. Aren't your line people charged with the
16 responsibility first and foremost to compare what is being
17 asked for in the way of payment with what the IEP instructs
18 them to give to the student? Aren't they charged with that
19 first and foremost?
20 A. No, they are not. That's not really their role to
21 be aware of what's being billed for by the provider. Their
22 main function is to make sure that what the IEP says the
23 services are necessary are being provided.
24 Q. I think that's what I just asked you.
25 A. Okay.
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1 Q. Isn't one of their first and foremost
2 responsibilities to look at what is being charged for and
3 payment being requested for --
4 A. You mean authorized sort of?
5 Q. Well, being requested from someone in your
6 department, division, to compare that with the IEP to see if
7 they are in line, consistent?
8 A. Yes.
9 Q. Right?
10 A. That would be a responsibility.
11 Q. So when it comes across your desk, somebody has
12 already raised a question, otherwise it probably wouldn't
13 come across your desk?
14 A. Otherwise I wouldn't know about it, yes.
15 Q. Have there been situations where some providers
16 were not delivering the services for which they are billing?
17 In other words, billing for something that didn't happen?
18 A. I don't have specific information about that. I've
19 certainly heard people concerned about that.
20 Q. I understand that you heard much about that when
21 Dr. Gardiner and Mr. Stewart testified last week, and
22 apparently Mr. Bauder pointed out to you instances where it
23 does look quite questionable to you. Are you going to change
24 your practices to be a little more careful about those types
25 of issues?
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1 A. One of the things I discussed is the need for a way
2 of doing that. I mean, right now the supervisors and the
3 care coordinators have so much on their plate right now, I
4 really don't want to have to turn them into auditors as well.
5 I guess I would prefer to have some numbers people sort of do
6 more of that, whether you'd want to call it a watchdog agency
7 or whether it's part of CAMHD or someone that can go into
8 that kind of detail and look for the red flags.
9 Q. You'd have no problems with the auditor's office
10 coming in and reviewing those types of things for you?
11 A. No.
12 Q. Thank you. Now, let me ask you questions in
13 another area, sir, and that has to do with Central Pacific
14 University and Loveland Academy. You've heard much about
15 that, have you not?
16 A. Yes, I have.
17 Q. And apart from your work for the Department of
18 Health, you operate Central Pacific, would that be a right
19 term, correct term?
20 A. I'm the president of it.
21 Q. President and one of the directors?
22 A. Yes.
23 Q. You are in the highest position that one could be
24 for a nonprofit organization such as Central Pacific?
25 A. Yes. I conceived of the school.
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1 Q. And are you an instructor also?
2 A. Yes, I do act as a faculty advisor for some
3 students.
4 Q. And do you consider yourself an employee of Central
5 Pacific?
6 A. Yes.
7 Q. In other words, Central Pacific -- strike that.
8 In other words, when you provide services for
9 Central Pacific, you are paid as an employee?
10 A. No. I'm salaried as an officer.
11 Q. I see. As an officer?
12 A. Yes.
13 Q. Now, Central Pacific, though, is the type of
14 university where much of the work is done over the Internet;
15 am I correct?
16 A. Yes, that's what distance learning is all about.
17 Q. By the way, you say distance learning, does an
18 institution that considers itself to be in this category of
19 providing distance learning, does it need to have a campus?
20 A. In the early days of it I think it was sort of
21 assumed that you would still have to stick with some
22 traditional classroom types of instruction, but as we move
23 into the 21st century, now there are universities springing
24 up all over with regional accreditation now where you can get
25 a fully accredited degree on line. I think it's kind of the
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1 way of the future. A lot of noted professionals in the
2 education field are saying that some day many classrooms may
3 become obsolete in our high tech society right now. So
4 on-line courses -- I mean, UH, HPU, Chaminade, they are all
5 moving in this direction, more and more on-line classes.
6 There's a lot of advantages to that. I don't think it
7 necessarily means that the quality of education is any less.
8 Q. When did you start Central Pacific, sir?
9 A. August of '99 the corporation was formed.
10 Q. Well, you say corporation was formed.
11 A. Through the nonprofit.
12 Q. Did you, for example, obtain a franchise to open
13 that or you just opened it?
14 A. Just opened it.
15 Q. And what previous experience had you had running an
16 institution of higher learning prior to that?
17 A. I've been involved I think in my last 20 -- most of
18 my adult life I've either been in the area of mental health
19 or some level of training or education. Just prior to CPU,
20 though, I had been employed as an independent contractor
21 faculty for Honolulu University.
22 Q. Where you obtained your master's and your
23 doctorate?
24 A. Yes.
25 Q. Who -- I might use the wrong term. Who owned
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1 Honolulu University when you were there?
2 A. Who owns it?
3 Q. Who was the president?
4 A. President at that time was Dr. Earl McMyland.
5 Q. And who were the members of the board at that time?
6 A. I'm not really sure.
7 Q. Now, when you started Central Pacific, though, you
8 felt that it would not be a bad idea to have a campus, right?
9 A. Right. We had a plan -- you know, CPU really in
10 its conception was kind of two prongs that we were trying to
11 accomplish. One would be the degree granting, distance
12 education school, the other part being a nonprofit Hawaii
13 corporation. In our charter we had a vision and a mission to
14 provide low cost or free education seminars, training,
15 workshops, those kinds of things to Hawaii residents and
16 so -- and early on as well we wanted to maybe even form
17 practicum sites for students to do some hands on stuff if
18 they were willing to come to Hawaii. We thought that was
19 good for Hawaii. We thought it was good for the students.
20 We thought it was good for everyone. It's still a goal of
21 mine, and I still hope to continue to provide public
22 education. This is not the degree granting part, but public
23 education seminars, training, be kind of known as a training
24 institute here in Hawaii. So it's kind of those two
25 different departments of CPU.
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1 Q. All right. Now, Loveland, if I might move to
2 Loveland for a few minutes. Loveland is a provider of
3 services to special education students, is it not?
4 A. Yes.
5 Q. And you have from time to time been contacted by
6 your staff to review the payment of bills received from
7 Loveland?
8 A. Yes.
9 Q. And that, of course, would be your responsibility
10 as branch chief?
11 A. Yes.
12 Q. From time to time providers at Loveland -- I should
13 say the people at Loveland have called you, though, directly
14 inquiring about questions that have been raised about their
15 bills, right?
16 A. Yes, as do many providers.
17 Q. The ones at Loveland that contacted you include, as
18 you heard her testify today, Dr. Dukes, right?
19 A. Yes.
20 Q. How about Dr. Koven, she call from time to time?
21 A. From time to time.
22 Q. And you resolve those inquiries -- I should say you
23 resolve those questions -- well, strike that.
24 You are in the position to resolve those questions,
25 are you not?
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1 A. If it comes to my level, which is usually about
2 three levels up, if they haven't been satisfied or if they
3 haven't gotten the service authorization, they'll bump it to
4 the supervisor, and if there is still a problem, they may
5 call me. That's probably happened maybe three times totally
6 since they've been in existence.
7 Q. As they apply to Loveland, how many times?
8 A. That's what I was referring to, about three times
9 probably totally.
10 Q. Have you resolved those questions one way or the
11 other?
12 A. I have attempted to. Usually what I do is just go
13 right back to the supervisor and care coordinator and say,
14 what's the problem here? Why haven't we gotten this service
15 authorization out? Is it because a care coordinator has been
16 out sick and they never got it in on time, is it because it
17 got lost on someone's desk, is it because they are asking for
18 something that's above and beyond what the IEP says? I mean,
19 I ask a lot of those kinds of questions. If it's something
20 that we screwed up on, yeah, I try to move quickly and get
21 them their money, as I would with any agency, because I don't
22 want people working for nothing out there. If it's something
23 that they are asking for that we have some problems with,
24 then it needs a little further analysis.
25 Q. In those three occasions where questions were
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1 raised -- brought up to your level, anyway, regarding
2 billings that were presented by Loveland Academy, do you
3 recall in any of those three occasions deciding the issue
4 against Loveland?
5 A. The only one I really recall happened recently
6 where I got the call, and I don't even know if that's been
7 resolved yet. I pretty much have my fiscal guy looking at
8 it. It was two or three different kids that they mentioned
9 to me that I need this service auth, this service auth, and
10 so I pretty much emailed the information to the care
11 coordinator and to the supervisor and said let me know what
12 the problem is here, and if it's just a matter of not getting
13 the service auth out, get it out. We try to pride ourselves
14 in having a 24-hour turnaround. From the point in time that
15 we know a service is needing to be authorized and they fill
16 out the form, we try to turn that around within 24 hours that
17 they have the service authorization in their hand either by
18 fax or email so that we can efficiently get the services
19 going. So I don't really have a recollection of how the
20 other two came out because it was a long time ago.
21 Q. That's what I was going to ask you.
22 A. I was guessing at that number three.
23 Q. There has been more than one occasion in which
24 these issues were raised to you regarding Loveland?
25 A. Yes.
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1 Q. In addition to that type of issue, as branch chief,
2 do you also participate in the process of authorizing certain
3 types of care?
4 A. I wouldn't use the term authorizing because really
5 the only authorizing body is the IEP team, and it's kind of a
6 misnomer to even use the term service auth or service
7 authorization because if the team decided it's going to
8 happen, it's already authorized. So a better term would
9 probably just be different levels of review, and usually and
10 only -- I guess the only levels that have ever come to my
11 level for review are flex, respite, and hospitalization.
12 Q. Those sometimes raise questions, don't they?
13 A. Oh, yes.
14 Q. And questions that are open to interpretation,
15 right?
16 A. I'm not sure what you mean.
17 Q. Well, let me back up a bit. When you say the IEP
18 is the document you ought to look at to see what types of
19 care were authorized and not authorized, the IEP itself is
20 not always definitive, is it?
21 A. Unfortunately not.
22 Q. And there are situations where you need to
23 interpret what the IEP is authorizing?
24 A. That's true. Sometimes we've been instructed to
25 sort of purposefully keep it a little vague, in that we're
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1 going -- DOH will provide mental health services, which could
2 be interpreted all kinds of ways. Other times they will say
3 20 hours of therapeutic aide, four hours a month of
4 individual therapy, so it does kind of vary and there isn't a
5 lot of consistency, and maybe that's why they call it
6 individualized education plan. Each one is individualized
7 and there's a different principal and a different school and
8 different providers involved, and I think they have some
9 flexibility in how they do it. I prefer them to be pretty
10 tight so I know exactly what it is we're supposed to be
11 providing and there isn't much wiggle room other than if
12 there's an emergency or a crisis and they need a bunch more
13 services because of that. We'd certainly want to jump to it.
14 Q. Wouldn't you agree, though, sir, that to say if the
15 IEP says, for example, to provide mental health services,
16 that really isn't adequate, is it?
17 A. No.
18 Q. And that you'd rather have it be a lot more
19 specific than that for your purposes as the oversight person?
20 A. I think it's to everyone's advantage to have it a
21 little more specific. Even though mental health and
22 psychology is not an exact science, I think when you start
23 talking about contracted providers and billing and everything
24 else, I think we have to be very tight about what we offer,
25 what the IEP asks for.
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1 Q. And in any case, sir, this interpretive process, if
2 it has to happen where you need to interpret really what the
3 IEP is authorizing, you do at the top of the process become
4 involved with authorizing certain types of care because for
5 whatever reason you feel it's justified?
6 A. Yes, and in my early days as chief I used to go to
7 a lot of IEPs because everybody kind of wanted me, I guess,
8 to -- when they felt they were being ganged up on or whatever
9 they would want some help, and those were situations when
10 sometimes I really had to, I think, be firm about pinning
11 people down as to what is it you're really asking for but
12 more importantly what is it that the child really needs, and
13 sometimes those are two very different things, what parents
14 or teachers want and what the child needs, and that's where
15 those discussions can sometimes become heated and, you know,
16 I have to play kind of two roles.
17 Most of my staff doesn't really worry too much, I
18 think, or has been told not to worry too much about costs of
19 services. They want to just make sure that the services are
20 getting out there, that they are good services, that they
21 apply to the IEP, that they are going to make a difference
22 for kids. I have to also be aware of the bottom line,
23 budgets, the money, and certainly the concerns that this
24 committee has, and I'll probably -- I think in some ways I
25 think I'm probably known to be one of the few chiefs that may
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1 bring up the money issue in an IEP, and of course I'm told
2 that that's a no-no, but sometimes in IEPs that I go to,
3 which usually are some of the most contested, I just have to
4 remind people of the kinds of money that we're spending and
5 are we kind of getting the most bang for the buck, is this
6 really what is going to make a difference for the child or
7 are we just pouring more and more because we feel more is
8 always better, which it is not always.
9 Q. So you obviously share the goals and purposes of
10 this committee, then, don't you?
11 A. I believe we are in line on lots of things, yes.
12 Q. Good. Now, am I correct, and correct me if I'm
13 wrong, but am I correct that of all the family guidance
14 centers that we have here in the state, that your center, the
15 Diamond Head Family Guidance Center, has referred the
16 majority of its students with autism to Loveland?
17 A. That's probably correct, being we have the most
18 autistic students by far.
19 Q. And when you say we, are you including -- are you
20 saying now the Honolulu Family Guidance Center or Diamond
21 Head?
22 A. I'm usually referring to Honolulu. I do have a
23 visual that may just show you that.
24 Q. Sure. Does it involve autism?
25 A. This is state wide the autism, and this pie chart
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1 just basically shows the piece of the autism for the whole
2 state of which is Diamond Head's. That's the red section.
3 It's actually kind of a weird shape, but it's 27 percent,
4 so --
5 Q. Of the entire state?
6 A. Honolulu has 27 percent of all the autistic kids.
7 If you look at this one, you'll see this is Honolulu and
8 again the red section is the autistic kids. So you'll see 37
9 percent of the Felix kids that I'm responsible for are
10 autistic.
11 Q. And the majority of those kids who were referred to
12 a provider have been referred to Loveland?
13 A. Yes, I believe, being they are the only -- if
14 you're talking about day treatment?
15 Q. Day treatment.
16 A. Day treatment they are the only ones in Honolulu.
17 Q. As branch chief, sir, you have the general
18 oversight responsibility over bills that Loveland provides,
19 do you not?
20 A. No, I wouldn't say that.
21 Q. You don't have the general oversight
22 responsibility? If someone raises an issue -- I thought I
23 heard you testify earlier if someone raises an issue about
24 Loveland Academy's bills, ultimately it comes to you for
25 final resolution?
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1 A. Okay. I guess every time I hear you say bills, I
2 kind of think of the billing process between the providers
3 and CAMHD, which completely has nothing to do with the
4 guidance centers. They send their billings directly to
5 CAMHD.
6 Q. I'm talking --
7 A. But if there's a dispute about a certain service
8 for one of our kids, it might come to my level at that time.
9 Q. Or if one -- the people that works for you under
10 your supervision wants to raise an issue regarding bills and
11 payment therefore, ultimately you have that general oversight
12 responsibility, do you not?
13 A. Yes.
14 Q. Now, would you agree with me, sir, that as an
15 employee of the state that you should not receive a personal
16 benefit from a business that is supposed -- that you are
17 supposed to be overseeing?
18 A. Yes.
19 Q. And that you should not receive a benefit from a
20 business that you can -- where you can decide whether or not
21 to use the services of that business?
22 A. I would agree, and I do not -- I am not the one
23 that decides where the kids go for services.
24 Q. Nonetheless, you did receive a personal benefit
25 from Loveland, though, did you not?
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1 A. They allowed me to use that classroom, yes.
2 Q. You provided -- you were kind enough to provide
3 Mr. Bauder a copy of an internal investigation that was
4 completed earlier this year.
5 A. That's true.
6 Q. Were you not?
7 A. Yes.
8 Q. And it was your position in providing it to
9 Mr. Bauder that, in essence, as far as you're concerned, it
10 vindicated you?
11 A. My purpose was that based on the questioning of
12 some of my colleagues, I assumed that this committee had some
13 concerns about that, and I thought that by coming forward and
14 saying that, you know, this has already been looked at, it
15 may expedite things and I think it would be some valuable
16 information for this --
17 Q. So you have no objection to the committee members
18 having copies of the report of your internal investigation?
19 A. No. It was a confidential internal investigation,
20 so I did check it out with my boss first and said could I
21 share this with you folks and she said yes.
22 Q. I just wanted to be sure you authorized it before I
23 gave it to the committee members. I understand you gave it
24 to Mr. Bauder, but he wasn't sure whether you had authorized
25 him to provide it to all the members. I, as their attorney,
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1 was allowed to look at it. No objections, though?
2 A. No.
3 Q. Now, what we're talking about, sir, is Central
4 Pacific University's relationship, if any, to Loveland
5 Academy, right?
6 A. Yes.
7 Q. And the audit that was performed focused on the
8 inquiries that they set forth as the focus of the
9 investigation, which was, number one, what is the present
10 relationship between Central Pacific University and Loveland
11 Academy, and number two, does the relationship in whatever
12 design constitute a conflict of interest for the branch chief
13 of Diamond Head Family Guidance Center or CAMHD in general;
14 is that correct?
15 A. Yes.
16 Q. And what was given to us, I understand, is a
17 complete file of the investigation that was done and the
18 information that was gathered, right?
19 A. Yes, it's in its entirety.
20 Q. And what the investigation revealed, though, sir,
21 was that you did receive a personal benefit and still may be
22 receiving a personal benefit from a business that you are
23 charged with overseeing?
24 A. I didn't read that in this report.
25 Q. Well, you did not read that?
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1 A. No. Which page are you referring to?
2 Q. Well, I'm talking about the gist of the report.
3 You know, what we ought to do, just to be sure, sir, I'm not
4 suggesting to you that that is exactly what was said because
5 the conclusions that were submitted -- I might have to
6 paraphrase. It's kind of long. Talking about your use of
7 Central Pacific -- your use of Loveland's -- strike that.
8 I'm talking about Central Pacific's use of Loveland
9 Academy for whatever purposes. It says, "Although perhaps
10 deceptive and providing a basis for an allegation of a
11 perceived conflict of interest on the part of Dr. Drews, I
12 find no substantiation for a charge of actual conflict of
13 interest." Do you see that?
14 A. Yes.
15 Q. That's the conclusion you're relying on?
16 A. Yes, and it went on to say a little more.
17 Q. I'm not -- I'm not meaning not to read it, sir.
18 Which would you like me to read?
19 A. Just that, you know, I had -- just the next few
20 sentences as well.
21 Q. Sure. I find -- let's see. Dr. Drews had on file
22 his record of outside employment, attachment 3, and had
23 disclosed to his supervisor his connection to Loveland
24 Academy, attachment 4. See that? Is that what you read?
25 A. Right. I just wanted to point out that I thought I
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1 had dotted the I's and crossed the T's. I was fully
2 cognizant at the time that I was forming this relationship
3 with Loveland that there may be an appearance that there
4 could be a conflict, and I wanted to make sure that
5 everything was up front and that I followed all the
6 procedures.
7 I checked with the board of ethics and got a verbal
8 from them as well, and basically the questions that anyone
9 has ever asked are, do I have any say about kids that go to
10 Loveland or can I influence of who -- influence kids that go
11 to Loveland? And I cannot. And do I have any say of whether
12 Loveland gets a contract or not? And I do not. And is there
13 any money exchanging hands between Loveland and myself? And
14 there is not.
15 And other than that, you know, we were trying to
16 work together to get some classes and workshops going that
17 would benefit the public, parent instruction, CPR classes.
18 We were planning on some things like disaster debriefing.
19 Recently I was thinking about that. Stress management and
20 preventing burnout on the workplace. Lots of good things for
21 the public, and possibly at the beginning I was hoping that
22 we might even be able to do some training and be kind of a
23 supplement to maybe the training institute. We have such a
24 lack of TAs and trained practitioners here in the field, and
25 I guess I didn't feel that there was a problem if I'm trying
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1 to do something outside of my realm of work with the
2 department to also help families and Felix kids. If I was
3 trying to hide something, I wouldn't have hung a sign out on
4 Piikoi Street.
5 Q. We'll talk about that. Or whether you have any
6 oversight responsibility over that organization, that
7 question, you didn't name that -- you didn't list that among
8 the four or five that you listed.
9 A. Oversight of what?
10 Q. Of their bills as we've already established or
11 authorizing services as we have already established. Did you
12 ask that question of yourself?
13 A. I would, but I don't see how that would be a
14 conflict.
15 Q. Did you ask that question of yourself back then?
16 A. Of whether my oversight of billings --
17 Q. And the fact that at least Dr. Dukes calls you from
18 time to time -- had called you from time to time about issues
19 of that type, disputes about billing and payment, things of
20 that nature, did you think about that?
21 A. I probably didn't at that time, no, I did not, sir.
22 Q. In looking at your disclosure sheet that you're
23 talking about, it's called a record of outside employment?
24 A. Yes.
25 Q. You did fill that out back in September of 1999; is
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1 that correct?
2 A. Yes.
3 Q. That's when you completed it, September of 1999?
4 A. That is.
5 Q. And you have written in your hand, I believe,
6 certain information. You say your employer was Central
7 Pacific University. Do you see that?
8 A. Yes.
9 Q. And you set forth under description of duties,
10 among other things, faculty advisor for psychology students
11 and some administrative duties. Do you see that?
12 A. Yes.
13 Q. And you have the address of Central Pacific as 1188
14 Bishop Street?
15 A. Yes, that's what it was at that time.
16 Q. Number 3001, Honolulu, Hawaii, 96813?
17 A. Yes.
18 Q. You didn't include the campus address, though, did
19 you?
20 A. No, I did not.
21 Q. And the campus address is the same address as
22 Loveland Academy, is it not?
23 A. Yes, it is.
24 Q. And some of your correspondence at or about that
25 time had on that correspondence letterhead the campus address
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1 of Loveland Academy? The Piikoi Street address is what I'm
2 talking about.
3 A. On what correspondence?
4 Q. Your correspondence, Central Pacific University's
5 correspondence?
6 A. Okay. We didn't really see that as anything we
7 were doing any operations out of. We were never there.
8 There was no phone. There was nothing. It was just a
9 classroom that they had donated to us and other
10 organizations, I believe, that wanted to do some training and
11 seminars.
12 Q. It may be how you looked at it, sir, but if one
13 were to look at your letterhead, Central Pacific, it has as
14 an executive office the Bishop Street address, but it has
15 below that campus location.
16 A. Yes.
17 Q. 1506 Piikoi Street, Honolulu, Hawaii, and that is
18 the address of Loveland Academy?
19 A. Yes, it is.
20 Q. There is a memorandum of agreement dated October 1,
21 1999 evidencing the understanding that you and Dr. Dukes had
22 as far as what you would get and what you would provide?
23 A. Yes.
24 Q. And it's dated October 1st, 1999. Is that the date
25 it was -- this memo of agreement was drafted and signed?
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1 A. Yes.
2 Q. And it indicates that you were going to be provided
3 free of charge classroom space on the third floor of their
4 north building; is that correct?
5 A. Yes.
6 Q. And you would be, quote, giving back, refurbishing,
7 and upgrades to those classrooms, which I believe you in fact
8 did, right?
9 A. Yes.
10 Q. You didn't use those classrooms very much, did you?
11 A. Probably totally three hours' worth.
12 Q. What you really needed Loveland Academy for, sir,
13 was not the room so much as being able to suggest that you
14 had a campus?
15 A. No, that's not true.
16 Q. You had a Web page, did you not, that advertised
17 the services that Central Pacific provided?
18 A. Yes.
19 Q. And that Website was -- how often do you change
20 that Website, modify it?
21 A. I think it's modified -- gee, I don't know.
22 Q. When was the last time you made a modification?
23 A. I really don't know. I don't do that. I'm not the
24 techy person.
25 Q. Who is the techy person?
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1 A. My wife, Nadan, actually does the Web page itself.
2 I'm not sure the last time it's been changed.
3 Q. You, of course, are aware of the changes, are you
4 not?
5 A. Sure, and with specific to this investigation, of
6 course we made the changes that were requested.
7 Q. That's why you made the changes, because of this
8 investigation. You did not do it voluntarily, did you?
9 A. No, the changes that they asked us to make were
10 just the wording of affiliated with Loveland, because they
11 weren't comfortable with that terminology, and the -- I think
12 there was a statement in there that talked about training of
13 practicum students, which had been our original plan. I
14 thought it was a nice plan, and it wasn't something we ever
15 did so we shouldn't be talking about it, so we took that out.
16 Q. I noticed someone pointed out to me that there is a
17 change here to your Website that apparently occurred on
18 October 8th, '01, this year, a number of days ago. Do you
19 remember what that change was?
20 A. No.
21 Q. All right. But I'm looking at a Web page
22 reproduction dated March 18, 2001, and that Web page
23 information would have been different from what we saw after
24 this investigation we're talking about was completed, right?
25 A. It probably reflected the changes, yes.
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1 Q. And if we might look at that -- in that report of
2 the internal investigation, they have I think a complete
3 reproduction of what was contained on your Web page --
4 Central Pacific's Web page prior to the investigation.
5 A. Yes.
6 Q. And under the page entitled Central Pacific
7 University campus site, do you see that?
8 A. I'm not sure which page you're looking at.
9 Q. My highlighting.
10 A. Yes.
11 Q. What it shows there is people in a classroom, of
12 course, right?
13 A. Yes.
14 Q. It says our campus location --
15 A. Yes.
16 Q. -- at 1506 Piikoi Street in Honolulu can
17 accommodate up to 400 students in classroom settings.
18 Central Pacific University is affiliated with Loveland
19 Academy, a private school which offers therapeutic day
20 treatment programs for special needs children. Now, you had
21 the use of only two rooms, though, didn't you?
22 A. At that point.
23 Q. When it says can accommodate up to 400 students,
24 what did you mean by that, in classroom settings?
25 A. I think it's similar to the question you asked
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1 Dr. Dukes. How much room do you have, how big is the campus,
2 and it's a huge campus, and I probably used the number of --
3 if, you know, we really got big and it really got off the
4 ground, we could handle as many as that many students. I
5 think that campus can handle 400 plus students.
6 Q. Did you have an agreement of that nature with
7 Dr. Dukes?
8 A. No. We only had the agreement of the two
9 classrooms.
10 Q. Did you have some kind of oral agreement that
11 perhaps if your -- if your institution took off, that she
12 would give you more room free?
13 A. There was a possibility. At the time that we
14 looked at that, they weren't using that whole third floor, so
15 there was the option at that time, because they were first
16 starting out and they had way more room than they needed,
17 that we could expand further and go further if needed, but as
18 I said, the campus really became not necessary for us.
19 Q. She was going to provide that for your use,
20 Loveland was going to?
21 A. There was no formal agreement about that.
22 Q. There was an understanding, though?
23 A. I think she said that there would be that
24 possibility, but of course she didn't know what the future of
25 Loveland was going to be and of course if they needed the
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1 room they would certainly have first dibs on it because it's
2 their place.
3 Q. And the next photograph that shows buildings there
4 at Loveland says, Part of the campus is utilized as an
5 innovative practicum site for psychology students. Here
6 students can benefit from highly qualified professionals in
7 the field and get hands-on experience with the special needs
8 population. Now, again, this is not suggesting this was
9 something that might happen in the future. This is
10 suggesting that this was something that was taking place, is
11 it not?
12 A. It wasn't taking place, but it was planned. We
13 were hoping.
14 Q. Part of the campus is utilized as an innovative
15 practicum site. It does not -- the words do not seem to
16 connote future prospects, does it?
17 A. No.
18 Q. And then below it says, Central Pacific University
19 at their campus location provides classroom instruction,
20 seminars, workshops, and guest speakers for both
21 international students and the local community. You've
22 talked about that, and then the last photograph related to
23 that is showing, again, a classroom with students and faculty
24 person. In my copy I can't make out who that person is. Who
25 is that faculty person?
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1 A. Me.
2 Q. And though -- although you do have these -- strike
3 that.
4 As far as you were concerned, it was an important
5 aspect of your Website to show that you had a campus site,
6 right?
7 A. Well, I think it would have added some credibility,
8 but I must stress that from the beginning it was always our
9 plan to have seminars and workshops and public education
10 kinds of things run out of there.
11 Q. Oh, I'm not suggesting you thought otherwise, sir,
12 but this information on this Website, again, what you're
13 trying to do is to attract students to your institution of
14 higher learning, right?
15 A. Sure. A Website is an advertisement.
16 Q. In any advertisement that you were involved with,
17 sir, you would try to be as accurate and honest as possible,
18 would you not?
19 A. I would try to.
20 Q. And you would try not to misrepresent to those who
21 might be looking at that Website for the potential of being a
22 student of yours?
23 A. Yes. Really a Website is just the first step of an
24 advertisement, just like a newspaper ad, to get people to
25 call in or what have you. After that, of course, you could
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1 explain to them that, you know, if you are really interested
2 in traditional classroom instruction, that's not really the
3 way we're set up. We are a distance learning educational
4 facility. But we thought it would add some credibility. We
5 thought it would do something for the community, and we
6 really had hoped that we could get some good seminars going
7 out of there.
8 Q. But the two photographs showing the building --
9 portions of the building, would you agree someone looking at
10 that -- looking -- strike that.
11 The two photographs that show parts of the
12 buildings there, do they not suggest to one looking at them
13 that Central Pacific University is or I should say occupies
14 all of those buildings?
15 A. That wasn't the intent. It was just to show that
16 we had some. It could be that way. This was taken before
17 Loveland got their sign up. Finally they got a sign up and
18 it's -- if you drive by, the Loveland sign is right below
19 that.
20 Q. You still have that Central Pacific University sign
21 up?
22 A. The exterior one is still up.
23 Q. And you have it there by virtue of occupying two
24 rooms that you've used four times in the last two years?
25 A. Yes, but that sign actually is physically right
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1 there where the classrooms are.
2 Q. And again, now, in terms of representing the truth
3 or misrepresenting, these two photographs showing classroom
4 setting, one of which shows you as a faculty person and
5 students, who are these students?
6 A. They are I think employees of -- they were actually
7 just people that were around that day. It was staged, and I
8 might add that if you look at any college catalog. In most
9 cases, if you see pictures, they are staged. It isn't
10 someone walks through a campus and starts clicking their
11 camera, but we were a new school, we were starting up, we
12 needed to show something. That's sort of the way the
13 education system is, that you don't have any respect until
14 you're accredited, yet you have to be in operation, have
15 infrastructure, have students, have graduates, have alumni
16 for three years before you can get accredited. So you've got
17 to start somewhere, and, you know, we thought that this would
18 help launch a really respectable, good school.
19 Q. You wouldn't -- you wouldn't gain respect, sir, by
20 misrepresenting, though, would you?
21 A. No.
22 Q. And when you say universities do it. You're right.
23 Many colleges and university catalogs have quite similar
24 photographs like these, as these, but in every case, though,
25 what they do is they take photographs of either current
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1 students or ex-students who graduated and went on, but they
2 are students of that institution, right?
3 A. I'm aware of -- that some use models and nice
4 looking people and may not have anything to do with some of
5 the schools.
6 Q. Some of them? Which ones that you're aware of do
7 that, sir?
8 A. I've -- you know, just in the educational circle
9 that --
10 Q. University of Hawaii doesn't do that, do they?
11 A. That I don't know.
12 Q. Hawaii Pacific University doesn't do that, do they?
13 When they have these ads showing students from all around the
14 world, they are where they say they came from, right? Right?
15 A. Yes.
16 Q. And what these people are, actually, they are staff
17 members or employees of Loveland that you utilized in
18 using -- well, in taking this photograph that you then placed
19 on your Web page?
20 A. I'm not sure --
21 Q. Let me ask you this. Did you tell the Department
22 of Health person who was doing the internal investigation --
23 did you tell him that these people were not actual students
24 of Central Pacific?
25 A. I'm not sure if he even asked me that.
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1 Q. Did you tell him?
2 A. I don't recall honestly.
3 Q. And that's not one of the photographs they asked
4 you to take down, did they?
5 A. They didn't ask us to take any photographs down.
6 Q. I'm sorry. They asked you to change the text,
7 though?
8 A. Yes.
9 Q. And they asked you to take off the portion that
10 talks about your campus being utilized as an innovative
11 practicum site, that's for sure, right?
12 A. Yes. What they asked us to do, we did.
13 Q. In any case, as far as what Central Pacific does,
14 sir, there is a certain amount that is the rate, charge,
15 tuition to get a certain degree? In other words, for a
16 master's degree in whatever discipline we're talking about is
17 3,500 and for a Ph.D. in whatever discipline we're talking
18 about is 4,000, no matter how long or short it takes to get
19 that degree; is that a fair statement?
20 A. Yeah, there's some variability with the bachelor's
21 areas, but the master's and Ph.D.s have a set fee. We don't
22 go by the credit hour. We go by the program.
23 SPECIAL COUNSEL KAWASHIMA: I have no further
24 questions. Thank you.
25 CO-CHAIR REPRESENTATIVE SAIKI: Members, we'll
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1 begin with questioning by members, starting with Vice-Chair
2 Oshiro, followed by Vice-Chair Kokubun.
3 VICE-CHAIR REPRESENTATIVE OSHIRO: Thank you,
4 Co-Chair Saiki.
5 EXAMINATION
6 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
7 Q. Dr. Drews, in regards to Loveland Academy -- I'm
8 sorry, in regards to CPU, what is your current student
9 makeup?
10 A. Excuse me?
11 Q. What is your current student makeup?
12 A. About 75 percent of them are from mainland U.S. and
13 about 25 percent are all over the world, Europe, Asia,
14 Africa.
15 Q. And then how many estimate students would that be?
16 A. Currently, I think the number would be somewhere
17 around 140 students.
18 Q. And are there any Hawaii students that are enrolled
19 in CPU right now?
20 A. None -- let's see. Not in the degree granting. We
21 have folks that are invited for seminars and things like
22 that, but actual students for degree granting, two inactive
23 ones that I think haven't done anything for the last few
24 years, but nobody now.
25 Q. How many instructors do you have?
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1 A. We have 15, I think, currently, some being utilized
2 more than others.
3 Q. And these 15 instructors, are any of them graduates
4 of CPU or Honolulu University?
5 A. Yes.
6 Q. How many?
7 A. I'm not sure about the exact numbers. Some are UH
8 faculty, some are Chaminade faculty, HPU, KCC, Juliard School
9 of Music, they -- I guess I'd have to be asking -- guessing,
10 I mean.
11 Q. Just an estimate.
12 A. Four or five.
13 Q. I wanted to talk a little bit more about Loveland.
14 I think earlier when Mr. Kawashima was questioning you you
15 had said something to the extent of you can recall about
16 three instances where you had complaints about Loveland or
17 issues regarding their billing and you had to deal with them;
18 is that --
19 A. I believe he was referring to phone calls. We've
20 had other meetings, which I think you'll remember
21 Dr. Gardiner spoke at quite length about concerns among my
22 management staff and so forth, but what I can recall is maybe
23 about three phone calls just about strictly just a billing
24 fiscal thing, which is usually not a billing dispute. It's
25 more like we need our service auth kind of thing. That's
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1 usually the kind of call I get.
2 Q. I am a little confused because earlier when
3 Dr. Dukes had testified there seemed to be a discrepancy in
4 Dr. Gardiner saying he tried to call them -- I think he said
5 17 times with no response, and when I questioned Dr. Dukes
6 she said she had actually called people in your agency and
7 not received any response. So do you have any explanation
8 for that? It's not like they are just saying they missed
9 each other once or twice. They seem to be saying they are
10 missing each other numerous, numerous, numerous times?
11 A. Yes, I know that Loveland, as do many of the other
12 providers, have pretty regular communication with lots of my
13 staff, whether it's clinical things about kids or maybe even
14 some billing things. I don't -- if Dr. Gardiner says he made
15 17 phone calls and never got a call back from Dr. Koven, you
16 know, I guess that's, you know, what happened in his case.
17 But I did remember him testifying -- saying that he
18 was only interested in talking to Dr. Koven, no one else
19 there, because she was the one that had been signing off on
20 such and such and, you know, Dr. Gardiner has only worked for
21 the state for two month, and I think a good portion of those
22 two months that he worked at the state Dr. Koven wasn't even
23 on the island. So I know she had been out sick for some
24 time. I know she was at a convention for quite a while. So
25 I don't have an explanation for why they didn't connect, but
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1 my experience has been that there is usually someone you can
2 speak to at Loveland if you need to talk to them about
3 billing stuff.
4 Q. But I think when Dr. Gardiner testified he also
5 seemed to be saying it had a little bit more to do than just
6 trying to talk about the progress notes. As I seem to
7 recall, Dr. Gardiner was saying that he actually had
8 complaints by his care coordinators that they couldn't even
9 get access onto Loveland Academy, and it was issues such as
10 this in terms of their access to overall information, not
11 just the progress notes and not just Dr. Koven, but access to
12 information and that's why he had to make these calls to
13 Loveland, whether he made them specifically to Dr. Koven or
14 not, but in regards to these concerns by Dr. Gardiner,
15 considering that I think they are a little bit more
16 comprehensive than just the progress notes, what -- what is
17 your agency or department doing about that?
18 A. Well, you know, this didn't just start with
19 Dr. Gardiner, and, you know, we have -- I was actually --
20 since these testimonies have recalled that early on when
21 Loveland started I recall a meeting that was kind of similar
22 in that we had some -- it wasn't necessarily billing
23 concerns, but we just needed to communicate better, and I
24 remember we had a meeting at Diamond Head where Dr. Dukes and
25 Bob Hurd I know was there who was doing a lot of the business
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1 stuff at that time for Loveland, some of my staff and
2 division folks. I think we sat down and talked. At that
3 time it was a very cordial meeting, but it was that we had
4 some concerns. We don't really understand this or that and
5 we had one of those meetings probably sometime in late '99.
6 Then I thought we got good resolution and everything kind of
7 moved smoothly after that.
8 Then the next time I think it came up with respect
9 to Loveland was probably early in the summer, probably like
10 May-ish or so. Again, before Dr. Gardiner was ever -- before
11 I ever met the man, and that was when a few of my other
12 staff, then, were having some concerns, some of those kinds
13 of concerns that have been brought up before. So we had
14 several management meetings, me, the supervisors, the public
15 health administrative officer, and so forth discussed some of
16 these things and were trying to determine, first of all, what
17 the issues are, and I wanted to get more clear information.
18 And then the plan was that we were going to go forward and
19 have a meeting with the Loveland folks and try to work it out
20 again. I try to work out those kinds of things at my level
21 and not have to keep bumping them higher and higher and more
22 and more levels of bureaucracy.
23 Then what happened is I had a big turnover of
24 staff. I lost a clinical director, I lost two supervisors, I
25 lost my public health administrative officer. They all went
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1 different places for different reasons, but it just sort of
2 all happened, and then it was the summer when schools were
3 closed and there wasn't really as much activity, things kind
4 of died down, and I didn't have the management meetings for a
5 while, then, during the summer, and so those concerns
6 didn't -- weren't really on the front burner, I guess, at
7 that time.
8 Then it kind of resurfaced as school started again
9 in September, and this is when Dr. Gardiner had been hired
10 and another supervisor. We had a clinical director. We had
11 a new public health administrative officer, and so again we
12 kind of picked up the pieces and said, okay, now we have to
13 kind of work this -- work out some of these concerns. I had
14 told the team I would go and get a copy of Loveland's
15 contract, because we don't keep those at Diamond Head, but I
16 requested one from division, got it and brought it to the
17 next management meeting, but in the process of that I had
18 also then had my own supervision meeting with my boss and
19 said, you know, we're about to kind of launch a little mini
20 investigation of our own about some of these things from
21 Diamond Head KP, and is there any problem with that or is
22 that -- I was just kind of checking it out above to see if
23 that's proper protocol.
24 I hadn't been in the state that long either to know
25 all the different protocols, and we were going to actually,
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1 you know, have contract -- and actually talk about contract
2 issues and what's really covered with day treatment and
3 what's really covered with therapeutic aide, so on and so
4 forth. And at that time that's when I was instructed that
5 there's already an ongoing audit with Loveland, and I know
6 they had previous ones in the past and they had come out okay
7 on them. So I was informed at that point, you know, let the
8 people that do the audits do the audit. Let's not take that
9 on ourselves, and so I just made sure that all of --
10 Dr. Gardiner and everyone else that had a concern, all their
11 concerns were transmitted to the people that go out and do
12 the audits.
13 As a matter of fact, I even invited them, two of
14 the contracts people from division, to our management meeting
15 and they came, introduced themselves. They were kind of new,
16 too, in our system. There is that turnover problem, and
17 again, I let them face to face tell these contract folks,
18 here's some of the concerns I have, will you please in your
19 ongoing investigation look at all this stuff too, and that's
20 where it was left, and to my knowledge that's still going
21 forward, but I'm not involved in that audit.
22 VICE-CHAIR REPRESENTATIVE OSHIRO: Okay.
23 Thank you very much.
24 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
25 Members, we've been going for about an hour now, so we'd like
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1 to take a five-minute recess. Recess.
2 (Recess taken.)
3 CO-CHAIR REPRESENTATIVE SAIKI: Members, we'd
4 like to reconvene our hearing. Next up for questioning is
5 Vice-Chair Kokubun, followed by Representative Ito.
6 VICE-CHAIR SENATOR KOKUBUN: Thank you,
7 Co-Chair Saiki
8 EXAMINATION
9 BY VICE-CHAIR SENATOR KOKUBUN:
10 Q. Dr. Drews, I wanted a little bit more information
11 about Honolulu University. Is that still in existence?
12 A. Yes.
13 Q. Does that have a specific address? Are you aware
14 of where they're located?
15 A. Yes, they are 1314 South King Street.
16 Q. And are you involved in that Honolulu University at
17 all in an administrative or faculty role?
18 A. No.
19 Q. So primarily your relationship was that you got
20 your degrees, your master's and your Ph.D. from Honolulu
21 University?
22 A. Yes. I did my course work and dissertation through
23 them, got the degree, and then afterwards they approached me
24 to be an adjunct faculty, so I worked with, oh, probably
25 about ten students over the years mentoring them through
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1 their programs there. And that's where I learned, of course,
2 a lot about distance education and then they had some
3 changeover there, new president, new administration. We
4 didn't really see eye to eye, and that's when I decided that
5 I'd like to do this on my own.
6 Q. I wanted to also get to some of your comments about
7 the fact that a lot of the referrals are really driven by the
8 IEP.
9 A. Yes.
10 Q. And the IEP team?
11 A. Yes.
12 Q. And that there was a certain latitude in terms of
13 interpretation?
14 A. Sometimes.
15 Q. Does the IEP identify a specific institution to
16 refer a child to?
17 A. Not usually. Depends on who is at the team. I
18 mean, I've seen that where sometimes when you have a strong
19 advocate or someone in the IEP meeting, they make sure that
20 an actual name is put in there. It usually doesn't show up
21 in the body of the IEP, but it's what they call the
22 conference notes, which is kind of the narrative section, and
23 I have seen there it will say so-and-so program, will attend
24 so-and-so program, something like that.
25 Q. But if it's not --
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1 A. We try to not do that.
2 Q. Excuse me for interrupting. So, for instance, when
3 you get that IEP and you are to refer a student to a specific
4 institution for service, how do you -- is there a list that
5 CAMHD or the Department of Health has given you in terms of a
6 reference?
7 A. Yes, there's a -- I think we refer to it as the
8 provider directory.
9 Q. There was previous testimony by Dr. Kravets about
10 his institution, Alaka'i Na Keiki, and their -- in his
11 opinion his organization's ability to also provide day
12 treatment for autistic children. Were you aware -- you were
13 in the audience yesterday, weren't you?
14 A. I did hear that testimony, yes.
15 Q. Would you agree with that?
16 A. With?
17 Q. His assessment of his organization, Alaka'i Na
18 Keiki.
19 A. If they --
20 Q. If they are able to --
21 A. If they are able to do a day treatment for autism?
22 Q. Uh-huh.
23 A. I know Dr. Kravetz has good knowledge and
24 background in the area of autism. I believe he worked with
25 Dr. Lovaas at UCLA, so I would think that they would have the
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1 expertise to maybe get something like that off the ground if
2 they wanted to.
3 Q. Have you ever referred any students to him for day
4 treatment, to Alaka'i Na Keiki?
5 A. They do not have a day treatment.
6 Q. Okay.
7 A. They -- I think what he testified is they put in a
8 proposal, but they were not awarded it. They do not have a
9 day treatment, I don't think, not for autism. I believe the
10 only autism day treatment program is Loveland in Honolulu and
11 then Child and Family Service has one out in the Ewa Beach
12 area, and let's see, I don't believe -- on Oahu -- actually,
13 in Honolulu another school organization that gets just as
14 many as Loveland from Honolulu is Variety School. Now,
15 Variety School isn't a contractor with the state. They're a
16 private school, so when we -- when it's decided at an IEP
17 that a child is going to go to Variety School, that's usually
18 paid for either through our flex funds with the DOH or it's
19 paid for by the DOE. But the last time I actually checked
20 the numbers, there's 14 or 15 kids at Loveland and 14 or 15
21 kids at Variety School in Honolulu which are autistic. Most
22 are paid for by the DOE there, though. So as you heard
23 Dr. Gardiner say, you know, there's only a few shows in town.
24 VICE-CHAIR SENATOR KOKUBUN: Thank you.
25 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
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1 Representative Ito, followed by Senator Slom.
2 REPRESENTATIVE ITO: Thank you, Co-Chair
3 Saiki.
4 EXAMINATION
5 BY REPRESENTATIVE ITO:
6 Q. Dr. Drews, you know, is Loveland Academy the --
7 located in the old Island Paradise school? Is that the
8 old --
9 A. I'm seeing heads nodding.
10 Q. I was looking at the pictures here.
11 A. Paradise school?
12 Q. Island Paradise.
13 A. I'm not familiar with that.
14 Q. Former Island Paradise.
15 A. I was familiar with Elite Academy. I think it was
16 called that at one time way back when, but I hadn't heard
17 that other term. I think it has been several schools over
18 the last decade. It's a pretty old campus that's been around
19 since the '50s, I think.
20 Q. Do you know of any DOH or DOE personnel that went
21 to Honolulu University who graduated from Honolulu?
22 A. DOE or DOH?
23 Q. Yes.
24 A. Yes.
25 Q. What, DOE or DOH?
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1 A. I know of one from DOH on my staff.
2 Q. That graduated from Honolulu --
3 A. Yes.
4 Q. -- University?
5 A. He got his master's degree at Honolulu University.
6 Q. What about DOE?
7 A. No, not that I'm aware of.
8 Q. You know, once you receive this degree, does that
9 meet the state minimum requirements, you know, for doing the
10 servicing for the Felix kids for this kind of clinical type
11 of --
12 A. I think, as I mentioned before, any credentialing
13 or requirement by the state that I've seen in writing says
14 regional accreditation, and if that's the case, then
15 certainly my school wouldn't qualify and Honolulu University
16 would not either. They have an international accreditation,
17 but it's not regional accreditation.
18 Q. Let's say I open up my own school, a private
19 school, does that qualify, I mean, to get contracts?
20 A. I don't think there's anything keeping anyone from
21 opening a private school, but to get accredited, of course,
22 is a long, intensive process, which I'm just going to be
23 learning quite a bit about soon because we finally have our
24 two years now that we can actually be eligible for candidacy.
25 Q. You know, besides Loveland Academy, you know, does
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1 CPU use other physical plant or any other schools or
2 institutions for instruction?
3 A. Do we -- does CPU use other physical plants?
4 Q. Besides Loveland.
5 A. Well, I mean, our main office is on Kapiolani. It
6 used to be on Bishop and we moved our main office to
7 Kapiolani.
8 Q. So basically only two facilities?
9 A. Yeah, we have the classroom, which we never use, or
10 at least haven't had a chance to use much of, and then our
11 main office at Kapiolani.
12 REPRESENTATIVE ITO: Thank you.
13 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
14 Senator Slom, followed by Representative Kawakami.
15 SENATOR SLOM: Thank you, Co-Chair.
16 EXAMINATION
17 BY SENATOR SLOM:
18 Q. CPU, you said it's a nonprofit. Is it a 501(C)3
19 corporation?
20 A. Yes.
21 Q. Are the 990 tax returns on file?
22 A. Yes.
23 Q. Did this committee receive any copies of that, do
24 you know, the latest?
25 A. No, I don't believe so.
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1 Q. I'm just curious, because you have so many
2 administrative responsibilities for the Department of Health,
3 how is your day split between Department of Health and CPU?
4 How many hours do you devote to CPU?
5 A. I don't devote very many hours to CPU at all.
6 Basically on my weekends I'm -- you know, for some of the
7 students that I'm mentoring I'll be grading papers at home or
8 reading a thesis or different kinds of course papers.
9 Usually that's what I do on the weekends. I'm never at the
10 Kapiolani office to speak of.
11 Q. So it's not really a day to day, hands on --
12 A. My full-time job is with the state, and this is
13 something I've, again, begun to do on the side, and of course
14 most of the work is done by the different faculty that are
15 around the country. They work on line with the students.
16 Q. You had testified that as far as the student mix,
17 about 75 percent were from mainland and 25 percent were from
18 the rest of the world, as I recall?
19 A. Right.
20 Q. And you have about 140 students all together?
21 A. Right.
22 Q. Is that an accurate number? I'm referring to a
23 memo from Doug Miller dated April 19th, 2001 when he was
24 talking to Dr. Dukes, and at that time in that memo Dr. Dukes
25 said that CPU is a distance learning school with most, if not
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1 all, students located in Europe and Asia. Is there a change?
2 A. That was just inaccurate. I don't think Dr. Dukes
3 knew that much about the students of CPU.
4 Q. Okay. In that same April 19, 2001 memo, the
5 statement is that Dr. Dukes advised that there are no formal
6 agreements between CPU and Loveland, yet there is a copy of
7 what seems to be a formal agreement dated October 1st, 1999
8 entitled memorandum of agreement between Loveland Academy and
9 Central Pacific University talking about the donation of the
10 classroom space and signed by you and by Dr. Dukes. Is that
11 not a formal agreement?
12 A. Yes, it is. Which was the first thing that you
13 were referring to where it said there is no formal agreement?
14 Q. On the memo --
15 A. Memorandum for the record?
16 Q. Yeah, April 19, 2001.
17 A. Which bullet is it, how many down?
18 Q. It's the last one, very last one. Dr. Dukes
19 advised there are no formal agreements between CPU and
20 Loveland and no money has been exchanged for any purpose, and
21 yet there was, in fact, a formal agreement on October 1st,
22 1999.
23 A. Right.
24 Q. So that was a discrepancy.
25 A. That was a discussion between Doug Miller and Patty
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1 Dukes, and I -- certainly we had that agreement. We didn't
2 do anything until we had that agreement on file so that --
3 Q. And then your supervisor had indicated that she
4 never saw -- actually saw nor signed your disclosure of
5 outside employment dated September 1999. Was there any
6 reason or anyone know why she didn't see it or didn't sign
7 it?
8 A. What this says is -- because I knew I sent it in
9 downstairs, and again, as I said, I was playing by the rules.
10 Evidently it says something in there that it got lost
11 downstairs.
12 Q. Within the office itself.
13 A. But once the investigation started, they found it
14 down there.
15 Q. I see. One final question. There also is a memo
16 dated April 10th, 2001 to all family guidance center branch
17 chiefs from, again, the supervisor, the chief of CAMHD, and
18 it's a two-page memo. It's about services to Felix youth
19 during the HSTA strike. The very last sentence in bold face
20 says, Please notify me immediately if anyone has already
21 procured additional services beyond a student's IEP or MP.
22 You're familiar with that memo?
23 A. Yes.
24 Q. Did you at any time authorize increased services to
25 Loveland Academy during that strike or any other time beyond
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1 the IEP?
2 A. No, I did not. As a matter of fact, the report I
3 think states that they went down during that time.
4 SENATOR SLOM: Thank you. Thank you,
5 Mr. Chair.
6 CO-CHAIR REPRESENTATIVE SAIKI: Representative
7 Kawakami, followed by Senator Buen.
8 REPRESENTATIVE KAWAKAMI: Thank you, Chairman.
9 EXAMINATION
10 BY REPRESENTATIVE KAWAKAMI:
11 Q. Just a few questions. Actually, Dr. Drews, you
12 wear two hats, am I correct?
13 A. Sometimes I feel like it's about ten.
14 Q. I was trying to get it straight in my mind. So
15 you're the branch chief of the guidance center, right?
16 A. Honolulu Family Guidance Center.
17 Q. Which changed its named to Honolulu Family Guidance
18 Center; is that right?
19 A. Right.
20 Q. Which encompasses some of the other guidance
21 centers as well as Diamond Head?
22 A. Right.
23 Q. When did that occur?
24 A. I don't know if you would find an official date
25 that there was an official change. If you actually look at
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1 some of the documents and stuff with CAMHD, you'll see that
2 Kalihi, Palama, and Diamond Head are still kind of separated
3 out. At one time they were separate family guidance centers.
4 Each one had their own branch chief. The position at
5 Kalihi-Palama was actually moved to division, and I was asked
6 by Tina Donkervoet to assume the responsibility for both of
7 them. This was kind of in the early days of my employment
8 with the state, because, again, we were trying to align
9 ourselves with the school districts. We seemed kind of
10 disjointed. They were having some problems at Kalihi-Palama
11 and needed some leadership and help and basically we came to
12 the decision that I would be the chief for both plus the two
13 day treatments.
14 Q. Has it worked out better?
15 A. I think we do a pretty good job in Honolulu. I'm
16 very proud of the work that we've done. I think we are more
17 efficient. I think it was a little too disjointed before in
18 the old days, and, you know, I think the accomplishments
19 speak for themselves. I'm hoping in a couple of weeks I can
20 say Honolulu is in full compliance with the consent decree.
21 We only have one more service testing to get through in two
22 weeks, and I have every reason to believe that we'll pass
23 that and we will be in full compliance.
24 Q. Which one is left?
25 A. The one that's left is Roosevelt, and that's in two
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1 weeks.
2 Q. Okay. And then you also are the president of CPU,
3 am I correct?
4 A. Yes.
5 Q. Going back to your message and, you know, what you
6 put out, you have a very extensive school of psyche,
7 religion, et cetera, et cetera, that goes out to all over?
8 A. Uh-huh.
9 Q. Most of the students that use that come from where?
10 You're getting kids from --
11 A. The ones that I personally work with them on their
12 programs? I usually work with the psyche students because
13 that's really my background. I've been in mental health 25
14 years. I've had a few business students. Really it does
15 look like we have a lot of different areas, and some are much
16 more popular than others. Really our main areas for CPU are
17 computer science, business, psychology, education, and music.
18 Those -- was that five? Those five make up the bulk of our
19 students.
20 Q. So you handle all of that?
21 A. No, no. I just work with some of the psyche
22 students. We have other faculty that have expertise in the
23 other areas and they work with them.
24 Q. How many students are enrolled in these main areas?
25 A. Oh, in each of the areas?
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1 Q. Well, in the five that you mentioned, about how
2 many students roughly?
3 A. As I said, we have about 140 students, so my guess
4 would be well over a hundred of them are in those five areas.
5 Q. So when they complete your course work, which runs
6 for how long?
7 A. It depends on the student. Each one is on an
8 individualized program. Some of them may be coming with lots
9 of transfer credits from other schools they've attended, some
10 may need a lot of course work, so it can vary. Some of them
11 with us from the beginning and aren't working too fast. One
12 of the nice things about distance education is it is
13 self-paced so a person doesn't have to quit their job and go
14 back to a classroom and, you know, stop the paychecks from
15 coming in. They can work in the evenings. They can work on
16 line. They can do papers on the weekends, so some of them
17 really jam at it real hard and can get the work done in --
18 you know, if they have ten credits or so to do, they can do
19 that in four or five months. Others, they may be working
20 with us for a year or so. It really is individualized.
21 Q. Are those mostly students from away rather than
22 locals?
23 A. Yes.
24 Q. All, almost all?
25 A. Almost all, yeah. We don't --
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1 Q. Go ahead.
2 A. Sorry. We don't do any local advertising at all.
3 All we have is the Web page.
4 Q. Where are they concentrated from?
5 A. Mainland U.S., you know, all the 50 states, and
6 then, as I said, we get them from every other conceivable
7 country. As long as they speak -- they have to do it in
8 English, so they have to be English-speaking students because
9 all of my faculty are American faculty, but around the world
10 there's getting to be more and more people that are fluent in
11 English, so China, Japan, Taiwan, Malaysia, Africa, Europe.
12 Really some very interesting people. And these aren't people
13 that are just fresh out of high school. You know, we really
14 are geared for working professionals already involved in
15 their careers that can't just stop everything and go back to
16 school. Many of them have all kinds of training and
17 expertise in their areas and we bring them back together. We
18 try to bring the credits all into one place so that we can
19 apply them towards their area of expertise, and some of them
20 are, you know, CEOs of corporations, some of them are top
21 level educators, some are, you know, computer programmers for
22 NASA. It's really an impressive bunch of people.
23 Q. It's an array?
24 A. Yes.
25 Q. Are you giving mostly master's and Ph.D.s?
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1 A. No, bachelor's as well, but for the bachelor's what
2 we require is that they at least come in with -- it takes 120
3 credits to get a bachelor's degree, which is a four-year
4 degree. We won't take anybody that doesn't have already 60
5 traditional credits. I really don't believe that someone
6 should come right out of high school and do distance
7 learning. I really do feel that -- especially an
8 undergraduate, it's a very valuable experience. It was for
9 me, and I think they should go to traditional classrooms and
10 have professors and have the social life of a college, so on
11 and so forth, but -- so most of those, they get all their
12 core courses, their general studies out of the way and we
13 really just focus on their area, their field of endeavor, if
14 it's psychology or business, what have you, and we just focus
15 on those courses, then, and we can of course keep those
16 tuitions much lower than ones at other schools because we
17 don't have to pay for a football team, and a gymnasium, and
18 all kinds of buildings, and a big library. All we pay for is
19 the instructors to work directly with the students, and I'll
20 hold my graduates up to any other graduate around.
21 Q. And then just maybe the last question. I wanted to
22 follow up on that service authorization during the strike. I
23 think Senator Slom kind of mentioned it. So what actually
24 went on for those students that were caught in the strike, et
25 cetera, was there a service reauthorization in terms of what
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1 you would add hours to, et cetera?
2 A. No. We were informed and told not to do that,
3 because when there's a strike, there's no school going on,
4 and of course mental health is a related service to
5 education. If there's no education, there usually wouldn't
6 be a whole lot of related services. We didn't stop therapy,
7 of course, and we didn't stop anything abruptly that would
8 hurt the child or the family, but during the strike, of
9 course, there was lots of people saying I want a whole bunch
10 of TA, I want a whole bunch of after school, because these
11 kids weren't in school and the parents weren't working,
12 didn't know what to do with the kids.
13 So there was always kind of requests, and we're not
14 in the business of child care, so we were instructed not to
15 increase services, and I think that's what triggered this
16 whole investigation was a competitor of Loveland made a
17 complaint sayings they thought I was doing that, and of
18 course they furnished them with all the documentation and I
19 had not done that and I -- out of the goodness, I think, of
20 Dr. Dukes' and Dr. Koven's heart I think they took on a bunch
21 of these kids pro bono just to help the parents and the
22 families during that really tough time for all of us. So I
23 think they probably lost a lot of money during that time, or
24 at least they worked for free a lot, but we didn't authorize
25 extra services during the strike.
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1 Q. I thought I remember Ms. Donkervoet's memo saying
2 that you were -- they were supposed to keep in contact with
3 your care coordinators, et cetera.
4 A. Sure.
5 Q. They did that type of outreach?
6 A. We made phone calls to all the parents, is there
7 anything we can do to help. Not necessarily give money or
8 services, but connect you with some community resources, the
9 Y, you know, things like that, offer them something to really
10 help them out because we knew they were in a jam.
11 REPRESENTATIVE KAWAKAMI: I want to thank you
12 very much.
13 CO-CHAR REPRESENTATIVE SAIKI: Senator Slom,
14 followed by Senator Leong. I'm sorry, Senator Buen, I'm
15 sorry.
16 SENATOR BUEN: Thank you, Co-Chair Saiki.
17 EXAMINATION
18 BY SENATOR BUEN:
19 Q. Dr. Drews, I'm looking at an email -- copy of an
20 email from Christina M. Donkervoet. Ms. Donkervoet is who to
21 you?
22 A. She's my boss. She's the chief of the division,
23 CAMHD.
24 Q. In the email note it says here, Alan brought to my
25 attention late Friday afternoon on March 16, 2001 that the
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1 attorney general's office had notified him that they were
2 completing an investigation about yourself, your relationship
3 with Loveland Academy. And by the way, who is this Alan?
4 A. I'm sorry?
5 Q. Who is this Alan that she's referring to?
6 A. She's probably referring to Alan Shimobokuru who
7 used to work for DOH.
8 Q. And Alan commented that he found this odd because
9 usually the AGs would only investigate if there was criminal
10 activity, and Alan notified me that the issue apparently
11 involved Central University, CPU, sharing space with
12 Loveland. My question is: Did you notify Ms. Donkervoet or
13 any of the others that you were being investigated by the
14 AG's office?
15 A. I never was being investigated by the AG's office,
16 so I don't know what that was all about, or at least if they
17 investigated me they never let me know about it, and I
18 believe in one discussion with Tina later on she said she
19 didn't know where that came from, but there's a big rumor
20 mill out there, I guess.
21 Q. So there was no investigation by the AG's office?
22 A. Not that I'm aware of.
23 Q. Can you tell me if the sign at the Loveland
24 Academy -- the CPU sign is still up outside of the Loveland
25 Academy?
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1 A. Yes, it is.
2 Q. It's still up there?
3 A. I haven't been there in a while, but I haven't
4 taken it down. I wasn't instructed to.
5 Q. There was another email from Doug Miller. Now, who
6 is Doug Miller?
7 A. He's the assistant chief of CAMHD, so sort of the
8 deputy to Tina.
9 Q. This email is again discussing the Loveland issue
10 with CPU, and it's the last page in what was handed out to
11 us.
12 A. Is this the one dated May 18th?
13 Q. This is dated May 18th of this year regarding
14 Loveland investigation it says. Who was that investigation
15 done by?
16 A. The investigation was done by CAMHD. Doug Miller
17 led the investigation.
18 Q. I see. There was a message from yourself to Doug
19 Miller and to Tina Donkervoet regarding this investigation,
20 and it says here Tina reviewed the modifications you made on
21 the Web and expressed that she was okay with them. And was
22 she okay with them?
23 A. Yes, that's what she told me. She called me in
24 after this investigation was completed, called me to sort of
25 give me the results of it and basically said here's what we
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1 came up with and here are the things that we feel that you
2 need to do, and that was already discussed, that was the
3 changing of some of the text in the Web page and the -- and I
4 spoke about the sign issue with her specifically because
5 there was a little confusion there. There's really two signs
6 we're talking about. There's this one that's on the outside
7 of the building that you can see from Piikoi.
8 Q. And the other one was inside?
9 A. Was inside the classroom, yeah. And see, that sign
10 inside the classroom originally was glued to the wall, so it
11 wasn't really movable, and what they had suggested was to
12 make it movable so that you only hang it up if you're using
13 that room for something, because Loveland has IEPs in that
14 room and staff meetings in that room, and obviously it
15 wasn't, I don't think, in anybody's best interest to have a
16 CPU sign there when they are conducting their own business.
17 So what we were instructed to do is if we are just going to
18 use the classroom once in a while for seminars and so forth,
19 you can hang it up there because those would be evening kind
20 of things anyway where Loveland is already shut down and the
21 kids aren't there and the staff isn't there and then you can
22 put the sign up, but in the meantime, fix it so you can
23 remove the sign. So I know Dr. Dukes instructed one of her
24 folks to rip it off of the wall and make it hangable just
25 like a picture, and that's what they did.
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1 Q. Thank you. Also you had said that you had assured
2 Tina that you would apprise her of any changes in CPU that
3 might have other conflict ramifications. Were there any
4 changes since what you had done and Tina said she's okay
5 with?
6 A. No.
7 Q. Now, what was this Tina also said I could have a
8 copy of the entire file you created?
9 A. Right, that was just me requesting a copy of this,
10 because there was only the one so far at that time from Doug.
11 Q. And you had asked that these agreements can be made
12 apart of the official file. Now, what are these agreements?
13 A. Oh, the information in that email. I guess I was
14 just trying to document what had occurred in a meeting with
15 Tina and myself, and that is, okay, are we clear now on what
16 you want me to do, you know, what changes you want me to be
17 made. So I just wanted that documented.
18 Q. Dr. Drews, wearing all these hats that you do, as
19 the branch chief for the Honolulu Family Guidance Center and
20 having to -- how these children -- these high end autistic
21 children go to the day care center and also having a CPU sign
22 out there at the Loveland Academy, going through all of this,
23 you know, do you really feel that there is really no conflict
24 of interest here?
25 A. You know, I've tried to the best of my ability to
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1 separate these two as cleanly as possible. I really have.
2 You know, in Hawaii it's just a fact for probably half the
3 people in this room that we have more than one job just to
4 live in this state, and I don't think there's anything wrong
5 with that. But to try to separate them, I think just about
6 anybody that's seen me in action as a branch chief knows that
7 I'm speaking for the state. I'm very clear on what my role
8 is. If I'm in an IEP, I could be in an IEP with Maggie and
9 Patty here and we might go head to head, and it has happened
10 in the past.
11 I really separate those two, and I talk about that
12 with them, saying I'm here in the capacity as branch chief,
13 or the few times I have been there it's obvious I'm there
14 after hours and I'm there in the capacity of CPU. I really
15 try to draw the line. My own staff has approached me asking
16 if they can enroll in my school, and I've discouraged that
17 because there I think is a clear conflict of interest. I've
18 been asked to be on the committee that decides who gets
19 contracts for autism before, and I declined to be on that
20 committee because I thought that would constitute a conflict
21 of interest, but what has gone on I don't feel did constitute
22 it.
23 Is there an appearance of conflict? Obviously a
24 lot of people had some concerns, so evidently there is an
25 appearance, but an appearance doesn't constitute a real
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1 conflict, and again, if I had been firmly instructed saying
2 get the sign down, cut off all your communications with
3 Loveland as far as CPU or you're out of here, you know,
4 certainly I would have done that, but I just tried to be
5 forthcoming all the way and honest and up front and dot all
6 the I's and cross the T's and not hide anything and really
7 try to separate those two things because I'm very committed
8 to both and I'm trying my best to keep them separate.
9 SENATOR BUEN: Thank you, Dr. Drews.
10 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
11 Representative Leong, followed by Senator Sakamoto.
12 REPRESENTATIVE LEONG: Thank you, Chair.
13 EXAMINATION
14 BY REPRESENTATIVE LEONG:
15 Q. When we were discussing the billing done to
16 Loveland and you said you really didn't know but you had
17 someone to pull it up in the computer very quickly if you
18 needed to have this done. How many times have you had to do
19 this if questioning it?
20 A. For Loveland?
21 Q. Yes, or for any account.
22 A. I think we get, you know, questions about billings
23 on a -- well, maybe not a daily basis, but every few days
24 probably something comes up, and it's not like these are
25 terrible, drastically bad things, but that's part of
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1 operating a business, people will have a little concern, and
2 of course I have the ability to pull that up on my computer,
3 but I don't do it. I don't even know what my password for
4 that is lately because I rarely, rarely even look at that
5 kind of stuff. I go to my fiscal guy, who is my numbers
6 person, and say check this out and see what's going on with
7 the billing. And as I said, it rarely is something that has
8 been talked about prior in testimony about the double billing
9 or something that might be deceptive in some way. It's
10 usually we need our service auth, please get us our service
11 authorization so we can get paid. It may be the care
12 coordinator didn't get it sent in, it could be another fault
13 on our part that someone didn't do their job or get it in on
14 a timely basis, or it could be on the provider's side where
15 we sent it to them but they lost it or it got misplaced or
16 their fax wasn't working or something like that. That's the
17 typical kind of thing that my PHAO -- and especially most of
18 my tenure at the state was a previous PHAO, I mean, he just
19 handled all that and kept me from all those headaches, which
20 I really appreciated.
21 Q. What's a PHAO?
22 A. Public health administrative officer.
23 Q. Thank you.
24 A. And basically that person's responsibility is
25 two-fold. They're kind of a personnel person as well as the
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1 fiscal.
2 Q. In the same line of questioning you talked about
3 IEPs, that the amount of hours seemed to be too extreme, that
4 you knew what the IEP had stated by looking at it. I always
5 question how do you know when you're servicing a child how
6 many hours are really required when you really don't know the
7 exact condition? I mean, you've got some history because you
8 have these IEPs, how do you know how many hours are going to
9 be predetermined?
10 A. I don't think anybody knows that, you know, for
11 sure. We have some standards. We have experience. We kind
12 of know how many hours may help the child. There's such
13 individual situations, but a lot of them have to do with what
14 kind of scheduling and curriculum is the child in. When they
15 talk about TA, for instance, do you need the one-on-one in
16 the classroom? We know how long a classroom goes, so that's
17 pretty cut and dry. Do you really need one-on-one in the
18 after school program? If so, we know usually know how long
19 that goes. Then they may be asking for TA at home or on the
20 weekends and, again, you know, you have to look at each kid
21 and what's appropriate.
22 Most of the time I think it is appropriate. It's
23 an expensive service. It adds up a lot and, you know, I
24 usually get pulled in when it gets to the point of
25 something's really sounding ridiculous. I've been in IEPs
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1 where a kid has been assigned by the IEP team, usually
2 because there's an advocate or an attorney pushing for it
3 pretty hard, 300 hours a month. If you do the math, that's
4 $8,700 just for the TA for a month for one kid. It may be
5 warranted, but some people might say that's excessive.
6 One of the first questions I'll ask is does the
7 parent ever see this child, because that's almost -- I think
8 that comes out to nine and a half hours a day that they are
9 with the TA, and usually those kinds of kids also have a
10 13101, which is intensive in-home, and they've got a bunch of
11 hours and maybe they're seeing an individual therapist and
12 there's some hours and maybe -- and they are in school, so
13 sometimes you start just looking at the day in the life of a
14 child and, you know, they are being raised by the state.
15 Now, those are extreme cases, and I don't want to
16 any way make it sound like that's the norm, but those are the
17 kinds of IEPs and the cases that come to my level and I guess
18 I get a little jaded after awhile because those are the kinds
19 of cases I always see, but these are a minority. That's
20 usually when I get in on those levels of the billings.
21 Q. Now I have some questions about the university of
22 which you are the president of.
23 A. Yes.
24 Q. First of all, I want to know who evaluates these
25 credits that your students come in with? You say they have
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1 to have at least 60 credits. Who does the actual evaluation
2 of them to see that they have passed or what they have done
3 with these credits?
4 A. There's an evaluation committee made up of myself
5 and the registrar and some of the faculty and we'll look that
6 over. Some of it is very easy to verify. We always have the
7 transcripts sent to us by the university that they attended
8 somewhere else, so of course those are official documents.
9 If it's less official things like they attended a bunch of
10 seminars or they got some continuing education credits here
11 and there, usually those certificates will all be sent.
12 We'll get a whole package of stuff from the student early on,
13 which we have their resume, we have all their transcripts, we
14 have any documentation of other trainings and so forth that
15 they've done, and we verify all that, and then based on that
16 evaluation we know how many more credits they need in order
17 to get their degree, and that's what dictates what their
18 educational program is going to be.
19 Q. Okay. And if you have a candidate for a Ph.D., and
20 I don't know how many you have, but if you have a candidate
21 for it, and do I understand that your CPU is not yet
22 accredited?
23 A. No, they are not now.
24 Q. So if someone earns his Ph.D. in a nonaccredited
25 university situation, how valid is it for him to put on his
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1 resume that he has an actual Ph.D.?
2 A. Well, it's --
3 Q. And in line with that, sir, where did you get your
4 Ph.D.?
5 A. I already testified from Honolulu University.
6 Q. At Honolulu University, and is that an accredited
7 school also?
8 A. It has international accreditation. It does not
9 have a regional accreditation. It's APICSE, Academy for the
10 Promotion of Internation Culture and Scientific Exchange.
11 It's an accrediting body out of Europe which is legitimate
12 and does accredit schools, I believe, in Europe and possibly
13 Asia. The United States has kind of a unique situation in
14 that we're the only country in the world that has a
15 third-party outside accrediting agency that accredits the
16 schools, such as WASC or something like that. Most countries
17 you can't even have a school unless the government certifies
18 it, the ministry of education or something like that.
19 Q. I've been given the time, but one quick question,
20 sir. How long does it take to earn a Ph.D. and what does it
21 cost?
22 A. The cost is $4,000 and the length of time it takes,
23 again, depends on how many transfer credits they already --
24 they have to do a dissertation, which is a major course
25 project. They all do a dissertation, just as every master's
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1 student does a full-on thesis, but then there may be
2 additional course work.
3 Q. Thank you.
4 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
5 Senator Sakamoto, followed by Representative Marumoto.
6 SENATOR SAKAMOTO: Thank you, Chair.
7 EXAMINATION
8 BY SENATOR SAKAMOTO:
9 Q. Maybe we've exhausted your university side. So
10 back to your other hat. You have the service authorizations,
11 so the IEP is done, let's say one was done Friday and then
12 your staff would do a service authorization based on what
13 was --
14 A. Agreed at the IEP.
15 Q. If it's TAs or any of the other services?
16 A. Yes.
17 Q. Is that -- does someone then quantify student 432
18 has X amount of treatments at X amount of dollars as a budget
19 based on that IEP?
20 A. I'm not sure what you mean by a budget.
21 Q. I guess I mean, you know, day treatment, $222; TA,
22 $29, et cetera, et cetera. So I guess I'm saying if
23 yesterday the IEP said the agreement was day treatment for
24 three months, TA for two hours a day, et cetera, et cetera --
25 A. Right.
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1 Q. -- does someone in your staff, then, transform that
2 into -- for the particular student, these are the dollars
3 authorized?
4 A. Yeah, actually, our MIS system, our management
5 information system, automatically does that so we can get
6 reports run back so we can at any given time I think pull up
7 and see -- we can pull it up by child. If we want to know
8 exactly what services Johnny has and how much they are, I
9 think they do have a pretty good system of breaking out
10 exactly the dollar figures.
11 Q. So going forward from now the system globally could
12 say we've estimated X million dollars for the month of
13 November based on current service plans based on IEPs, MPs?
14 A. Yes. We break it up quarterly. I did just do some
15 numbers, anticipating that you might ask that, but for
16 Honolulu I can tell you we spend 20 million a year on
17 services, that's procured services for Felix kids. Our
18 operating budget is $90,000 for both centers and the day
19 treatment, so we can operate very cheaply, I think, but the
20 services, of course, are quite expensive.
21 Q. And along with that, is there -- just as you can
22 budget dollars clearly based on service authorized, is there
23 some sort of performance saying and this will result in these
24 performance measures?
25 A. Well, we're always sort of tracking performance, if
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1 I'm reading you right. You mean outcomes of the kids?
2 Q. Well, I hear CALOCUS, et cetera, et cetera, so
3 obviously there's some measures of where the person is.
4 A. Right.
5 Q. So along with the servicing, here's dollars and
6 here's hours, is there also related to that here's what
7 outcomes or what measures we hope to achieve?
8 A. Yes, certainly, and that's something that I really
9 stress to the care coordinators is not -- it used to be when
10 people had 120 cases each, they were doing a good job if they
11 could just get all the service authorizations out and get the
12 paperwork done. We had no way of really tracking if it got
13 done or if the kids were getting better or not. They were
14 just overwhelmed by their case loads.
15 Now that they are so reasonable, certainly we want
16 to start using the CAFAS, the CALOCUS, the Achenbach, which
17 all will measure progress in a kid, and of course the DOE has
18 all kinds of ways of measuring academic achievement too. You
19 look at all of those things and I, at least, and some of my
20 staff will also look at, you know, are we getting some good
21 benefits for all the services that we have in place and look
22 at that comparison. I think they probably analyze data in a
23 lot of different ways in this state in terms of how much does
24 it cost to, say, bring an ADHD kid to so-and-so level of
25 functioning and they kind of look at that.
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1 So yes, we really want to track outcomes.
2 That's -- again, if anyone has ever seen me in an IEP, you'll
3 see me ask the question many times, you know, show me the
4 evidence this kid is getting better.
5 Q. So you're in the process of increasing your
6 capability to track the outcomes?
7 A. I think we're doing a much better job at that now,
8 yes.
9 Q. So in autism, services such as Loveland Academy has
10 provided, are there others similar or they are primarily
11 for -- your referrals primarily go to Loveland for the types
12 of autism services that they perform?
13 A. If it's day treatment that the IEP determines the
14 child needs for autism, Loveland will get it because they are
15 the only ones.
16 Q. For biopsychosocial?
17 A. For BPSR, biopsychosocial rehab, then we had some
18 choices. We use the SEED program, which is part of CARE, one
19 of our other agencies, there is Loveland's after school,
20 there is I think Child and Family Service.
21 Q. How are the distributions done? Is it one for you,
22 one for you, one for you, one for you, one for you, or is it
23 looking at the outcomes or is it looking at addresses? How
24 do you distribute who gets what, who gets which client?
25 A. I don't get involved in that at all, but it's
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1 basically up to the care coordinators. They are the ones
2 that have the relationship with the providers, and some of
3 them have their favorite providers that they'll use. It's
4 not that there's big discrepancies in the cost. They are all
5 pretty similar. So it's just who they have the relationship
6 with. Sometimes it's whoever has the opening, you know, but
7 it's up to the care coordinators.
8 Q. So far you haven't mandated use outcomes as a
9 measure of who to send the new clients to?
10 A. That's a very good question, and I guess if I could
11 be privy to maybe better data about who's doing the best job
12 out there, I'd certainly like to send more folks that way. I
13 think unofficially a lot of the care coordinators already
14 have a pretty good idea of who they think does a better job
15 than others, but the thing is there's such a shortage in the
16 state of certain providers that the ones that do the best job
17 are always booked up.
18 Q. So finally, then, based on your knowledge as far as
19 Loveland, has there been satisfactory performance or, gee, we
20 wish we had somebody else but they are the only show in town
21 so we send them there anyway or they're doing a good job and
22 we're happy that they're doing a good job?
23 A. Well, I've only been involved, to be honest,
24 personally with two kids at Loveland in different capacities.
25 One was because I was just covering for one of the
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1 supervisors that's involved in service testing, so I've been
2 following this one child. And then a while back there was
3 another child that all of us branch chiefs were supposed to
4 get training in FBA, or functional behavioral assessment, and
5 we all had a child assigned to us that we had to do a lot of
6 observations. So I was on campus at Loveland watching this
7 child and so forth. So that's the only two kids I've had
8 firsthand experience with of, you know, seeing Loveland in
9 action with a kid, you know, and I have no problems with what
10 I've seen with those two kids.
11 Anecdotally, of course I get all kinds of feedback,
12 and I would say in general the majority of it is positive. I
13 mean, I know of particular cases where the praise is a little
14 stronger than that, like, wow, you guys worked miracles with
15 a couple of these kids, I mean, kids that were totally
16 nonverbal when they arrived there and within a few months
17 they got the kids talking in five-word sentences, so there's
18 been some really good work done there.
19 Should there be another show in town? I guess
20 competition is always healthy. I would really like to see
21 the day where the state -- no offense to Loveland or anyone
22 else, but where, you know, the school can handle the kids at
23 the public school and they have really good resources there.
24 I think we all want to get there, but we aren't there yet.
25 There's a need for Loveland. Whether there's a need for
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1 other agencies like Loveland, I don't know. I'm not sure of
2 their capacity and if they have a lot of kids on the waiting
3 list or not or if there's a lot of need for more day
4 treatment for Loveland.
5 I know everybody was pretty excited once they
6 opened their doors because we didn't know what to do with a
7 lot of these kids and the schools didn't know what to do with
8 a lot of these kids, and that's why I think everybody was
9 very happy that Loveland was going to take a big risk and try
10 setting up a day treatment program for autism. There's 172
11 autistic kids in Honolulu. That's what I'm aware of, and of
12 172, about 14 of them are at Loveland. I don't know that
13 many more of those kids need to be at Loveland.
14 I think we are getting better and better at
15 bringing up the capacity of the Department of Education and
16 the schools to -- there's a lot more expertise on the DOE
17 side now. They've got their own consultants. They've got
18 more clinicians. I know Loveland folks are usually always
19 happy to consult with the schools to help them build up their
20 capacity. I guess we all say that, you know, if we're going
21 to do a good job, we'd work ourselves out of a job, but
22 that's, you know, in essence, what we'd like to do is be able
23 to keep the kids handled right at the school level.
24 And the same with school-based mental health
25 services, the majority of those kids hopefully can be handled
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1 at the school as well. I hope there will always be a place
2 for CAMHD and our guidance centers for the really, really
3 tough ones that no way can be on the school campuses, but the
4 vast majority of them, with more capacity, with more
5 training, with more support, I think the DOE is going to be
6 able to take care of a lot more of them.
7 SENATOR SAKAMOTO: Thank you.
8 Thank you, chair.
9 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
10 Representative Marumoto.
11 REPRESENTATIVE MARUMOTO: Mr. Chairman, I'll
12 pass.
13 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
14 Members, we've been going for over an hour, so we'd like to
15 give our court reporter a break. We'll take a five-minute
16 recess. Recess.
17 (Recess taken.)
18 CO-CHAIR REPRESENTATIVE SAIKI: Members, we'd
19 like to reconvene our hearing. We'll proceed with
20 questioning by Vice-Chair Hanabusa -- Co-Chair Hanabusa.
21 CO-CHAIR SENATOR HANABUSA: That's all right,
22 I'll be your Vice-Chair.
23 EXAMINATION
24 BY CO-CHAIR SENATOR HANABUSA:
25 Q. Dr. Drews, let me get some background, first of
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1 all. You were here during the hearing where Dr. Gardiner and
2 Mr. Stewart testified, were you not?
3 A. Yes, I was.
4 Q. One of the impressions that I was left with for
5 both of their testimonies was that there had been this
6 concern raised about Loveland even before Dr. Gardiner got
7 here and that it had been brought to the attention of, I
8 guess, CAMHD. Would you agree with that?
9 A. Yes, I believe there were several audits.
10 Q. And what was the basis of those concerns?
11 A. Are you talking about the concerns prior to
12 Dr. Gardiner --
13 Q. Right.
14 A. -- or when he came on board? Prior?
15 Q. Right.
16 A. Well, those other audits were not triggered by me
17 or anyone at Diamond Head. I think I may not be totally
18 accurate here, but I believe that it is the responsibility of
19 CAMHD to do annual audits of all the providers, and so I
20 think some of those at Loveland were routine ones that
21 everyone went through, and I do get the reports after those
22 have been done. Sometimes I read them closely, sometimes I
23 don't. Again, there's so much pressure on us to get the
24 services out there and make sure the right services are out
25 there that as long as someone isn't saying there's a major
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1 problem, we continue to use the providers.
2 Q. I don't think you understood my question. My
3 question was, the impression I got from listening to their
4 testimony, especially with Bob, Mr. Stewart's testimony, was
5 there was concerns about Loveland raised to CAMHD even prior
6 to the concerns that Dr. Gardiner raised, and I wanted to
7 know if you were aware of those and you agreed with his
8 statement?
9 A. I was aware of the ones that I alluded to a little
10 earlier that were starting early in May or so where we were
11 more involved in them, and again, as I said, we tried to
12 handle that as best we could, and then I was told to let the
13 auditors do the job.
14 Q. And that's May of this year, correct?
15 A. Yes.
16 Q. In this packet that you were so kind to provide us,
17 on March 19, 2001 you write an email to Christina Donkervoet,
18 and basically you say that Diamond Head, and I assume that's
19 referring to your operation, is having meetings with them,
20 and this is Loveland, regarding some of their practices with
21 respect to the state, and you list a whole bunch of things,
22 like insisting on the most expensive level of care, no down
23 grading of services, demanding the IEPs be held at their
24 facility, and you were listing these as examples of why you
25 do not believe that you have showed any kind of preferential
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1 treatment for Loveland; is that correct?
2 A. Right.
3 Q. So these were concerns or issues that you were
4 raising yourself; is that correct?
5 A. Well, I didn't raise it myself. People brought it
6 to my attention and then I kind of took the lead with it.
7 That stimulated one of those meetings that I discussed before
8 where we brought them in and discussed some of that. I think
9 one of the things, if I may say so, that there may have been
10 some confusion over is what really is in the contract with
11 Loveland, because I had been -- when we brought these
12 concerns -- and I couldn't tell you the month, but when we
13 brought them to Loveland's attention, at one time I recall
14 that we were told that they had some special supplements or
15 riders or addendums made to their contract that gave them
16 some special abilities or what have you.
17 I never really saw those and I never really got
18 good information from CAMHD that that was true or not, and I
19 think that might have been one of the reasons that we wanted
20 to actually sit down with them and go over the contract and
21 see what specifically it said, because one of the things that
22 people had confusion about was that I think people were under
23 the impression that if you have a kid in day treatment, at
24 the highest level of day treatment, there's three levels, and
25 if we're paying for the most expensive level of day
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1 treatment, people had the impression that that automatically
2 comes with one-on-one all day long.
3 I think Dr. Gardiner was under that impression as
4 well, and my understanding is it's a three-to-one ratio that
5 their contract states, and so if they were to put on some
6 additional TAs, then, on someone in their day treatment and
7 if that is correct, then I don't think that would be a
8 problem, but I think people saw that as, hey, we're supposed
9 to already get a TA, now you're charging us for a TA, that
10 must be double billing. So that's why I thought the
11 contracts people were the ones that were appropriate to
12 really dig in and look at this because I wasn't sure what
13 kind of wording the contract was.
14 Q. Have the contracts people finished their audit?
15 A. I have not been informed they have. I invited them
16 up to my staff meeting and said, guys, whatever you're
17 looking at, please look at all this too, and that's the last
18 I've talked to them.
19 Q. You know, I've looked at your Central Pacific
20 University I guess sort of like a hand-out, and like with all
21 university systems, would it be correct to say the 400 series
22 to 300 series classes are undergraduate and five and 600,
23 700, and 800 -- five to 600 could be graduate and 700 and 800
24 seems to be for Ph.D. levels?
25 A. Generically speaking, yes, we try to follow kind of
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1 the norm with other schools.
2 Q. Now, Dr. Dukes testified that she received her
3 Ph.D. from Central Pacific University, and one of her
4 statements --
5 A. No, her master's.
6 Q. Her master's.
7 A. She has an accredited Ph.D.
8 Q. And she received her master's from you -- well,
9 Central Pacific University in psychology?
10 A. Yes. She originally had enrolled at Honolulu
11 University, and I was assigned to be her mentor at that time.
12 This was before Loveland days.
13 Q. Was she one of your first master's degrees that was
14 issued at Central Pacific University?
15 A. Yes, I believe she was one of the first.
16 Q. Have you issued any master's degrees to anyone
17 who's presently employed or was employed at Loveland other
18 than Dr. Dukes?
19 A. No.
20 Q. One of the other issues that was raised in this
21 report, let me read it to you, was a concern, and they felt
22 that if -- and I think this is the line of questioning that
23 Senator Buen was talking about, that if the banner was placed
24 on the Loveland Academy building wall on the evening when
25 graduation ceremonies were conducted, that thought that that
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1 would eliminate the perception of conflict and also that your
2 Website accurately depict the relationship between CPU and
3 Loveland. Do you recall those statements?
4 A. Yes.
5 Q. And as Mr. Kawashima alluded to, there is a new
6 Website printout. The pictures are the same and I assume --
7 well, this one is dated 10/8/2001. Do you know if you've
8 adjusted it since that day?
9 A. We adjusted it shortly after the results of this
10 investigation and did what they instructed us to do about the
11 wordage.
12 Q. So what is on as of October 8, earlier this week,
13 was probably what you adjusted for; would that be correct?
14 A. Probably.
15 Q. One of the -- as you compare the two, first of all,
16 I think in Dr. Dukes' statement which was provided to the
17 investigator, Mr. Miller, she said that the students pictured
18 in the photographs of the CPU campus site are really her
19 employees?
20 A. I think some were employees, some were maybe
21 parents, some were people that were hanging out there. I
22 really don't know who they were.
23 Q. One of the statements that's contained in this is
24 that the campus can accommodate up to 100 students in
25 classroom settings, and originally you said up to 400
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1 students in classroom settings. That's in the March 18, 2001
2 Website printout that's attached to this report, and the
3 present one says 100 students. Is there a reason why you
4 went from 400 to 100?
5 A. Yeah, I thought that -- I guess that wasn't one
6 that had been asked of us to change, but I just thought I
7 wanted to make that more accurate because the two classrooms
8 that were offered to me probably could hold that many
9 students. They could probably have 50 each in it. I've
10 never used the second classroom ever. I've barely set foot
11 in it. I just cleaned it up and painted it and stuff, but
12 the first classroom we've --
13 Q. In fact, you don't use classrooms, do you, because
14 of this long distance learning?
15 A. Most of the degree students -- the people on the
16 degree track for distance learning, yeah, there's not
17 classrooms. It's a cyber kind of a -- it is not necessary to
18 have a classroom. As I said, the classrooms were for public
19 seminars, workshops, things like that.
20 Q. The second part, which is really not changed too
21 much, it's -- you say that part of the campus is utilized as
22 an innovative practicum site for psychology -- for students
23 in psychology and social work. Do you recall that?
24 A. This is in the new one?
25 Q. It's part of your statement here. Part of the
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1 campus is available for innovative practicum programs in
2 psychology and social work.
3 A. Yeah, that's what was prior to the investigation,
4 yeah.
5 Q. No, that's the new one.
6 A. It is?
7 Q. Yes.
8 A. I wasn't aware of that.
9 Q. So I guess my question is, practicum programs
10 implies like an internship or something along those lines.
11 Would you agree with me that that's the impression someone
12 would get when they read innovate practicum program?
13 A. Can you read the actual full sentence, please?
14 Q. Part of the campus is available for innovative
15 practicum programs in psychology and social work.
16 A. Practical or --
17 Q. Practicum.
18 A. To be honest with you, I thought that was already
19 off the Website.
20 Q. Let me go on. It goes on to say, Here students can
21 benefit from highly qualified professionals in the field and
22 get hands-on experience with special client populations. And
23 I assume that refers to the description of basically what
24 Loveland is in the prior sentence, saying that it's --
25 Central Pacific University is located on the site of a
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1 private school which offers therapeutic day treatment and
2 biopsychosocial rehabilitation programs for special needs
3 individuals, and the next sentence goes on with hands-on
4 experience. My question is this: By reading this, it seems
5 to me to link what you're offering in terms of Central
6 Pacific University to accessibility, whether in a practical
7 situation or hands-on experience with Loveland Academy.
8 A. Yeah, I thought that had already been modified and
9 it would imply that it was the plan originally, so it wasn't
10 that we were making this up. We really hoped that we could
11 not just -- for the students that would come here and
12 actually do residence -- academics with us, then we could
13 provide some hands-on training for them which, again, would
14 be really beneficial to the students of Loveland, it would
15 help the kids, and Felix and so on and so forth. So that was
16 the plan, but it never got off the ground, and based on the
17 comments of some of you folks right now, it probably isn't a
18 good idea to get it off the ground.
19 Q. Let me ask you this, then. If that was the plan, I
20 assume that you've had discussions about this with Dr. Dukes
21 at the very minimum because you're talking about the use of
22 Loveland for this, and I don't believe that you would put
23 something like this on a Website without her concurrence.
24 A. We had discussed that idea. I knew that, you know,
25 she had a lot of things going on with training of people and
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1 kids. It just seemed to be a kind of a nice mix. If the
2 opportunity presented itself, we weren't -- we thought that
3 in the early days of setting up this arrangement we were
4 under the assumption that we would have quite a few Hawaii
5 students and they would need a place to come in and get
6 training and classes and so forth, and so we thought that
7 that would be useful. As it turned out, it really just took
8 off in the whole distance learning area and the use of the
9 classroom is minimal or nil.
10 Q. So the idea of locating Central Pacific University
11 at Loveland Academy was because you had envisioned the
12 opportunity to give students hands-on experience in the
13 Loveland situation basically with a special -- with the
14 special needs students that Loveland was servicing?
15 A. Yeah, we hadn't worked out any details of whether
16 that would be a conflict or not or whether CAMHD would even
17 buy into it somehow. Again, you've got to realize we were in
18 a jam for finding trained people and getting services for
19 autistic kids. We have the most of them than anybody in
20 Honolulu. We're encouraged to develop relationships with the
21 community and the private sector and do whatever we can to
22 try to get the services out there for the kids, and I thought
23 I was doing something good for Hawaii.
24 CO-CHAIR SENATOR HANABUSA: Thank you very
25 much.
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1 Co-Chair Saiki.
2 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
3 EXAMINATION
4 BY CO-CHAIR SAIKI:
5 Q. I just have a few questions, Dr. Drews, as a
6 follow-up to Co-Chair Hanabusa's question. Would the
7 Department of Health regulations allow for an entity to bill
8 for services provided by a practicum student?
9 A. I guess I'd be guessing if I answered that. I'm
10 not really sure as far as clinical standards and so forth. I
11 think there are some certain levels of service where someone
12 that doesn't have all the full credentials still can perform
13 the service if they are supervised by someone with the
14 credentials, but I can't really recite the clinical standards
15 here. We do use practicum students in the guidance center.
16 I have supervised practicum students in my previous
17 employment too as far as UH and Chaminade practicum students
18 and whether we bill for their services -- most of the time we
19 kind of see them as shadowing someone, kind of learning the
20 ropes that way. That's how we've used them at the guidance
21 center. I'm not sure how they use practicum students in the
22 private sector.
23 Q. But as branch chief, have you ever seen a situation
24 where services of a practicum student have been billed to the
25 state?
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1 A. Practicum --
2 Q. As branch chief.
3 A. A practicum student working with a private
4 provider?
5 Q. In any capacity.
6 A. Well, we have practicum students that work with us
7 within the state, but we're not billing the state for our
8 services. We're just salaried, so, for instance, we have
9 practicum students that will act as care coordinators
10 sometimes after they are like a second year student and
11 they've already learned a lot and we can actually have them
12 oversee maybe some of the case loads, but, you know, no one
13 is getting billed for that because, you know, they are acting
14 like a state employee would act.
15 Q. Well, what if that practicum -- second or third
16 year practicum student was working in a private entity, would
17 that student be able to bill the state for the services
18 provided?
19 A. Yeah, that's the thing I thought you were getting
20 at, and honestly I don't know if -- you know, every agency
21 has their own contract with CAMHD, and I'm not aware of all
22 the intricacies. There may be some agencies that use
23 practicum students a lot more than others, and if the
24 contract says they can do that, I suppose they can. I really
25 don't know, and I'm not sure -- I don't know if that goes on
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1 or not. I know they use resident docs for certain things,
2 doctors, but I really don't know if the state is actually
3 getting billed for practicum student work.
4 Q. Okay. Thank you. Does CPU have an advisory board
5 of directors separate from the board of directors?
6 A. No, it's the same three. It's a small operation.
7 Q. Was Dr. Dukes ever a member of the board of
8 directors?
9 A. No.
10 Q. Do you know why she would -- do you know why the
11 Loveland Academy brochure would state that Dr. Dukes was a
12 member of CPU's advisory board of directors? Well, I'll read
13 what it says on page 62, that Dr. Dukes, quote, is a member
14 of the advisory board of Central Pacific University. This is
15 the August 20, 2000 brochure of Loveland.
16 A. Okay. I -- maybe in an informal capacity. We've
17 talked about having an advisory board. It's not an entity
18 that within our organization has, you know, been really
19 documented, but I think people that work with us, I guess
20 we'd probably consider them in an advisory capacity. I'm not
21 familiar that we actually set up a formal advisory board.
22 Q. Well, is Dr. Dukes affiliated with CPU?
23 A. No, other than having attained a degree from them
24 and the classroom arrangement that we've talked about ad
25 nauseam.
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1 Q. Did you -- prior to July 1999, did you and
2 Dr. Dukes discuss the formation of CPU and Loveland,
3 specifically in or about the time that you were at Honolulu
4 University?
5 A. Not while I was at Honolulu University, I don't
6 believe.
7 Q. Or any time prior to the formation of Loveland or
8 CPU was there a discussion about the two of you forming these
9 entities?
10 A. She had really nothing to do with me forming CPU.
11 That -- she wasn't in that loop of discussion at all. The
12 only way I knew of Dr. Dukes was that I was assigned to be
13 her mentor at HU, you know, when she was a student there.
14 Q. Was she the first graduate of CPU?
15 A. She wasn't the first. She was one of the first.
16 Q. So it's coincidence that Loveland was established
17 or opened its doors on July 7, 1999 and that CPU was
18 established about a month later, August 17, 1999?
19 A. That is a coincidence as far as I'm concerned. I
20 basically -- I formed CPU just briefly after I cut off my
21 communication or my employment with Honolulu University and
22 had nothing to do with Dr. Dukes.
23 Q. How many IEPs do you attend in a given year on
24 average?
25 A. Nowadays?
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1 Q. Well, for the past -- for the past years that
2 you've been branch chief, how many IEPs?
3 A. It's really changed, because in my first few years
4 I was really going to a lot of them, I mean, six, seven,
5 eight a week, and now very, very rarely.
6 Q. How would we be able to determine -- and I'm sure
7 that the auditors office will be reviewing IEP records, but
8 how would we determine whether or not you attended an IEP
9 would your name be listed on the IEP form?
10 A. It would be a request that would come from either
11 the DOE or one of my care coordinators or supervisors. You
12 have to realize that in the early days we didn't have many
13 supervisors. I was pretty much it, so I directly supervised
14 a lot of the care coordinators, and they were new and they
15 were green and they needed a lot of support, and so I went
16 out with lots of them basically as a training apprenticeship,
17 if you will, kind of thing. So I went out a lot, and then
18 as, of course, the care coordinators got more up to speed and
19 their skill levels improved as I started building a good
20 management team under me, you know, the need for me to be
21 involved at that level became less and less and now, as I
22 said, it's very, very rare. I've been to one. It's the same
23 kid. I've been to it twice now, I think, or one was an IEP,
24 one was a treatment team meeting. That's the only one I've
25 been to in probably -- in months.
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1 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
2 Members, are there any further follow-up questions? First by
3 Special Counsel.
4 SPECIAL COUNSEL KAWASHIMA: I have about three
5 areas, I think.
6 EXAMINATION
7 BY SPECIAL COUNSEL KAWASHIMA:
8 Q. Sir, when Chair Hanabusa was questioning you about
9 the May 19, 2001 email from Christina Donkervoet to you, in
10 the second paragraph it talks about areas that I assume the
11 reason you had set forth those areas was because they were
12 identified as problem areas that the department was having
13 with Loveland, am I correct?
14 A. The March 19th?
15 Q. March 19, 2001, 7:59 a.m., second paragraph, you've
16 listed a number of areas, about four of them. I assume
17 you're attempting to --
18 A. Yes.
19 Q. -- set forth problem areas?
20 A. Yes. I thought it was kind of interesting that
21 people said I might be doing favors for Loveland when that's
22 a group of individuals at that time that I probably had more
23 disagreement with than any other agency.
24 Q. One of them had to do with demanding IEPs be held
25 at their facility, right?
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1 A. That was one thing that came up, yes.
2 Q. I think I heard you testified that the rooms that
3 had been dedicated to Central Pacific at Loveland were used
4 for a number of community-based activities, one of which was
5 holding IEPs, right?
6 A. Yes, I believe they use it.
7 Q. So what is the problem with Loveland demanding IEPs
8 be held at their facility?
9 A. I didn't have a huge problem with that. I think
10 the DOE did, because usually an IEP is held, you know, at the
11 public school, and I think --
12 Q. Or at home?
13 A. At home?
14 Q. Or at the child's home, if possible?
15 A. An IEP, no, no. You would only have the IEP --
16 normally you have an IEP at the school. The school is really
17 in charge of the IEP. You need its administrator and certain
18 individuals from the DOE in order to even call it an IEP, and
19 in most circumstances those are always done at the home
20 school, even if a child goes to school somewhere else and the
21 complaints I was hearing from DOE and my staff is why was it
22 that Loveland was always insisting it had to be at their
23 place and, you know, I'm sure it was convenient for them, but
24 other folks I guess had complained about that.
25 Q. All right. The other area -- the second area, sir,
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1 I forgot to ask you earlier. You were here when Dr. Gardiner
2 and Mr. Golden testified a week or two ago?
3 A. Dr. Gardiner and whom?
4 Q. Mr. Stewart testified.
5 A. Yes.
6 Q. And you heard them say that they had some concerns
7 about having to -- being here testifying, at least
8 Dr. Gardiner did?
9 A. About being here testifying?
10 Q. Yes, yes.
11 A. I heard his testimony.
12 Q. And I understand that at one point in time prior to
13 that, when Dr. Gardiner at the auditor's request went to the
14 auditor's office to discuss matters such as what was going to
15 be testified about --
16 A. Right.
17 Q. -- that you became concerned about that?
18 A. Well, I guess you could say I became concerned. I
19 became confused about it. I think he also said that, too,
20 that at first there was a lot of confusion about what was
21 going on. I mean, the first thing I was told by Mike Stewart
22 when he came in was that he was asked to speak to some
23 auditor's office, it was as a private citizen, not as a
24 Department of Health -- he said he was chosen because he's an
25 upstanding citizen in the community and that's all they
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1 wanted to talk about, but yet, they wanted to talk about
2 fiscal matters of DOH, and that sounded kind of strange to
3 me. He also went on to say that it was going to involve some
4 kind of a meeting after hours in a park, and I thought what
5 is all this cloak and dagger stuff. So I immediately called
6 my boss and said what's going on here, and that's when it got
7 cleared up that I wasn't aware of this auditor's
8 investigation at that time, and once I spoke to my boss and
9 they said, you know, cooperate and it's okay, and then I said
10 fine.
11 Q. Did you call the auditor's office yourself, if you
12 had that confusion?
13 A. I think I called my -- I'm just trying to recollect
14 the sequence of events, but I think I called my boss first
15 and I think she informed me here's the name and number of the
16 person you're supposed to call about this, and I believe I
17 called them.
18 Q. That was the deputy attorney general, was it not?
19 A. That was the -- yeah, it was the AG's office.
20 Q. And you instructed Mr. Stewart to contact the
21 deputy attorney general?
22 A. That's what they told me to tell him.
23 Q. And the deputy attorney general instructed
24 Mr. Stewart to cooperate in every way possible, right?
25 A. That's what I heard.
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1 Q. You also asked, though, as far as Dr. Gardiner was
2 concerned, you also asked his immediate superior,
3 Mr. Stewart, to debrief Dr. Gardiner, in other words, get the
4 information from Dr. Gardiner as to what he told the auditor
5 and to give you that information, did you not?
6 A. I don't think that's really accurate.
7 Q. That's what he testified to under oath.
8 A. I understand that. My recollection of that was
9 that Dr. Gardiner was willing to let me know whatever
10 Mr. Stewart had discussed with him. I never instructed
11 anybody to come back and debrief me of what they asked you.
12 Q. In any case, sir, your position was after you
13 talked to your supervisor, your direct supervisor, that
14 anyone in your office, including yourself, ought to cooperate
15 with this investigation in every way possible --
16 investigation in every way possible, right?
17 A. Once we got through all that confusion, that's
18 exactly what we were told, participate openly, completely.
19 Q. And I think I've asked you this, but as far as what
20 Dr. Gardiner and Mr. Stewart testified to that you heard when
21 you were here, you have no real quarrels with what they said,
22 do you?
23 A. No.
24 Q. So that as far as they are concerned, their
25 cooperating with this investigation and their testifying
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1 under subpoena would not be cause for you in any way to
2 retaliate against them, would it?
3 A. Of course not.
4 Q. And one other question. I'm not sure I have asked
5 you this, sir. I did ask you about CPU and Loveland in terms
6 of your getting the space for free, and I notice in several
7 places there are references by you and/or Dr. Dukes that no
8 money changed hands. Aside from that transaction, in other
9 words, getting the space for free, continuing to get it for
10 free, being able to put your University's name up on the
11 wall, is there any other fashion -- any other way in which
12 you received any compensation, remuneration of a financial
13 nature or value from Loveland?
14 A. No, there's not.
15 SPECIAL COUNSEL KAWASHIMA: Thank you. No
16 further questions.
17 CO-CHAIR REPRESENTATIVE SAIKI: Thank you.
18 Members, any follow-up questions? If not, Dr. Drews, thank
19 you very much for your testimony today.
20 Members, our final witness is Dr. Margaret Koven.
21 Dr. Koven, please be seated at the witness table. You can
22 keep your shoes off.
23 CO-CHAIR SENATOR HANABUSA: Dr. Koven, do you
24 solemnly swear or affirm that the testimony you're about to
25 give will the truth, the whole truth, and nothing but the
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1 truth.
2 THE WITNESS: I do.
3 CO-CHAIR SENATOR HANABUSA: Thank you very
4 much. Members, we'll be following the same procedure,
5 Mr. Kawashima.
6 SPECIAL COUNSEL KAWASHIMA: Thank you, Madam
7 Chair.
8 EXAMINATION
9 BY SPECIAL COUNSEL KAWASHIMA:
10 Q. Please state your name and business address, ma'am.
11 A. Margaret Koven. I work at Loveland Academy at 1506
12 Piikoi, Honolulu, 96822.
13 Q. And your position at Loveland, ma'am, is what?
14 A. I'm a psychologist and I'm the clinical director.
15 Q. Will you briefly recount for us your educational
16 background, higher education?
17 A. I have a bachelor's degree from New York University
18 in actually film and television, and I spent a lot of time
19 working in documentary film doing things about kids and
20 families and that sort of thing and got interested in working
21 myself. I experimented with law school for about a year and
22 a half and was so worried about the social implications of
23 the law that I went back to school and became a speech and
24 language therapist, so I got a master's in speech and
25 language, worked on parent-child communication.
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1 Q. From where?
2 A. Texas Tech University, and that's where I met
3 Dr. Dukes. In the 1970s she was my professor and taught me a
4 lot of what I know about kids, but then after three or four
5 years of working as a speech pathologist I decided that what
6 I really liked doing on the multi-disciplinary teams that I
7 was working on was more of what the psychologists did. So
8 about two years into a doctoral program for speech and
9 language at the University of Colorado I entered the
10 psychology program, the doctoral psychology program at the
11 University of Northern Colorado in Green Leaf.
12 Q. And received that degree when?
13 A. 1991.
14 Q. All right. And from that time on, where and how
15 were you employed?
16 A. I worked briefly while I was finishing my degree.
17 I was in California at Stanford Children's Health Counsel,
18 and after several years there and finishing my dissertation I
19 came here just at the end of the dissertation process and
20 went to work at Diamond Head in the early child find unit
21 downstairs and was there for about nine months, at which time
22 I became the first psychologist at the Zero-to-Three early
23 intervention program.
24 Q. I'm sorry, which was the last program?
25 A. Zero-to-Three Hawaii Project, which was then an
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1 RCUH program and introduced infant mental health really for
2 the first time in Hawaii, and that's when we began
3 identifying children with autism and autistic spectrum
4 disorders in the state for the very first time. I think in
5 the first three years I think it was probably me that
6 identified the first 125 kids.
7 Q. And then where did you go next?
8 A. From there I went into private practice. I had a
9 part-time contract with Kaiser Permanente's developmental
10 pediatrics clinic, and I went one day week to do diagnostics
11 at Kaiser, but most of the rest of the time I spent in
12 private practice in a multi-disciplinary office, and it was
13 around that time that Dr. Dukes moved to Hawaii and was
14 starting a speech and language school at Scottish Rite
15 Cathedral and got a few of my reports about children with
16 autism who were very, very bright and I thought if they had
17 some good communication therapy in preschool instead of just
18 a regular special ed class they might do better and she read
19 a couple of my reports and called me up and said, Maggie, is
20 that you, and I said, yeah, it is. And she stayed at the
21 university for a few more years and then eventually joined
22 the private practice.
23 Q. What were the years you were in private practice,
24 ma'am?
25 A. About 1994 to 1999.
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1 Q. Then in 1999 you joined Dr. Dukes in starting up
2 Loveland?
3 A. Yeah, I became an employee when we opened.
4 Q. You have remained an employee; is that correct?
5 A. Yes.
6 Q. And your compensation there at Loveland is by
7 salary?
8 A. Yes.
9 Q. And what is your salary at Loveland, yearly,
10 annually?
11 A. I think it's 60,000, and it's net of like 52.
12 Q. Net after taxes?
13 A. Yeah.
14 Q. Do you receive any type -- any other type of
15 compensation from Loveland for any work that you do?
16 A. No. I occasionally do, you know, once or twice a
17 year something outside of Loveland for Zero-to-Three on
18 contract or go give a speech somewhere, but primarily I work
19 only at Loveland.
20 Q. Do you provide any other type of mental health
21 service at Loveland for which other organizations are charged
22 or billed?
23 A. Could you ask me that again?
24 Q. Do you provide any other service at Loveland for
25 the students there for which another organization or another
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1 entity is billed, such as the state of Hawaii? I'm not
2 suggesting that you are. I'm just asking you.
3 A. In my capacity as the psychologist at Loveland, I
4 sometimes do an outpatient evaluation and I'm specifically
5 asked for and the service authorization comes. I'm not paid
6 for that. That's a Loveland authorization, but there are
7 services that I do outside of day treatment and BPSR, like
8 diagnostics or outpatient therapy, but nothing is billed
9 under me. It's all billed under Loveland.
10 Q. I see. And you get no share of whatever is billed
11 out in that way?
12 A. No.
13 Q. Now, how many -- we may have asked Dr. Dukes this.
14 How many children does Loveland Academy have presently under
15 the DOE contract? And you might, if you can, segregate them
16 as day care treatment, after school care, and other programs,
17 the three areas: One, day care treatment; another, after
18 school care; the third, all other programs.
19 A. There's about 22 kids currently in day treatment.
20 All together, including the BPSR kids, I think we are usually
21 running around 36 children, and right now, including
22 outpatient, the outpatient program is really small. In fact,
23 we've reduced it over time because just dealing with the in
24 patient kids is such a huge job. I don't think there's more
25 than eight out patient therapy cases in -- for all of us
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1 right now.
2 Q. So day care treatment, 22 students; BPSR, which is
3 after school, 14?
4 A. Yes.
5 Q. And --
6 A. In addition to the day treatment kids who do stay
7 later.
8 Q. That's what I'm trying to determine. How many of
9 the day care treatment students stay for after school care?
10 A. I would have to look at the list. Many stay.
11 Probably two-thirds stay.
12 Q. I see. The 36, then, is what, the total students
13 in any capacity?
14 A. Right.
15 Q. Now, if you know, how many of these students at any
16 one of these area have been referred to Loveland by someone
17 at Diamond Head Family Guidance Center?
18 A. All the kids come in through the IEP process for
19 the most part, and I thought that you should know that
20 involved in the IEP process there are kids that are coming in
21 as a result of IEPs that don't work that are assigned to
22 Loveland as a result of a due process settlement or a federal
23 court action and we're kind of lumping them into the IEP
24 process as well, but Diamond Head and the other mental health
25 centers don't refer to us directly.
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1 Q. Diamond Head and the other family guidance centers
2 have to approve an IEP that refers a student to you, right?
3 A. Actually, the IDEA language and the IEP process, it
4 is not the job of a care coordinator to actually approve or
5 disapprove what the team decides. What the care coordinator
6 usually does is facilitate the team's decision and try to get
7 the services organized, so --
8 Q. It is your position that a family guidance center
9 has no say in a student being referred to Loveland?
10 A. As part of the IEP team, we all discuss it
11 together, but technically it's not an approval or disapproval
12 just by the mental health center care coordinator. It's the
13 team decision, and then like the school SSC or the guidance
14 center care coordinator then facilitates making it happen.
15 Q. When you say, though, as part of the IEP process,
16 the care coordinator is involved with the IEP process?
17 A. Yes.
18 Q. Now, the care coordinator comes from what type of
19 facility?
20 A. They come from the child and family guidance
21 centers.
22 Q. That's what I'm talking about.
23 A. Yes.
24 Q. How does that person from Diamond Head or Honolulu
25 or wherever else, Windward, get into that IEP?
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1 A. They come to every IEP meeting.
2 Q. And are they asked to come for certain students
3 because the student is interested in going there or not?
4 A. They are supposed to come if the student is on
5 their case load or --
6 Q. What if the student is not on their case load? Why
7 would they be there?
8 A. Then they wouldn't be attending because they
9 wouldn't be a part of the team.
10 Q. So I'm still trying to determine -- maybe you
11 answered my question, but I'm still trying to determine what
12 authority or what say a family guidance center has as to
13 whether or not a student goes to Loveland or not? I
14 understand the IEP process, the fact that you have to have
15 that and everyone has to agree or I guess you litigate it,
16 but what say, if any, does the family guidance center have to
17 do with a student coming to your facility?
18 A. I think it would be best answered by them. I find
19 that there's still some confusion about the role of the care
20 coordinators, that many people interpret IDEA to mean that
21 the care coordinator facilitates the decision of the team but
22 is not necessarily a member of the team because they don't
23 treat the child, they don't do therapy with the child, and
24 often they haven't met the child. On the other hand, there
25 are child and family guidance centers that interpret it
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1 slightly differently and like to have a vote on the team, and
2 so there are sometimes differences from IEP to IEP.
3 Q. I see. But these family guidance centers, though,
4 they do have the authority to approve service authorizations,
5 for example?
6 A. Once the IEP team decides what the child needs and
7 we write up all the services, then the care coordinator
8 usually makes a list of all of that and takes all the team
9 agreements from the conference notes and goes back and then
10 issues the service authorizations that match those services
11 and gives a number to them.
12 Q. And are these IEP plans always specific enough so
13 that the care coordinator can write the items out for the
14 service authorization without having to confer with anyone
15 else?
16 A. No. Sometimes they are not specific enough, and
17 sometimes they are so specific that if a child needs one hour
18 of something different, 27 people have to meet again to
19 approve it. So I think errors go in both directions, but --
20 Q. Who makes the call, then, if there's a dispute?
21 A. -- if we're lucky, there's a balance.
22 Q. If there is a question as to what type of service
23 ought to be allowed, who makes the call?
24 A. The IEP team.
25 Q. What if we've gone by that point and the family
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1 guidance center person, the care coordinator, is trying to
2 interpret what service ought to be allowed, how is that
3 resolved? Are you looking at me in a way to say that that
4 never happens?
5 A. Could you ask me one more time?
6 Q. Maybe I'm not making myself clear.
7 A. When I get really nervous I like space out a little
8 bit when I'm trying to listen, and I'll calm down in a few
9 minutes.
10 Q. I'm not trying to make you nervous.
11 SENATOR SAKAMOTO: Do you need therapy?
12 THE WITNESS: Yeah, I do. After today I
13 probably will.
14 Q. I thought in questioning, let's see, Dr. -- who was
15 I questioning earlier -- Dr. Drews, that they have a certain
16 degree of say once they look at an IEP and then service
17 authorization is requested as to what they can approve or not
18 or will approve or not. I thought I heard him say that. Did
19 you hear him say that?
20 A. Some child and family guidance centers get involved
21 more in the budgeting of services than others.
22 Q. There's nothing wrong with that, is there? If they
23 are trying to control costs, nothing wrong with that?
24 A. I think it's important to think about it and do it,
25 yeah.
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1 Q. So in those instances, then, does the care
2 coordinator have the say as to whether or not a certain
3 service will be allowed at a certain price, or is it still
4 something that has to be taken back to the IEP?
5 A. It would still have to go back to the IEP team and
6 be rediscussed. If, say, for instance, CAMHD people or
7 guidance center people were disagreeing with the rest of the
8 team, probably the team would get together again, but I
9 haven't seen situations -- I haven't been in a situation
10 where that's happened where the whole team has agreed and
11 Child and Adolescent Mental Health have said, well, even
12 though you all agree, we don't want to discuss that with you.
13 You're not going to get it. I've never been in that
14 situation at all.
15 Q. Now, I don't think you were here that day, ma'am,
16 but Dr. Gardiner from Diamond Head testified.
17 A. I heard about it.
18 Q. And he was very specific about problems he had with
19 your facility in terms of getting in contact with people when
20 he needed. I understand I've seen correspondence, memos,
21 perhaps E-mails where you've investigated the situation; is
22 that correct?
23 A. Yes, I did.
24 Q. And you investigated the situation by looking at
25 telephone logs?
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1 A. That was one of the things I did, yes.
2 Q. What else did you do?
3 A. I talked to my care coordinators and the office
4 staff.
5 Q. Well, you -- do you yourself recall Dr. Gardiner
6 attempting to contact you, you yourself?
7 A. Apparently -- I believe that there was one occasion
8 where I might have gotten a call from Ken Gardiner prior to
9 leaving for the mainland on vacation and that I called back
10 and left a message on his machine. At that point in time I
11 didn't know who he was. I didn't know who he worked for. I
12 didn't know if he was a private provider or a care
13 coordinator. We had never been introduced or received a
14 notice that there was a new person on board. At the time
15 which I came back from vacation I still didn't know who he
16 was. In fact, I didn't know who he was until 6:00 o'clock in
17 the evening the -- after the day that he testified and a
18 reporter called me and said, hey, do you know this guy named
19 Ken Gardiner? And I said no, and the reporter said, hey, he
20 said he called you 17 times and that he works for Diamond
21 Head. And I said, we've never met him. He's never been
22 over. We've never had any contact with him, and if he has
23 kids here, he's never visited them or looked at their
24 records.
25 Q. Did you do any other type of investigation with
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1 regard to those allegations?
2 A. I did call the secretary at Diamond Head and say do
3 you have a Dr. Ken Gardiner working for you, and they
4 verified that he did, and so I sent him a letter and said I
5 heard that you had trouble getting through to me and that you
6 had questions about records, please come over and review your
7 children's records, please give us a call and we'll work with
8 you any time.
9 Q. Anything else you did to either substantiate or not
10 substantiate his claim that he made those calls, anything
11 else that you've done?
12 A. Several things, and I don't know whether they are
13 really functional or not because this is one of the strangest
14 experiences as a psychologist I ever had. He called me the
15 next day.
16 Q. The day after what?
17 A. The day after the newspaper article was published.
18 He saw it around 4:00 o'clock in the afternoon, about four
19 hours after he got my letter, which he didn't understand
20 until he saw the newspaper article, and he called me and he
21 was crying. And he told me that he worked for Diamond Head
22 and that he wasn't a psychologist and that he knew he didn't
23 have any fiscal management responsibilities over that and
24 that he was misquoted and he felt set up and that he was a
25 cancer patient and he thought he would probably have to quit
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1 his job and this was the last job he was ever going to have
2 because he came to Hawaii to die and could we please help
3 him, could I please help him get through this.
4 Q. Did he mention the fact that the reference to 17
5 telephone calls to you was untrue? Did he specifically
6 address that?
7 A. No. Yes, he did. He actually said that although
8 other things were confused, that he actually did make 17
9 phone calls, and I told him that -- just exactly what I told
10 the reporter, I have no way of knowing if he actually picked
11 up the phone, dialed, and got connected 17 times, but that
12 myself and office staff had gone back through actually seven
13 weeks of memo pads looking for any reference to Dr. Ken
14 Gardiner and I didn't have a single message from Ken Gardiner
15 to me with a return phone number, and I asked them to check
16 messages to everybody else at Loveland and there wasn't a
17 single recorded message, memo for anybody else at Loveland
18 with his name on it. I talked to my care coordinator, case
19 manager, and she said she vaguely recalled that someone named
20 Ken Gardiner might have called once or twice and left no
21 message when he was told that I was unavailable or out of
22 town.
23 Q. Do you voicemail for yourself there at Loveland?
24 A. We have voicemail on some of the lines but not all
25 of the lines.
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1 Q. On yours?
2 A. We also have email.
3 Q. On yours, do you have voicemail on your line?
4 A. I don't use the voicemail on my line because I'm
5 often all day long in the classroom with the kids. So what I
6 tell people to do is email me, fax me, tell the office staff
7 to come and get me, because voicemail I may not get to until
8 8:00 o'clock at night.
9 Q. How do you disarm the voicemail capacity on your
10 phone?
11 A. Basically what I did was put a message on the
12 machine saying this voicemail is shared by several other
13 therapists, I don't get to it until late in the day, if you
14 want to reach me, instead of putting something on voicemail,
15 please call the main numbers and have the staff come get me
16 on the floor and bring me the phone.
17 Q. In this conversation you had with Dr. Gardiner the
18 day after he testified, aside from what he told you, am I
19 correct, then, that he did not disavow testifying that he had
20 attempted to contact you 17 times with no success?
21 A. No, he didn't. He did say that he called 17 times
22 and it wasn't successful and that he just couldn't say he
23 didn't do that. I just can't find any record, and again, I
24 was on vacation. That was the first vacation I had had in
25 four years, and I was gone for about two and a half, two and
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1 three quarter weeks.
2 SPECIAL COUNSEL KAWASHIMA: That's all I have.
3 Thank you, Madam Chair. Thank you.
4 CO-CHAIR SENATOR HANABUSA: Members, we'll
5 continue with the normal rule, five minutes. Let's begin
6 with Senator Slom, followed by Vice-Chair Oshiro.
7 SENATOR SLOM: Thank you, Co-Chair.
8 EXAMINATION
9 BY SENATOR SLOM:
10 Q. Did you say that you and Dr. Dukes formed Loveland
11 together at the same time or came together at the same time?
12 A. No. Dr. Dukes was approached to start Loveland
13 Academy and she started it as a solely owned business and
14 asked me if I would come in and be the psychologist.
15 Q. Do you have any ownership in the business itself?
16 A. No.
17 Q. So you're just on salary?
18 A. Yes.
19 Q. And who sets the salary for you?
20 A. Dr. Dukes.
21 Q. Dr. Dukes, okay. Mr. Drews testified on a number
22 of occasions about the Website and about specifically that
23 term the practicum, and he indicated that he -- that was his
24 hope, his desire, his dream, and that he had discussions with
25 you. Do you ever remember having discussions about that,
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1 about setting up a practicum?
2 A. I didn't participate in any discussions about
3 setting up a practicum, and I would hope and assume that if
4 there were any it would be his people supervising a practicum
5 because I would never agree and would counsel everybody at
6 Loveland that it wouldn't be appropriate for us to supervise
7 any of his students. I would never do it.
8 Q. And why would that be? Why would you counsel them?
9 A. Because that would be doing a very serious service
10 that would be interpreted as a conflict of interest, and the
11 code of ethics for psychologists, as opposed to business
12 people and community business people, especially practicing
13 psychologists, is very strict about dual relationships and
14 about things like that, and I would be -- I'm absolutely
15 paranoid about stuff like that, so I would bend over
16 backwards not to do it, myself personally.
17 Q. Do you have a problem with the relationship as
18 presented by CPU and the perception of a conflict?
19 A. Most of this information I just heard today.
20 Q. How about the sign, the banner on the building?
21 A. I was uncomfortable and I have voiced my
22 discomfort, but I also saw the reports that said it was okay,
23 so I assumed that between CAMHD and Loveland that there was
24 some kind of comfort level that had been come to and that it
25 was no longer my business since I was an employee and a
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1 clinical director.
2 Q. Who did you express your discomfort to?
3 A. I talked to Dr. Dukes about it a couple of times
4 and was very reassured after I saw the letter that even
5 though people had said they were uncomfortable with the
6 appearance, that it appeared that people realized that he was
7 never at Loveland and his students were never at Loveland,
8 and so it seemed that CAMHD and Dr. Drews had obviously come
9 to some kind of an agreement that it was okay.
10 Q. Dr. Koven, earlier I had asked Dr. Dukes, reading
11 from the four-page memo that the both of you had sent to us,
12 I asked the question that said here who documents problems
13 and progress at Loveland, and the answer that Dr. Dukes gave
14 me was that there's no one person, that it comes from all of
15 you involved. Was there ever any suggestion that maybe there
16 should be one person that would be able to bring all those
17 things together and look at that, examine it?
18 A. Can I explain it in a little more detail?
19 Q. Yes.
20 A. We're dealing with very complicated kids who are
21 not getting therapy an hour at a time and going home. They
22 are on the campus six to eight hours a day, and there are
23 very strict rules in most professions that treat kids
24 regarding who is writing the primary notes in what time
25 periods, and the people who are supposed to be writing the
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1 primary notes in any given time period are the people who are
2 doing hands-on work with the children. Therefore, at
3 Loveland, on any given day, the TA who is spending six hours
4 or five hours or three hours with the child is writing, the
5 classroom teacher is writing, the speech pathologist will
6 write their own note, the OT may write their own note, an
7 adaptive PE teacher might write a note, the psychologist
8 staff might write their notes, and in addition to the notes
9 there's other data that's being taken.
10 For instance, the report cards -- this is not
11 traditional mental health therapy the way we think about it
12 in terms of somebody comes to your office, they play games,
13 you talk about their memories, their bad experiences, their
14 parents' divorce, they have this incredible insight and they
15 get over it. This is developmental psychological therapy and
16 developmental behavioral intervention, and children with
17 autism have behaviors that create barriers for them in school
18 that are related to inability to communicate, inability to
19 tolerate any sensory stimulation or play that for other kids
20 would be terribly pleasurable, and then they also have other
21 mental health problems that anybody else can have. They
22 might be hyperactive. They might be depressed. They might
23 have post-traumatic stress disorder from being abused. So
24 those kinds of things are very different.
25 Because we're day treatment and we're DOE/DOH, all
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1 of the goals and objectives for our kids that we're
2 responsible for are on the IEP plans and the mental health
3 treatment plans, and for the most part during the school day,
4 the goals that we're responsible for are the goals that are
5 extracted off the mental health treatment plan that have to
6 do with school functioning and peer relationships and all of
7 the goals on the IEP, behavioral and educational and
8 therapeutic. So we're not necessarily in the middle of the
9 school day working with traditional mental health kinds of
10 issues, and autistic children need an incredible amount of
11 consistency and routine and follow-up and multiple exposures
12 over a long period of time to the same things over and over
13 and over again to master them.
14 So what you would find is that the TAs would be
15 filling in kind of activity-based data. We did this, the
16 response was this. We did activity number two, which we
17 always do at this time every day, the response was this. We
18 did activity three, the response was this. Then the mental
19 health people, the speech and language people, the OT people
20 who are degreed and have graduate degrees would be putting
21 the TA information together with their information and the
22 information from the teachers and working with the whole team
23 and the mental health people to figure out, okay, these are
24 all the observations from all these people, what do they
25 mean?
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1 And those kinds of issues are tracked in a lot of
2 other ways. They are tracked in team meetings, they are
3 tracked by formal testing, they are tracked through the
4 grades on the report cards and the grades on the mental
5 health treatment plans, they are tracked on brief
6 psychological reports, comprehensive psychological
7 evaluations, and you almost have to sit down with all the
8 data together to fully track a child. It's so much
9 information, it's very hard to put it even on one data
10 tracking sheet and figure out a way to put it in so that
11 people understand it.
12 Q. Thank you, Doctor. Thank you.
13 CO-CHAIR SENATOR HANABUSA: Vice-Chair Oshiro,
14 followed by Senator Sakamoto.
15 VICE-CHAIR OSHIRO: Thank you, Co-Chair
16 Hanabusa.
17 EXAMINATION
18 BY VICE-CHAIR OSHIRO:
19 Q. I just have a few questions. In your experience at
20 being at Loveland, have you had to have any personal
21 interaction with Dr. Drews?
22 A. Rarely. Sorry. Rarely. I've seen him at IEP
23 meetings on extremely high end cases that are very
24 complicated. I've also called him once or twice a year for
25 consultation about clinical standards and procedures. I can
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1 give you an example. We were working with one child or
2 considering working with a child who had been hospitalized
3 three or four times, and since we don't usually hospitalize
4 our kids in day treatment, we can usually handle pretty much
5 everything on site, but this child had been sent from day
6 treatment, another program, to the hospital, directly from
7 the school a few times and I wanted to clarify in CAMHD
8 procedures at which point does the day treatment center give
9 over custody of the kid -- the child to the emergency team,
10 at which point does DOE completely step out of the picture,
11 do emergency acute hospitalizations get covered by CAMHD or
12 do we call parents' private insurance companies, and then if
13 the child has to stay, who covers that, because we've never
14 done it and I was just thinking if there's a risk that we
15 took this child in our program I might need to know about
16 that. So that might be something I might call him for. I
17 also -- and that would be if a child might be at Diamond
18 Head. I might also call any other director that I could get
19 a hold of that day.
20 Q. So just for clarification, I mean, you stated you
21 rarely talked to Dr. Drews?
22 A. Rarely.
23 Q. Just to get a little bit more clarification on what
24 Senator Slom was talking about. As I understand, what you're
25 saying is that under your procedures at Loveland, everybody
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1 involved in the whole process is doing the documentation?
2 A. We require that everybody who is working with a
3 child is documenting what they do.
4 Q. But previously when Dr. Dukes had testified, she
5 had stated something to the extent that the care coordinators
6 actually didn't want to see all the documentation and just
7 preferred to see this sort of condensed form. Is that
8 something that you would be signing off on the condensed form
9 or at what point are you actually reviewing the progress
10 notes or compiling it or putting it together? Are you
11 involved in that process at all?
12 A. All of the mental health staff and also even the
13 speech and language staff and the OT rehab staff are involved
14 in reviewing everything very regularly, and yes, I often sit
15 down and read everything as it's going out whenever I can.
16 It's not a requirement, but I like to do it and I like to
17 sign off on everything and indicate that yes, I read it and
18 yes, it's going out. Also I often review a lot of the daily
19 notes and the notes that don't go to CAMHD as part of their
20 official record, the more confidential ones, and from looking
21 at the notes, I can look at trends in a child's behavior and
22 pull a TA in and say why don't we try this, could you please
23 do a little more research and tally this for a week, or give
24 them suggestions and Xerox the note and send it back to them
25 and say, you know, right here you could have done this, why
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1 don't you try this next time.
2 Q. But in terms of the actual form that the care
3 coordinators are getting, is that the one you're signing off
4 on consistently?
5 A. I'm signing off on it pretty consistently, yeah.
6 Q. Thank you very much.
7 CO-CHAIR SENATOR HANABUSA: Senator Sakamoto,
8 followed by Representative Ito.
9 SENATOR SAKAMOTO: Thank you, Chair.
10 EXAMINATION
11 BY SENATOR SAKAMOTO:
12 Q. I guess following up on the previous questions. A
13 previous testifier, not today, seemed to indicate some of the
14 reports seemed to have sort of canned -- same answer, and I
15 realize some children don't change very much month to month,
16 but can you respond to that?
17 A. Yeah. I agree that for anyone in mental health or
18 probably in any other field to sit and look at notes
19 regarding autism treatment, if that's not something they are
20 familiar with and very enthusiastic about, might become kind
21 of boring and repetitive and redundant, but there are things
22 in those notes, even when they seem repetitive, that seems so
23 small that are major breakthroughs that are very important
24 for us to know, and that's why we kind of ask them to do it
25 that way so that we can detect very small changes.
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1 Q. So although someone -- say I might feel it was a
2 cut-and-paste response, but for you the cutting and pasting,
3 even a word, you're saying is a meaningful difference?
4 A. Yeah. The paperwork burdens are enormous, and we
5 don't like it when the TAs or the therapists use any therapy
6 time when the children are on the campus to do their notes.
7 We don't like them to write any notes until they've actually
8 turned that child over to the next person who is working with
9 them. So if there's an introductory portion on a note that
10 says the child is in this classroom and these are the five
11 activities we do and those five activities stay the same, we
12 would allow them to cut and paste the introduction and then
13 write all the notes about the child's behavior that day that
14 are unique.
15 The other thing that we always do is -- and this is
16 for the benefit of the TAs and to help with supervision, is
17 that periodically we go in and supervise, and on all of our
18 notes are the goals for the child in the IEP program, the
19 primary ones, and the goals for the child in the mental
20 health treatment plan are put on the top of the notes, and
21 that's so when TAs who are paraprofessionals are writing
22 notes, they can always be looking at the top of the page and
23 be reminded, well, what was I trying to do at that moment and
24 what is the goal I'm trying to meet and how can I describe
25 what happened in terms of those goals, and then periodically
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1 the goals change, we take the note back and make another
2 master for them so that they can always be reminded of what
3 they are working on and that would definitely be repetitive
4 also.
5 Q. So at the next IEP, whether it's the annual one or
6 an intermediate one, someone can look at those goals and see
7 based on from June till now this has changed or has not
8 changed?
9 A. Somebody like myself or Dr. Dukes or the other
10 professional therapists would sit down with those like 35
11 pages of notes or 350 pages of notes and tally things that
12 they've seen off those notes during the day and then look for
13 the trends and the percentages and add them up and then
14 compare that to what they see in terms of tallies that aides
15 keep in the classes, and then record the data and look at
16 whether or not we need to move on to new goals, and that's
17 another way that we track the kids. Obviously if the IEP
18 goals are met and we've had to do all new ones and the new
19 ones are another level higher, we know the kids are doing
20 better.
21 Q. Last question. Dr. Dukes testified that sometimes
22 children are diagnosed with autism and Loveland finds maybe
23 they are not autism, conversely, maybe diagnosed mental
24 retardation or something else and found to have autism, and
25 obviously at least -- well, not obviously, it may -- seems to
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1 me that the person who gave the original diagnosis would sort
2 of feel offended or professionally challenged when you or
3 Dr. Dukes says, you know, you have this thing upside down.
4 Did you get many comments back from other professionals or
5 others in the community or parents saying, you know, you
6 don't know what you're doing, we had it right, you guys
7 turned it upside down?
8 A. Usually people thank us because we've had so much
9 experience with children with developmental disabilities that
10 when we do an arena eval and everybody is involved, we can
11 sometimes see things that you don't see in an office visit
12 for an hour. Sometimes when we do an eval we'll have parents
13 bring in videotapes from when the child was a baby so that we
14 can look at childhood behaviors or videotapes of the child in
15 other settings. We dig pretty deep when a child is not
16 getting better no matter what everybody does and try to
17 figure out why. So I don't think that that's a huge problem,
18 but it is an occasional problem.
19 Q. Last question. Final point. So I guess I asked
20 Dr. Dukes about what her feeling was and I'm asking if your
21 feeling is that there are people in the community or
22 somewhere trying to undermine Loveland for whatever reason?
23 A. It's hard to talk about because it sounds so spooky
24 and paranoid. I think there's an unbelievable amount of
25 stress and competition between the private agencies at a time
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1 when there probably shouldn't be. We don't ever expect a
2 huge population of children with autism, but the epidemiology
3 reports, it used to be one in 10,000, now it's one in 500 or
4 one in 250. This is a huge change over the last ten or 15
5 years. Believe me, there are enough children for everybody
6 to be working full-time and for us to try and persuade ten or
7 20 more people to move here, but the situation is very
8 competitive.
9 I don't think more than ten to 14 percent of
10 children with autism would ever need to be in a community day
11 treatment program. That's about the average across the
12 United States. There are some kids that just always need
13 something special that doesn't fit at a school, but I don't
14 think it's ever going to be a big thing. The other thing
15 that I think is happening and that I see as such a huge
16 problem is that the tension in the entire system has arisen
17 tremendously from spring until now because everybody is very
18 worried about what's going to happen with the court and
19 whether the system is going to change and whether DOE is
20 going to be treating all the kids and what will happen to the
21 kids if they do, and so nobody knows who their client base is
22 going to be and nobody knows, including DOE and DOH people,
23 who is going to be blamed for everything that is not working.
24 And my experience the last three months going to
25 IEP teams and care coordination meetings and briefings and
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1 everything else is that everybody is very snippy and
2 everybody is very tense and everybody is criticizing
3 everybody else. When we should be pulling together, we're
4 tearing each other apart. So I don't think this is unusual
5 for right now.
6 Q. Thank you.
7 SENATOR SAKAMOTO: Thank you, Chair.
8 CO-CHAIR SENATOR HANABUSA: Thank you, Senator
9 Sakamoto.
10 Representative Ito, followed by Representative
11 Kawakami.
12 REPRESENTATIVE ITO: Thank you, Madam
13 Co-Chair.
14 EXAMINATION
15 BY REPRESENTATIVE ITO:
16 Q. I just have a couple questions. Dr. Koven, you
17 know, you have been on the faculty as an adjunct professor or
18 lecturer at CPU or Honolulu University?
19 A. No. When I was in private practice I taught a
20 couple of classes for ASPP for about a year, but I've never
21 done anything for CPU.
22 Q. What about at Loveland, have you graded any
23 students that did any kind of -- or supervise any students
24 that did OJT, you know, on-the-job training or practicum type
25 of thing?
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1 A. I've worked with students from Honolulu
2 University -- not Honolulu University, Hawaii Pacific
3 University -- I still get these things screwed up -- ASPP,
4 American School of Professional Psychology, which is now
5 Argosy. I have some doctoral students and some master's
6 level students there. We've had some community college
7 students and we've had a couple of students from University
8 of Hawaii in areas like social work.
9 Q. So in that capacity, what, you got paid?
10 A. Did they get paid?
11 Q. No, did you get paid?
12 A. No. I'm still on salary. It's just part of my
13 salary at Loveland.
14 Q. Okay. Thank you very much.
15 REPRESENTATIVE ITO: Thank you, Chair.
16 CO-CHAIR SENATOR HANABUSA: Thank you.
17 Representative Kawakami, followed by Representative Leong.
18 REPRESENTATIVE KAWAKAMI: Thank you very much,
19 Chair.
20 EXAMINATION
21 BY REPRESENTATIVE KAWAKAMI:
22 Q. I just wanted to ask this, kind of an observation.
23 I heard it several times over the years having been a teacher
24 and principal, et cetera. Autism has always been there.
25 Autistic kids have always been in the classroom. It's only,
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1 I don't know, over the so many years, a recent kind of thing,
2 that people are more aware of that. Is that true?
3 A. You know, in the early 1990s that's what most of us
4 believed. We couldn't possibly get our minds around the fact
5 that we might have an epidemic, and so we were looking at
6 diagnostic standards, had they changed, clinical training,
7 had it changed, was there some other way to account for the
8 fact that all of a sudden there were more and more kids, and
9 as it turns out, all the national studies are really showing
10 that there are more and more kids not just in the United
11 States but also internationally, and they don't think it's
12 because of changes in diagnostics. So while autistic kids
13 have probably always been in schools, they were probably in
14 schools much more rarely than they are now.
15 Q. Much more rarely you said?
16 A. Right. There were just fewer autistic children.
17 One in 10,000 is real different from one is 250 to 500.
18 Q. I guess in my mind I was trying to think, you know,
19 as a teacher was it that we did not recognize at an early
20 stage that these kids were autistic? I mean, you know, it's
21 really only come in -- really, the ones coming out today are
22 saying, no, those kids have been in the classroom and they've
23 seen it, et cetera, and I just wondered. And that's why the
24 problem has ballooned and you really see, you know, so many
25 more, as you say, one in --
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1 A. I know that it's almost impossible to imagine that
2 the population is growing that fast, especially -- even here
3 in Hawaii, but the number of autistic children for the
4 population and among special needs children and for the
5 number of live births is about in line with where it is
6 everywhere else. It certainly wasn't when I got here and it
7 wasn't even in line with the national statistics at the
8 beginning of the consent decree, so we were underidentifying,
9 I know, from like 1990 to about 1998.
10 Q. The other question I wanted to ask, Dr. Gardiner
11 from the Diamond Head Family Guidance Center said he worked
12 very closely with you; is that correct?
13 A. I've never met him.
14 Q. You never met him?
15 A. I actually -- when he called me crying the day the
16 newspaper article came out I said, please come over. He
17 said, oh, I will. And then he got some phone calls from
18 families, I guess, of autistic children and when I talked to
19 him next he said please talk to the families for me because
20 I'm getting angry phone calls and I don't want them, and I
21 said I would think about it and I had to write him back and
22 say, you know, this is -- there's an investigation going on,
23 there's a consent decree, I can't influence families and tell
24 them what to say and what not to say, just like I can't call
25 you and tell you to please tell the care coordinators you
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1 work with what to say or not to say about Loveland. It
2 wouldn't seem -- it wouldn't be proper and I can't do it. He
3 said, oh, that's okay, I've got an attorney and I'm probably
4 going to have to quit my job, and after that I haven't spoken
5 to him and he hasn't come over like he said he would and I
6 assume that's probably because he's getting advice that he
7 shouldn't, but the campus is open to him.
8 Q. I mean, I kind of jotted down when he said because
9 you were looking or doing the documentation and the notes and
10 he was working closely with you on these, he didn't?
11 A. I've never seen him. I don't know what he looks
12 like. Until this whole thing happened, I had never actually
13 spoken to him.
14 Q. Did you -- were you the person that were doing all
15 the billings?
16 A. No, I don't --
17 Q. Signing off on them?
18 A. No, I don't sign off on them. I sign off on
19 clinical case notes, but as Dr. Dukes will tell you and
20 anybody else in our organization, I could probably take
21 business management and math courses from now until dooms day
22 and I would probably be the worst bookkeeper anyone ever saw.
23 So I try not to touch anything that has numbers on it.
24 Q. Thank you very much.
25 REPRESENTATIVE KAWAKAMI: Thank you, Chair.
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1 CO-CHAIR SENATOR HANABUSA: Thank you,
2 Representative Leong.
3 REPRESENTATIVE LEONG: Thank you.
4 EXAMINATION
5 BY REPRESENTATIVE LEONG:
6 Q. I've been a teacher for a long time, and when I
7 speak with my fellow teachers they -- and ask them, you know,
8 did you have -- do you recognize the autistic children? And
9 many of them have said they don't recall having had any
10 autistic children, but I could identify some children in my
11 classes that were mainstreamed into those other resources
12 classes, and it's been interesting the progress that's
13 happened with many of those children but not really extreme
14 cases. Now, the record shows that east Honolulu has a
15 greater numbering of autistic children. Do you have any
16 facts for it or why it is?
17 A. You know, I really don't. Obviously population
18 density right here is greater. There's also a lot of
19 military bases in --
20 Q. Actually --
21 A. Not east Honolulu, but Honolulu.
22 Q. Actually, I was thinking of east Honolulu and I was
23 looking at do you suppose it's the economic situation that's
24 doing it or is that probably a plausible reason? What is
25 your feeling about that?
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1 A. You know, unless somebody actually did the research
2 and looked at all the socioeconomic factors and everything
3 else, I'm not sure we could say. I initially thought that
4 maybe some of the statistics could be accounted for by the
5 fact that this -- that Hawaii military basis are approved for
6 exceptional families and that some people might get
7 transferred here who have children with special needs and not
8 other places because there were more medical services here,
9 but, you know, I looked at it for a couple of years and that
10 just didn't seem to be it.
11 Q. I see. Well, maybe that's something we need to
12 explore. Also in your capacity, would you -- I'm sorry I had
13 to step out this morning. I had a very -- something I had to
14 attend, but I wanted to know what is your title at Loveland
15 because you have a special title?
16 A. I'm the clinical director.
17 Q. And how many of you are there at Loveland?
18 A. There's only one of me. I'm the one and only
19 clinical director, and I work with the mental health teams
20 and then have all the mental health people interface with all
21 the other therapies.
22 Q. So therefore you must be very busy during the day
23 when you're working with these different cases. I mean, you
24 have 20 students but you must be working with them; is that
25 correct?
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1 A. Yes.
2 Q. So what I'm trying to get at -- excuse me -- is
3 that when someone is trying to call you and you leave a
4 message and say, well, call me and I'll leave my -- I mean, I
5 wouldn't feel good about having you leave your class to come
6 and talk to me, but I would prefer to leave a message on your
7 voicemail, therefore, you could call me at your convenience.
8 A. The care coordinator at Loveland usually takes all
9 the messages in details and I usually get them and then I
10 make a note on the message book about what I did or put a
11 note in a chart about what I did or staple the message onto a
12 chart to put it in, tracking what I did. I found that if I
13 just left the messages on the message machine, I could have
14 like 29 to 50 messages in a day and the message machine would
15 be full and I wouldn't even know it. So without people to
16 actually pick up the phone or the email process or the fax
17 process, like, Dr. Koven, I'm trying to reach you, fax me
18 back tomorrow and tell me this, we could play telephone tag
19 with care coordinators for like four or five days. Where if
20 they just fax and say can you get me this and I can fax back
21 and say, yeah, then I can do that at 10:00 o'clock at night
22 or the next day when they are out at a meeting and we can
23 still get things done. So the message machine eventually was
24 just not enough to handle it.
25 Q. I could sense Dr. Gardiner's frustration when he
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1 said he tried to call you 17 times, and I know when I try to
2 call people I note how many times I called them. So in
3 actuality he probably did try to call you 17 times but
4 couldn't get through or leave a message for you, and I know
5 that in his condition -- his physical condition it was even a
6 greater anxiety for him, because when I get calls from my
7 office and they tell me that -- you know, he probably tried
8 to call you and then he was advised to go down and talk to
9 you personally?
10 A. I was on vacation I believe during the period of
11 time that he's reporting he was calling me, and so honestly I
12 can't say. That's kind of what's so peculiar about the whole
13 situation because when I came back from vacation and reviewed
14 every message book and all of my messages, I just didn't have
15 anything or I would have called him back. And I guess he
16 might have thought I was like the only person there he could
17 talk to, because apparently he never said, well, can I talk
18 to somebody else about this. So since I haven't been able to
19 talk to him about what happened in detail, I still honestly
20 do not know what happened and I'm frustrated too and I feel
21 awful for him.
22 Q. Thank you. Thank you for being here.
23 CO-CHAIR SENATOR HANABUSA: Thank you,
24 Representative Leong.
25 Representative Saiki.
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1 CO-CHAIR REPRESENTATIVE SAIKI: Thank you. I
2 have just a couple of questions.
3 EXAMINATION
4 BY CO-CHAIR REPRESENTATIVE SAIKI:
5 Q. How many staff members -- and this is in the area
6 of biopsychosocial services, how many staff members at
7 Loveland provide these services?
8 A. Dr. Dukes did the count while we were sitting and
9 listening to the other testimony and there are 26 employees
10 who are providing the afternoon services for BPSR.
11 Q. So that's a total number -- there aren't any day
12 treatment type providers providing these services? It's only
13 after school? It's only in the after school?
14 A. I'd have to explain the day to you again, because
15 there are some people that come in at 9:00 or 10:00 and stay
16 till 6:30, so they would be providing day treatment services
17 from, say, 9:00 to 2:00 or 10:00 to 2:00 when they came in
18 and then when the children transitioned to BPSR they would
19 then be in charge of a group or a team or an activity in BPSR
20 so there are providers that do only day treatment and only
21 BPSR and then there's the mid-day staff that have skills that
22 we need in both programs and they actually provide some
23 services to both groups of kids.
24 Q. So generally for these 26 staff members, what hours
25 of the day are they providing these services?
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1 A. We're open from 8:00 to 6:00.
2 Q. So it could be between the hours of 8:00 and 6:00?
3 A. Yes.
4 Q. Thank you very much.
5 EXAMINATION
6 BY CO-CHAIR SENATOR HANABUSA:
7 Q. Dr. Koven, as you were sitting here today you said
8 that you did not know about the whole CPU and Loveland
9 connection. You do do practicums for other institutions and
10 have no problem supervising them. Is your concern with the
11 CPU connection the fact that it is something to do with
12 Dr. Drews and it would be viewed as a conflict?
13 A. I don't know how I would have reacted to it if I
14 had learned about it before I learned there was a conflict,
15 but since learned about it after everybody else had decided
16 it was a conflict, obviously, I think it would be better if
17 everybody just shook hands and parted as friends and didn't
18 do this anymore. I think I might have been uncomfortable if
19 I heard about it earlier, but I won't know. I will never
20 know.
21 Q. Have you ever looked at the CPU Website?
22 A. No.
23 Q. You've never looked at it. How about the testimony
24 that you heard earlier or the questioning by Mr. Kawashima of
25 Dr. Dukes when he pointed out that for fiscal year '01
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1 Loveland had billed Department of Health over $2 million.
2 Were you surprised to hear those figures?
3 A. No. I think that in the beginning when we were
4 writing the RFP and we were calculating the services, we
5 actually looked at a lot of the children who are in the
6 outpatient system who we were patching services together for
7 ala cart who had TAs in school, TAs after school, TAs on the
8 weekend, and people working with them in the community and
9 driving back and forth and things were being done at home,
10 and those kids were costing somewhere between 70 and $120,000
11 a year, so one of our goals was to figure out how to do an
12 incredibly intensive program that would get kids into school
13 with minimal or no services that would be much more efficient
14 than that, and 50 to $60,000 a year seemed like a reasonable
15 target because that's what we looked at in terms of what
16 mainland programs in day treatment for autism were averaging
17 out to cost in more expensive states to live in.
18 Q. When we did just a rough math, we were coming out
19 pretty close to $100,000, so that's the reason. My last
20 question.
21 A. I think that's with BPSR also.
22 Q. Right. The last question I have is when Dr. Drews
23 made a statement, I just happened to be looking at you and
24 you were agreeing with him. He said he's the greatest critic
25 with what he called the day in the life of a child and he
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1 wants to ensure that the state is not raising the child or
2 the child is not raised by the state. And his concern, of
3 course, was what you just went through in terms of the litany
4 of the therapeutic aides over the weekend and he said he adds
5 up the hours and he doesn't see where the parents are taking
6 their, I guess, proper role in all of this. And you were
7 nodding like you are now. Can you tell me why you were
8 nodding your head? Are you in agreement with that statement?
9 A. I am in agreement with it. Parents are around for
10 the life of the child and children with autism have normal
11 life spans and will live to be 80 just like we will if we're
12 lucky. And so family members are extremely important in
13 their treatment.
14 When we wrap a child with services, one of the
15 major objectives has to be that we will support that family
16 and help facilitate for that family any training or expertise
17 that they can get that will make them the most prominent
18 experts in what their child needs and how to do it so that
19 when they move from service to service, they know what they
20 need and they know what they want and they can handle
21 everything independently that they possibly can.
22 Otherwise, if you wrap a child with services and
23 you disable a family or participate in disabling a family,
24 you're actually doing harm instead of good and I -- things
25 need to be family driven. So the idea of giving very
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1 intensive services is not to get the family to abdicate their
2 responsibility but to help them meet them.
3 Q. And how do you -- or are you aware of a way to
4 prevent the abdication but providing the services, like is it
5 a time frame or do you look for certain signs or is it, like
6 many things, just basically depending on the family
7 themselves? Some parents will, you know, go out of their way
8 to care for their child on their own or want that
9 independence and others may not by the figures that you've
10 given us. How do you work towards this -- I guess this
11 abdication of responsibility?
12 A. One of the things that we did, for example, in
13 creating Loveland was to make it a grass roots organization.
14 All of the parents and all of the families with autistic
15 children in the area, whether they were going to be, you
16 know, DOE mainstream or special ed kids or whether they were
17 going to be day treatment type kids, gave us a lot of input
18 on what would work for them, and we tried to build this with
19 cast principles and family centered care principles in mind
20 so that parents would be participating every step of the way.
21 They can walk into the classroom any time they
22 want. They can work with the TAs and their teachers and stay
23 for a day and watch any time they want and come regularly.
24 They can see us at the end or beginning of any workday and
25 actually do sessions. They can come in on the weekends and
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1 meet with us and we can train them. We can train grandma, we
2 can train aunty, we can train older brothers and sisters. We
3 can really take the time to make the family as knowledgeable
4 as they want to be and they possibly can be, and pretty soon,
5 after a few years usually, they sometimes come up with great
6 ideas in a pinch that we haven't thought of, and that's when
7 we know we're really doing great.
8 Q. Thank you.
9 CO-CHAIR SENATOR HANABUSA: Now, do we have
10 any follow-up from any members?
11 If not, thank you very much.
12 And members, I believe that is all. Members, this
13 ends the hearing for today. We will be reconvening, as you
14 know, on Wednesday, October 17th in this room at 9:00 o'clock
15 a.m. Thank you very much.
16 (Proceedings ended at 5:06 p.m.)
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1 STATE OF HAWAII )
2 ) ss:
3 CITY & COUNTY OF HONOLULU )
4
5 I, JESSICA R. PERRY, do hereby certify:
6 That on October 13, 2001, at 9:06 a.m. the
7 foregoing proceedings were taken down by me in machine
8 shorthand and was thereafter reduced to typewritten form by
9 computer-aided transcription; that the foregoing represents,
10 to the best of my ability, a full, true and correct
11 transcript of the proceedings had in the foregoing matter.
12 I further certify that I am not attorney for
13 any of the parties hereto, nor in any way concerned with the
14 cause.
15
16 DATED this 5th day of November 2001, in
17 Honolulu, Hawaii.
18
19
20
21
22
23 Jessica R. Perry, CSR 404
Notary Public, State of Hawaii
24 My commission expires: 5/11/03
25
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