1 SENATE/HOUSE OF REPRESENTATIVES
2 THE 21ST LEGISLATURE
3 INTERIM OF 2001
4
5
6
7
8
9 JOINT SENATE-HOUSE INVESTIGATIVE COMMITTEE HEARING
10 NOVEMBER 2, 2001
11
12
13
14 Taken at the State Capitol, 415 South Beretania,
15 Conference Room 325, Honolulu, Hawaii, commencing at
16 1:20 p.m. on Friday, November 2, 2001.
17
18
19
20 BEFORE: SHIRLEY L. KEYS, RPR, CM, CSR 383
21 Notary Public, State of Hawaii
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23
24
25
Page 1
1 APPEARANCES:
2
3 State-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
14 Senator Sam Slom
15
16 Also Present:
17
18 Ms. Mary Brogan
19
20
21
22
23
24
25
Page 2
1 I N D E X
2
3 WITNESS: MARY BROGAN
4
5 EXAMINATION BY: PAGE
6 Special Counsel Kawashima 6
7 Vice-Chair Representative Oshiro 55
8 Vice-Chair Senator Kokubun 59
9 Senator Slom 61
10 Representative Kawakami 65
11 Representative Leong 71
12 Representative Marumoto 74
13 Co-Chair Representative Saiki 79
14 Co-Chair Senator Hanabusa 85
15 Special Counsel Kawashima 93
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17
18
19
20
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22
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24
25
Page 3
1 CO-CHAIR SENATOR HANABUSA: The Joint
2 House -- Senate-House Investigative Committee to
3 investigate the State's efforts to comply with the Felix
4 Consent Decree will come to order. Will Vice-Chair
5 Oshiro please call the roll?
6 VICE-CHAIR REPRESENTATIVE OSHIRO:
7 Co-Chair Hanabusa?
8 CO-CHAIR SENATOR HANABUSA: Here.
9 VICE-CHAIR REPRESENTATIVE OSHIRO:
10 Vice-Chair Kokubun?
11 VICE-CHAIR SENATOR KOKUBUN: Here.
12 VICE-CHAIR REPRESENTATIVE OSHIRO:
13 Senator Buen?
14 SENATOR BUEN: Here.
15 VICE-CHAIR REPRESENTATIVE OSHIRO:
16 Representative Ito?
17 REPRESENTATIVE ITO: Here.
18 VICE-CHAIR REPRESENTATIVE OSHIRO:
19 Representative Kawakami?
20 REPRESENTATIVE KAWAKAMI: Here.
21 VICE-CHAIR REPRESENTATIVE OSHIRO:
22 Representative Leong?
23 REPRESENTATIVE LEONG: Here.
24 VICE-CHAIR REPRESENTATIVE OSHIRO:
25 Representative Marumoto?
Page 4
1 REPRESENTATIVE MARUMOTO: Here.
2 VICE-CHAIR REPRESENTATIVE OSHIRO:
3 Senator Matsuura, excused. Senator Sakamoto, excused.
4 Senator Slom?
5 SENATOR SLOM: Here.
6 VICE-CHAIR REPRESENTATIVE OSHIRO: We
7 have quorum.
8 CO-CHAIR SENATOR HANABUSA: Thank you
9 very much. The investigative committee issued a subpoena
10 to require Miss Mary Brogan to appear as a witness before
11 this committee. Miss Brogan did appear and kindly agreed
12 at the last hearing to return today. Miss Brogan, will
13 you please step forward? Have a seat.
14 MS. BROGAN: Okay.
15 CO-CHAIR SENATOR HANABUSA: Miss
16 Brogan, as you know, you've been observing our other
17 hearings, I will now place you under oath, so do you
18 solemnly swear or affirm that the testimony you're about
19 to give will be the truth, the whole truth and nothing
20 but the truth?
21 MS. BROGAN: Yes, I do.
22 CO-CHAIR SENATOR HANABUSA: Thank you,
23 Miss Brogan. Members, we will be following our usual
24 procedures. We will begin the questioning with
25 Mr. Kawashima.
Page 5
1 SPECIAL COUNSEL KAWASHIMA: Thank you,
2 Madam Chair.
3 E X A M I N A T I O N
4 BY SPECIAL COUNSEL KAWASHIMA:
5 Q. Please state your name and business address,
6 ma'am.
7 A. My name is Mary Brogan. I work at the Diamond
8 Head House Center, 3627 Kilauea Avenue, Honolulu.
9 Q. All right. And that is with the Department of --
10 Department of Health?
11 A. Yes.
12 Q. Now, will you briefly recount for us your
13 educational background?
14 A. Yes. I have a Bachelors degree in elementary
15 education, a Masters degree in counseling, both from the
16 University of Hawaii, and I have done some work in the
17 Ph.D. program in social welfare at the university.
18 Q. Now, how about your -- let's see. When did you
19 receive your Bachelors, ma'am?
20 A. 1988.
21 Q. And your Masters?
22 A. 1990.
23 Q. So you went straight on from your undergraduate
24 to the advanced degree?
25 A. Yes.
Page 6
1 Q. So am I to understand then your work history
2 was started in 1990?
3 A. No, I worked before that. I graduated from
4 high school earlier.
5 Q. Oh, I see. How about any work that is related
6 to the work you do, of course it all is, but directly
7 related to your work with the Department of Health, when
8 did that start?
9 A. I started working with the Department of Health
10 in 1998.
11 Q. All right. Before that if you might recount
12 your work history then from 1990 to 1998?
13 A. I worked at the Office of Youth Services until
14 1992. I then worked at the Office of the Governor from --
15 Q. What years?
16 A. 1993 through 1998.
17 Q. And what were your job descriptions at the
18 governor's office?
19 A. I was a planning and policy analyst. Previous
20 to being a planning and policy analyst I was a child
21 development officer.
22 Q. And that analyst position, what type of work
23 did you do specifically?
24 A. I worked on children's policy issues and I did
25 work on things related to the Felix Consent Decree. I --
Page 7
1 we did a partnership with the monitoring project out of
2 the Office of the Governor around the early years of
3 service testing.
4 Q. I see. I see.
5 A. And other systems development issues.
6 Q. All right. Now, when you started with the
7 Department of Health in 1998, in what capacity did you
8 start?
9 A. I started as a program performance specialist.
10 Q. And what -- tell me what the duties of that job
11 were?
12 A. I worked on -- at that point service testing
13 became a partnership between the Department of Education,
14 Department of Health and the monitoring project. I
15 worked on that as well as other areas of measuring
16 performance and on projects related to systems
17 development, training and supervision systems and things
18 in developing the practice of the work in the field.
19 Q. All right. And then did you move to another
20 position subsequently?
21 A. Yes. I did. I became the performance manager
22 after that.
23 Q. I'm sorry?
24 A. The performance manager.
25 Q. For what?
Page 8
1 A. Performance management at the Child and
2 Adolescent Mental Health Division, oversees the overall
3 performance of the system, performance of the family
4 guidance centers and of our contract to provider
5 agencies.
6 Q. I see. And for what period of time then did
7 you occupy that post as performance manager?
8 A. From June 2000 until present, about a year and
9 a half. About eight months of that time I was -- the
10 sections merged and I also oversaw the clinical services
11 office for eight months of that time.
12 Q. For what period did you also oversee the
13 clinical services offices?
14 A. From February 1, 2001, until several days ago.
15 Q. All right. Several days ago meaning this week?
16 A. Yes.
17 Q. And what happened several days ago in terms of
18 that position in clinical services?
19 A. I vacated that position and went back to being
20 the performance manager. We had for a eight month period
21 joined the two sections, and a decision was made to
22 unmerge the two sections.
23 Q. Were you considered the clinical director?
24 A. Yes.
25 Q. And my understanding, ma'am, of the clinical
Page 9
1 director, is it usually -- or it should be someone who
2 has some clinician's background?
3 A. Yes.
4 Q. Have you had that type of background?
5 A. I have a Masters degree in counseling, I did a
6 APA internship at the counseling center at the
7 university, so I have done clinical work in the clinical
8 services offices also overseeing the functions of
9 utilization review, training, and those kind of things,
10 so in addition to having direct clinical knowledge, it's
11 also the things that you need in order to manage a mental
12 health system.
13 Q. As far as the requirements for that position of
14 clinical director, the department and the State
15 requirements, do you fulfill those requirements?
16 A. Yes, I do.
17 Q. Clinical director?
18 A. Yes.
19 Q. There is no requirement that there be some
20 clinical background in the area of child mental health?
21 A. As I said, I have training in counseling, which
22 is a mental health discipline.
23 Q. Was there a finding that you were qualified to
24 serve in the position of clinical director if in fact the
25 department chose to leave you there?
Page 10
1 A. Yes. There was a finding that I was qualified
2 to take the position.
3 Q. And how did that finding come about, ma'am?
4 A. I was recruited for the position and accepted.
5 Q. By whom?
6 A. By Tina Donkervoet, who's the chief of
7 children's mental health.
8 Q. So you were actually recruited for the position
9 of clinical director then?
10 A. Yes. I was asked to take the position.
11 Q. And you took that position as clinical
12 director?
13 A. I took that position, and again, at that point
14 in time we merged the areas of performance and clinical
15 services. It's -- the technical term for the position is
16 clinical services office manager.
17 Q. Not clinical director?
18 A. It's a commonly used term for that position.
19 Q. If we were to look at a job -- job description
20 chart or list, explanation, it would say clinical
21 services director?
22 A. Clinical services office manager.
23 Q. Okay. That's --
24 A. Not that you're an office manager, but you're
25 the manager of the clinical services office and I was
Page 11
1 also overseeing the performance management office.
2 Q. I understand that, but the title would be as
3 you suggest, in whatever chart we might look at that is
4 current, and I assume has been there for some time now?
5 A. Right, in the organizational chart?
6 Q. Yes.
7 A. In the official organizational chart.
8 Q. Yes.
9 A. Says clinical services office manager.
10 Q. Is there such a thing in that clinical -- I'm
11 sorry, in that organizational chart as the clinical
12 director, in that area that you're serving?
13 A. No, the official term is clinical services
14 office.
15 Q. All right. Now, what was the reason why they
16 split out the offices?
17 A. The two offices are very large, and the scope
18 of work is something that I believe was seen as being
19 something that would need some extra resources, so they
20 split out the two offices because I believe the thinking
21 was that just it was too much for one person to oversee
22 as the system grew.
23 Q. Would that -- would that area come under your
24 purview as performance manager or not?
25 A. The clinical services?
Page 12
1 Q. Yes.
2 A. No longer.
3 Q. No longer?
4 A. It was, but no longer.
5 Q. All right. Would your position as performance
6 manager be at the same level of the person who would be
7 in charge of clinical services?
8 A. Yes, it is.
9 Q. Have they appointed a person for that position
10 yet?
11 A. No, no. It's a vacant position.
12 Q. Do they intend to appoint a person for that
13 position --
14 A. Yes.
15 Q. -- in the future? All right. And by the way,
16 who made that decision?
17 A. Tina Donkervoet, who's the chief of the Child
18 and Adolescent Mental Health Division.
19 Q. And again, it had to do purely with the fact
20 that the position that you were occupying really was too
21 much for one person?
22 A. I think that was probably a key consideration.
23 Q. Were there others that you're aware of, other
24 considerations?
25 A. I think that what was expressed, that was the
Page 13
1 main consideration. I think that the other is that there
2 is a growing movement in children's mental health
3 nationally as well as here to install more evidence based
4 treatments. These are treatments that research has shown
5 that have efficacy and that work with the populations
6 that we are working with, and I think that there was a --
7 because of the emphasis on this and the need to have
8 somebody who could really drive forward a massive
9 training initiative on this, that that would be again
10 something that we would need to bring in more support
11 for. And my particular expertise and background is much
12 more on measurement and managing performance, so it was a
13 tactical decision, I believe, and again, I would not be
14 able to answer all the questions around the reasons why.
15 Q. All right. To the extent that you do have the
16 answers, that's all we're asking.
17 A. This is as far as my knowledge.
18 Q. All right. So that they would need to bring
19 someone with essentially a different background in to do
20 what you are proposing?
21 A. And I think that the other is if you look at
22 the organization, we merged two very large sections and
23 operationally it just makes much more sense to be able to
24 manage it.
25 Q. Sure.
Page 14
1 A. In a way that makes more sense.
2 Q. Sure, I understand. I understand what you
3 explained earlier about the size of the job being too
4 large for one person, but they would also have to bring
5 in someone with a different background as far as
6 education and experience is concerned than you to occupy
7 that position, right?
8 A. I think in order to fully address the growing
9 needs for the organizational emphasis on evidence based
10 treatment, that that certainly is a consideration.
11 Q. All right. Do you know if anyone's under
12 consideration for that position?
13 A. I believe that there is somebody under
14 consideration for the short term, and I think that what's
15 going to happen for the long term is it's going to be
16 recruited for.
17 Q. All right. Who's under consideration for the
18 short term?
19 A. For the short term, Dr. Bruce Trapida, who's at
20 the university.
21 Q. All right. Now, if I might ask you some
22 questions about your area of supervision when you were in
23 that position as being the head of clinical services, all
24 right?
25 A. Uh huh.
Page 15
1 Q. Let's start, I believe as you say, in February
2 of this year up to a few days ago, would you then
3 supervise, for example, psychologists, psychiatrists,
4 other mental health professionals?
5 A. I supervise no psychiatrists, although I did
6 work with the clinical directors at the family guidance
7 centers who are psychiatrists. I did work with them.
8 Q. How about psychologists?
9 A. There were -- there are several psychologists
10 in our area.
11 Q. Other -- are there other mental health
12 professionals over which you had supervision as head of
13 clinical services?
14 A. There are mental health professionals.
15 Q. Also? All right. When you say no
16 psychiatrists, is that because there are no psychiatrists
17 under contract or working with you or because that is
18 under someone else's purview?
19 A. The medical director is under the supervision
20 of the chief.
21 Q. I see.
22 A. But is certainly a part of our -- the office.
23 Q. Sure.
24 A. We work together very closely.
25 Q. So you are then -- you were responsible for
Page 16
1 reviewing mental health services and mental health
2 evaluations of students?
3 A. Yes. We reviewed.
4 Q. Your department is what I'm saying?
5 A. Yes. We reviewed services and we reviewed the
6 performance of the system.
7 Q. All right. Now, I think you already testified,
8 ma'am, that you obtained that position having been
9 recruited for it by Tina Donkervoet?
10 A. Yes.
11 Q. And so you didn't actually apply for that
12 position, did you?
13 A. No. I didn't apply for the position.
14 Q. So you were recruited for it, you, I assume
15 went through the normal interviews, you were already
16 working there actually, were you not?
17 A. Yes.
18 Q. Now, I think you explained it already, ma'am,
19 but will you do it again for me, explain to me what prior
20 clinical experience you had prior to when you took that
21 position as head of clinical services?
22 A. I have a Masters degree in counseling. As part
23 of that, I did a internship, which is a American
24 Psychological Association approved site. I did testing
25 and therapy, including group and individual, counseling
Page 17
1 and treatment with clients at the university. I did
2 counseling internships in schools.
3 Q. While you were working with -- for your degree?
4 A. Yes. And over time I have done work with the
5 development of treatment plans, coordinated service
6 plans, conducted training on those and been involved in
7 our system since approximately 1995.
8 Q. I'm sorry. What about 1995?
9 A. That's when I really started working with the
10 children's mental health and educational system around
11 systems development, practice development of youth.
12 Q. Is that when you were working on, as you say,
13 the treatment plans and the coordinated --
14 A. Coordinated service plans.
15 Q. -- service plans?
16 A. Right, which is --
17 Q. From 1995?
18 A. Uh huh.
19 Q. Yes? So up to that time then, up to 1995 then,
20 your experience with clinical -- your clinical experience
21 was limited to the internship you did as a part of
22 obtaining your Masters of arts?
23 A. I would say -- Masters of education.
24 Q. I'm sorry.
25 A. I would say that my formal clinical experience
Page 18
1 is --
2 Q. All right.
3 A. -- that.
4 Q. As a part of the Masters of education program
5 and internship with an American Psychological Association
6 approved site?
7 A. Uh huh.
8 Q. Is that what it was?
9 A. Yes.
10 Q. Had you done any other -- or had you had any
11 other clinical experience in either the private industry
12 or in -- with government, other than as you've already
13 testified to?
14 A. No. It would be included in the work I've done
15 in mental health.
16 Q. Okay. You were though as the head of clinical
17 services then overseeing psychologists and other mental
18 health providers other than psychiatrists?
19 A. I oversaw a lot of people in a lot of
20 functions.
21 Q. Okay. Now, part of your responsibility as head
22 of clinical services was to oversee the MST program, was
23 it not?
24 A. MST was part of the clinical services office
25 and there was an MST administrator who was the supervisor
Page 19
1 for MST.
2 Q. You're talking about John Donkervoet?
3 A. No, I'm talking about Carol Matsuoka. John
4 Donkervoet was the clinical supervisor for MST.
5 Q. Oh, I see. The term MST coordinator, is there
6 such a term?
7 A. I believe those are the positions within.
8 Q. Okay. John Donkervoet was clinical director of
9 MST?
10 A. Yes, he was the clinical supervisor.
11 Q. That MST program, you've been here when we've
12 asked questions about that before. It consists of a home
13 based MST program and also a continuum?
14 A. Yes.
15 Q. Am I correct? The continuum though was a
16 research project?
17 A. It was.
18 Q. And that began in July of last year?
19 A. Yes.
20 Q. And what they did was they took a control group
21 of students and in the continuum, in the research project
22 there was a control group and a group that received MST
23 services, is that correct?
24 A. Yes.
25 Q. Whose decision was it to have this research
Page 20
1 project?
2 A. I believe it was the management at that time
3 decided to engage in it.
4 Q. Were you a part of that decision making
5 process?
6 A. No, I was not.
7 Q. All right. But am I correct that what was
8 happening with the MST continuum, although it was
9 providing services to children, it essentially was a
10 research project that the State funded, was it not?
11 A. It was a research project. It provided
12 services to children.
13 Q. But it was in and of itself though not just
14 providing services, it was providing services in a
15 research project setting, was it not?
16 A. The research was of the services and of the
17 delivery of services.
18 Q. I understand, I understand. But again now, if
19 you were merely delivering services under an MST program,
20 that would not necessarily include a continuum, would it?
21 A. I'm not sure exactly what you're asking.
22 Q. MST, in every situation where they have MST in
23 place, do they have continuums in place?
24 A. No. It was a -- two distinct --
25 Q. It was --
Page 21
1 A. -- projects.
2 Q. It was a project for which the State of Hawaii --
3 which the State of Hawaii funded?
4 A. Yes.
5 Q. What's your understanding as to how the results
6 of this project was to inure to the benefit of the State?
7 A. The benefit to the State, from my
8 understanding, is that it would help us to demonstrate
9 through research a method of serving kids that would for
10 this particular population divert them from hospital
11 settings. So the benefit of the State was to build -- to
12 look at a service delivery and treatment methodology that
13 would work with children and families to prevent them
14 from going -- having services in the hospital.
15 Q. To your knowledge, has -- was a project such as
16 that undertaken anywhere else prior to when it was -- or
17 when it originated in July of 2000 here in Hawaii?
18 A. There was a similar study conducted at another
19 site.
20 Q. And starting when, ma'am?
21 A. I'm not sure when that was.
22 Q. About the same time or long before?
23 A. No, there was another study. There was a
24 concurrent study, I believe, being conducted in
25 Philadelphia. But there was another study before that
Page 22
1 that had shown promising results, which was a hospital
2 diversion study. MST itself has multiple sites with
3 different populations, I think in Houston, 25 states.
4 Q. If they had another project that showed
5 promising results, why did they need to have a research
6 project here? Why did they not just implement what they
7 learned from that other project?
8 A. I think for several reasons. I think that what
9 you have to do is to establish actual efficacy, and what
10 the other thing is to be able to -- for us to be able to
11 see if these services work in a setting such as Hawaii
12 that has rather unique characteristics such as
13 multi-cultural population, it's within the context of a
14 joint service system that is closely linked to education,
15 and that has -- we're also very isolated and there hasn't --
16 there often are treatment studies that are done in other
17 kinds of settings, but very few are done in a Pacific
18 island setting, so this is valuable information.
19 Q. At that point though, we or you, the Department
20 of Health, did not know whether or not MST would even
21 work here in Hawaii, home based MST would even work here,
22 right?
23 A. Home based MST has multiple research studies
24 behind it.
25 Q. No. But as far as knowing whether or not it
Page 23
1 would work here in Hawaii, you had not -- you did not
2 know that when you embarked on this research project in
3 July of 2000, did you?
4 A. At that point in time it was a new program.
5 There -- it is being looked at carefully and has started
6 to show preliminary positive outcomes for this
7 population, preliminary cost benefit, and again, positive
8 results in a bunch of different indicators so --
9 Q. Was there a budget or a strategic plan
10 established when the project -- before the project was
11 embarked on to determine things such as how much it was
12 going to cost, what the prospects of success were, so
13 that you don't just merely spend a lot of money and get
14 nothing out of it?
15 A. I wasn't involved at that time, but as far as I
16 know, it was looked at very carefully in terms of
17 implementation to be able to impact things like school
18 attendance, because that's something we're very
19 interested in, is school outcomes. Particularly in the
20 light of our charge with Felix, we want to be able to
21 insure that children are benefiting from their education.
22 It's also looking at the particular populations that are
23 children that are -- have willful misconduct issues, so
24 are kind of the juvenile offender type of kids, these are --
25 Q. That's what it was designed for, right,
Page 24
1 juvenile offenders?
2 A. Right, and these are programs that
3 traditionally in Hawaii we had been doing other kind of
4 interventions or IEP teams and so forth had been tending
5 to -- we had been seeing a lot of them pop up in out of
6 home placements and hospital settings.
7 Q. Let me ask you this. Was there any type of
8 study done to see whether you could get enough students
9 into the program to make it make sense?
10 A. For the home based MST?
11 Q. No, no, the research project, because you
12 needed a certain number of students to statistically make --
13 to statistically have it be valid, right?
14 A. At that point in time there were -- the
15 population that were being referred to the hospital was
16 fairly high.
17 Q. Was there a determination made that you would
18 get the requisite number to statistically validate that
19 project?
20 A. I believe at that time it was believed that we
21 certainly could.
22 Q. Didn't the project have to be terminated
23 because of lack of participation?
24 A. During the year or so that MST continuum was in
25 place, there were fairly dramatic changes in the system.
Page 25
1 We were able to stabilize case loads, we were able to do
2 intensive practice development and expectation setting,
3 strong supervision, and also to bringing aboard the
4 clinical directors in the family guidance centers. So
5 the system strengthened so much, and also, the
6 expectations that we set around if a child does not
7 belong in a hospital setting, they should not be there.
8 We had average lengths of stay quite high compared to,
9 you know, what we would expect for this population. And
10 so we did a lot of intensive work over the past year.
11 Q. But that doesn't speak to the number of
12 students you could get into the program?
13 A. It's related because we were able to impact the
14 children with intensive needs to such an extent that far
15 less of them were entering the hospital. We've now, you
16 know, like yesterday we had around eleven children in
17 Kahi.
18 Q. In your mind is that why you couldn't get
19 enough students for the continuum, is that the reason
20 why?
21 A. I would say that that was a key reason why we
22 couldn't get enough students for the continuum, was we
23 were -- children did not have as intensive needs. I
24 think that we have been -- it's a good indicator that we
25 have been fairly successful in serving kids in their
Page 26
1 communities and at homes.
2 Q. Was it --
3 A. Which is nice.
4 Q. Was one of the reasons that you could not
5 convince parents to place their child into the continuum?
6 A. No.
7 Q. Not at all?
8 A. No, I have never heard that to be a reason.
9 Q. So if anyone were to testify that that was a
10 reason, that person would be wrong then, huh?
11 A. I believe so. I think they were recruiting
12 kids into the continuum. I have never heard that as a
13 reason. It could be an opinion.
14 CO-CHAIR SENATOR HANABUSA: Miss
15 Brogan, you've been very patient with us, but we're going
16 to have to take a break at this time, and we'll ask that
17 you remain here. Members, the Co-Chairs are going to be
18 making a motion that we go into executive session. The
19 purpose of this executive session is to consult with the
20 Attorney General, who is -- we have just received word
21 that he has arrived, so with that, members, any
22 discussion? If not, Co-Chair Saiki, will you take the
23 roll?
24 CO-CHAIR REPRESENTATIVE SAIKI:
25 Co-Chair Hanabusa?
Page 27
1 CO-CHAIR SENATOR HANABUSA: Aye.
2 CO-CHAIR REPRESENTATIVE SAIKI: Senator
3 Kokubun?
4 VICE-CHAIR SENATOR KOKUBUN: Aye.
5 CO-CHAIR REPRESENTATIVE SAIKI:
6 Vice-Chair Oshiro?
7 VICE-CHAIR REPRESENTATIVE OSHIRO: Aye.
8 CO-CHAIR REPRESENTATIVE SAIKI: Senator
9 Buen?
10 SENATOR BUEN: Aye.
11 CO-CHAIR REPRESENTATIVE SAIKI:
12 Representative Ito?
13 REPRESENTATIVE ITO: Aye.
14 CO-CHAIR REPRESENTATIVE SAIKI:
15 Representative Kawakami?
16 REPRESENTATIVE KAWAKAMI: Aye.
17 CO-CHAIR REPRESENTATIVE SAIKI:
18 Representative Leong?
19 REPRESENTATIVE LEONG: Aye.
20 CO-CHAIR REPRESENTATIVE SAIKI:
21 Representative Marumoto?
22 REPRESENTATIVE MARUMOTO: Aye.
23 CO-CHAIR REPRESENTATIVE SAIKI: Senator
24 Matsuura is excused. Senator Sakamoto?
25 SENATOR SAKAMOTO: Aye.
Page 28
1 CO-CHAIR REPRESENTATIVE SAIKI: Senator
2 Slom?
3 SENATOR SLOM: Aye.
4 CO-CHAIR REPRESENTATIVE SAIKI: We have
5 eleven ayes.
6 CO-CHAIR SENATOR HANABUSA: Thank you.
7 Members, we'll convene next door and hopefully we will be
8 out in half an hour, so we'll reconvene at 2:15, and
9 again, our apologies, Miss Brogan.
10 (Recess.)
11 CO-CHAIR REPRESENTATIVE SAIKI:
12 Members, we'd like to reconvene our hearing. We'll
13 continue with the questioning by special counsel.
14 SPECIAL COUNSEL KAWASHIMA: Thank you.
15 Q. Miss Brogan, I was asking you some questions
16 earlier about position titles and stuff.
17 A. Yes.
18 Q. And I'm looking at some documents that were
19 given to us by the Department of Health where they have
20 an organizational chart, at the top of which is you,
21 clinical services multi-systemic therapy. The title is
22 clinical director. The person is Mary Brogan.
23 A. Uh huh.
24 Q. Is that different from what you testified about
25 earlier?
Page 29
1 A. It's not different. Those are unofficial
2 organizational charts just to show the relative placement
3 of people now. What you asked me about was the official
4 title of the position and I believe that on the official
5 organizational charts filed with the Department of Health --
6 Q. Why is this not an official organizational
7 chart?
8 A. Because as you know, the Child and Adolescent
9 Mental Health Division has added personnel and functions
10 over the past several years in order to address the
11 growing capacities within the system.
12 Q. This is dated August 15, '01, you know. You
13 understand that?
14 A. I do understand that. There's -- I think
15 there's a difference between an official organizational
16 chart that needs to be approved by the department and a
17 functional organizational chart.
18 Q. So what they sent to the auditor's office when
19 that chart was requested was an unofficial chart?
20 A. It would have been a functional chart versus
21 what is officially approved as an organization.
22 Q. There would be another one called CAMHD
23 executive, another chart, the top is which is division
24 chief, Dr. Tina Donkervoet, and down further at the
25 bottom right it says clinical director, clinical
Page 30
1 services, Mary Brogan. Under you, under you comes
2 clinical services office and performance management
3 office?
4 A. Yes.
5 Q. Both under your purview?
6 A. Yes, that's correct. That's the functional
7 organizational chart and that is the function that I
8 served in.
9 Q. So you are familiar then with the term clinical
10 director? I asked you about that term as well.
11 A. Yes, yes, and I was just making the distinction
12 about what the official term was versus what the
13 functional term was.
14 Q. Now, your Masters in counseling is from which
15 school at the university?
16 A. It's from the College of Education.
17 Q. Does the College of Psychology also provide a
18 Masters for applicants who wish to obtain a Masters
19 degree?
20 A. There is a Masters degree in psychology.
21 Q. All right. So your degree is not in any way in
22 psychology, is it?
23 A. It's not in psychology, it's in counseling.
24 Q. And I'm looking at the recommended
25 qualifications for clinical director, which was your
Page 31
1 position, and it says six years of professional clinical
2 experience which include -- I'm sorry, which involved
3 mental health. You did not have that experience, did
4 you?
5 A. I've worked extensively in programs with youth
6 that have mental health issues. I have worked
7 extensively in the field, I am very familiar with the
8 mental health field. And I also believe that the
9 functions of this office is mental health administration,
10 including the growing capacity to provide the functions
11 that you need in order to manage and disburse mental
12 health services on a large basis statewide.
13 Q. Ma'am --
14 A. Including quality control so --
15 Q. Your recommended qualifications for your job
16 was six years of professional clinical experience which
17 involved mental health.
18 A. Those are the recommended qualifications.
19 Q. Right. You did not have those qualifications,
20 did you?
21 A. I do not -- I did not have direct clinical -- I
22 did not work as a therapist, if that's what you mean.
23 Q. Not what I mean, these are your rules, not
24 ours. It says six years of professional clinical
25 experience which involve mental health. That you did not
Page 32
1 have, obviously?
2 A. I think obviously the people who hired me
3 thought I could do the job.
4 Q. Now, I'm not sure if you were here, I think you
5 were when I was questioning Mr. Donkervoet --
6 A. No, I was not.
7 Q. You were not. All right. I asked him about
8 instances where -- in the continuum now for awhile, in
9 the continuum, envelopes were switched so that a
10 particular student would be placed within the continuum.
11 Have you heard complaints of that nature?
12 A. No, I have not.
13 Q. How about MST therapists being hired over the
14 Internet, and some with no clinical background. Have you
15 heard any complaints of that nature?
16 A. No, I have not. No complaints like that have
17 come to me.
18 Q. How about complaints when the continuum project
19 was abruptly discontinued? Were there complaints then?
20 A. We did not receive any formal complaints.
21 Q. When you say formal complaints, ma'am --
22 A. Right.
23 Q. -- what do you mean by that?
24 A. Formal or informal, I did not receive any
25 complaints.
Page 33
1 Q. Oh, you had no knowledge of any complaints by
2 anyone involved in the project who complained about the
3 abrupt discontinuation of the project and the manner in
4 which it was discontinued?
5 A. Nobody complained to me about that.
6 Q. And nobody related to you someone else
7 complaining about it?
8 A. No, sir.
9 Q. Mr. Donkervoet never mentioned to you that
10 there were such complaints?
11 A. No.
12 Q. Now, do you know that there were -- I should
13 say when the project was discontinued that family
14 coordinators were instructed not to have any further
15 contact with their clients even though the clients wanted
16 to have further discussions with them?
17 A. I believe --
18 Q. Were you aware of that?
19 A. I believe that the family coordinators in some
20 cases did accompany the therapists and the team to talk
21 with families. That was -- my knowledge is that.
22 Q. I understand that. I understand that but --
23 A. Uh huh.
24 Q. Do you have any knowledge that family
25 coordinators were actually instructed not to have any
Page 34
1 further contact beyond a certain point in time with their
2 former clients?
3 A. I was not -- during the time that they worked
4 for the project they could continue to contact --
5 Q. No, no.
6 A. After the project, you know, it would not make
7 any clinical sense for them to continue --
8 Q. No, what I meant was projects --
9 A. -- contact.
10 Q. You would agree that the project was
11 discontinued prematurely?
12 A. The project, there was a decision to
13 discontinue the project.
14 Q. Because the project was to last two years,
15 wasn't it?
16 A. It originally was.
17 Q. And it lasted about a year?
18 A. Yes.
19 Q. So when it was -- and I assume what happened
20 was when the project was discontinued from a client
21 standpoint, it was something that was done abruptly,
22 right?
23 A. There were transitions were managed for every
24 single child in the continuum.
25 Q. The parents were given how much notice that the
Page 35
1 project was going to be discontinued?
2 A. There was a range of time, they were told
3 immediately because they should have been told.
4 Q. So immediately from that point in time to when
5 it was discontinued, how long would that have been, in
6 the closest --
7 A. There was a range of transitions from some
8 children had actually graduated from high school, one
9 child had graduated from high school and so that was an
10 easy transition. Some of the children were doing -- they
11 had more complex transitions and those transitions lasted
12 up until just recently, so it was a range and it depended
13 on the needs of the child and the family, and those were
14 done on a case by case basis. Every child was reviewed
15 to determine exactly what transition supports they would
16 need, what the transition actions and invitations, what
17 those -- how they would occur, and those were managed by
18 staff.
19 Q. Were you -- are you aware of any complaints
20 regarding these discontinuations, the discontinuation
21 complaints from former clients that they were told that
22 they were not allowed to have any further discussions
23 with the family coordinators?
24 A. No, there were no complaints.
25 Q. None?
Page 36
1 A. No complaints came to me.
2 Q. Well, no complaints to you directly or
3 indirectly, right?
4 A. Sir, I did not hear of any complaints of that
5 nature.
6 Q. Now, if I might move to another area involving
7 mental health services, if I might, understanding your
8 background, your position, what type of scales or
9 instruments were used to measure mental health outcomes?
10 A. There are various scales.
11 Q. I mean in this case, in the case of Felix
12 children now?
13 A. Right.
14 Q. All right? Go ahead, I'm sorry. What was
15 used, actually?
16 A. Well, there was the instrument that you know
17 about, which is service testing, which was used to
18 measure various indicators of child well-being, so the
19 things that were measured were whether the child was
20 making learning progress, whether the child was making
21 treatment progress, how well they were doing emotionally
22 and behaviorally, how well parents were satisfied with
23 services, their stability, because for some kids, not all
24 kids, stability is a very important issue.
25 Q. So was that the only scale or instrument that
Page 37
1 was used?
2 A. No. There were -- our care coordinators are
3 also trained to administer the child and adolescent
4 functioning scale, the CAFS, and that's used by clinical
5 teams to determine improvements.
6 Q. I'm sorry. Will you -- will you -- I missed --
7 it went by. What did you call this functioning scale?
8 A. It's called the CAFS, the child and adolescent
9 functioning scale. It's developed by Kay Hodges, it's --
10 Q. I see. That's a scale that is used?
11 A. It's used across the country and high validity
12 and reliability studies have been done on the scale and
13 it's used by virtually every mental health system that I
14 know of.
15 Q. Any other scales?
16 A. They also often use the Auchenbach or the child
17 behavioral checklist, CBCL, which is also commonly used
18 in mental health, again is a very useful clinical tool.
19 Q. How is it decided which scale or instrument is
20 going to be used with a certain child?
21 A. These are -- two of those both scales are used
22 extensively.
23 Q. Service testing? No?
24 A. Service testing is used on a random sample of
25 children. And it's probably about ten to twenty percent
Page 38
1 of the population within a given complex and will tell
2 you.
3 Q. You're talking about the CAFS, and what's the
4 other one, Auchenbach?
5 A. Those should be applied more broadly.
6 Q. That's what I mean. That's what you're
7 referring to, the ones that are used more broadly, the
8 CAFS?
9 A. Yes.
10 Q. And what is the other one?
11 A. The Auchenbach or the CBCL. We also have the
12 CA Locus.
13 Q. Are they used in every case, both of them?
14 A. We encourage every care coordinator to use the
15 scales on every child.
16 Q. Those two scales?
17 A. Yes.
18 Q. So the -- well, who makes the decision though
19 whether to use both or one or whatever?
20 A. They are to be administered quarterly on every
21 child.
22 Q. And is that part of any court order, do you
23 know?
24 A. Is it part of a court order?
25 Q. Part of the Felix Consent Decree in any --
Page 39
1 A. It's part of our mental health practice.
2 Q. No, I understand, but does the consent decree
3 in any one of its inherentions require this type of
4 testing?
5 A. The consent decree does not require those
6 specific instruments to be used to measure outcomes.
7 Q. So who administers these assessments, these
8 skills and this testing?
9 A. The care coordinator and in some cases there's
10 also a teacher report.
11 Q. The care coordinators, are they actually
12 employees of the DOH?
13 A. Yes, they are.
14 Q. And what steps does the department take to
15 insure that those administering these assessments are
16 doing it in a reliable way?
17 A. They are trained.
18 Q. By the department?
19 A. Yes, by the department, and also by the
20 originator of the instruments in the case of the CAFS.
21 We also have a training of trainers so they have to be
22 certified as a trainer to train in it. It's a fairly --
23 it's not -- you certainly don't need any advanced
24 training besides what the training that you go through.
25 Q. Do the care coordinators also collect the data
Page 40
1 on the various children, information on the children?
2 A. They collect a lot of data on the children.
3 Q. And what is done with that, is that kept
4 manually in the chart or kept in some kind of computer
5 system, data processing system?
6 A. It's kept in charts, and it's also kept in the
7 MIS system.
8 Q. I see. Your MIS system?
9 A. Yes.
10 Q. And then I assume then that data is analyzed by
11 someone?
12 A. The data on the children.
13 Q. Yes.
14 A. The specific children, most -- the best
15 application for those tools are to inform clinical
16 decisions, so it's used by -- by teams to determine how
17 the child is functioning. It's also used to see how the
18 child is progressing over time. What we want to do is to
19 have -- create base line information so that you can
20 aggregate data across the system or across the family
21 guidance center, you know, be able to analyze that data
22 broadly so that we can determine how our children overall
23 are progressing. There are other indicators of child
24 well-being.
25 Q. Sure.
Page 41
1 A. Like whether they're attending school or not,
2 that's something that we certainly want to know. We also
3 want to know arrests, some of the family guidance centers
4 track discreet data like how many of their kids are in
5 HYCF, that's a good indicator of how effective your
6 services are. There are multiple child outcome
7 indicators that we would like to track over time to show
8 how effective our services are. Another key one is how
9 many children --
10 Q. You can stop.
11 A. Well, you asked so --
12 Q. You can stop. We have a limited amount of
13 time.
14 A. Uh huh. But it just -- I'd just like to
15 demonstrate that it's a multi-faceted measurement and --
16 Q. I understand that. I'm not suggesting it
17 isn't. I'm not suggesting it isn't. What I wanted to
18 ask you was so these analyses are used then to determine
19 whether or not additional treatment should be given or a
20 different type of treatment or even termination of
21 services, right? That's what it is used for?
22 A. It's part of the body of knowledge that can
23 tell you how well the child is functioning and
24 progressing, certainly.
25 Q. And also to decide whether or not further
Page 42
1 treatment is needed or not needed?
2 A. It would be again part of the body of
3 knowledge.
4 Q. Sure. Now, are reports generated then for each
5 child based upon the data that's collected and treatment
6 that is given?
7 A. Is a report generated by instrument?
8 Q. No. I mean in terms of each child, are there
9 reports of the results of these analyses for each child?
10 A. The report -- there are different types of data
11 that again, will inform how well the child is doing.
12 Ultimately, where that's all wrapped up into is the
13 coordinated service plan, and the section of the
14 coordinated service plan that tells you current status of
15 the child.
16 Q. Okay.
17 A. And that's informed by multiple measures and
18 multiple team members.
19 Q. And that information that results in that
20 coordinated services plan, comes from the data that's
21 collected on each child, right?
22 A. That data should inform the current status of
23 the child as well as formal assessment.
24 Q. Okay. Now, by the way, you had -- the
25 department had agreed to provide student information
Page 43
1 relating to these issues, and I understand now the
2 department is saying they will not give us that
3 information, is that correct, a correct statement or not?
4 Student information, understandably there needs to be
5 some way, and I don't think it's difficult to maintain
6 the confidentiality of the file.
7 A. Uh huh.
8 Q. But there also needs to be a way to identify
9 the file, by number perhaps, not by name, so we preserve
10 the anonymity of the student and parents, but to give the
11 auditor's office access to those files, and I understood
12 that you were going to do that and now you're not, am I
13 correct or not?
14 A. I have absolutely no knowledge of that.
15 Q. Well, I understand that you were part of that,
16 those discussions though, no?
17 A. No.
18 Q. Well, let me ask you then, ma'am, would you
19 provide those documents if we can preserve the anonymity
20 and the privacy of the students?
21 A. Which documents are you referring to?
22 Q. The files relating to the students that are
23 given services and regarding which data is collected and
24 analyzed just as you described?
25 A. I believe over time and particularly in the
Page 44
1 last review that was conducted, there were charts that
2 were provided, and what we did is preserve the
3 confidentiality by redacting any confidential information
4 identifiers.
5 Q. But you did put on a number identifier, I
6 assume some way to identify?
7 A. That must have been the way it was managed, but
8 those files were turned over because I remember being a
9 part of that.
10 Q. Well, ma'am, when you say must have, would you
11 agree the way it should be done is that there should be a
12 system that -- devised to determine, to allow the
13 auditor's office to track a child, for example, through a
14 process of evaluation, assessment, treatment and so
15 forth? There should be a way and I think --
16 A. Yes.
17 Q. -- the way is by giving it an identification
18 number. You have no problems with that, do you?
19 A. I do not have any problems with that.
20 Q. Sure. As long as we maintain the anonymity in
21 terms of the names of the people involved?
22 A. Right. You mean to review the progress of the
23 child, by --
24 Q. Right. Right. Well --
25 A. Sure.
Page 45
1 Q. We of course have to leave the names of the
2 providers, for example, but not the child and the child's
3 family. Now, are you saying you gave that information?
4 A. During the audit that was conducted, there were
5 multiple files that were transported to --
6 Q. Were -- let me ask it this way. Recently was
7 there any request from the auditor's office that was not
8 complied with?
9 A. There was no request like that that came to me
10 or that I heard about. It might have come to another
11 section in our division, but it doesn't even sound
12 remotely familiar to me. I'm sorry.
13 Q. Well, certainly if in fact those requests are
14 made, you would comply with them, would you not?
15 A. I would of course need to check with my
16 supervisor, but I don't -- I personally do not.
17 Q. You don't see any reason why they should not be
18 provided, do you?
19 A. I do not see a reason why they shouldn't be
20 provided.
21 Q. Okay, thank you. Now, let me ask you a few
22 questions about service testing. You are familiar with
23 service testing?
24 A. Yes, I am.
25 Q. In fact, I think you testified that you were to
Page 46
1 some extent involved with it while you were with the
2 Office of Children and Youth?
3 A. Yes. With the Office of the Governor.
4 Q. I thought I saw somewhere where you had some
5 involvement with some Felix project, Felix staff
6 development training institute. Were you involved with
7 that?
8 A. I was -- I did do some work for them in my
9 capacity with the Office of the Governor.
10 Q. I see.
11 A. I did some training and I did systems
12 development work with them.
13 Q. Okay. So that was that period where you were
14 in the governor's office?
15 A. Yes.
16 Q. Of children and youth?
17 A. At that time it was not the Office of Children
18 and Youth. By then, the Office of Children and Youth had
19 been disbanded and we were part of the executive
20 chambers.
21 Q. I see. Now, the service testing instrument
22 that was utilized in this case, in the case of Hawaii,
23 was an instrument that was copyrighted by a company owned
24 by, among others, Ivor Groves. Are you aware of that?
25 A. The service testing instrument was developed by
Page 47
1 them.
2 Q. Yes. Them meaning whom?
3 A. By Dr. Groves and Dr. Foster.
4 Q. All right. Now, did the State of Hawaii pay
5 for training DOH and DOE personnel to implement this
6 service testing instrument?
7 A. I believe so.
8 Q. And where -- did those funds come from the
9 Felix funds, to your understanding?
10 A. To my understanding.
11 Q. Yes?
12 A. Yes.
13 Q. All right. Now, to your understanding, did
14 either Dr. Groves, Dr. Foster or their company charge the
15 State of Hawaii for the use of this testing instrument?
16 A. I don't believe so.
17 Q. Do you know if that testing instrument that was
18 utilized in Hawaii had ever been validated anywhere any
19 time prior to being put into use in Hawaii?
20 A. It had been used in other states, yes. It's
21 not --
22 Q. Before Hawaii?
23 A. Yes.
24 Q. It had been validated in other states?
25 A. It's not a psychometric instrument so --
Page 48
1 Q. Ma'am, had it been validated in other states
2 prior to first being utilized in Hawaii?
3 A. Again, the term validation usually refers to
4 psychometric instrument.
5 Q. Well, this instrument I'm talking about, the
6 one that was copyrighted by Dr. Groves' company, that
7 instrument, it may be psychometric, there may be others
8 like it, I'm asking about that specific one. Had it been
9 validated in any other state prior to its coming into use
10 in the State of Hawaii?
11 A. It had been used in other states.
12 Q. Had it been validated in any other state prior
13 to it -- that instrument now?
14 A. It's a methodology.
15 Q. Well, ma'am --
16 A. I need to explain to you --
17 Q. No, wait a minute.
18 A. Because validation is the wrong term to use.
19 Q. Perhaps, perhaps, but this instrument was
20 copyrighted by Dr. Groves' company, right?
21 A. I believe that came several years later, as far
22 as I know. It had been used in other states.
23 Q. That specific instrument?
24 A. I think that it's a context specific design so
25 depending on what questions you're trying to answer --
Page 49
1 Q. Ma'am --
2 A. -- there will be different indicators used.
3 Q. Well, ma'am, was that specific instrument ever
4 used in any other state prior to its first coming into
5 use in Hawaii? And what states, if there were?
6 A. I believe it had been used in Alabama.
7 Q. So one that was copyrighted --
8 A. In Tennessee.
9 Q. -- by his company now, you understand that?
10 A. Right. At that point it wasn't copyrighted, as
11 far as I know, but it had -- I know I had read an article
12 back in '94 and it was part of the original monitoring
13 plan that was submitted to the courts in 1994.
14 Q. Where?
15 A. In Hawaii.
16 Q. Uh huh.
17 A. And it was accepted by --
18 Q. Where else?
19 A. -- the courts.
20 Q. Where else?
21 A. There were several other states that I can't
22 recall.
23 Q. Several now?
24 A. Yes.
25 Q. Other than Alabama?
Page 50
1 A. There were several other states.
2 Q. Where this instrument was used prior to coming
3 into use in Hawaii?
4 A. Yes. The methodology. I think again, some of
5 the questions might have changed because this is a mental
6 health specific whereas in other places it was child
7 welfare or broader children's services.
8 Q. Well, I'm asking in the context of mental
9 health services though because that's how it was being
10 used here, was it not?
11 A. Well, mental health and education because --
12 Q. Mental health and education. Was it used in
13 any other mental health context in any of these other
14 states, to your knowledge?
15 A. I don't know. I believe it was but I'm not
16 sure which states.
17 Q. Which state?
18 A. I'm not sure which states.
19 Q. When you say you believe it was, what is that
20 belief based upon?
21 A. I read an article that was written about it and
22 it described the utilization in other states. Of course,
23 this was 1994, which is -- I don't remember everything
24 that I read over the past seven or eight years, but there
25 were several other states that were cited at that time.
Page 51
1 This was not the first state where they have the --
2 Q. Do you know whether this instrument that was
3 copyrighted after being used here in Hawaii has ever been
4 sold to any other state in that general form, as you say,
5 using the same methodology, has been sold to any other
6 state?
7 A. I don't know.
8 Q. You don't know that?
9 A. The methodology is used in other states but I
10 don't know what you mean by sold.
11 Q. This copyrighted instrument --
12 A. Whether other states used the copyrighted
13 instrument, I believe they did.
14 Q. For a fee? For a fee?
15 A. I'm not sure.
16 Q. You don't know?
17 A. I believe that it's been used in many other
18 places.
19 Q. Well, after Hawaii I'm talking about, ma'am.
20 A. Before and after Hawaii.
21 Q. Well, I'm not asking before, I'm asking about
22 after. After Hawaii, this instrument that was
23 copyrighted by Dr. Groves' company in that form, of
24 course adapted, as you say, or modified --
25 A. Right.
Page 52
1 Q. Was it used in any other state for a fee, to
2 your knowledge?
3 A. Right. And there are two versions of the
4 protocol that are used in Hawaii. So I believe --
5 Q. So what is the answer to my question?
6 A. Again, I think that the methodology was used in
7 many other places. Whether the exact instrument was
8 used, I doubt.
9 Q. And whether it was for a fee you doubt?
10 A. I'm sure other states -- I'm sure they're not
11 doing the work for free.
12 Q. I'm just wondering if they're charging for the
13 use of that instrument, ma'am, if it was copyrighted?
14 A. I think they're charging for the use of the
15 methodology.
16 Q. For that instrument, yes or no?
17 A. Our instrument says Hawaii. It has context
18 specific, you know, wording but --
19 Q. Sure. Those words can be changed for other
20 states.
21 A. I cannot tell you that the same instrument that
22 is used here has been used in other places. I don't know
23 that.
24 Q. All right.
25 A. I have no knowledge of that.
Page 53
1 Q. That's all I wanted to know. Now, is the
2 Department of Health still using service testing?
3 A. Yes.
4 Q. And in what -- what ways are you still using
5 service testing?
6 A. We are using service testing to measure the
7 progress of the Felix Consent Decree.
8 Q. How are you using it?
9 A. We are using it in the reviews that are done of
10 complexes through the school based services review of
11 samples of children and through the coordinated service
12 review, which is used to look at kids with more complex
13 issues with multi agency involvement, so that's how the
14 State's using it.
15 Q. Is the Department of Health using service
16 testing to monitor contracts?
17 A. We use a case based review methodology that
18 looks at children. We don't call it service testing at
19 all. We do look extensively at kids by reviewing their
20 records, by interviewing all the intervenors that are
21 involved, by interviewing the parents.
22 Q. But is the methodology the same as service
23 testing, ma'am?
24 A. It's very similar.
25 Q. And --
Page 54
1 A. It's not quite the same.
2 Q. You are using an instrument like that to
3 monitor your Department of Health contract?
4 A. We use it as part of the way to determine the
5 well-being of the kids that are being served and how well
6 the program is performing, so we look at multiple areas
7 of whether the programs are doing the things that they
8 need to around children, whether they are providing safe
9 and effective therapeutic services for kids.
10 Q. So you are using service testing then to
11 monitor DOH contracts?
12 A. We are using a case based review. We are not
13 using the service testing protocol.
14 Q. But the methodology is very similar then?
15 A. Yes, it's very effective.
16 SPECIAL COUNSEL KAWASHIMA: All right.
17 That's all I have, Madam Chair.
18 CO-CHAIR SENATOR HANABUSA: Thank you.
19 Members, we'll begin our questioning and we'll impose the
20 five minute rule. We will begin with Vice-Chair Oshiro
21 followed by Vice-Chair Kokubun.
22 VICE-CHAIR REPRESENTATIVE OSHIRO:
23 Thank you, Co-Chair Hanabusa.
24 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
25 Q. Hi, Miss Brogan.
Page 55
1 A. Hi.
2 Q. I just wanted to get a little bit more
3 clarification in regards to the structure of your
4 department.
5 A. Uh huh.
6 Q. Is there still a Dr. Terry Lee that's --
7 A. Yes.
8 Q. Where does he fall in terms of the
9 organizational structure?
10 A. Dr. Lee had been the MST continuum
11 psychiatrist.
12 Q. So in terms of him being the psychiatrist, and
13 you being the clinical director, where does that fall in
14 terms of the hierarchy or organization in comparison to
15 Mr. Donkervoet?
16 A. They had all been part of the continuum of care
17 project and so there was an administrator, John was the
18 clinical supervisor, and Dr. Lee was the MST
19 psychiatrist, and they managed the project and the
20 project leadership, and I was over them.
21 Q. Okay. Because previously we've heard a lot of --
22 I guess different criticisms about the MST continuum
23 project, and it's our understanding that a lot of these
24 criticisms were voiced to Dr. Lee. Did Dr. Lee ever
25 discuss any of these criticisms with you?
Page 56
1 A. He has discussed issues in the program with me.
2 Q. Is there any particular issues, because I think
3 when Mr. Kawashima was questioning you, you hadn't heard
4 about any envelope switching and you hadn't heard about
5 therapists not having any clinical experience, and you
6 also hadn't heard any complaints about the termination of
7 the project, so what kind of issues were brought to your
8 attention?
9 A. The issues that were brought to my attention
10 were not around the termination of the program at all.
11 There were ongoing issues that you would -- you would
12 identify issues that need to be improved. They had to do
13 with communication, roles within the project and
14 clarifying, and they were pretty much regular management
15 issues that if you were going to improve the
16 relationships with this, with staff, or clarify the
17 roles, those are the kind of things that were brought to
18 management and so I would have regular management
19 meetings with them and do -- suggest improvements and do --
20 write improvement plans with them.
21 Q. Okay. But have you heard of any more core
22 criticisms such as -- I guess things such as culture
23 insensitivity or things such as the therapist not even
24 knowing what the DSM4 is, things really core to what the
25 therapists are supposed to be doing in the MST continuum
Page 57
1 project? Have you heard any of those criticisms?
2 A. I had not heard the specifics around DSM or the
3 therapists not being knowledgeable about that. I had
4 heard issues that the therapists needed a lot of support
5 and the cultural insensitivity, I had heard that there
6 were some lining up of the staff around, you know, locals
7 and haoles and that kind of thing that really needed to
8 be addressed because that's -- it's counterproductive to
9 really serving families, so you know, we talked about --
10 a little bit about how that needed to be really
11 addressed.
12 Q. I haven't ever heard an accurate figure, but do
13 you know how many actual therapists are staffed within
14 the MST continuum project were from the mainland as
15 opposed to local ties?
16 A. No, I don't know that.
17 Q. Okay. I also wanted to ask in terms of
18 utilizing the MST, I guess project, we had previously
19 heard that I guess there was involvement by a
20 Dr. Hengler?
21 A. Yes.
22 Q. And as we understand it, I guess he had -- he
23 was a resource that provided some training or monitoring,
24 is that correct?
25 A. I don't believe he had a direct role. He is
Page 58
1 the lead person on MST nationally. But he was not
2 directly involved with the training of staff or the
3 supervision of staff. I believe he had come early on to
4 do some system training and some awareness building among
5 the different agencies that were going to be involved, or
6 you know, family court, and our -- just our system in
7 general to build awareness around the program.
8 Q. But as far as you know, he didn't really
9 provide any monitoring kind of resource or continuum?
10 A. I don't believe he did directly.
11 Q. Okay. Thank you very much.
12 A. Uh huh.
13 CO-CHAIR SENATOR HANABUSA: Vice-Chair
14 Kokubun followed by Representative Ito.
15 VICE-CHAIR SENATOR KOKUBUN: Thank you,
16 Madam Co-Chair.
17 BY VICE-CHAIR SENATOR KOKUBUN:
18 Q. Ms. Brogan, I wanted to ask about your -- while
19 you were working in the Office of the Governor.
20 A. Uh huh.
21 Q. You worked on the Felix Training Institute?
22 A. I did at one time, yeah, for a period of time.
23 Q. Right. And did you happen to also work on
24 Kapiolani Health Demonstration Project?
25 A. No, I did not.
Page 59
1 Q. While you were with the Felix Training
2 Institute, what role did you play in that?
3 A. I worked with systems development around the
4 practices around coordinated service planning
5 specifically, so community training and care coordinator
6 training, and at that time it was also provider training.
7 Q. And at that time was Mr. Donkervoet the head of
8 that?
9 A. Yes.
10 Q. The training institute?
11 A. Yes, he was.
12 Q. So you worked under Mr. Donkervoet there?
13 A. Yes. I was attached, but he was not my direct
14 supervisor.
15 Q. Okay. Had you heard while you were at the
16 governor's office about this Kapiolani Health
17 Demonstration Project?
18 A. Yes.
19 Q. You were aware of it?
20 A. Yes.
21 Q. You just didn't work directly in that program?
22 A. No, although we did -- we might have interfaced
23 with training of staff because I remember taking several
24 trips to the Big Island to do staff training.
25 Q. Uh huh. Uh huh. Do you have any idea when
Page 60
1 that started or do you have any background information on
2 that?
3 A. On the Kapiolani project?
4 Q. Yeah.
5 A. I just know about it, but I don't know -- I was
6 not involved with it at all.
7 Q. Okay. Do you know who was in charge?
8 A. Kapiolani?
9 Q. Yeah. Who, you know, who were the administers
10 or administrators for that project?
11 A. I know that Dr. Lynn Fox was involved, was the
12 clinical director. I'm not sure who the administrators
13 were. I'll hear -- I remember at the time there were
14 quite a few that were involved from the Kapiolani side,
15 but again, I just know very corefully from afar.
16 Q. Okay. Thank you. That's all my questions.
17 CO-CHAIR SENATOR HANABUSA:
18 Representative Ito followed by Senator Slom.
19 REPRESENTATIVE ITO: Madam Chair, I
20 have no questions at this time.
21 CO-CHAIR SENATOR HANABUSA: Thank you.
22 Senator Slom followed by Representative Kawakami.
23 SENATOR SLOM: Thank you, Co-Chair.
24 BY SENATOR SLOM:
25 Q. Good afternoon, Ms. Brogan. When you were in
Page 61
1 the governor's office, what was the extent of services or
2 involvement you provided with the monitor's office?
3 A. There was an agreement, like a memorandum of
4 agreement that the governor's office would help to
5 provide the operational support in order to conduct
6 service testing, so we partnered with them to implement
7 the reviews basically and to do training of communities
8 around service testing. This was when -- probably in
9 1995, '96, you know, at that point in time, to '97.
10 Q. And you were with the governor's office until
11 '98. Did other work continue for the monitor from '97?
12 A. I'm not sure what you're asking, I'm sorry.
13 Q. Well, you said that this particular project
14 lasted through '97. Did you do anything else in regard
15 to the monitor's office from '97 to '98?
16 A. Around 19 -- not in '97, '98, it was mostly
17 just the service testing.
18 Q. Okay. When did you first become aware of the
19 MST program?
20 A. Last year.
21 Q. Just last year? And you mentioned earlier to --
22 in response to Mr. Kawashima, that you believe that it
23 was used in other places in addition to Philadelphia?
24 A. MST, yes, has been -- I believe used in -- it's
25 being used in about 25 states as well as other countries,
Page 62
1 countries in Europe, and I believe now starting New
2 Zealand so there's --
3 Q. Prior to its use in Hawaii?
4 A. In the other states?
5 Q. Yes.
6 A. Yes.
7 Q. But of all the other states or locales, is it
8 safe to say that Philadelphia probably is the location
9 that's been studied the most or has the most available
10 information?
11 A. No. I would say the other communities. It's --
12 Philadelphia is just one that also is -- the particular
13 application of the research is around hospital diversion.
14 And in other places, it's -- its most established use is
15 for children who have willful misconduct issues, so it's
16 the juvenile offenders and kind of a -- more of a
17 incarceration diversion. It's been used -- I believe
18 it's been studied on multiple populations.
19 Q. But can you point to a community or to a state
20 where there is a greater body of information?
21 A. I have the information with me.
22 Q. But --
23 A. It was cited, I know in the last surgeon
24 general's report on mental health as being used in
25 multiple communities, I believe in Seattle.
Page 63
1 Q. But none springs to mind? Seattle?
2 A. Seattle is one, and many other states.
3 Q. Okay, because I'm more familiar with
4 Philadelphia. In Philadelphia, correct me if I'm wrong,
5 but they studied that for quite a long period of time
6 before they implemented that. Is that safe to say?
7 A. The particular study that I was talking about
8 is just starting there. There might have been other
9 studies there, but I'm not familiar with them.
10 Q. Well, I guess my point is that they really
11 examined whether or not they were going to use it and
12 other uses of it for a period of about one and a half or
13 two years. Does that sound reasonable?
14 A. I think they looked pretty extensively at it.
15 Q. And in Hawaii's case, do you know how long we
16 studied it before we implemented it?
17 A. No, I'm not sure. I was not involved with the
18 inception of MST here.
19 Q. And in Philadelphia, the number of students
20 that were involved in the program you don't know?
21 A. No, I don't. I'm sorry.
22 Q. And in Hawaii when the program started, do you
23 know how many students?
24 A. I know they started off in cohorts, in groups,
25 and by the end there were 29 in each condition.
Page 64
1 Q. And when you say each condition, what does that
2 mean?
3 A. So the group that are getting mutual services
4 and the ones that were getting MST services, so in the
5 continuum itself there were 29 new.
6 Q. Okay. And your testimony was that when the
7 program concluded a year earlier than originally
8 scheduled, that number one, you did not hear any
9 complaints personally to you, and number two, that all of
10 the students were taken care of and transitioned?
11 A. Yes, that's correct.
12 Q. Thank you.
13 SENATOR SLOM: Thank you, Co-Chair.
14 CO-CHAIR SENATOR HANABUSA: Thank you.
15 Representative Kawakami followed by Senator Buen.
16 REPRESENTATIVE KAWAKAMI: Thank you,
17 Chair Hanabusa.
18 BY REPRESENTATIVE KAWAKAMI:
19 Q. Miss Brogan, you have an MA in elementary
20 education, am I correct?
21 A. I have an MED.
22 Q. MED?
23 A. Uh huh.
24 Q. You have never taught in any --
25 A. I've taught --
Page 65
1 Q. Elementary or --
2 A. No.
3 Q. -- secondary schools?
4 A. No.
5 Q. No? Have you taught at the college level?
6 A. Student teaching. I have done some teaching at
7 the college level as part of my job at the university.
8 Q. Uh huh.
9 A. With students in general, organizational
10 development and a little bit with a group of kids that
11 were in a preservice education from the medical school.
12 Q. I see. Okay, was that a short stint or a year
13 or --
14 A. Yes, about a year.
15 Q. About a year?
16 A. Uh huh. I have also done work in cooperative
17 learning, teaching cooperative learning and social skills
18 development, organizational development in schools when I
19 was part of Office of Youth Services, so I worked in
20 schools there.
21 Q. I see. Okay. I wanted to ask you about
22 service testing, also.
23 A. Uh huh.
24 Q. What were the components of the service
25 testing, the mechanism?
Page 66
1 A. To describe the process of service testing?
2 Q. Yeah. Uh huh.
3 A. What happens is a random sample of children are
4 chosen and then appointments are set up with anybody
5 who's involved with that child. So all the teachers,
6 anybody providing a mental health service, counselors,
7 parents, it could be the probation officer, the CPS
8 worker, the care coordinator, pretty much anybody who's
9 involved with the child, and trained reviewers go out and
10 do extensive record review and interviews and make a
11 determination through a -- kind of a triangulation
12 getting all this information to find out whether the
13 child is doing acceptably well or not across indicators
14 of child well-being, and then they also determine whether
15 the services are being provided in a way so they look at
16 is the child being identified early enough to make a
17 difference, do we have enough knowledge about the child
18 in order to create a good plan, is the plan good, and you
19 can't just have a good plan, you have to be able to
20 implement that plan, and the timeliness of that
21 implementation, how well it's implemented and ultimately
22 whether the services are having results for the child.
23 Q. You also interviewed the parents, correct?
24 A. Yes.
25 Q. And then you used the rating scale, I
Page 67
1 understand, am I correct?
2 A. Yes.
3 Q. So you rated them from what, one, two?
4 A. Yes, one to six.
5 Q. One to six?
6 A. Uh huh.
7 Q. With six being the highest?
8 A. Six being the highest.
9 Q. Achievement?
10 A. Uh huh.
11 Q. And so far -- okay. I'd like to ask the
12 trainers were picked how?
13 A. The people who train on service testing?
14 Q. Right.
15 A. Dr. Ray Foster over the past few years has been
16 the core trainer for service testing. In the past I have
17 trained and also personnel from the Department of Health
18 and Education trained the field primarily to do their own
19 self assessments and internal reviews.
20 Q. I see.
21 A. In preparation of the service testing.
22 Q. Okay. So when they went out to the school, how
23 many trainers to a complex?
24 A. When they went out to the schools? DOH?
25 Q. Yeah, when they were doing the service testing?
Page 68
1 A. The actual service -- the official reviews that
2 are done, those reviewers were brought in for the
3 training.
4 Q. So how many you had?
5 A. How many reviewers?
6 Q. I was trying to figure out how the service
7 testing was done by certain people selected to do the
8 service testing. How many of them were there that were
9 at a school, at a complex at one time doing the testing?
10 A. It depends on how many kids are in the sample,
11 but it could be anywhere from ten to 15 to 20 reviewers
12 at a time looking at the practices of one complex.
13 Q. Okay. Let's say at the end of that testing
14 period --
15 A. Uh huh.
16 Q. -- they got together and all these scores were
17 analyzed?
18 A. Right.
19 Q. Etc.?
20 A. What they do is they debrief child by child, so
21 in groups, and they have the team leaders, so it's more
22 experienced people listening to make sure that their
23 ratings were accurate. They have to have enough evidence
24 to support every single rating.
25 Q. Okay. Yeah. This was a comment made by
Page 69
1 several people to me, and that was that the target was a
2 moving target, was always being changed. In other words,
3 if they had a certain percentage, the next time when the
4 service testing came around, the -- it went up. They had
5 to go higher. It wasn't always, you know, at the same
6 level.
7 A. As long as the complexes were being -- we went --
8 moved to reviewing the complexes, and one time it was the
9 district, which is very large, it has to my knowledge
10 always been the 85 percent.
11 Q. Always 85?
12 A. Uh huh.
13 Q. I've heard it changed at various times, and
14 some of the principa were kind of upset because it was
15 like a moving target, you know, you thought you reached
16 it and then it moved? No?
17 A. No.
18 Q. You can't --
19 A. No.
20 Q. You're not sure?
21 A. It pretty much stayed the same.
22 Q. Okay.
23 A. When it started, when it shifted to the complex
24 reviews for compliance, it stayed -- it was 85 percent
25 from that.
Page 70
1 Q. I see. Okay. My time is up, but thank you
2 very much, Miss Brogan.
3 A. You're welcome.
4 CO-CHAIR SENATOR HANABUSA: Thank you.
5 Senator Buen followed by Representative Leong.
6 SENATOR BUEN: Thank you. I choose to
7 give you my time, Madam Chair.
8 CO-CHAIR SENATOR HANABUSA: Thank you.
9 Representative Leong followed by -- Senator Sakamoto's
10 not here, Representative Marumoto.
11 REPRESENTATIVE LEONG: Shall I -- thank
12 you. Thank you, Chair.
13 BY REPRESENTATIVE LEONG:
14 Q. Miss Brogan, I had a question on your testing,
15 also.
16 A. Uh huh.
17 Q. I notice that how many -- at one time when you
18 did this testing, was it always at a time when you had
19 testing or was just anyone did their own testing?
20 A. Our complex is scheduled for the review.
21 Q. Is scheduled for. So how many students or how
22 many people were involved as being tested?
23 A. It depends on how large the complex is.
24 Q. Uh huh.
25 A. But we do, I think, at a minimum ten percent of
Page 71
1 the population of Felix class children or more.
2 Q. And what was the range, could you tell me again
3 for my information, the range of ages?
4 A. The range of ages?
5 Q. Uh huh.
6 A. Were from zero to twenty.
7 Q. At this one time when you did the testing?
8 A. Yes. We include the early intervention as well
9 all the way on up.
10 Q. And I notice that you had several kinds of
11 testing ongoing. At any time did you have for the
12 purpose of evaluating it, you must have had a group of
13 students of the same ability or the same needs be tested
14 the same time to equate how they were doing, because you
15 don't just give everybody the testing?
16 A. It's a random sample, so it's whoever is chosen
17 through the random draw, which --
18 Q. And so you took your evaluation from each
19 testing that was done and recorded it and had it looked
20 at, is that correct?
21 A. The review is on a child by child basis.
22 Q. Yes.
23 A. So the determination is made for one child.
24 Q. Uh huh.
25 A. And then they aggregate the results for all the
Page 72
1 children that are reviewed at that point in time to see
2 how well the complex is doing.
3 Q. But you also had records on each one of these
4 children?
5 A. Yes.
6 Q. So you never could see well, this child is
7 progressing very well as compared to another child of the
8 same ability?
9 A. Yeah, each child is looked at individually.
10 Q. I see.
11 A. And reports are written on each child because
12 the reviewer has to be able to support their findings and
13 we want a record of that. Also, these reports really
14 help to inform, it helps you to look at the patterns of
15 what's going on with that child and it can really help to
16 determine what the recommendations might be for
17 improvement, so from that, then we look at how is the --
18 what are the patterns within the complex, what kind of
19 things do they need to improve on, what are they doing
20 well and are they -- for example, do they need to do a
21 little bit more monitoring of kids. You know, once you
22 create the plan, are they -- are they checking to see if
23 the plans are working, so it helps you to see what the
24 patterns of performance are.
25 Q. And my last question was regarding these
Page 73
1 trainers, they were trained themselves to be trainers to
2 give these tests out? Did they need to have any
3 particular training themselves or education?
4 A. Yes, the reviewers need to have extensive
5 training.
6 Q. But what about their qualifications?
7 A. Most of them are professionals in either
8 education, mental health, human services.
9 Q. And you supervise these people?
10 A. Yes, they're closely supervised.
11 Q. All right, thank you very much. No other
12 questions.
13 A. You're welcome.
14 CO-CHAIR REPRESENTATIVE HANABUSA:
15 Thank you. Representative Marumoto?
16 BY REPRESENTATIVE MARUMOTO:
17 Q. Thank you for coming today.
18 A. Uh huh.
19 Q. We are asking questions, a lot of questions,
20 but really we don't mean to harass, we really have the
21 best interests of the children at heart.
22 A. I understand that.
23 Q. I want to know something about this continuum
24 research project. What was the goal of this project?
25 A. The goal of the project was to determine
Page 74
1 whether this intervention and this way of doing work
2 around kids and families would be more effective than not
3 having it. So it was really to look at the kids who were
4 slated by teams to need a hospital level of care, which
5 is the highest level of care. So this might be a normal
6 response of a team. This child needs to be hospitalized
7 or needs very intensive services, so I look at if we
8 could serve them through a team in the community that
9 would have the ability to respond to their crises, to
10 respond to the needs of the parents and to provide
11 intensive treatment in communities and homes. So how we
12 can do it more effectively by keeping them in the least
13 restrictive environment, so that was the goal of the
14 project.
15 Q. You wanted to prove the effectiveness of this
16 multi-systemic therapy?
17 A. Yes, for this particular population.
18 Q. Okay. And there was two groups that you used
19 to -- to get some findings, right? One was a control
20 group and one -- the other group had MST?
21 A. Yes.
22 Q. Was treated through the MST process. There was
23 two groups. Were they about equal size?
24 A. Yes.
25 Q. And were they chosen on a random basis?
Page 75
1 A. Yes.
2 Q. And we had heard from Mr. Donkervoet that they
3 were chosen by computer through some place in North
4 Carolina, is that correct?
5 A. South Carolina.
6 Q. South Carolina? Okay.
7 A. So it was random assignment. It was luck of
8 the draw.
9 Q. You can attest to this, that this is the way it
10 was done?
11 A. Yes. This project was reviewed by the
12 institutional review board of the Department of Health
13 and the institutional review board of the Medical
14 University of South Carolina, so it's very stringent
15 conditions and things that you have to prove in order to
16 show that you are running a tightly controlled research
17 study, so you can't just do research on people without
18 going through institutional review boards and states.
19 Q. The reason I ask this question is that we did
20 have somebody who came forward to testify that there was
21 some envelope switching or switching of families or there
22 was a deliberate placement of certain students into
23 certain groups?
24 A. Uh huh. The person who managed this, I've
25 talked to extensively, and she said there was no way that
Page 76
1 that either happened or could have happened.
2 Q. Did high end students end up in one group?
3 A. There was --
4 Q. And lower end students --
5 A. No.
6 Q. -- in another?
7 A. No. It was completely luck. These were same
8 types of kids, kids that were headed toward the hospital,
9 and then they were randomly assigned to each group, so
10 it's luck of the draw which group you end up in.
11 Q. Why was the research project terminated very
12 abruptly?
13 A. It was terminated because when the project was
14 started, there were a large group of kids in my mind that
15 were still going to higher levels of care. During that
16 year, our -- and as you know, you know, our mandate
17 around the changes for Felix happened very quickly,
18 systems change had to occur fast, so we brought up at the
19 same time many therapeutic foster homes, we did intensive
20 training with our care coordinators, we brought a board
21 psychiatrist in our system, we did a lot of intensive
22 supervision with staff so that they don't make the easy --
23 the easy thing to do is to put the kid in out of home
24 placement. You know, there's a lot of incentives for
25 that. You don't have to manage kids as tightly almost in
Page 77
1 theory when they're in an out of home placement, but what
2 we did is we made our care coordinators do the hard work
3 that it took to keep kids in homes and community. This
4 was our strong initiative. We believe that kids once
5 they go out of home, that either don't come back
6 sometimes or they miss out on a lot of the experiences
7 that they need to which is to stay in a stable high
8 school or intermediate school.
9 Q. Did you end MST, were they out of the MST at
10 that point or --
11 A. No, these were kids that would normally have
12 been going to the hospital but stayed home with their MST
13 services.
14 Q. Yeah, but I don't understand why the project
15 was ended?
16 A. Because during that time of that year, there
17 were far fewer kids being referred to hospitals because
18 of the strength of our system.
19 Q. So you just ran out of people?
20 A. We were projected to start running out of -- we
21 needed 200 people.
22 Q. Some children were just dropped when the stop
23 abruptly --
24 A. In order to continue the research, we would
25 have needed 200 children to study.
Page 78
1 Q. Okay.
2 A. And as of tomorrow, like yesterday we only had
3 eleven kids in Kahi so --
4 Q. Thank you.
5 A. That obviously shows that we don't have enough.
6 Q. Thank you very much.
7 CO-CHAIR SENATOR HANABUSA: Thank you.
8 Co-Chair Saiki.
9 CO-CHAIR REPRESENTATIVE SAIKI: Thank
10 you.
11 BY CO-CHAIR REPRESENTATIVE SAIKI:
12 Q. I just have a few questions, Miss Brogan.
13 First, with respect to MST, MST had been included as a
14 benchmark. Are you familiar with that?
15 A. I am familiar with that, yes.
16 Q. So I believe that there needed to be 56 youths
17 secured by July 2001?
18 A. Yes.
19 Q. Why was MST included as a benchmark?
20 A. It was -- the benchmarks were developed from
21 the plans that the departments put forth. So it was in
22 one of the plans around service capacity development that
23 it was put forth as this -- this was a project that the
24 department was going to engage in, and therefore, was
25 identified as a benchmark. That's how the benchmarks
Page 79
1 were --
2 Q. Just --
3 A. -- handled.
4 Q. I'm sorry. Just to clarify, the benchmarks in
5 part are used to determine whether or not the State is in
6 compliance?
7 A. Yes. Whether the State is making progress in
8 its efforts to comply, yes.
9 Q. Right. So you know, I asked the previous
10 witness about this benchmark. I just didn't understand
11 why an experimental program is included in a benchmark
12 which is used to evaluate or to track the State's
13 progress in meeting compliance when it's an experimental
14 program that's untested, no proven results?
15 A. I think because of the -- I assume, and I can't
16 really answer that, I assume it was because of the
17 promising nature of the intervention and how much we
18 really wanted to keep kids out of the more expensive
19 hospital based residential programs. Those programs cost
20 625 a day when you could actually serve a child for much,
21 much lower than that in the community. Of course, cost
22 isn't our only consideration, we want to get better
23 outcomes for kids, but I think it was chosen because of
24 the promising nature of it and the fact that we really
25 would like to see things that are based on what works for
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1 kids.
2 Q. Do you know -- were you in the department, in
3 the health department at the time that this benchmark was
4 developed?
5 A. I was in the department, but I did not develop
6 the benchmark.
7 Q. Who was responsible for developing this
8 particular benchmark?
9 A. I couldn't speak to that. I'm sorry.
10 Q. But it was solely a recommendation of the
11 health department?
12 A. I believe it was derived from looking at the
13 plans that were submitted to the courts.
14 Q. Did the court monitor's office have
15 consultation on these particular benchmarks, did it ever
16 express concerns or have discussions on the benchmarks
17 before finalizing them, to your knowledge?
18 A. I think they were pretty much chosen by the
19 courts, but I couldn't speak to that. There could have
20 been discussion about them.
21 Q. Do you know if the court monitor ever rejected
22 a benchmark?
23 A. I don't think that the department identifies
24 their own benchmarks. I think that what they do is they
25 offer the plans and what recommended, you know, kind of
Page 81
1 ways of measuring our progress, but was the question
2 whether there's been one rejected? I have no idea.
3 Q. Okay. Just a couple of service testing
4 questions. You had mentioned that Dr. Foster did the
5 trainings for service testing. What was the time frame
6 in which the training occurred, generally?
7 A. You mean how long the trainings were?
8 Q. Or between what years were the trainings --
9 A. The training started in 1995 and up to the
10 present day.
11 Q. Up until the present time?
12 A. Yes.
13 Q. How often are the trainings?
14 A. I would say from once a year to once every six
15 months more recently. In the beginning they were
16 probably once a quarter.
17 Q. Does Dr. Foster do all of these trainings?
18 A. He -- more recently he's been doing all of
19 them.
20 Q. So he comes here from Florida?
21 A. Yes.
22 Q. Does the State pay him to do these trainings?
23 A. I believe it's part of their -- the Felix
24 monitoring budget, but I have no knowledge of --
25 Q. Do you know if the Department of Health pays
Page 82
1 Mr. Foster or his company?
2 A. We do not have any direct contracts with him.
3 Q. So you're assuming that the Felix monitoring
4 project is paying Dr. Foster or his company?
5 A. I believe that the Felix monitoring project
6 manages that.
7 Q. They're paying him or his company?
8 A. I believe so. I have no knowledge of what
9 transacts between the monitoring project and --
10 Q. Well, do you know if he's volunteering his
11 time?
12 A. Whether he's volunteering his time, I don't
13 think so.
14 Q. Do you know if the DOE is paying for this, for
15 this cost?
16 A. I believe it's paid for out of the monitoring
17 project budget.
18 Q. Do you know what the charge is?
19 A. I have no idea.
20 Q. Do you know who would know whether the Felix
21 monitoring project is paying Dr. Foster or his company
22 for these trainings?
23 A. Who would know? Felix monitoring project, I'm
24 sure.
25 Q. Anybody from the departments?
Page 83
1 A. Not me.
2 Q. There's no one in the health department or no
3 one in the DOE that would know?
4 A. I don't know, sir.
5 Q. I'm sorry. You're -- how many days is a
6 typical training?
7 A. The training, this overview training is two
8 days. That's the part that Dr. Foster would do. Then
9 there's field training that is done not by Dr. Foster but
10 by experienced reviewers, so in order to be able to
11 conduct a review, you have to observe -- you have to be
12 shadowed by an experienced reviewer, so it's a mentoring
13 coaching model.
14 Q. Okay. So just to -- I guess to summarize this,
15 I think you stated earlier that the State paid Dr. Groves
16 to develop the service testing instrument or protocol.
17 Is that what you said earlier?
18 A. No.
19 Q. You didn't say that?
20 A. No. I didn't say that.
21 Q. Okay, I'm sorry.
22 A. Did I say that?
23 Q. Did the State -- did the State pay Dr. Groves
24 to develop the protocol?
25 A. I have no idea.
Page 84
1 Q. Okay. All right, thank you.
2 A. Okay.
3 CO-CHAIR SENATOR HANABUSA: Thank you.
4 CO-CHAIR SENATOR HANABUSA:
5 Q. Miss Brogan, I have this printout of 10-17-01
6 off of the Internet for the Hawaii Department of Health
7 and it's entitled the Felix Consent Decree. And it
8 identifies you as the contact person for service testing
9 training. Is that correct?
10 A. Sure, they could contact me.
11 Q. Well, I mean --
12 A. It's under my venue.
13 Q. Right. Well, it's on this Felix Consent Decree
14 publication on the Internet, and it has service testing
15 reviewers, this is all under you, and it has a series of
16 dates, August 24 to 25, September 22, November 3,
17 November 8 to 9. Do those dates mean anything to you?
18 A. Is that the training? Is that a training
19 publication?
20 Q. It says service testing reviewers. Yes, I
21 think so. It's under service testing training.
22 A. It could be those are the days that trainings
23 occurred.
24 Q. And you would be involved in that?
25 A. Not directly on those particular trainings.
Page 85
1 That would be staff.
2 Q. Why did they identify you under service testing
3 training?
4 A. Because it's under my supervision.
5 Q. Under your supervision? Do you actually
6 participate in the service testing training?
7 A. Not recently. I have in the past.
8 Q. And when you participate in it, do you
9 participate as an instructor or what's your role?
10 A. I have participated as a trainer.
11 Q. As a trainer. And it looks like there are
12 about four training sessions as I read that off to you.
13 And you said that in the beginning they were quarterly
14 and then they sort of -- you think it may be less than
15 that now? And is it back to being quarterly again?
16 A. It depends on what kind of training. There's
17 the training for reviewers, and then there's the
18 trainings that are done for complexes that are going to
19 be involved in reviews. We are like teaching to the
20 test.
21 Q. Right. So reviewers when they are being
22 trained, they're being trained to review when the
23 complexes are being tested, aren't they?
24 A. Most of the -- a lot of the people that are
25 involved in that training, there are a lot of personnel
Page 86
1 that want to come to those trainings, too, because they
2 again want to hear more about what the expectations are,
3 which is valid.
4 Q. Okay. We got this report to the 21st
5 Legislature, State of Hawaii from the -- I guess it's
6 from the Department of Health. And it says that for the
7 2001 Legislative -- well, 2001 fiscal year, the CAMHD
8 paid $600,000 to the Felix monitoring office. Does that
9 sound correct to you?
10 A. I'm not aware of that.
11 Q. You're not aware of that? You're not aware
12 that the budget is increased to $750,000 for this
13 upcoming fiscal year?
14 A. No, I'm sorry. That's not in my area.
15 Q. So you don't know how much the department pays
16 for Felix compliance?
17 A. No, I don't.
18 Q. Now, there's a couple of points I'd like to
19 clarify, too. You mentioned that on the MST -- well,
20 let's back up. There's both the MST home base and the
21 MST continuum, is there not?
22 A. Yes.
23 Q. And my understanding is the home MST home base
24 still continues?
25 A. Yes.
Page 87
1 Q. Does that fall under you?
2 A. Not right now, no, it doesn't.
3 Q. So who controls the MST home base?
4 A. There is a coordinator for that. His name is
5 Bill Hummel, and currently the overall supervision for
6 that project would be under our chief, Christine
7 Donkervoet.
8 Q. Okay. And the MST continuum, which is
9 basically ending or ended, that fell under your
10 jurisdiction?
11 A. It had fallen under me, yes.
12 Q. And would you say for all intents and purposes
13 it's no longer in existence?
14 A. The last day is November 5, which is Monday.
15 Q. And Miss Donkervoet's husband, John, is it
16 John? I think it's John.
17 A. Yes.
18 Q. Yes. He was actually the one who was like the
19 coordinator for that program?
20 A. He was the clinical supervisor. So he
21 supervised the therapists.
22 Q. There is no coordinator for the MST continuum?
23 A. There was an administrator, who was Carol
24 Matsuoka, who --
25 Q. And did Mr. Donkervoet report to her?
Page 88
1 A. I believe they actually kind of were along the
2 same levels.
3 Q. Okay, and it fell under you though?
4 A. Yes.
5 Q. And then your supervisor would be his wife,
6 Tina Donkervoet?
7 A. My supervisor is Tina Donkervoet, yes.
8 Q. And in the MST continuum issue it would also be
9 Tina Donkervoet, right?
10 A. Yes.
11 Q. You know, you said something about -- and you
12 confirmed with John Donkervoet, you told us, which is
13 that there is this random selection in South Carolina
14 that's being done as to the students who would
15 participate in the programs, is that correct?
16 A. I believe so. I am not that familiar with the
17 selection process. But I believe that was correct.
18 Q. And you said part of the problem with the
19 program was that there really were not enough students or
20 I guess participants?
21 A. Uh huh.
22 Q. From that pool that you could draw from?
23 A. It was projected that we would over time not
24 have enough. Now, the research itself was not something
25 that we funded, that was a grant through Annie Casey
Page 89
1 Foundation. What we did is we ran the program.
2 Q. Right. Now, can you tell me this? Do you know
3 what information was necessary to give to South Carolina
4 for them to randomly select the participants?
5 A. No. I don't know.
6 Q. I mean I assume it's more than simply everybody
7 whose name ends with A, for example, is in one pool, I
8 mean it's got to be more than that for you to go all the
9 way to South Carolina to get your random selection pool?
10 A. I think, you know, it's -- nowadays South
11 Carolina is not really that far in terms of, you know,
12 being able to transfer information, but I think that was
13 just part of the process that was approved in order to
14 keep the integrity of the selection process in place.
15 Q. Well, that's exactly --
16 A. I believe.
17 Q. -- my point. I assume that you are
18 transmitting information other than simply saying if we
19 give everyone a number from one to 200, all these numbers
20 will be in one and all these numbers because you could
21 generate that yourself, you could just put in a simple
22 program?
23 A. I think it's more to have the safeguards around
24 the process, I believe, but I need to say that I am not
25 familiar with the intricacies of how the random selection
Page 90
1 process was managed.
2 Q. Well, my concern is the release of confidential
3 student information to an entity, whether it's the
4 Medical University of South Carolina or wherever it may
5 be, so do you know what kind of information was released
6 to effect the selection process?
7 A. No, I don't. I don't know.
8 Q. If confidential information -- I mean we can't
9 even get names, so if confidential information was
10 released, would that have to have your approval?
11 A. It would have to have the approval of the
12 institutional review board, and that's the process that
13 it went through.
14 Q. And who is the institutional review board?
15 A. It's part of the Department of Health.
16 Q. Yeah, but who in the Department of Health makes
17 that determination?
18 A. There's a board that is convened to -- and I'm
19 not sure who all the board members are.
20 Q. You don't know who all the board members are?
21 A. No, but it's a process that's used widely in
22 any research project in any state.
23 Q. Do you know if this institutional review board
24 will pass on issues such as transferring or transmitting
25 information on students to like some kind of institution
Page 91
1 like the Medical University of South Carolina versus us
2 when we request it?
3 A. I think that research has different parameters,
4 I believe.
5 Q. Do you know if it's more lenient than it is to --
6 for example, the legislative auditor for the State of
7 Hawaii, I mean is it easier to get this type of
8 information from the Department of Health if you're the
9 Medical University of South Carolina versus the State of
10 Hawaii?
11 A. I think it's apples and oranges.
12 Q. Why?
13 A. Because one is for research and the other is
14 for an oversight process.
15 Q. So which one do you think is I guess more
16 important?
17 A. Which do I think is more important?
18 Q. Right.
19 A. I think they're both important.
20 Q. Well, which one has --
21 A. I really believe that -- I think that oversight
22 is imminently important.
23 Q. So do you feel that there's somehow an easier
24 process to get information out if you're doing a research
25 project on students versus if you're doing oversight?
Page 92
1 A. I believe there -- I don't think that -- I
2 honestly don't think that you can compare those two
3 things.
4 CO-CHAIR SENATOR HANABUSA: I see the
5 court reporter is out of paper. Okay, members, we've
6 been going for awhile, so let's take a five minute break
7 and we'll come back for other questions if anyone has it.
8 Thank you, Miss Brogan, please don't leave.
9 (Recess.)
10 CO-CHAIR SENATOR HANABUSA: Members,
11 we'll reconvene at this time. Do we have any follow up
12 questions?
13 SPECIAL COUNSEL KAWASHIMA: Just a few.
14 CO-CHAIR SENATOR HANABUSA:
15 Mr. Kawashima.
16 BY SPECIAL COUNSEL KAWASHIMA:
17 Q. Miss Brogan, I just wanted to clarify so that
18 there's no misunderstanding in the future that the
19 information I was asked to ask for was a electronic form
20 of data that based on the CAFS and I think maybe the
21 Auchenbach for each child, apparently it's in data form?
22 And I think during the break someone from the auditor's
23 office discussed it with Ms. Donkervoet and they agreed
24 that that would be provided.
25 A. Okay.
Page 93
1 Q. So I just wanted to let you know what it was.
2 A. It wasn't the client files.
3 Q. You're right, I misspoke. I was wrong. Thank
4 you.
5 A. Sure.
6 CO-CHAIR SENATOR HANABUSA: Any other
7 follow up questions, members? None? Thank you, Miss
8 Brogan.
9 A. Could I just say one thing?
10 CO-CHAIR SENATOR HANABUSA: Sure.
11 A. I really welcome the chance to be able to
12 explain our program, and I'm glad for the interest and I
13 really do believe in oversight. I just wanted to say
14 that for many years I and my staff have been working
15 very, very diligently, long hours, and I think that we've
16 accomplished a lot. I'm from here, I went to Waipahu
17 High School, I have a lot of investment in the local
18 community and I think we've made a tremendous amount of
19 progress in a short period of time and will continue to,
20 you know, work our hearts out at this. We are also
21 interested in cost effective and accountability in all
22 our services and we welcome this. We just -- we want to
23 also be able to say that we have many accomplishment that
24 we'd also like to share and it's not always adversarial,
25 so thank you.
Page 94
1 CO-CHAIR SENATOR HANABUSA: Thank you
2 very much. Thank you. And thank you for accommodating
3 us.
4 A. Sure.
5 CO-CHAIR HANABUSA: Thank you.
6 Members, we have to, because of time constraints, Miss
7 Johnston will be rescheduled to next week Friday at one
8 o'clock. And with that we will -- members, we will be
9 going into another -- an executive session, a very short
10 one at this time. The reason for the executive session
11 is to discuss future testimony, but for members of the
12 public, this will end the hearing for today, and we will
13 be reconvening tomorrow morning at nine o'clock, so with
14 that, any discussion from the members? If not, we'll
15 take a vote to go into executive session.
16 CO-CHAIR REPRESENTATIVE SAIKI:
17 Co-Chair Hanabusa?
18 CO-CHAIR SENATOR HANABUSA: Aye.
19 CO-CHAIR REPRESENTATIVE SAIKI:
20 Vice-Chair Kokubun?
21 VICE-CHAIR SENATOR KOKUBUN: Aye.
22 CO-CHAIR REPRESENTATIVE SAIKI:
23 Vice-Chair Oshiro?
24 VICE-CHAIR REPRESENTATIVE OSHIRO: Aye.
25 CO-CHAIR REPRESENTATIVE SAIKI: Senator
Page 95
1 Buen?
2 SENATOR BUEN: Aye.
3 CO-CHAIR REPRESENTATIVE SAIKI:
4 Representative Ito?
5 REPRESENTATIVE ITO: Aye.
6 CO-CHAIR REPRESENTATIVE SAIKI:
7 Representative Kawakami?
8 REPRESENTATIVE KAWAKAMI: Aye.
9 CO-CHAIR REPRESENTATIVE SAIKI:
10 Representative Leong?
11 REPRESENTATIVE LEONG: Aye.
12 CO-CHAIR REPRESENTATIVE SAIKI:
13 Representative Marumoto?
14 REPRESENTATIVE MARUMOTO: Aye.
15 CO-CHAIR REPRESENTATIVE SAIKI: Senator
16 Matsuura is excused. Senator Sakamoto, excused. Senator
17 Slom?
18 SENATOR SLOM: Aye.
19 CO-CHAIR REPRESENTATIVE SAIKI: Ten
20 ayes.
21 CO-CHAIR SENATOR HANABUSA: Members, we
22 will reconvene next door in executive session and after
23 the executive session is over, we will be in recess till
24 tomorrow morning at nine. Thank you very much. Thank
25 you.
Page 96
1 (Hearing concluded at 4:23 p.m.)
Page 97
1 C E R T I F I C A T E
2 STATE OF HAWAII )
3 ) SS.
4 CITY AND COUNTY OF HONOLULU )
5 I, SHIRLEY L. KEYS, Notary Public, State of
6 Hawaii, do hereby certify:
7 That the hearing was taken down by me in
8 machine shorthand and was thereafter reduced to
9 typewriting under my supervision; that the foregoing
10 represents to the best of my ability, a true and correct
11 transcript of the proceedings had in the foregoing
12 matter.
13 I further certify that I am not an attorney
14 for any of the parties hereto, nor in any way concerned
15 with the cause.
16 DATED this ______ day of _____________, 2001,
17 in Honolulu, Hawaii.
18 ______________________________
SHIRLEY L. KEYS, CSR 383
19 Notary Public, State of Hawaii
My Commission Exp. May 19, 2003
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