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 7, 2001
11
12
13
14 Taken at the State Capitol, 415 South Beretania,
15 Conference Room 325, Honolulu, Hawaii, commencing at
16 9:13 a.m. on Wednesday, November 7, 2001.
17
18
19
20 BEFORE: SHIRLEY L. KEYS, RPR, CM, CSR 383
21 Notary Public, State of Hawaii
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25
Page 1
1 APPEARANCES:
2
3 Senate-House Investigative Committee:
4 Co-Chair Senator Colleen Hanabusa
5 Co-Chair Representative Scott Saiki
6 Vice-Chair Senator Russell Kokubun
7 Vice-Chair Representative Blake Oshiro
8 Senator Jan Yagi Buen
9 Representative Ken Ito
10 Representative Bertha Kawakami
11 Representative Bertha Leong
12 Representative Barbara Marumoto
13 Senator David Matsuura
14 Senator Norman Sakamoto
15 Senator Sam Slom
16
17 Also Present:
18 Special Counsel James Kawashima
19 Ms. Anita Swanson
20 Dr. Bruce Anderson
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22
23
24
25
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1 I N D E X
2
3 WITNESS: ANITA SWANSON
4
5 EXAMINATION BY: PAGE
6 Special Counsel Kawashima 6
7 Vice-Chair Representative Oshiro 52
8 Vice-Chair Senator Kokubun 57
9 Representative Ito 62
10 Senator Buen 65
11 Representative Kawakami 68
12 Senator Slom 73
13 Representative Leong 76
14 Senator Sakamoto 78
15 Representative Marumoto 84
16 Senator Matsuura 91
17 Co-Chair Representative Saiki 94
18 Co-Chair Senator Hanabusa 100
19 Special Counsel Kawashima 107
20 Senator Sakamoto 111
21 Vice-Chair Senator Kokubun 115
22 Vice-Chair Representative Oshiro 117
23 Co-Chair Senator Hanabusa 119
24 Representative Marumoto 123
25 Co-Chair Representative Saiki 125
Page 3
1 Representative Kawakami 127
2 Senator Sakamoto 129
3
4 WITNESS: DR. BRUCE ANDERSON
5
6 EXAMINATION BY: PAGE
7 Special Counsel Kawashima 133
8 Vice-Chair Senator Kokubun 154
9 Vice-Chair Representative Oshiro 160
10 Senator Slom 163
11 Representative Kawakami 168
12 Senator Sakamoto 170
13 Representative Leong 174
14 Representative Marumoto 178
15 Co-Chair Representative Saiki 180
16 Co-Chair Senator Hanabusa 185
17 Co-Chair Representative Saiki 192
18 Co-Chair Senator Hanabusa 194
19 Senator Sakamoto 197
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1 CO-CHAIR SENATOR HANABUSA: The joint
2 Senate/House Investigative Committee to investigate the
3 State's compliance with the Felix Consent Decree will now
4 come to order. Members, we have subpoenaed Miss Anita
5 Swanson, who is here. Miss Swanson, will you please come
6 forward? Oh, I'm sorry, before we begin, I have to take
7 the roll. Scott's not here. Vice-Chair Oshiro, will you
8 please call the roll?
9 VICE-CHAIR REPRESENTATIVE OSHIRO:
10 Co-Chair Hanabusa?
11 CO-CHAIR SENATOR HANABUSA: Here.
12 VICE-CHAIR REPRESENTATIVE OSHIRO:
13 Co-Chair Saiki, excused. Co-Chair Kokubun?
14 VICE-CHAIR SENATOR KOKUBUN: Here.
15 VICE-CHAIR REPRESENTATIVE OSHIRO:
16 Oshiro. Senator Buen?
17 SENATOR BUEN: Here.
18 VICE-CHAIR REPRESENTATIVE OSHIRO:
19 Representative Ito?
20 REPRESENTATIVE ITO: Here.
21 VICE-CHAIR REPRESENTATIVE OSHIRO:
22 Representative Kawakami?
23 REPRESENTATIVE KAWAKAMI: Here.
24 VICE-CHAIR REPRESENTATIVE OSHIRO:
25 Representative Leong?
Page 5
1 REPRESENTATIVE LEONG: Here.
2 VICE-CHAIR REPRESENTATIVE OSHIRO:
3 Representative Marumoto, excused. Senator Matsuura,
4 excused. Senator Sakamoto, excused. Senator Slom,
5 excused. We have a quorum.
6 CO-CHAIR SENATOR HANABUSA: Thank you
7 very much. Miss Swanson, I'll now place you under oath.
8 Do you solemnly swear or affirm that the testimony you're
9 about to give will be the truth, the whole truth and
10 nothing but the truth?
11 MS. SWANSON: I do.
12 CO-CHAIR SENATOR HANABUSA: Thank you
13 very much. Members, we'll follow our usual protocol.
14 We'll begin first with the questioning by Mr. Kawashima.
15 SPECIAL COUNSEL KAWASHIMA: Thank you,
16 Madam Chair.
17 E X A M I N A T I O N
18 BY SPECIAL COUNSEL KAWASHIMA:
19 Q. Please state your name and business address.
20 A. My name is Anita Swanson. I'm the deputy
21 director for behavioral health, which is located in Kinau
22 Hale, 1250 Punchbowl Street, Honolulu, Hawaii.
23 Q. And that is the address of the Department of
24 Health, is it not?
25 A. Correct.
Page 6
1 Q. And so you're deputy director for health?
2 A. I am deputy director for the Behavioral Health
3 Administration.
4 Q. Okay. Miss Swanson, how long have you served
5 in that position?
6 A. I've served in that position since December of
7 1999.
8 Q. And prior to that where were you employed?
9 A. Immediately prior to that, because it's related
10 to that employment, I was the special assistant to the
11 director for the Behavioral Health Administration, and I
12 began that employment in January of 1999.
13 Q. January 1999. Is that when you joined the
14 Department of Health then?
15 A. Correct.
16 Q. And then when did you assume the deputy
17 director position?
18 A. Effective December 1 of 1999 I was appointed by
19 the governor.
20 Q. All right. Now, prior to joining the
21 Department of Health, where were you employed?
22 A. I had been employed as a certified public
23 accountant since 1977, approximately 15 years in private
24 and public practice on the mainland and then I have done
25 several part-time positions while I lived on the Big
Page 7
1 Island of Hawaii.
2 Q. And the last being -- what kind of positions
3 were those?
4 A. I served actually on the island of Oahu for
5 Arthur Anderson in supporting a team of tax professionals
6 for the twelve month period immediately preceding my
7 employment with the Department of Health, and prior to
8 that I assisted North Hawaii Community Hospital in the
9 start up of the hospital and the recruitment of their
10 medical staff.
11 Q. All right. Perhaps you can briefly go through
12 your educational background for us starting with higher
13 education?
14 A. I graduated from Ohio State University with a
15 BS and a specialization in business administration in
16 March of 1977. I immediately began working, I graduated
17 March 17 and started working April 1 of 1977 with Ernst
18 and Ernst. It has gone through several name changes. I
19 worked then through February of 1992 where I left as an
20 experienced tax manager with Arthur Anderson, another
21 large national accounting firm. During that tenure, I
22 worked with health care entities, I served as an auditor
23 and as a business consultant. From February of '92
24 through March of '94 I went to work for one of my
25 clients, which was a 450 physician group who negotiated
Page 8
1 contracts with 120,000 member managed care entity in
2 southern Arizona. We moved to the Big Island in the fall
3 of 1993 and from then I served six months as the acting
4 director of West Hawaii Mediation Services, and then, as
5 I mentioned, from January of 1995 to June of 1996 I
6 served as assistant to the CEO for the development of
7 North Hawaii Community Hospital.
8 Q. Your CPA was obtained when then, ma'am, in '77?
9 A. It was -- actually I passed the test in '77 and
10 finished the practice requirement and was certified in
11 1979 in the State of Arizona.
12 Q. All right. Now, in your position as deputy
13 director for Behavioral Health Administration, you report
14 directly to the director then, Dr. Anderson?
15 A. Yes.
16 Q. And then what divisions, sections, whatever you
17 want -- whatever you call them, report to you?
18 A. I'm responsible for the Adult Mental Health
19 Division, which includes our community mental health
20 centers on each of the islands and Hawaii State Hospital.
21 I'm responsible for the Child and Adolescent Mental
22 Health Division and I'm also responsible for our Alcohol
23 and Drug Abuse Division.
24 Q. I'm sorry, the third one was what?
25 A. Alcohol and Drug Abuse Division.
Page 9
1 Q. As you know, the business of the committee
2 focuses primarily on the Child and Adolescent Mental
3 Health Division, CAMHD, we're calling it. You have been
4 here throughout most of the hearings, have you not?
5 A. That's correct.
6 Q. And am I to understand that if you were not
7 here, I'm sure you had pressing business, but you
8 familiarized yourself with what the committee was doing
9 in your absence, I mean the type of business it was
10 obtaining, information it was obtaining?
11 A. Yes.
12 Q. And you reported directly to the director in
13 terms of that type of information?
14 A. Yes.
15 Q. Now, in your position then, if we might focus
16 on CAMHD, because Felix -- CAMHD is primarily Felix, is
17 it not?
18 A. That's correct. We serve no other children but
19 Felix eligible children.
20 Q. And so that you are familiar with the types of
21 programs and services that have been rendered under the --
22 under the CAMHD program for Felix children?
23 A. Yes.
24 Q. Now, we haven't inquired into this area
25 previously, ma'am, but you know what respite care and
Page 10
1 flex care or flex services are?
2 A. I can talk about them from a nonclinical
3 perspective, from a management perspective, yes.
4 Q. All right. And are they the same thing or are
5 they two separate types of care and services, respite and
6 flex?
7 A. I would not describe them as a type of care, I
8 would describe them as a means for us to classify
9 payment. Respite is more --
10 CO-CHAIR SENATOR HANABUSA: Excuse me,
11 Miss Swanson. They're having difficulty hearing you.
12 Can you bring your mike a little closer to yourself?
13 Thank you. Sorry.
14 A. Is that better? Okay.
15 Q. It's a little bit difficult, ma'am, but if you
16 might just slow down a little bit, okay? The reporter is
17 taking both you and I and we both speak very fast, and
18 you faster than me. So all right. So what is -- how
19 would you define respite care, respite services?
20 A. Respite care is that care that's offered to a
21 family for the entity or the group of individuals
22 providing care to a child generally with intensive needs,
23 to prevent that child from needing a higher level of
24 service or to prevent that child from requiring
25 potentially an out of home placement.
Page 11
1 Q. How about flex care, flex services?
2 A. Flex is -- I would not describe as a type of
3 care but is a means for us to pay for those services that
4 we do not have a contracted provider to provide that care
5 for. In particular, I might describe it as services on
6 the Big Island where we do not have a contracted provider
7 to provide medication monitoring in Ka'u, then we might
8 flex that care to another provider. But we would not
9 hold a contract with that person.
10 Q. Medication -- I'm sorry, you said medication
11 what?
12 A. Monitoring.
13 Q. What is that? What is medication monitoring?
14 A. To -- it's for a physician or a psychiatrist to
15 evaluate the child's need for medication to monitor their
16 emotional or behavioral condition.
17 Q. Well, the monitoring aspect of it though is
18 what?
19 A. His assessment, again, you're asking a
20 nonclinical person, but it's my understanding it is his
21 or her assessment in looking at the child, evaluating
22 them, having discussion with the primary care givers to
23 see how effective the medication is responding to the
24 needs that it has been prescribed for.
25 Q. If you know, why is that any different from
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1 what a physician or a -- any health provider does for any
2 patient?
3 A. It's not.
4 Q. And why can't that be paid in any other way
5 than under what you call flex, flex services?
6 A. I offered it as an example. We have physician
7 psychiatrists who are under contract to provide that
8 level of service. If we need to access that care from
9 someone that we do not have a contract with, we use a
10 terminology we flex the funds and pay it out of that
11 category.
12 Q. Otherwise, how would that individual have been
13 required to fulfill whatever is necessary to become a
14 person that could be paid under your normal way of doing
15 business?
16 A. We would have -- that person would have either
17 associated with a contracting agency who would have
18 responded to the CAMHD RFP or would have entered into a
19 contact or a memorandum of agreement directly with the
20 Child and Adolescent Mental Health Division.
21 Q. I see. Am I to understand then these
22 individuals who are allowed to provide that type of care
23 are providing that type of care outside of the normal
24 procurement system that the State has set up for
25 departments such as the Department of Health to follow?
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1 You understand my question?
2 A. I understand your question. Whether or not it
3 falls outside of the requirements of 103D, I would assume
4 that it is under the dollar amount that would not require
5 us to follow 103D.
6 Q. If it is not under the required amount to fall
7 under 103D, then 103D should have been followed then?
8 A. That's correct. And then we would either enter
9 into a contract and if the authority was -- it was
10 subsequent to the director of health receiving his waiver
11 authority, we may have used his waiver authority.
12 Q. Waiver authority. What authority is that,
13 ma'am?
14 A. The Federal Court authorized Dr. Anderson and
15 Dr. LeMahieu to waive the requirements of 103D and F to
16 accomplish the terms of the revised consent decree in
17 August of 2000.
18 Q. You're talking about what we've loosely termed
19 the super powers, is that what you're talking about?
20 A. In the Department of Health we describe it as
21 Dr. Anderson's waiver authority.
22 Q. All right. Dr. Anderson's waiver authority
23 though was placed into effect by virtue of an order
24 issued by Judge Ezra on July 21, 2000, am I correct?
25 A. Yes.
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1 Q. And subsequent to that it's been modified from
2 time to time, but that's the basic order upon which
3 Dr. Anderson's waiver authority has been given, is
4 through this July 21, 2000 order by Judge Ezra, is that
5 correct?
6 A. That's correct.
7 Q. Now, but these flex services or flex care,
8 whatever we might call them, were ongoing even prior to
9 July 21, 2000 though, right?
10 A. That's correct.
11 Q. And so that am I to understand then as far as
12 waiver authority, that only comes into play after July 21
13 of last year?
14 A. I tried to describe that earlier, yes.
15 Q. Right. So prior to that time, I understand
16 that there was -- or there were situations where flex
17 services were authorized. In all of those instances what
18 you're telling me is that to your knowledge, they were
19 situations where they came under the amount over which
20 103D would have to be followed?
21 A. That would be my understanding and we'd be
22 happy to provide you a list.
23 Q. So there should not be situations where the
24 required amount under 103D was exceeded yet the
25 requirements of 103D not followed, am I correct, to your
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1 knowledge?
2 A. To my knowledge, yes.
3 Q. All right.
4 A. Would you like us to obtain a list of those?
5 Q. Please.
6 A. A list of the flex payments? Okay.
7 Q. We asked you to bring some documents, did we
8 not?
9 A. You did.
10 Q. And do you have those with you?
11 A. We've previously provided them to Senator
12 Hanabusa's office.
13 Q. All right. So that there's nothing here you
14 have that is responsive to the subpoena duces tecum that
15 has not already been provided?
16 A. That's correct.
17 Q. All right. What do you have before you though?
18 A. I have information just to jog my memory.
19 Q. All right. How about the respite -- respite
20 services? What -- you described those, but give us
21 examples of what are respite services?
22 A. Again, a nonclinical explanation --
23 Q. Sure.
24 A. -- of them would be services that are provided
25 to a family of a child with autism where that -- that
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1 family is experiencing such turmoil in their day to day
2 living that a couple of hours of time away from the child
3 where the child is being cared for in a safe environment
4 would be beneficial to the primary care givers.
5 Q. I see. So that they provide, for example,
6 babysitting services?
7 A. I would not describe it as babysitting
8 services.
9 Q. What would you describe it as?
10 A. It's a therapeutic service provided to prevent
11 that child from accessing a higher level of care.
12 Q. Well, the therapeutic care then would be
13 provided by what types of individuals?
14 A. It could be someone who has some association
15 with the child.
16 Q. A relative?
17 A. It could be.
18 Q. A brother, a sibling, in other words?
19 A. I've heard that described in these hearings.
20 Q. And in your mind that's something that falls
21 within your understanding of what respite care should be,
22 to pay a sibling to care for a brother, sister, so that
23 the parents can have some time away?
24 A. Again, I would come back to it's to prevent the
25 child needing more intensive services, and if that person
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1 is an appropriate and a safe care giver, I would not rule
2 out someone who is related that may be a very safe
3 environment.
4 Q. I understand. But you consider that to be
5 therapeutic care then, paying a sibling to care for
6 another sibling so that the parents could have time away?
7 A. If it prevents the child who is -- who is
8 needing the services from having to access potentially
9 out of home care, absolutely. I think it's important to
10 take into consideration and maybe it's an appropriate
11 time to say that on an annual basis there are less than
12 500 individual children who receive respite care out of
13 approximately 12,000 children that the Department of
14 Health provides services to.
15 Q. Why should the number make any difference,
16 ma'am? Why should the number make any difference,
17 whether it's 500 or 50 or 50,000? Why should it make any
18 difference?
19 A. I felt it was important to put it in
20 perspective of the context.
21 Q. But you feel that this type of care ought to be
22 continued though, don't you?
23 A. Absolutely.
24 Q. And it ultimately may, as other costs have, it
25 may expand and increase, become very substantial, right?
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1 A. I can't come to the conclusion that this has a
2 potential to expand or increase.
3 Q. All right.
4 A. It has been fairly constant.
5 Q. Do you have an idea for the last fiscal year
6 how much was spent then in that area?
7 A. It's less than a million dollars.
8 Q. Well, less than, something close to approaching
9 a million dollars?
10 A. I believe it's in the $850,000 range.
11 Q. That's a fairly substantial amount though,
12 ma'am, is it not?
13 A. Yes, it is. Would you like the exact amounts?
14 Q. If you can, please.
15 A. Okay.
16 Q. Now, how about flex services, flex care? What
17 types of items go into that category?
18 A. I gave you an example of medication monitoring.
19 Q. Okay. I've heard other examples, that's the
20 reason I'm asking you.
21 A. Maybe it would be helpful rather than me search
22 my mind, I would be happy to respond to what you have
23 heard.
24 Q. Sure. Horseback riding lessons?
25 A. That decision -- that's possible. That's
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1 possible that that has been paid out of flex.
2 Q. Are you aware that it has been?
3 A. No, I do not review flex payments.
4 Q. How about sailing lessons?
5 A. It's possible that it could be paid.
6 Q. How is that possible?
7 A. An IEP team under the direction of the
8 principal at the school where there is participation of
9 the parents and a care coordinator would have evaluated
10 how to respond to that child's educational needs. And in
11 that team based discussion, they would have identified
12 that that was an appropriate service. That request would
13 come to the Department of Health or through -- not to the
14 Department of Health, but to the CAMHD division, and with
15 the -- in order to meet the needs and the terms of the
16 individualized education plan, those services would be
17 provided.
18 Q. Am I to understand, Miss Swanson, that if a
19 properly constituted IEP prescribes or recommends
20 something for a child and the family unit that CAMHD will
21 always approve it?
22 A. We might question the team based decision and
23 ask if there was any additional information they needed
24 to further evaluate those services. But the offer of the
25 appropriate educational needs of the child is done at the
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1 IEP team.
2 Q. And so that in almost all of the cases they're
3 not routinely, but they are approved by the department,
4 whatever recommendations IEP comes up with?
5 A. We are legally bound to the IEP decisions.
6 Q. Legally bound though, that doesn't mean you
7 can't question it?
8 A. We can question it and we can question the team
9 based decision and ask if they need help in identifying
10 whether or not there might be a more appropriate service,
11 and we do do that through our supervision and monitoring
12 of care coordinators and a family guidance branch chiefs.
13 Q. Is it your understanding that you cannot reject
14 it, an aspect of it, say one small aspect of what the IEP
15 recommends, you cannot reject it?
16 A. That is my understanding. That would be a
17 legal question that I would defer if you have a specific
18 example of some time where we did, but the free and
19 appropriate education is an offer made by the Department
20 of Education and we are bound by the terms of the IEP.
21 Q. Certainly, but it is not without limits,
22 though, is it? This free and appropriate education, this
23 broad term, is not without limits though, is it? For
24 example, if the IEP were to recommend something that
25 would cost $300,000, for example, I imagine the
Page 21
1 department would question that?
2 A. Absolutely.
3 Q. And perhaps reject it?
4 A. We would question the team based decision and
5 ask for them to provide what research or what evidence
6 based or what best practice there is to support that
7 care.
8 Q. And if that -- if that turned out not to be
9 enough to satisfy the department, what then would occur?
10 A. We're bound by the decisions made in the IEP.
11 Q. That's what I am trying to get to. I've heard
12 of the term due process hearings. Is the Department of
13 Health involved in those hearings from time to time?
14 A. We are involved in the hearings. The parent or
15 the Department of Education can go to due process
16 hearing.
17 Q. Not the health -- not Department of Health?
18 A. Right.
19 Q. I see.
20 A. But again, I would say that we have an integral
21 role to play in discussions with the Department of
22 Education, as it relates to mental health services to
23 bring to their attention if there was a service that we
24 didn't think the child would benefit from or that
25 potentially would cause harm to the child, and we have
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1 engaged in decisions where -- we have engaged in
2 discussions with the Department of Education when we
3 thought there was a potential of harm to the child.
4 Q. Okay. Now, do you recall that sailing lessons
5 were -- was one of the aspects of flex care that was
6 approved?
7 A. I don't -- I don't review flex care payments.
8 Q. Are you aware though based on your position as
9 the deputy of Behavioral Health Administration, that
10 these types of services have been offered and actually
11 have been rendered?
12 A. I have heard that statement made in legislative
13 hearings and I have heard that in these committee
14 discussions. I have also offered whenever I have heard
15 that that if someone will give me the specific
16 information, the date, the time, the child's name, even
17 the family guidance center so that we could research it,
18 I would be glad to then bring back, not identifying the
19 child, the information to the committee or whoever has
20 asked and say these were the circumstances as it was
21 described in the IEP.
22 Q. All right. So in other words, it was something
23 that you heard about and was of interest to you, that
24 issue?
25 A. I would like to --
Page 23
1 Q. Among others?
2 A. I would like to understand how it happened.
3 Q. Well, all right.
4 A. But I've never been provided with specifics
5 enough to go back and research it.
6 Q. But having -- well, occupying the position you
7 do though, ma'am, you have the ability to ask the people
8 who serve under you whether or not they're aware of such
9 instances and to research that without us even giving you
10 any specific instances, right? You can do that?
11 A. That's correct.
12 Q. Have you done that?
13 A. I have not done that.
14 Q. Do you think maybe asking them if they're aware
15 of it and whether they can research whether that
16 happened, because I believe it did, I could be wrong, but
17 I believe it did. Do you think asking them to go
18 research that would probably result in finding out
19 whether or not it occurred, do you think?
20 A. We could.
21 Q. All right.
22 A. And I can base that only on the looking back at
23 the names of the providers and if there was a provider.
24 Q. I understand one of them was Marimed,
25 M-A-R-I-M-E-D, Foundation?
Page 24
1 A. Okay, that's very helpful.
2 Q. Okay.
3 A. There is a program for a young man on the
4 Windward side where they participate in a sailing program
5 to respond to their behavioral needs.
6 Q. How did they pick sailing lessons or
7 participating in sailing to be something that ought to be
8 paid for by the State of Hawaii? Sailing lessons, how
9 did they come to that conclusion that that ought to be
10 paid for by public funds?
11 A. I would offer that although I am only familiar
12 with the program from hearing about our contract status
13 with them, not the clinical, that there is a behavioral
14 benefit to young men by being in that environment. I'm
15 not sure that I could say that the State benefitted by
16 sailing lessons. I think I could say that the State
17 benefitted by the support structure and the behavioral
18 interventions that are done in that therapeutic
19 environment. Now, again, I would be happy to provide a
20 clinical explanation for you.
21 Q. If that issue had come before you, would you
22 have looked at it and probably approved it, sailing
23 lessons?
24 A. It did -- they do not come before me for
25 review.
Page 25
1 Q. What is the highest level of review in your
2 department for something like that? What level would it
3 be, Miss Donkervoet?
4 A. Yes, they are reviewed, I believe, by the
5 division chief.
6 Q. All right. Now, let me move to another area,
7 ma'am, and it has to do with the consent decree in terms
8 of the efforts to comply with the condition of the
9 decree. There has been much discussion, and I'm sure
10 you're aware of the benchmarks that the Department of
11 Health has had to meet in order to comply with the Felix
12 Consent Decree?
13 A. Yes.
14 Q. And now, you've heard witnesses testify about
15 the MST program and that there are two components of it,
16 the home based project and the continuum?
17 A. Yes.
18 Q. Were you part of the decision making process
19 that decided that the continuum would be -- would be
20 terminated after one year although it had been initially
21 designed to be a two year program?
22 A. I was part of the decision making process to
23 not continue the research side of the continuum project.
24 Q. Right, that's what I'm talking about. Well,
25 continuum, isn't the continuum project the research
Page 26
1 project?
2 A. Right. The decision we made was not to
3 continue the research.
4 Q. Right. Were you aware that there were
5 complaints about that project? You heard them here, I'm
6 sure, in the hearing, but were you aware that there were
7 such complaints?
8 A. Prior to the discontinuance of the research
9 project, I was not aware of. Subsequent to, I did become
10 aware of.
11 Q. Okay. Was anything done to investigate those
12 complaints?
13 A. Subsequent, yes.
14 Q. What was done?
15 A. I spoke with three individual families who
16 called me directly and I had discussions with the
17 clinical staff to understand what the transitions were
18 for the children, the complaints that revolved around
19 transition, and that was the end of the discussion.
20 Q. All right. That -- oh, actually putting into
21 effect of the continuum, the research project, you were
22 part of that decision making process, also?
23 A. Yes.
24 Q. I understand that the benchmarks that Judge
25 Ezra ordered, that one of the benchmarks was this
Page 27
1 continuum project?
2 A. That's correct.
3 Q. What is your understanding as to how a research
4 project such as the continuum project became one of the
5 benchmarks ordered by the Federal Court?
6 A. After -- in the summer of 2000, when we
7 developed the service capacity plan, which was the
8 Department of Health's CAMHD's response to establishing
9 those services that were necessary to meet the needs of
10 children, in our service capacity development plan we
11 described how we would wrap up or roll out the research
12 based continuum, and we had certain internal targets for
13 the number of children that we would bring into the
14 research project. From those internal targets, the court
15 monitor proposed a benchmark to hold CAMHD and us to the
16 terms of our internal goals.
17 Q. All right. So then ultimately when the project
18 was not continued, was there a court order allowing that
19 to happen?
20 A. No. The benchmark was removed.
21 Q. I see. And that benchmark was removed pursuant
22 to the court order issued by Judge Ezra?
23 A. Yes, it was.
24 Q. To your knowledge?
25 A. To my knowledge. It may be more legally
Page 28
1 correct to say that that benchmark was replaced with a
2 benchmark that requires us across the State to meet the
3 needs of children, not in exactly those legal terms
4 but --
5 Q. Well, to meet the needs of children across the
6 State?
7 A. Right, to meet the specific -- and I'd be happy
8 to provide you the exact language, but we were held to a
9 revised benchmark that requires us to have the capacity
10 to meet the needs of children in their home communities.
11 Q. Oh, wasn't that part of the prior benchmark
12 that had been issued for home based MST?
13 A. There was no prior benchmark for home based
14 MST.
15 Q. Just for the continuum?
16 A. Only for the continuum.
17 Q. Why is that? Why was that necessary that you
18 have then -- or strike that. Why did you not have a
19 benchmark for the home based MST?
20 A. That was a decision, I believe, made by the
21 court monitor. We don't propose benchmarks, the State
22 does not propose benchmarks.
23 Q. But I'm sure the court monitor would not have
24 done that without the concurrence or discussion with the
25 Department of Health MST especially.
Page 29
1 A. I did not specifically talk --
2 Q. Wouldn't you agree?
3 A. -- with the court monitor about the benchmark
4 related to the continuum project.
5 Q. Or why home based MST was not a benchmark prior
6 to that point in time when the continuum was made a
7 benchmark?
8 A. That's correct.
9 Q. All right. Excuse me. Excuse me.
10 CO-CHAIR SENATOR HANABUSA: Miss
11 Swanson and members, we are going to now go into
12 executive session because the Attorney Generals are here,
13 so we ask your indulgence, and we will be back probably
14 around -- maybe about 9:15 or so. So with that --
15 SPECIAL COUNSEL KAWASHIMA: 10:15.
16 CO-CHAIR SENATOR HANABUSA: 10:15.
17 We'll come back at about -- I'm sorry, 10:15. Sorry,
18 10:15, so members, the Chair's motion is to go into
19 executive session at this time. Is there any discussion?
20 And then the purpose of this executive session is that we
21 will be meeting the Attorney Generals who have been
22 assigned to this committee. Hearing none, Vice-Chair
23 Oshiro?
24 VICE-CHAIR REPRESENTATIVE OSHIRO:
25 Co-Chair Hanabusa?
Page 30
1 CO-CHAIR SENATOR HANABUSA: Aye.
2 VICE-CHAIR REPRESENTATIVE OSHIRO:
3 Vice-Chair Kokubun?
4 VICE-CHAIR SENATOR KOKUBUN: Aye.
5 VICE-CHAIR REPRESENTATIVE OSHIRO:
6 Senator Buen?
7 SENATOR BUEN: Aye.
8 VICE-CHAIR REPRESENTATIVE OSHIRO:
9 Representative Ito?
10 REPRESENTATIVE ITO: Aye.
11 VICE-CHAIR REPRESENTATIVE OSHIRO:
12 Representative Kawakami?
13 REPRESENTATIVE KAWAKAMI: Aye.
14 VICE-CHAIR REPRESENTATIVE OSHIRO:
15 Representative Leong?
16 REPRESENTATIVE LEONG: Aye.
17 VICE-CHAIR REPRESENTATIVE OSHIRO:
18 Representative Marumoto?
19 REPRESENTATIVE MARUMOTO: Aye.
20 VICE-CHAIR REPRESENTATIVE OSHIRO:
21 Senator Matsuura?
22 SENATOR MATSUURA: Aye.
23 VICE-CHAIR REPRESENTATIVE OSHIRO:
24 Senator Sakamoto?
25 SENATOR SAKAMOTO: Aye.
Page 31
1 VICE-CHAIR REPRESENTATIVE OSHIRO:
2 Senator Slom?
3 SENATOR SLOM: Aye.
4 CO-CHAIR SENATOR HANABUSA: Thank you,
5 members. We will be meeting next door. What's the room
6 number? Whatever that room number is. Recess.
7 (Recess.)
8 CO-CHAIR SENATOR HANABUSA: We will
9 reconvene. Mr. Kawashima?
10 SPECIAL COUNSEL KAWASHIMA: Thank you,
11 Madam Chair.
12 Q. Ms. Swanson, I'd like to move to another area,
13 and that has to do with testimony that has been taken by
14 and about one of your employees, Dr. David Drews, and his
15 involvement with Loveland Academy. You are obviously
16 quite aware of that, that relationship, are you not?
17 A. I was aware of his testimony.
18 Q. Were you aware of the business relationship
19 that had been established between Loveland and David
20 Drews prior to hearing about it here in one of the
21 hearings?
22 A. No, I was not.
23 Q. That was not brought to your attention by
24 Ms. Donkervoet?
25 A. No, it was not.
Page 32
1 Q. Subsequent to it being brought to your
2 attention though, I'm sure you had conversations with
3 Ms. Donkervoet, among others?
4 A. Yes.
5 Q. About that issue?
6 A. Yes.
7 Q. And was there -- perhaps you can tell me what
8 was your response or what was the -- what was the subject
9 matter with which you discussed this issue with Miss
10 Donkervoet?
11 A. She shared with me that we had done an
12 investigation and had -- what the summary recommendations
13 were in that investigation.
14 Q. And was she referring to an investigation that
15 had taken place in the not distant past but sometime
16 prior to the hearings ever being commenced?
17 A. They were not in close proximity.
18 Q. All right.
19 A. I don't remember the exact date of when --
20 Q. Sure. I think what it was, if I might refresh
21 your recollection, I think there's been testimony, and it
22 appears to be correct, that before David Drews entered
23 into that relationship, he did in fact discuss it with
24 one or more people at the Department of Health. You're
25 aware of that?
Page 33
1 A. I have heard that, yes.
2 Q. Now, and you're also aware that it appears that
3 the Department of Health put its stamp of approval on
4 that relationship continuing once it was revealed, once
5 the relationship was revealed?
6 A. I have not read the investigative report so I
7 cannot conclude that we put a stamp of approval on it. I
8 would hope that we came to the conclusion that there was
9 no conflict of interest.
10 Q. All right. We can work with that. Do you know
11 though in the -- you would call it investigation if it
12 rose to that level, in the work that was done to
13 determine whether or not this relationship ought to be
14 allowed to continue or whether or not there was a
15 conflict, whether the department looked at matters such
16 as how David Drews was using the Loveland facilities in
17 his advertising for Central Pacific University, do you
18 know if that was specifically looked into?
19 A. I have not read the investigative report.
20 Q. All right. Would you agree if in fact David
21 Drews was using the facilities at Loveland, in other
22 words, having a sign placed on a building such that one
23 would reasonably interpret that to mean that Central
24 Pacific University had a campus, and that a campus --
25 that its campus consisted of a number of buildings
Page 34
1 because any photograph showing the sign on the building,
2 a number of buildings were shown in the same photograph
3 that was mounted onto a web site, that certainly that
4 would be misrepresentative of the facts that existed as
5 to how the relationship occurred and what the
6 relationship consisted of, would you agree with that?
7 A. Mr. Kawashima, I think as I mentioned, and it
8 was stated so in the newspaper article, my training is in --
9 as a certified public accountant, looks at the perception
10 of conflict of interest, and I did address that with the
11 reporter, and I have asked questions sufficient for me to
12 conclude that while there may have been a perception of a
13 conflict of interest, based on the questions that I have
14 asked, there was no conflict of interest. I can't
15 comment -- I have never seen the building where Loveland
16 is, I have not seen Dr. Drews' signs, so to talk to you
17 about the specifics, it's not to my knowledge.
18 Q. No, I understand, that's why I'm trying to
19 assist you by giving you information that I believe is
20 correct and accurate to see what your position would be,
21 you see, and that's why I related to you what we
22 understood the facts to be. In other words, he had a big
23 sign that says Central Pacific University on the Loveland
24 campus, on one of the buildings, albeit the agreement was
25 that he would use only two rooms therein, but hardly use
Page 35
1 the rooms. All right? And having that sign there
2 mounted onto a web site suggesting that Central Pacific
3 University, first of all, had a campus, second of all,
4 this campus was where Loveland occupied the premises and
5 he occupied two rooms that he hardly used, that type of
6 information, would that not suggest to you that there
7 would be a problem with Mr. Drews in his position now,
8 entering into such a relationship?
9 A. I do not believe that Mr. -- that we have a
10 conflict of interest with Dr. Drews and his activities
11 with Central Pacific that would impact the expenditure of
12 funds as it relates to Felix eligible children. I have
13 not seen the sign, nor have I seen the web site.
14 Q. Well, just keep in mind that there is a
15 relationship, whatever it might be, between Loveland and
16 David Drews, such that he gets some benefit, whatever it
17 might be, some benefit from Loveland Academy, whether it
18 be using its buildings to appear to be his, whether it be
19 use of a couple of rooms there, whatever it might be.
20 Let's assume that to be correct and I can assure you
21 that's correct. Now, did you also hear testimony though
22 that David Drews from time to time did pass on requests
23 for payment from Loveland where someone from Loveland
24 contacted him directly because there was a dispute with
25 the care coordinator and then Mr. Drews approved payment
Page 36
1 and he remembers, I think, a few instances? Were you
2 aware of that?
3 A. I heard the testimony.
4 Q. Right.
5 A. And that is -- I would not differentiate that
6 from any other provider having the same type of
7 difference with the care coordinator that would be
8 brought to the attention of the branch chief.
9 Q. But any other coordinator though, ma'am, would
10 not have had the relationship that Mr. Drews had with
11 Loveland where they traded services or traded whatever
12 they traded, where he would be in a position then to pass
13 on requests for payment being made by Loveland, would you
14 agree with that?
15 A. I know of no other branch chiefs that have a
16 relationship that was described as Dr. Drews with Central
17 Pacific --
18 Q. Right.
19 A. -- and the Loveland building.
20 Q. So that he would not be any other provider,
21 would he, as you described it?
22 A. He is not a provider. Dr. Drews is the family
23 guidance center branch chief.
24 Q. I'm sorry. He does not have the relationship
25 with any other provider other than Loveland, does he?
Page 37
1 A. You're asking me to come to a conclusion on a
2 relationship that he has with Loveland, and I'm
3 describing to you what I have heard. I did not review
4 the investigative report. If you'd like me to review it
5 and come back and answer those questions, I might add
6 that Dr. Drews on his own volition, not at my request or
7 anyone else's request, did terminate his memorandum of
8 agreement with Loveland, and it's my understanding he has
9 removed the sign and removed any advertising from his web
10 site. I have also though not double checked because I
11 don't know where the Loveland building is.
12 Q. But this took place after all of this was
13 revealed though publicly though, ma'am, right?
14 A. To avoid the perception of a conflict of
15 interest.
16 Q. Well, you know, I don't necessarily need to
17 have you look at the investigative report, you may if you
18 wish, but I am asking for your opinions based on facts
19 I'm giving you to what we perceive to be more than a mere
20 perception of conflict. In other words, there was some
21 type of service or something of value traded back and
22 forth between Loveland and David Drews in a case where
23 Loveland, a provider, would be seeking assistance from
24 David Drews in authorizing payment that a care
25 coordinator, for example, was disputing, things of that
Page 38
1 nature, would you not agree in that specific situation
2 where Mr. Drews was having some type of relationship
3 where they traded services or products or whatever it may
4 be with the service provider, that he would be in a
5 conflict of interest situation? In that specific
6 situation, if you assume my facts as I stated them to be
7 correct?
8 A. I'm having difficulty, Mr. Kawashima, assuming
9 that your facts are correct because it was my
10 understanding that they have not traded services, and I
11 am confident of Dr. Drews' representation that he did not
12 approve services for payment on any different basis than
13 he would have done with any other provider.
14 Q. Well, that's what he said.
15 A. Okay, and you're asking me to confirm that
16 there was a conflict of interest. And I have said there
17 was a perception of a conflict of interest.
18 Q. You agree there was a perception?
19 A. Yes.
20 Q. Well, further though, ma'am, if you might
21 assume for the purposes of my questioning that in fact
22 Mr. Drews was allowed to use the premises of Loveland
23 Academy for whatever purposes he wished but one of them
24 turned out to be, as a matter of fact, a mounting on his
25 web site, a photograph that would suggest that Loveland
Page 39
1 Academy's premises was the campus of Loveland Academy,
2 for example, one, and he was also allowed to use two
3 rooms there whenever he needed to use them, they're
4 dedicated to his purpose, Central Pacific University's
5 purposes, although he testified he hardly used them,
6 which would suggest that the advertising was the more
7 important thing, but nonetheless, he in fact was getting
8 that for renovating those offices and making them
9 probably better than they were, but in exchange no rent,
10 nothing. He was getting that from Loveland. Can you
11 accept that so far, I mean do you have problems accepting
12 that?
13 A. I have heard testimony to that effect.
14 Q. Right. So if you will accept that as being as
15 fact, now David Drews passes on requests for payment from
16 Loveland Academy, among others, but Loveland Academy, do
17 you not see the conflict there?
18 A. There is a perception of a conflict of
19 interest.
20 Q. And your -- your determination that there was
21 not a conflict was based on discussing the matter with
22 David Drews and him telling you that he did not treat
23 Loveland any different than anyone else?
24 A. That's correct.
25 Q. Am I correct? And you don't intend to look
Page 40
1 further into that, ma'am?
2 A. I have no reason, no reason has been brought to
3 my attention. If you were to raise a specific example or
4 you are aware of something that you believe was approved
5 because of this relationship, I would like to look at it.
6 Q. How about -- how about the fact that Ms. Dukes
7 received a Masters degree from Central Pacific
8 University, have you looked into that?
9 A. No, I have not.
10 Q. Have you looked into whether or not she paid
11 for that degree?
12 A. I have not.
13 Q. She should have paid for that degree, shouldn't
14 she, assuming it was a profit --
15 A. I would assume.
16 Q. Profit -- it for profit organization or even if
17 it was nonprofit, if it had a tuition scale, she should
18 have paid for it, right?
19 A. You would assume that if she got the benefit of
20 the degree she would have paid for it, yes.
21 Q. So are you aware that she did or not?
22 A. I have no knowledge of that.
23 Q. Are you aware -- are you aware as to how long
24 it took for Ms. Dukes from the time she got -- or from
25 the time she started working on that degree until the
Page 41
1 point in time where she obtained that degree, Masters
2 degree in psychology, how long that took?
3 A. No, I do not know.
4 Q. Are you aware that that degree was necessary
5 for Loveland Academy to be able to apply for and be
6 accorded certain types of -- accorded the right to
7 provide certain types of services under a DOH contract?
8 A. I heard testimony, but I have not asked for
9 clarifying -- I have not asked clarifying questions.
10 Q. All right.
11 A. The testimony I heard was to differentiate
12 between speech therapy that she was clinically trained to
13 provide and her desire to provide mental health therapy.
14 Q. Exactly.
15 A. I have that knowledge purely by the testimony
16 that I've heard. I have no other knowledge of that
17 situation.
18 Q. You have no knowledge that she needed a Masters
19 degree to get a certain type of contract from the
20 Department of Health, you're not aware of that?
21 A. The extent of my knowledge is what I heard
22 during the testimony.
23 Q. All right. Now, one short area. You -- I
24 think you were here when Dr. Kenneth Gardiner testified?
25 A. Yes.
Page 42
1 Q. And I obtained a commitment from Mr. Drews that
2 there would be no retaliation against him for what he
3 said, in fact, I think David Drews agreed or did not
4 dispute what Dr. Gardiner testified to. But as far as
5 you're concerned, no one should retaliate against
6 Dr. Gardiner for coming forward here to testify?
7 A. Absolutely not.
8 Q. Or any other DOH or Department of Health
9 employee, for that matter?
10 A. Absolutely not.
11 Q. There was a matter of some billing information,
12 billing materials that were provided to your department
13 by one of the members of the auditor's office, and it
14 related to questionable billings. And I understand that
15 your department is working through that matter, but we
16 have yet to receive responses to that request. Do you
17 know if those responses are forthcoming, and if so, when?
18 A. I would assume that you've made the requests to
19 the Child and Adolescent Mental Health Division, not the
20 Department of Health.
21 Q. Well, through Mary Brogan, I believe?
22 A. I would be happy to check on that. I will
23 follow up with her and I can get you a date on the next
24 break.
25 Q. I understand, because it seems like it's a
Page 43
1 little longer than it should be. If you would, we'd
2 appreciate your expediting -- expediting that.
3 A. And if I could --
4 Q. If possible.
5 A. And I appreciate that, and I will check on it
6 at the next break, and if I could just clarify two issues
7 from prior to the break, we had previously provided a
8 schedule --
9 Q. I understand.
10 A. -- of flex payments and the respite amounts to
11 the auditor's office.
12 Q. Well, this is more than that, ma'am. In --
13 well, strike that. After having reviewed what you
14 already provided, ma'am, among other things --
15 A. Uh huh.
16 Q. -- documents we have, a question or questions
17 came up about some billings, and that was specifically
18 inquired into by Mr. Baudern in the auditor's office.
19 That's what I'm talking about, and I think Ms. Brogan
20 might know what I'm talking about.
21 A. Okay.
22 Q. Okay?
23 A. And I believe they have a meeting scheduled for
24 tomorrow, so it's possible that that information is being
25 presented tomorrow.
Page 44
1 Q. It may be available tomorrow, which would be
2 wonderful.
3 A. Okay.
4 Q. Thank you. You also heard testimony about
5 providers providing services for DOH clients?
6 A. Yes.
7 Q. As a general matter?
8 A. As a general matter, yes.
9 Q. Is there a -- is there a mechanism in place to
10 assure the accountability of those providers such that,
11 for example, they are in fact providing the services that
12 they claim to be providing, second, that the services are
13 providing the type of assistance that the child needs,
14 and also, whether or not -- or I should say some
15 prognosis as to how much longer the services would be
16 necessarily, would necessarily have to be provided, those
17 types of information, do you have a mechanism in place to
18 assure that these things are done?
19 A. There are multiple mechanisms.
20 Q. Good. What are they?
21 A. It starts with the IEP planning process that
22 looks at the strengths of the child and what services are
23 necessary for that child to benefit from their education,
24 where there's a participation of the Department of
25 Education, the parent, the child, if age appropriate, and
Page 45
1 the Department of Health CAMHD care coordinator. From
2 that process, the services are authorized, the services
3 would then be provided by the provider, the provider
4 would bill for those services. The CAMHD information
5 system needs to electronically link the service
6 authorization that the care coordinator put into the
7 information management system to the provider's billing,
8 and assuming that they match both by the type of service
9 and the quantity, if it's hours or days of service
10 provided, that would be one level of accountability. In
11 addition, the care coordinator and the family receive an
12 explanation of all the services provided to the child on
13 a quarterly basis, there's a level of accountability at
14 the family level, the family, you know, has the potential
15 to raise an issue to us that my child didn't receive
16 these services on the date and we can identify why not,
17 or maybe there was a mix up on the dates. The family
18 could raise the issue of, you know, my child's not
19 getting any benefit from this, we don't like this
20 provider, it's not relating well to my child, that issue
21 can be addressed by the care coordinator. The care
22 coordinator can look at the services provided and
23 ascertain as when preparing for the next IEP or as on an
24 ongoing basis that we're continuing with this level of
25 service, what benefit -- I believe Mr. Gardiner addressed
Page 46
1 that in his testimony, and then as the Department of
2 Education and the Department of Health planned for the
3 next IEP meeting, they look again at the strengths of the
4 child and what supports are necessary and what changes
5 need to be made for that child to continue to make
6 progress towards the goals that were established in the
7 IEP, which brings the education back in if the teacher
8 says we're not getting any results, then that's also an
9 indicator that a change in the level or the type of
10 service might be necessary.
11 Q. I see. Thank you. Of course, those -- those
12 procedures that you have in place are documented?
13 A. Yes.
14 Q. So that if questions were raised as to a
15 certain situation, whether or not it was documented or
16 not, you would be able to, with some reasonable amount of
17 time, of course, produce the documentation to support
18 what was done?
19 A. In general, that would be the IEP and the
20 progress notes, yes.
21 Q. Well, progress notes -- progress notes are
22 important, are they not?
23 A. Absolutely.
24 Q. And so that there should be reflected somewhere
25 documentation to support what was done, why it was done,
Page 47
1 maybe not in great detail but certainly to some extent so
2 that a reviewer would be able to determine whether or not
3 these types of procedures that you have described have in
4 fact been carried out?
5 A. Yes. And that's one of the reasons why in our
6 audits of our providers we look at the progress notes.
7 And I think as Mr. Gardiner shared, his frustration was
8 the lack of that information and knowing how the children
9 who are under the care of his care coordinators are being
10 appropriately -- how he can appropriately supervise them
11 if they're not getting the appropriate information.
12 Q. Okay, one last area, ma'am. We spoke earlier
13 about the court's order, the order of July 21, 2000
14 issued by Judge Ezra. It's entitled the stipulation
15 regarding plans for strengthening and improving the
16 system of care and then there's an order following the
17 stipulation. We referred to that as being the enabler
18 for the Department of Health and the Department of
19 Education to -- I don't mean this negatively,
20 necessarily, but to circumvent certain State statutory
21 requirements such as 103D and 103F. You recall that
22 discussion?
23 A. Yes.
24 Q. Was that, in terms of having the court ordered
25 that to happen, was the Department of Health in support
Page 48
1 of that, that happening? In other words, of course, the
2 department didn't disagree with it, but was the
3 Department of Health one of the parties that sought to
4 have this power given to the departments?
5 A. I can't use the words that you're asking me as
6 far as sought.
7 Q. All right, perhaps you can explain.
8 A. We were -- the Child and Adolescent Mental
9 Health Division and the Department of Health was being
10 held to a benchmark that requires us to provide services
11 to a child within 30 days of that child being identified
12 in need of specific services. And we were concerned
13 about that benchmark, and in our discussions with the AGs
14 and the court monitor, that if a situation arose where we
15 needed to procure services in order to meet that
16 benchmark, that we needed the authority to waive, and I
17 apologize, earlier I mixed my Ds and Fs, it's actually
18 for mental health services we waive 103F, that we would
19 need that authority to waive it. And that's how that
20 came into the discussion.
21 Q. I see. I see.
22 A. So it's an enabling for us to meet the
23 benchmark that requires us to provide services.
24 Q. Do you know if the Department of Health raised
25 objections though to the amount of time that was being
Page 49
1 imposed on the department to meet those benchmarks, the
2 30 days you just referenced? Did the department disagree
3 with and therefore object to that type of short time
4 limit being imposed on you?
5 A. Not to my knowledge.
6 Q. Did you believe those -- those requirements
7 could be fulfilled within 30 days with the system as it
8 existed prior to the super powers being accorded?
9 A. We have a need to provide services to children
10 in order to benefit from their education. If the
11 services aren't provided timely --
12 Q. I understand that. But see, what I understand
13 you saying is that the reason you needed the super powers
14 was because of the benchmarks and the shortness of time
15 that was given by the court to the departments within
16 which to fulfill those benchmarks, meet those benchmarks.
17 If in fact that you were aware of that and the shortness
18 of time, might not a request for more time have been more
19 opportune or more proper as opposed to trying to waive
20 any requirements of 103F? Was that discussed, ma'am?
21 A. That was not discussed, to my knowledge.
22 Q. Are you using 103F to a substantial degree?
23 A. Can you define substantial?
24 Q. How are you using 103F since the inception of
25 the order?
Page 50
1 A. To my knowledge, we have used Dr. Anderson's
2 authority to waive the 103F requirements in the range of
3 30 to 40 times since it was awarded. It does go through
4 the same review process that we go through with the
5 awarding of our contract. The Child and Adolescent
6 Mental Health Division puts a waiver request memorandum
7 together documenting why the services cannot be provided
8 by our contracted providers, that's submitted for my
9 review. From my review it goes to our administrative
10 services office and they review it, goes on to
11 Dr. Anderson's office and it goes -- the contracts go
12 through the same review process at the Attorney General's
13 office, and to my understanding, all of our contracts are
14 signed off by the Attorney General's office.
15 Q. All right. In other words, I think what you're
16 saying, ma'am, is even with the waiver requirement of
17 103F that the Department of Health has endeavored to
18 follow the requirements of 103F except for time
19 requirements. Is that a fair statement?
20 A. Except for the time required to release the
21 RFP, that's correct.
22 Q. All right. Thank you.
23 SPECIAL COUNSEL KAWASHIMA: That's all
24 I have, Madam Chair.
25 CO-CHAIR SENATOR HANABUSA: Thank you
Page 51
1 very much. Members, we'll begin your questioning with
2 the five minute rule. We'll begin first with Vice-Chair
3 Oshiro followed by Vice-Chair Kokubun.
4 VICE-CHAIR REPRESENTATIVE OSHIRO:
5 Thank you, Co-Chair Hanabusa.
6 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
7 Q. Hi, Miss Swanson. I just wanted to get some
8 clarification on one of the issues Mr. Kawashima brought
9 up, and that had to do with the documentation, and I
10 think you said that you agreed that progress notes were
11 very important, is that correct?
12 A. Absolutely.
13 Q. Okay. I'm a little confused because we heard
14 some conflicting testimony and I was wondering if you
15 could provide any clarification, or at least I guess a
16 promise that maybe you'll follow up on it, because on one
17 side I think what I remember hearing was Dr. Gardiner,
18 and you said that I think he -- he oversees care
19 coordinators, is that correct?
20 A. That's correct.
21 Q. Okay. I think remember in his testimony he
22 saying that there were progress notes he received from
23 Loveland Academy, and they were sort of boilerplate or
24 template and that he based on that couldn't make any
25 assessment as to the actual prognosis or the progress of
Page 52
1 the children in the academy. Do you recall something
2 like that?
3 A. I do.
4 Q. Okay. And then on the other hand when we did
5 talk to Dr. Colvin, who does work for Loveland Academy, I
6 specifically asked her about the progress notes and I
7 remember her response being something to the effect that
8 care coordinators told her that they didn't want detailed
9 progress notes, they just wanted these summaries and
10 therefore, that's all they got provided, was just the
11 short, you know, boiler template summaries, so on one
12 side Dr. Gardiner is saying he needs the detailed
13 progress notes and his care coordinators need them to
14 determine the prognosis, and on the other hand Dr. Colvin
15 is saying the care coordinators say that they don't want
16 it. Do you have any clarification on that or --
17 A. I asked the same question you did, and it was
18 explained to me in a historical context. Prior to the
19 additional care coordinator positions that were provided
20 by the legislature in 1999, our care coordinators had
21 case loads of 100 plus children to manage. At that point
22 in time, which was when that contract was entered into,
23 it was explained to me that they didn't have the ability
24 to look at the detailed progress notes. With the
25 additional care coordinators and our additional emphasis
Page 53
1 on evaluating how well children were doing, and that also
2 has been described in Ms. Donkervoet's testimony as far
3 as in supporting the development of our contracted
4 providers, that we have moved our contracted providers to
5 absolutely what Mr. Gardiner testified to, that we do
6 need the detailed progress notes. There is very clearly
7 something that needs to be clarified with that provider.
8 And there, as with all of our providers, they will be
9 reviewed in an upcoming review and that our clinical
10 standards will be very clear to them that the progress
11 notes need to be individualized and need to be addressing
12 those specific issues related to individual children.
13 Q. Okay. About what was the time frame that
14 you're talking about in the terms of the additional
15 positions being provided?
16 A. They were provided after the '99 session.
17 Q. Okay.
18 A. 70 additional care coordinator positions, which
19 brought us up to a little bit more than 150 positions, so
20 it was a significant increase. It's reduced the case
21 loads from over 100 to down -- with the school based --
22 with the transition to school based services, to case
23 loads in the range of one to 15 and one to 25.
24 Q. Okay. And then if I understand you correctly,
25 you're saying that administrative policy will now be
Page 54
1 stated to all providers that they need to provide these
2 detailed progress notes and not just these summary
3 template boiler ones, boilerplate ones, is that correct?
4 A. I believe our clinical standards are clear now,
5 that they need to be individualized progress notes. I
6 receive a copy of the -- our provider reviews when
7 they're complete, and I have seen evidence of our
8 requesting corrective action plans with other providers
9 related to progress notes, which tells me that our --
10 that those doing the review are well aware of our
11 clinical standards that requires the note and that we're
12 bringing it to the attention where it's appropriate.
13 Q. Thank you. I'd also like to follow up on the
14 issue of the flex care. You stated that you don't review
15 those particular payments, is that correct?
16 A. That's correct.
17 Q. Who does review those payments?
18 A. I believe they're reviewed by the family
19 guidance center branch chiefs and they're reviewed at the
20 division level. I don't know the -- at one time they
21 were reviewed by the division chief and I can check on
22 that to be sure.
23 Q. Okay. But I think you did state that you did --
24 you were aware of at least the Marimed sailing program, I
25 mean you had some personal knowledge of that program in
Page 55
1 existence?
2 A. They are a contracted provider for residential
3 services, and that's what I needed to differentiate. I
4 did not expect to see Marimed under flex payments, I
5 would expect to see Marimed as one of our contracted
6 providers.
7 Q. Okay. Because I -- just briefly, my time is
8 almost up, but I understand, I think, conceptually anyway
9 that for respite care, what you're trying to do is avoid
10 more expensive higher end emergency services and that's
11 why you provide respite care, but what's the standard
12 guiding flex care? I'm not really sure I understand if
13 something such as sailing programs or horseback riding --
14 I mean I can understand how they provide some sort of
15 behavioral benefit, but at the same time I think
16 Mr. Kawashima brings up a good point in that where is the
17 line, where can we draw the line in terms of behavioral
18 services versus therapeutic. I mean for the State in our
19 role, where is that line to be drawn and what's the
20 standard?
21 A. That line is drawn at the IEP. With the
22 State's offer, a free and appropriate education, if the
23 team based decision and the principal signs that IEP,
24 then we're required to provide those, quote, other
25 related services. And where we don't have a contracted
Page 56
1 provider to provide that service, then we have to be
2 flexible, which is where the flex comes from, and find
3 those services somewhere else. And so that's where it
4 comes in, but our participation in the IEP is our
5 opportunity to say demonstrate how that will impact that
6 child's mental health needs, address that child's goals,
7 and that's where we have to work, and we're still
8 developing those skills and we're mentoring our care
9 coordinators that they have the strength and the
10 understanding to challenge in that process, in that team
11 meeting to say what benefit will that child receive, but
12 once it goes into the IEP, then we're required to find
13 the service to respond to that need.
14 Q. Okay, thank you very much. Thank you.
15 CO-CHAIR SENATOR HANABUSA: Thank you.
16 Vice-Chair Kokubun followed by Representative Ito.
17 VICE-CHAIR SENATOR KOKUBUN: Thank you,
18 Madam Co-Chair.
19 BY VICE-CHAIR SENATOR KOKUBUN:
20 Q. With respect to the IEP, is there appeals
21 process or is it just simply a challenge when it's
22 happening in terms of changing the IEP?
23 A. I'm not an attorney, but both the State through
24 the Department of Education or the parents, if they don't
25 agree with the terms of the State's offer of fair -- a
Page 57
1 free and appropriate education, can request a due process
2 hearing.
3 Q. I see. So it's not necessarily a consistent
4 building process, it's -- you're looking at the needs of
5 the child and coming up with the services that would meet
6 the needs of the child, but everyone doesn't necessarily
7 have to agree with that package?
8 A. No. It is my understanding that the Department
9 of Education can make an offer of FAPE to a child for --
10 to respond to a child's needs.
11 Q. Okay. This due process hearing, has that ever
12 been invoked by the Department of Health, to your
13 knowledge?
14 A. To my knowledge, no, because to my knowledge
15 when I have asked that, only the Department of Education,
16 and again, that's a relationship issue, so our
17 opportunity to respond to that challenge is to bring
18 those issues to the attention of the principal, and that
19 would be the care coordinator with the principal. If it
20 needs to go higher it would be at the district level with
21 our family guidance center branch chief, which is at the
22 district level, and there are issues that come all the
23 way up to my level.
24 Q. Okay. To the best of your knowledge, has that
25 ever been, again, invoked by the Department of Health
Page 58
1 where you have gone to the appropriate person, the
2 principal or whoever to ask that it be changed, the IEP
3 changed?
4 A. Actually, we don't ask for the IEP to be
5 changed, we ask to clarify information to understand what
6 the child's need is.
7 Q. Okay. Has that ever happened?
8 A. Yes.
9 Q. And there have been amendments or some kind
10 of --
11 A. We have helped support a process to reconvene
12 the IEP. And again, you know, we want the team to have
13 the most knowledge to make the best decision about the
14 child, and you know, we don't expect everyone to be
15 experts in every area.
16 Q. Right. And that's why there's this other
17 process about modifying an IEP, right, is that correct?
18 A. I wouldn't use the term modification. I can't
19 change an IEP. The team can reconvene --
20 Q. Right.
21 A. -- and come to a different decision or the
22 Department of Education could make a different offer of
23 FAPE. But I can't administratively change an IEP.
24 Q. Right. No, I'm talking about through the
25 process?
Page 59
1 A. Right, you would have to go back through the
2 IEP process.
3 Q. Okay, thanks. I'm just trying to get a better
4 handle on this Kapiolani Health Hawaii Demonstration
5 project on the Big Island?
6 A. You need to ask Tina.
7 Q. Well, maybe we'll have to ask her to come back.
8 Do you have knowledge of that?
9 A. I have --
10 Q. This project?
11 A. It was closing out when I started.
12 Q. I see.
13 A. So I have some knowledge.
14 Q. Uh huh. You did not participate as a manager
15 or an administrator for that project at all?
16 A. No.
17 Q. Now, when it closed out, the Department of
18 Health assumed responsibility for that program?
19 A. We had responsibility for the children on the
20 Big Island and their other related services, correct.
21 Q. But when that particular program ended, that
22 what, those services were transferred to the Department
23 of Health?
24 A. We had the obligation to continue to serve
25 those children.
Page 60
1 Q. Okay.
2 A. Yes.
3 Q. One of the providers in that was Na Laukoa?
4 A. That's correct.
5 Q. Okay. They continued to provide services?
6 A. That's correct.
7 Q. And is there a termination for this
8 relationship or what is the -- what is the nature of the
9 relationship now between the Department of Health and Na
10 Laukoa?
11 A. It's my understanding we continue to have a
12 contract with one of the entities that is referred to as
13 Kaniu Na Laukoa, Kaniu Two LLC. We have a contract. I'm
14 not sure which is the legal entity. I'd be happy to find
15 out.
16 Q. Okay. And is that an annual contract? I'm
17 trying to get, you know, an idea of what the parameters
18 of that contract were?
19 A. There were two year contracts that were entered
20 into in 1999 and have been extended through June of '02.
21 Q. Okay. And the scope in terms of the
22 contractual amount?
23 A. I don't know. I believe we've provided it to
24 the committee or to the legislative auditor. I can get
25 that for you.
Page 61
1 Q. Okay. Thank you.
2 CO-CHAIR SENATOR HANABUSA: Thank you.
3 Representative Ito followed by Senator Buen.
4 REPRESENTATIVE ITO: Okay, thank you,
5 Madam Co-Chair Hanabusa.
6 BY REPRESENTATIVE ITO:
7 Q. Good morning.
8 A. Good morning.
9 Q. You know, you mentioned medical monitoring. Is
10 the DOH still doing that?
11 A. Medication monitoring?
12 Q. Medication monitoring.
13 A. Medication monitoring is considered an
14 outpatient service and that is now being procured through
15 the Department of Education with the school based
16 services transition.
17 Q. So now that it's transferred to the DOE, the
18 teachers are doing this medication monitoring?
19 A. No, it's done by a psychiatrist or a
20 pediatrician. So the Department of Education, it's my
21 understanding is contracting at the district level for
22 those services.
23 Q. I see. So what was the reason for the
24 transfer?
25 A. It was part of the scope of service that was
Page 62
1 included in out patient services, and maybe I should
2 clarify. There are some areas of the State where our
3 family guidance center psychiatrists continue to provide
4 some level of medication monitoring, I believe, and those
5 are the remote areas, Lanai, Molokai.
6 Q. Oh, I see. Another area right here, you
7 mentioned respite service. And you know, I heard that, I
8 don't know if it's true or not, that the Department of
9 Health approved construction of additional bedroom, you
10 know, for a person. Is that true?
11 A. I also heard that at this hearing, and if I
12 could ever get back to the person who says they know
13 about it, I'd like to look into it, but I don't have the
14 details.
15 Q. Okay. And also benchmarking, you know, I've
16 been hearing from teachers that, you know, every time
17 they move toward the benchmark, you know, it's -- it
18 moves again. It's just like a fleeting thing, you know,
19 they can never meet the benchmarks, and who sets the
20 benchmarks?
21 A. The court monitor sets the benchmarks.
22 Q. So every time, you know, we move toward that
23 goal, they keep moving it, the court monitor?
24 A. I'm not sure I would describe them as moving.
25 At one point in time we had 141 benchmarks so there were
Page 63
1 many of them, so maybe that was expressed to you as a
2 frustration for how many they needed to make. And if
3 they met one, then they just had -- if they met benchmark
4 23, then they needed to meet benchmark 36, but to my
5 knowledge, the benchmarks have never moved. And --
6 Q. Well, the word you used is replaced.
7 A. Yes. There was a benchmark that replaced --
8 that's correct. I used that terminology. Our specific
9 benchmark related to the number of children who were in
10 the MST continuum. It was rephrased, I think, much more
11 appropriately than it was the first time. Part of the
12 questioning that I did and in participation with the
13 decision making process, was to say how can we commit to
14 having 56 children in the research project at this point
15 in time if we don't have 56 kids who need that level of
16 service? So we should have -- looking back on it with
17 hindsight, it would have been a very difficult benchmark
18 to ever meet if the kids didn't present with those
19 conditions.
20 Q. So you know, it keeps moving like this, you
21 know, it's hard to, you know, comply, you know, with that
22 consent decree. And the monitor keeps moving it, you
23 know, the way I understand it, it was real difficult, you
24 know, especially for the special ed people in the DOE.
25 A. I can't respond as it relates to education, but
Page 64
1 I would not describe our benchmarks as having moved.
2 Q. Okay.
3 A. I think as they were redescribed, they were
4 more achievable and more -- they more closely represented
5 the commitments that we had made in our service capacity
6 plan.
7 Q. Okay. The last question, do you folks have an
8 internal auditor in the DOH?
9 A. Not to my knowledge.
10 Q. You think you need one?
11 A. No, I believe that the processes we have in
12 place and the review procedures are sufficient.
13 Q. Okay. Thank you very much.
14 REPRESENTATIVE ITO: Thank you, Madam
15 Co-Chair.
16 CO-CHAIR SENATOR HANABUSA: Thank you.
17 Senator Buen followed by Representative Kawakami.
18 SENATOR BUEN: Thank you, Co-Chair
19 Hanabusa.
20 BY SENATOR BUEN:
21 Q. Miss Swanson, the children with autism receive
22 services from the Department of Health, I understand?
23 A. That's correct.
24 Q. Can you name some of the kind of professional
25 services that the Department of Health provide for
Page 65
1 children with autism?
2 A. There are very clinical terms, primarily
3 educational. They teach them ways to express themselves
4 and I believe that has a term called PECS that probably
5 is an acronym for teaching them to use pictures to say
6 I'm thirsty, they use types of behavior therapy to teach
7 them responsibility for their own toileting activities,
8 they work with them in speech areas, that would be more --
9 that's my lay understanding but I'd be happy to have a
10 clinician talk with you.
11 Q. Okay. So you're saying professionals like
12 speech pathologists are provided for the children with
13 autism? Other than the speech pathologist, what other
14 professionals service these children?
15 A. Psychologists, social workers, behavioral
16 specialists, which could be, you know, a range of social
17 work to psychology, and again, when I hear you say
18 children with autism, there is a range of children with
19 autism. There are some who are very high functioning and
20 are in regular education classrooms, and then there are
21 some who need significant supports as it relates to daily
22 living skills.
23 Q. So these, the children, the parents are
24 involved in the IEP process and through that process they
25 receive these professionals to come in and receive
Page 66
1 services from these professionals?
2 A. Yes. The professionals are provided during the
3 day in an education environment, and if the child's needs
4 justify, they may be receiving some intensive in home
5 services to continue that educational development.
6 Q. Okay. I understand from some parents that they
7 are not receiving the professional help even though they
8 have expressed this through the IEP process, and they're
9 still not receiving this professional help, they continue
10 to ask and they have still not received the professional
11 help. I just wanted to know how much effort the
12 Department of Health is putting into rather than having
13 the parents go through the process that you mentioned
14 earlier, the due process, I just wanted to know how much
15 effort is the department putting in for these children to
16 receive that additional help that they feel -- the
17 parents feel that the child need.
18 A. Actually, listening to you further, I might add
19 that therapeutic aides also support children with autism.
20 And I'm trying to differentiate between a parent's clear
21 need and desire, these are very challenging children, for
22 services that have gone beyond what's agreed to in the
23 IEP. They may be voicing to you that there are -- there
24 are needs at home, and just in managing a very
25 challenging child that is above and beyond what has been
Page 67
1 agreed to in that child's IEP, and if they're voicing
2 that to you, I can appreciate and understand that. We
3 are funded and are only providing what's required for
4 that children's educational development through the IEP.
5 I can say that we've been responsive to the degree that
6 we've been able to find qualified personnel because as I
7 mentioned earlier, we have a benchmark that says no child
8 goes without needed services for more than 30 days. And
9 since that report was required in December of 2000, we
10 have had services in place for every child. Now, we do
11 track and try to manage where we have a mismatch of
12 services so we may not have the most appropriately
13 trained individual in the home with that child on
14 Molokai, on Lanai and in certain outlying areas of Maui,
15 but we identify that as a mismatch that we have some
16 service in there, but we don't have exactly the right
17 match right now, but that's -- that's what we're using as
18 a tool to identify where we have unmet need.
19 Q. Okay, thank you, Miss Swanson. My time is up.
20 Thank you.
21 CO-CHAIR SENATOR HANABUSA:
22 Representative Kawakami followed by Senator Slom.
23 REPRESENTATIVE KAWAKAMI: Thank you,
24 Co-Chair Hanabusa.
25 BY REPRESENTATIVE KAWAKAMI:
Page 68
1 Q. I just wanted to ask a few questions. I wanted
2 to find out in terms of respite care, who monitors the
3 type of respite care that is like horseback riding or
4 sailing, to know that that's the best practice for that
5 child?
6 A. I apologize, but respite care is not horseback
7 riding or sailing.
8 Q. Okay. That's simply what you said first
9 regarding respite --
10 A. Mr. Kawashima --
11 Q. -- timing with the flex?
12 A. Mr. Kawashima asked me to describe the respite
13 care, which is a level of care provided to support a
14 child in a family's need so that child doesn't have to
15 access more intensive services or potentially place that
16 child at risk for out of home services. It's to provide
17 additional supports to that family. Flex care are those
18 services such that you mentioned, the sailing and the
19 horseback riding that come through an IEP team decision,
20 and we don't have the contracted provider to provide so
21 we use a flexible arrangement, which is where the flex
22 comes from.
23 Q. Oh, I understand.
24 A. To meet the needs of that IEP.
25 Q. Okay.
Page 69
1 A. And I would agree with you that there is no
2 demonstrated research that shows that that service has a
3 research basis for it, and that's where we have a
4 responsibility at the care coordinator level, and as
5 they're supervised to ask those questions in the IEP
6 process. What are you trying to achieve for this child
7 and have the craft knowledge to say we can achieve that
8 same result with X and maybe not necessarily --
9 Q. So if the care coordinators, the teachers,
10 etc., who are at that IEP decide that they need to go
11 flex services instead for that child --
12 A. They would probably not use that terminology.
13 That's a terminology within division on how we pay for
14 it. They would say this child will benefit by this
15 therapeutic horse riding program and that will be written
16 in the IEP. Our care coordinator then has to go and get
17 that service and find a way to pay for it, and we use a
18 flex terminology in order to pay for it.
19 Q. So who is monitoring when that child has to be
20 doing this flex activity, let's say sailing or horseback
21 riding?
22 A. The therapeutic horse --
23 Q. The goal?
24 A. The horseback riding program would have a
25 responsibility to a progress note, a report, how that
Page 70
1 child was progressing through the program. That
2 information would come back to the care coordinator, and
3 my hope is that the care coordinator in discussion at the
4 IEP would come to a conclusion that the child -- that was
5 addressing the child's needs and the child was
6 benefiting, the child now has the ability to reach this
7 educational goal that he or she otherwise could not have
8 or to say you knew what, I've seen the program, I visited
9 the child, we're not making progress, we need to look at
10 other options.
11 Q. So there, I would think there would be very few
12 youngsters who would go that route, or are there a lot?
13 A. I have seen the number, and I'd be happy to
14 provide it to the committee. I believe we have provided
15 to the legislative auditor that there were 1,200
16 encounters that we had flexed, that we had paid in the
17 last year.
18 Q. Now, the reason I ask you also is because
19 recently I heard that dogs were included, they have to
20 have the pet, do you know?
21 A. No, that's the first I've heard of that, but
22 again, if someone can get me the details, and I will go
23 back and look at the names of the programs myself, and we
24 provided them, but if you can give me the details or the
25 child's name or even the school district, that will help
Page 71
1 me get to --
2 Q. Okay.
3 A. -- understanding. So then we can stop talking
4 about bedrooms and dogs and horses.
5 Q. Well, they said the pet had to be there, and
6 you know, was helping the child along, so I thought well,
7 this is --
8 A. And it could be -- there could -- that may be
9 the IEP team decision.
10 Q. Uh huh. Okay. And the last question was on
11 the benchmarks, as Representative Ito said, and I asked
12 that question prior because the principals were saying
13 that this moving target, and that's what they use, moving
14 target was bothering them, which is what the benchmarks
15 were changed, or as you said, moved or --
16 A. I didn't say they've moved. You know, that's
17 probably a better question for Miss Hamamoto because --
18 Q. Because it kind of bothered them?
19 A. Yeah, you're relating to principals. It's a
20 frustrating process and I can say that care coordinators
21 have shared with me, they want to do what's right for
22 kids and they want out of Federal Court oversight. And I
23 think we're close.
24 Q. Thank you very much, Miss Swanson.
25 REPRESENTATIVE KAWAKAMI: Thank you,
Page 72
1 Chair.
2 CO-CHAIR SENATOR HANABUSA: Thank you.
3 Senator Slom followed by Representative Leong.
4 SENATOR SLOM: Thank you, Co-Chair.
5 BY SENATOR SLOM:
6 Q. Good morning, Miss Swanson, it still is.
7 A. Yes. I checked.
8 Q. Is it accurate to say that your duties as
9 deputy director includes management of three separate
10 behavioral divisions?
11 A. Yes.
12 Q. And also, that you really have complete
13 oversight management of the Felix compliance project? Is
14 that an accurate statement?
15 A. As it relates to the Department of Health. No,
16 I'm sorry. The early intervention programs and -- are
17 what you might refer to as the zero to three programs,
18 are under the oversight of Dr. Presler. They are not
19 within behavioral health.
20 Q. I see. Okay, thank you. And you testified
21 about the Kapiolani Health project. Just so I'm clear,
22 you said you came in at the end of that project?
23 A. Yes.
24 Q. But did you have any direct involvement with
25 it?
Page 73
1 A. No. I participated in a discussion as to the
2 benefit of doing an audit and what we might recover from
3 a cost perspective. It was the services and the
4 agreement had been terminated, I believe, when I started.
5 Q. And to what extent did you in your position
6 work with people within the Department of Education?
7 A. At one point we had a Felix executive team
8 meeting that was a very structured meeting on a once a
9 month basis. I speak probably five or six times a week
10 informally with Miss Hamamoto, two or three times a week
11 with Mr. Houck when he was in his position, on, you know,
12 a couple of times a month with Dr. LeMahieu on various
13 issues, they are my primary contacts. It's on a frequent
14 basis. We tried to do problem solving so that we do have
15 one voice with the family and that we've looked at all of
16 the issues related to a child if we're discussing an
17 issue with the Attorney General's office.
18 Q. You mentioned that during these team meetings
19 you had met with people including Dr. LeMahieu. Did
20 specific contracts or indications of service providers
21 come up during these meetings? Were they discussed?
22 A. Yes.
23 Q. And was there any attempt, for example, in any
24 of these discussions to ask for your support or to try to
25 discuss any problems that had arisen because of any of
Page 74
1 these contracts?
2 A. Contracts -- in discussions prior to the
3 awarding of contracts?
4 Q. Yes.
5 A. Yes.
6 Q. They did. And what would be the response then
7 after you had the team meetings and all, was there any
8 follow up that was taken to resolve the questions or the
9 issues?
10 A. If there was clarifying information needed, we
11 would have provided it and --
12 Q. Okay. And the final question, was I correct in
13 hearing you say that earlier that it was your decision
14 and advocacy to discontinue or end the continuum, the
15 MST?
16 A. In discussion with Dr. Anderson, yes.
17 Q. And primarily for what reasons, what was your
18 feeling on it?
19 A. That we had developed services to the extent
20 that we no longer would have the need or the children
21 referred for that level of service. So we could not --
22 we had no justification to continue the research project.
23 Q. Did you see a need or make any recommendations
24 for any kind of alternative functions?
25 A. The children have all been transitioned to
Page 75
1 services that have been developed in the time period that
2 we first looked at entering into the research project.
3 So the level of therapeutic foster homes that we had at
4 the conclusion, at the termination of the research
5 project was substantially more adequate than it was when
6 we first went into it. Our level of intensive in homes
7 was substantially more developed than it was when we
8 entered into it. And the same is true, we had
9 significantly more capacity with the home based
10 multi-systemic therapy than we had when we entered the
11 research project.
12 Q. So you didn't see a need for any additional
13 services or any alternative?
14 A. I'm struggling with when you say alternative.
15 All of those children as of November 5 are receiving
16 services to support their needs as identified in the IEP.
17 Q. Okay, thank you, Miss Swanson.
18 SENATOR SLOM: Thank you, Co-Chair.
19 CO-CHAIR SENATOR HANABUSA: Thank you.
20 Miss Leong -- Representative Leong followed by Senator
21 Sakamoto.
22 REPRESENTATIVE LEONG: Thank you. My
23 questions were previously answered, but I just have one
24 more inquiry.
25 BY REPRESENTATIVE LEONG:
Page 76
1 Q. This past week we received a notice from
2 Loveland Academy asking that their employees update their
3 records. They haven't been completed, that they need to
4 be completed, which kind of implied that records were not
5 being documented on time, and I've heard that from other
6 parents who have been there and that if they didn't
7 update their documents by a certain time, they would not
8 get paid. I just want to know your reaction to that.
9 A. Well, I had the same concern that I believe
10 Tina Donkervoet expressed during her testimony, that it's --
11 that would not be in compliance with our clinical
12 standards and it's clearly something that we'll evaluate
13 as we do the review of their contract.
14 Q. I guess it's our concern because obviously it
15 was noted earlier and that this is still continuing and
16 that now this information is out. So I wondered if you
17 had anything more definite about it.
18 A. I was not aware of that memo prior to when
19 Mr. Kawashima brought it to the committee's attention, so
20 to say we were aware of it earlier, I was not aware of it
21 earlier.
22 Q. I see. Thank you very much.
23 REPRESENTATIVE LEONG: Thank you, Chair
24 Hanabusa.
25 CO-CHAIR SENATOR HANABUSA: Thank you.
Page 77
1 Senator Sakamoto followed by Representative Marumoto.
2 SENATOR SAKAMOTO: Thank you, Chair.
3 BY SENATOR SAKAMOTO:
4 Q. Hi.
5 A. Hi.
6 Q. Following up on Senator Kokubun's question
7 about the IEP process and when at the end of the IEP
8 there may be concerns raised from the Department of
9 Health side, how were those concerns documented?
10 A. That's not a question I can ask. When I -- at
11 the point that I get involved, generally people will
12 share with me a file that may include memos to the
13 district superintendent, it may include E-mails, so there
14 are multiple ways that show that they have tried to
15 address it at the school level, at the district level,
16 some of the correspondence is at the division level, but
17 there's not a set format.
18 Q. Okay, being that you're --
19 A. That I'm aware of.
20 Q. Being that your background is tax and
21 accounting, that field normally likes standardized forms
22 so that information is kept in a manner that can be
23 counted, can be verified. Is that something the
24 department should do as we go forward? Some way,
25 standardized way to say our department has concerns with
Page 78
1 the other department being that you're separate
2 departments?
3 A. In lieu of standardizing something that shows
4 our differences, I would rather put the energy and effort
5 into the knowledge of our care coordinators and
6 supporting their efforts and the Department of Education
7 so that they resolve more at the team level so that
8 they're better prepared when they go in, to set up a
9 tracking system to track differences, may be helpful to
10 understand where we need to work better together.
11 Q. Well, as a building contractor, periodically we
12 get a punchlist or these are items that need improvement
13 or need to be changed or need to be corrected. You
14 wouldn't be happy or the owner wouldn't be happy, the
15 architect wouldn't be happy if we just say but we all
16 agree we're trying to do a good thing and can we be
17 teammates, it's sort of at a point to say these are the
18 things that need to be addressed. Well, moving on then,
19 I guess --
20 A. Could I have one part? I think in our -- as it
21 relates to our care coordinators, they do have case
22 reviews done at the family guidance center level with our
23 quality assurance team and with our mentors, and so that
24 would bring out areas where they need to additionally
25 develop knowledge, and we do track that and we close the
Page 79
1 loop by okay, have you addressed this issue with the
2 school, so that is one process that would identify that,
3 but that is not a joint process with the Department of
4 Education.
5 Q. Okay. Changing to the benchmarks, in several
6 times when the issue came up, at least what I heard you
7 say is referring to the benchmarks as our benchmarks, we --
8 and to a certain extent when the department has proposed
9 this is what we plan to do, I heard you say and the court
10 adopted our plan. So my question would be how optimistic
11 in light of what has happened when we've not met
12 benchmarks, how optimistic were the plans or was it
13 almost a self fulfilling prophesy that because we were
14 overly optimistic we've not met many of the benchmarks?
15 A. As it relates to the Department of Health and
16 in particular, the Child and Adolescent Mental Health
17 Division, we have met on time the majority of our
18 benchmarks.
19 Q. Okay. So from your department side, if we were
20 to check which benchmarks related to you, they were
21 realistic goals with a few exceptions?
22 A. Yes.
23 Q. Back to the providers, when you review
24 providers, is that documented when providers need
25 improvement, when you do not recommend for continuance of
Page 80
1 a specific provider of service?
2 A. Yes. And I -- in answering maybe
3 Representative Oshiro's questioning, I receive a copy of
4 that provider review, which indicates, you know, what
5 actions, specific actions the provider needs to take in
6 terms of corrective action plan, and we follow up on that
7 corrective action plan, and then as Mr. Kawashima asked
8 what was in front of me, I also get a quarterly report
9 that has a narrative, and in fact, this most recent
10 quarterly report indicates that 86 percent of our
11 provider reviews indicate that they're an acceptable
12 level, even though they may still need some corrective
13 action, they're performing on an acceptable basis and
14 then it also tells me that we -- there are 19 that need
15 significant corrective action plans and then we
16 terminated one contract because they did not meet and
17 could not meet the corrective action plans.
18 Q. Does the department ever request reimbursement
19 or some financial adjustment when things aren't where
20 they should have been?
21 A. Yes.
22 Q. And have they collected money back
23 appropriately?
24 A. Yes. What we -- we withhold -- generally we
25 withhold funds from future payments. And I also receive
Page 81
1 a schedule of that.
2 Q. Okay. Thank you.
3 SENATOR SAKAMOTO: I'll ask questions
4 later again, Chair.
5 CO-CHAIR SENATOR HANABUSA: Okay, thank
6 you. Members, we've been going an hour, and
7 Mr. Kawashima is back, so I would -- the Chairs will make
8 a motion that we again resume executive session, and
9 again, the issue of the executive session will be to
10 discuss further witnesses as well as the special
11 attorneys. So any discussion on that? If not,
12 Vice-Chair Oshiro?
13 VICE-CHAIR REPRESENTATIVE OSHIRO:
14 Co-Chair Hanabusa?
15 CO-CHAIR SENATOR HANABUSA: Aye.
16 VICE-CHAIR REPRESENTATIVE OSHIRO:
17 Co-Chair Saiki?
18 CO-CHAIR REPRESENTATIVE SAIKI: Yes.
19 VICE-CHAIR REPRESENTATIVE OSHIRO:
20 Vice-Chair Kokubun?
21 VICE-CHAIR SENATOR KOKUBUN: Aye.
22 VICE-CHAIR REPRESENTATIVE OSHIRO:
23 Senator Buen?
24 SENATOR BUEN: Aye.
25 VICE-CHAIR REPRESENTATIVE OSHIRO:
Page 82
1 Representative Ito?
2 REPRESENTATIVE ITO: Aye.
3 VICE-CHAIR REPRESENTATIVE OSHIRO:
4 Representative Kawakami?
5 REPRESENTATIVE KAWAKAMI: Aye.
6 VICE-CHAIR REPRESENTATIVE OSHIRO:
7 Representative Leong?
8 REPRESENTATIVE LEONG: Aye.
9 VICE-CHAIR REPRESENTATIVE OSHIRO:
10 Representative Marumoto?
11 REPRESENTATIVE MARUMOTO: Aye.
12 VICE-CHAIR REPRESENTATIVE OSHIRO:
13 Senator Matsuura?
14 SENATOR MATSUURA: Aye.
15 VICE-CHAIR REPRESENTATIVE OSHIRO:
16 Senator Sakamoto?
17 SENATOR SAKAMOTO: Yes, sir.
18 VICE-CHAIR REPRESENTATIVE OSHIRO: And
19 Senator Slom?
20 SENATOR SLOM: Aye.
21 CO-CHAIR SENATOR HANABUSA: Motion is
22 carried. Members, we will convene next door in room 329
23 and we will reconvene the hearing at one o'clock. Thank
24 you.
25 (Recess.)
Page 83
1 CO-CHAIR REPRESENTATIVE SAIKI:
2 Members, we'd like to reconvene our hearing, and we will
3 continue with questioning by members, first with
4 Representative Marumoto.
5 REPRESENTATIVE MARUMOTO: Thank you,
6 Mr. Chairman.
7 BY REPRESENTATIVE MARUMOTO:
8 Q. Is it Dr. Swanson?
9 A. No, it is Anita Swanson.
10 Q. Okay. I'm sorry, I came in late so I --
11 A. I'm a certified public accountant by education.
12 I don't practice in the State of Hawaii. My experience
13 is in management.
14 Q. Interesting. You have nothing to do with
15 health?
16 A. I do. I have considerable health care
17 experience in -- from a consulting perspective.
18 Q. But not educational training. That's -- I
19 really wanted to talk about qualifications. I'm kind of
20 disappointed that a lot of the people that we have talked
21 to in the Department of Health have not -- not been
22 endowed with the proper credentials. And you know,
23 that's -- maybe it sounds strange from a legislator
24 because there's very little that we have to do except be --
25 live in the right district and be old enough, but
Page 84
1 nevertheless, we are trying to provide a service for
2 special education children, and we want to make sure we
3 have qualified people. So I notice that many of your
4 providers are not qualified either, and I'm wondering,
5 you know, whether the department will look to providing
6 people with the proper qualifications. I was very
7 disappointed to see that Dr. -- not Dr. Brogan, but Miss
8 Brogan has a Masters in education, and she is --
9 functions as the clinical director and oversees many
10 important programs and she's in the department. A
11 provider, Loveland School, the head of it is Miss Dukes,
12 and apparently her graduate degree is from a -- what
13 turns out to be a diploma mill. One of her speech
14 pathologists is not licensed to practice in the State in
15 contravention with State law. The Hawaii Families --
16 Hawaii Families as Allies, two very nice ladies seem to
17 be running it, but I don't think they have one degree
18 between the two of them, and here they are advising
19 parents on how to deal with IEPs. In the MST program
20 there were four therapist aides that were brought in from
21 the mainland, and one of our testifiers claimed that they
22 were unqualified. They were culturally insensitive, I
23 suppose. Also, there's some question whether they had
24 charged for services that were not rendered. I'm just
25 mystified by all the lack of credentials on the part of
Page 85
1 staff and providers. Also, we have information from your
2 department, thank you for providing it, that
3 Mrs. Donkervoet makes $8,195 a month, which is more than
4 you make as deputy director of the department, and I dare
5 say she probably makes more than the director of the
6 department. And I don't know what her credentials are,
7 but I don't see any initials after her name. Could you
8 please address this lack of qualification?
9 A. Sure. Hopefully I took notes in order to
10 respond in the order that you asked them. I'd be happy
11 to provide to you an opportunity to ask specific
12 questions about my background. When I was asked to take
13 this position, it was described to me, and I looked at
14 the credentials of the individuals that I supervise,
15 which is Elaine Fox -- I'm sorry, Elaine Wilson, who has
16 a Masters in social work supervising the Alcohol and Drug
17 Abuse. Dr. Linda Fox is the psychologist in the adult
18 program. Tina Donkervoet has her Masters in nursing and
19 a specialization in psychiatric children's programs, and
20 I can get you -- she does not use initials behind her
21 name, and I can get you her qualifications. I believe we
22 had previously provided to the committee her resume,
23 which will demonstrate that. What they were looking for
24 when they hired me was someone to oversee from a
25 management perspective because there were significant
Page 86
1 issues both with Felix, the Department of Justice, Hawaii
2 State Hospital, and so they were not in particular
3 looking for a clinician. I clearly hold out and I tried
4 when I responded to the other questions, I am not a
5 clinician and I do rely on their background as well as we
6 have, I believe, more than twelve child psychologists in
7 the children's division, we have a medical director from
8 Maui, who is our medical director for the division, and
9 we have numerous psychologists and psychiatrists in the
10 Adult Mental Health Division who supervise the activities
11 both in patient at Hawaii State Hospital and out patient.
12 Would you like me to give you an opportunity to ask
13 further questions or shall I go on answering the others?
14 Q. No, go ahead.
15 A. Okay. I'm concerned about your question as far
16 as many providers not qualified. We have very stringent
17 credentialing privilege or practice and monitoring within
18 CAMHD, and our providers do have to demonstrate that
19 those individuals they either subcontract with or employ
20 do meet those credentialing requirements. We go through
21 provider monitoring to assure such, and one part of that
22 is checking on their license. As it relates to Loveland
23 Academy, I cannot conclude on whether or not Miss Dukes
24 or Dr. Dukes' degree gave her the experience. It gave
25 her the level of experience for the services that we pay
Page 87
1 her for. Hawaii Families as Allies is a family
2 organization that provides an opportunity for families to
3 understand the bureaucratic nature of both the Federal
4 law and how we operate in the State of Hawaii. They do
5 not provide clinical services nor would I expect them to
6 have clinical degrees. You made a reference to MST
7 therapist aides. That's not a terminology that I'm
8 familiar with. You went on to describe the four
9 individuals that were recruited from the mainland, and
10 although I did not specifically hear the testimony, the
11 individuals that shared with me, John Donkervoet
12 described it in his description of being Dutch, and I
13 would not hold against them the fact that they relocated
14 to serve Hawaii's children. You had one person testify
15 before you who was employed by Hawaii Families of Allies,
16 and which I would ask the committee no one asked her
17 clinical background. She was employed as a family aide,
18 a family resource specialist, to provide that family
19 engagement. She gave you her opinion, and I recognize
20 she testified under oath and that may be her opinion, but
21 she is not a clinician to evaluate another clinician's
22 capabilities. I do appreciate when anyone brings it to
23 my attention that any of our providers, and I would
24 include myself in that category, if we're not culturally
25 responsive, but we may not be -- and we need to improve
Page 88
1 upon that skill if that's brought to our attention. My
2 compensation is set by statute, and I would love if I
3 could make a plea before this committee to increase it,
4 as I believe Dr. Anderson's is. The rest of our
5 professionals are paid based on their qualifications. I
6 believe that was your --
7 Q. Yes. My time is up, but you know, you say you
8 do adhere to strict credentialing, and I beg to differ in
9 some of these cases so I would hope that the department
10 would pay stricter attention because I think the services
11 to the kids are really at stake and I hope you do
12 continue to provide monitoring of it. Families as
13 Allies, we had two people come and speak to us, we did
14 ask for their credentials, they had none to really offer.
15 And if they are advising in terms of dealing with the
16 bureaucracy and Federal law, I would still contend that
17 they are not qualified, and regarding the therapist aides
18 who came from the mainland, we did not -- we were not
19 upset with the fact that they were from the mainland but
20 because they apparently were not -- were charging for
21 services not rendered.
22 A. I apologize. Our MST therapists do not charge
23 for services. That was incorrect, an incorrect statement
24 on behalf of the testifiers. I did write that down.
25 Q. I may be wrong, but there was some -- somebody
Page 89
1 in that program that was charging.
2 A. There are no individuals to my knowledge who
3 charge. They were employees of the Department of Health.
4 They cannot charge for their services. And if you're
5 aware of someone who is charged for their service while
6 they're an employee of the Department of Health, I would
7 like that brought to my attention.
8 Q. I can't really recall whether it was part of
9 the research project or the services rendered, but I will
10 check my records on that.
11 A. Okay. Thank you.
12 Q. And you say Tina Donkervoet is paid on the
13 basis of her qualifications. I'm -- I question her
14 qualifications in receiving about $8,200 a month, which
15 is $98,000 a year, you know, and perhaps we'd all like to
16 get that kind of salary, but she's getting paid a lot
17 more than a lot of doctors in your department, and I
18 realize that there's statute -- statutory constraints,
19 but I just wanted to bring up that fact of the lack of
20 qualification in certain cases.
21 A. Okay.
22 Q. Thank you.
23 CO-CHAIR REPRESENTATIVE SAIKI: Thank
24 you. Senator Matsuura.
25 SENATOR MATSUURA: Thank you, Co-Chair.
Page 90
1 BY SENATOR MATSUURA:
2 Q. Good morning -- good afternoon. You know, you
3 mentioned that you're in charge of adult mental health
4 also as well as adolescent mental health?
5 A. Yes.
6 Q. Did anybody -- has anybody actually reviewing
7 or advocating for the State what Felix -- how Felix will
8 impact adult mental health in the future?
9 A. Yes.
10 Q. Is anybody advocating, because apparently from
11 everything that we've been hearing so far, no one seems
12 to be actually even looking at the impact of adult mental
13 health or what are we going to do with these kids after
14 they turn, from Felix turn 18, to adult mental health?
15 A. We have a responsibility to -- under Federal
16 law to look at transition plans. There is -- the Adult
17 Mental Health Division serves those individuals who are
18 seriously mentally ill and have access to no other
19 resources. Not all children who are Felix eligible are
20 seriously mentally ill. We tend to describe children as
21 being severely emotionally disturbed or SED. That is
22 generally related to their education, and under Federal
23 law, we are funded and only pay for services that are
24 related to their education. But clearly, there are
25 children who will age out of the Child and Adolescent
Page 91
1 Mental Health Division and age into the need for both
2 adult mental health services, and more importantly, and I
3 think probably where it will impact it much greater from
4 a legislative perspective, is that children who will age
5 out into the developmentally delayed, the children with
6 autism, in that spectrum disorder, when I say it in
7 general, that's the children that as adults go into our
8 developmentally disabled program.
9 Q. So basically what you're saying then is we
10 should be actually looking at severe increases both in
11 the DDs as well as the Adult Mental Health Division then
12 as more of these children as we identify them more and as
13 they transition out then?
14 A. I think we can provide you with numbers and
15 then you can conclude whether or not it's severe. But it
16 will have an impact.
17 Q. Just one more final question. This is for my
18 personal clarification. You know, from the last one past
19 year, every time we dealt with an issue or a bill
20 relating to Felix, basically you are the one that was
21 advocating for or testifying for and against, you know,
22 at the hearings, as well as within, you know, on the
23 personal contacts, but from this past testimony that I've
24 heard, especially from counsel, you seem to have punted a
25 lot of your responsibilities to either Tina or some other
Page 92
1 division or department. This is just for my
2 clarification for next year. What exactly is your role
3 or your responsibility as it's related to Felix?
4 A. I am -- Tina Donkervoet reports to me, I am
5 responsible for the Child and Adolescent Mental Health
6 Division, and in no way was I attempting to punt
7 Mr. Kawashima's questions. I don't have the ability to
8 answer clinical questions. I am not a clinician. I rely
9 on, as I mentioned to Representative Marumoto, I do rely
10 on the clinicians to advise me on what the clinical
11 issues are and to bring to my attention what the fiscal
12 implications and what the systemic management issues
13 might be, and I consider their recommendations in light
14 of the other issues.
15 Q. Okay. Because that's why -- that's why I was
16 really kind of -- because I know your background as a
17 CPA, that's -- my understanding was you were there to
18 check out the fiscal management on how we handled a lot
19 of our, you know, all these contracts as relates to
20 adolescent mental health as well as the adult mental
21 health, but yet when we review a lot of this information
22 that we've been getting, some of the contracts that I've
23 seen, and I'm pretty sure you were here during the
24 testimony, any accountant would say you got -- the State
25 got to be nuts to actually have even drafted these
Page 93
1 contracts, or there is no accountability. There's
2 actually in terms of accountancy, I mean it was a mess.
3 A. I don't -- okay. I'd like to address
4 specifics. I don't review contracts for the Child and
5 Adolescent Mental Health Division and I don't review them
6 for any of our divisions. We use a standard format
7 contract that's provided, I believe, in a framework from
8 the State procurement office, and the legal review is
9 done by the Attorney General's office. I have reviewed
10 the process that we release the RFPs, I have had
11 explained to me how we score them, I've seen our rate
12 schedules, but I don't review specific payments.
13 Q. So if we were to review bills next session
14 directly related to financial issues, we should be
15 actually maybe talking then to Tina then more or people
16 more in the trenches rather than to yourself since you
17 don't review any of these contracts or this fiscal
18 management?
19 A. You're always welcome to ask anyone a question,
20 and I will make sure that I have our -- as well, Tina as
21 well as our contracting staff to answer your questions.
22 Q. Okay, thank you. My time's up.
23 CO-CHAIR REPRESENTATIVE SAIKI: Thank
24 you.
25 BY CO-CHAIR REPRESENTATIVE SAIKI:
Page 94
1 Q. Miss Swanson, I just have a few questions,
2 first basically on MST. Was there a student in Maui
3 County, maybe on the island of Lanai who was under the
4 care of MST who committed suicide? And I don't mean to
5 link the MST as the cause of the death, but was there a
6 child in that situation?
7 A. I'm not specifically answering because I don't
8 know if I'm aware of the circumstance that you're
9 describing. This is such a small population that we deal
10 with that in no way do I want to breach the
11 confidentiality. I'd be happy to give you specifics in
12 an executive session environment.
13 Q. Okay. I guess -- I mean what aspect is
14 confidential, the fact that the student was under MST or
15 are you able to identify the name of the student?
16 A. Well, clearly, the name of the student has, I
17 believe been publicized, and as with the approach with
18 MST, MST addresses family issues and potentially other
19 sibling issues.
20 Q. Well, I guess -- let me ask this. Was -- would
21 there have been an investigation done to see whether or
22 not MST was the cause of this kind of a situation if it
23 should ever happen?
24 A. We look at any sentinel event, whether it's a
25 child who is harmed or a child who is involved in
Page 95
1 ultimately -- unfortunately is killed or kills him or
2 herself. And we look at along with the therapeutic team,
3 from both a learning perspective and a risk management,
4 do we have other children potentially at risk, and yes,
5 there was a very thorough analysis done on that situation
6 and on other situations. That situation was not unique.
7 Q. When was the most recent analysis done?
8 A. On that particular --
9 Q. On any situation? The most recent analysis,
10 haven't you stated there was more than one analysis done?
11 A. In a written form or in verbal form?
12 Q. Any kind of analysis.
13 A. I've got a verbal analysis this morning on a
14 particular child.
15 Q. On an MST child?
16 A. No. It was not an MST.
17 Q. When was the most recent MST analysis done?
18 A. I don't think of children as MST or non MST, so
19 a child's situation may have been brought to my attention
20 without being told that it was home based MST.
21 Q. Okay. Well, let me ask this question because I
22 don't think we've been able to establish this yet in any
23 of our hearings. Basically, the inclusion of MST as a
24 benchmark, because MST is an experimental program, and I
25 think there was -- there was some questions as to why an
Page 96
1 experimental program was included as a benchmark, so I
2 seem to recall that maybe it was either last year or two
3 years ago when MST was included as one of the
4 department's top priorities for emergency funding
5 purposes. The health department director, and I believe
6 Scott Hengler were at the Capitol basically lobbying for
7 the funding for MST as a benchmark. How -- why -- who
8 decided that MST would be included as a benchmark?
9 A. Okay. This is very helpful because now I can
10 separate, I think maybe, and understand your questioning
11 better. The research continuum project was identified in
12 CAMHD's service capacity development plan, and the court
13 monitor established a benchmark for it. The benchmark
14 was established for the continuum project.
15 Q. Okay.
16 A. When we were advocating for our emergency
17 appropriation, there were two components of that
18 emergency appropriation. One was the home based teams
19 and the other was the research. For the home based, we
20 were at -- I'm not sure that if you heard that we were
21 putting MST therapy as our top priority, it was because
22 it is the only demonstrated research base empirical
23 supported therapy for conduct disorders, substance
24 abusing children. And up until the time that we
25 established the home based teams, those children were in
Page 97
1 very restrictive levels of care, in very restrictive
2 hospital levels of care. So in advocating for that, we
3 were advocating for a type of therapy that would be more
4 beneficial.
5 Q. Okay, I understand that. MST may have been a
6 demonstrated research based program, but the distinction
7 is that MST had never really been used on this type of
8 student population before. I think the only other
9 jurisdiction was Philadelphia or somewhere in
10 Pennsylvania, but not to the extent that Hawaii had used
11 it.
12 A. That's a true statement as it relates to the
13 research, the continuum care.
14 Q. Well, I'm just interested in the continuum
15 because that was included as a benchmark where we had to
16 have 56 students placed within MST by a stated deadline.
17 A. Uh huh.
18 Q. So you're saying it was the monitor's decision
19 to establish that as a benchmark?
20 A. The monitor proposes all benchmarks. The State
21 of Hawaii does not propose benchmarks.
22 Q. Does the health department give any input
23 though into those benchmarks, proposed benchmarks?
24 A. If we're asked for input, I don't specifically
25 remember if we were asked for input on that benchmark.
Page 98
1 Q. So you feel that the monitor may have
2 unilaterally created this benchmark?
3 A. He created the benchmark from CAMHD's service
4 capacity development plan, which was our internal goals
5 in order to bring up the research continuum project.
6 Q. Okay. So MST was mentioned in the capacity
7 plan --
8 A. Yes.
9 Q. -- in some respect. Okay. Is MST a variation
10 of the wrap around services that Lenore Behar created a
11 few years ago?
12 A. In Hawaii?
13 Q. No. Lenore Behar established some kind of a
14 wrap around program in North Carolina or somewhere in the
15 east coast.
16 A. I'm not familiar.
17 Q. Is MST a variation of this wrap around type
18 service?
19 A. My nonclinical understanding, and I'm familiar
20 with one wrap around project, but it's wrap around
21 Milwaukee, and it is not similar to wrap around Milwaukee
22 and I am not familiar with Lenore's project in North
23 Carolina.
24 Q. Well, do you know whether or not Lenore Behar
25 was involved in or lobbied Dr. Groves to include MST as a
Page 99
1 benchmark --
2 A. No, I have no knowledge of that.
3 Q. -- in Hawaii? Had Lenore Behar been in Hawaii
4 lobbying for MST at any point in time?
5 A. Not to my knowledge, and not directly to me.
6 Q. Okay. Thank you. My time's up.
7 CO-CHAIR REPRESENTATIVE SAIKI:
8 Co-Chair Hanabusa?
9 CO-CHAIR SENATOR HANABUSA: Thank you.
10 BY CO-CHAIR SENATOR HANABUSA:
11 Q. Miss Swanson, I want to clarify one of your
12 statements that you made. You said the priority that was
13 part of the department's request, budgetary request, you
14 said was MST, but you didn't distinguish between whether
15 it's the continuum or the home base. Which one was it?
16 A. I would have said the home based.
17 Q. The home base was the priority?
18 A. Yes.
19 Q. Even for the emergency appropriations?
20 A. I believe there were emergency appropriation
21 dollars related to the home based. And at the point in
22 time, and I can clarify that further, at the point in
23 time which is why we went into the research project, is
24 that we didn't have any other alternative for those
25 children other than very intensive hospital based
Page 100
1 programs, and we were getting zero results. We had been
2 criticized by the auditor for not looking at other
3 programs, for bringing in national experts, and this was
4 an opportunity to build on what we knew about MST home
5 based and say there should be a way to redesign that to
6 work with the seriously emotionally disturbed child. We
7 don't have --
8 Q. I'm sorry. Tell me what in your mind is the
9 difference between the home based and the continuum?
10 A. The home based has empirical research to
11 support its use with conduct disorder, substance abusing
12 children, which is a behavior in the home environment, in
13 the social environment, peers, community, school. And
14 you support the family, you reempower the parents to set
15 limits. The continuum are truly the emerging seriously
16 mentally ill children. They are the severely emotionally
17 disturbed child where they will have life -- likely, life
18 long care related to their mental health.
19 Q. Okay.
20 A. The bipolar, schizophrenic, if you want to use
21 clinical terms, it's the bipolar, schizophrenic, the more
22 typical words that you hear with the adult population.
23 Q. So you're saying is the difference between the
24 two programs that the continuum has the -- I guess the
25 higher need student in it?
Page 101
1 A. An oppositional defiant child can be more
2 challenging to a system. It's two clinical
3 differentiations, conduct disorder, oppositional defiant,
4 substance abusing in the home based.
5 Q. What I'm trying to understand here is what is
6 the difference between the programs themselves? You call
7 one home based, you call one continuum, and all I'm
8 hearing from you in terms of the difference is who makes
9 up that population. Is there no difference in the
10 program itself?
11 A. There is research to support you get results in
12 the home based, which is where we're using it. As it's
13 applied in the family environment, you are correct. It's
14 very similar with the addition of a psychiatrist, because
15 we've added the psychiatrist to the team in the continuum
16 project because these children have such significant
17 psychiatric needs. And that's what we were hoping had
18 there been sufficient children in Hawaii to continue the
19 research project. We would have shown that you would get
20 similar results, but you're exactly right, it's a very
21 similar environment in the home.
22 Q. But so the difference is the addition of a
23 psychiatrist in the continuum and really the population
24 that you've selected to be placed in the continuum?
25 A. Right. Because that population have never been
Page 102
1 researched.
2 Q. Okay. Now, the other question I have is
3 regarding the issue of the funding, it was our experience
4 during the last legislative session that when the
5 Department of Education, and we believe the Department of
6 Health came to us, a lot of the emergency appropriations
7 that were being sought was a result of the Felix response
8 plan or the FRPs that went into place and that's how the
9 DOE came up with this 76 million down to 41 and whatever
10 else. If I heard your testimony correctly, the emergency
11 appropriation that you were seeking was not for the MST
12 continuum that had been put into the Felix response plan,
13 but it was in fact for the home based MST, is that
14 correct?
15 A. There were two components. And the Department
16 of Health through the Child and Adolescent Mental Health
17 Division doesn't have FRPs. We use different
18 terminology, but our service capacity plan said that we
19 had to have certain services to respond to kids' needs in
20 place. We didn't have enough of the home based teams, so
21 we were, with the emergency appropriation, we were adding
22 additional home based teams and we also were requesting
23 the dollars to support the staff. These were Department
24 of Health staff for the research project. There were no
25 dollars requested for the research itself. The research
Page 103
1 was all done by Annie Casey Foundation funds.
2 Q. So the answer to my question is when you came
3 in for emergency appropriation, even if it was just
4 generically explained to us as MST, it was for both, the
5 home based plus the continuum in the sense that you
6 needed the staff?
7 A. I hear what you're saying now. We thought we
8 presented it as a line item for the home based MST teams,
9 and we thought we presented it as the staffing for the
10 continuum. But clearly as it was -- a reduction was
11 proposed to us, we did not make that distinction clear.
12 Q. So the money that we appropriated, I thought it
13 was about 800,000, I could be wrong about that, but that
14 would have been both -- that would have been for both?
15 A. No. I believe the 800,000 relates to the
16 staffing for the continuum project.
17 Q. Okay that's what I thought.
18 A. Approximately.
19 Q. That's why when you said you didn't believe it
20 was for the -- for the benchmark, I thought that was
21 incorrect. 800,000 was for the staffing?
22 A. For the continuum project.
23 Q. For the continuum project?
24 A. And that related to the benchmark.
25 Q. Okay. My next question is as part your
Page 104
1 request, you also asked for some monies to be
2 appropriated out of your Title 4E reimbursement. Do you
3 recall that, it was about $478,000?
4 A. That's correct.
5 Q. Okay. What is your understanding, because
6 you've made it very clear that you're not a clinician, I
7 don't want a clinical answer, but from a budgetary
8 standpoint, when you see Title 4E, what does that
9 represent to you?
10 A. These are Federal funds that we can expend for
11 training.
12 Q. And what qualifies for this training?
13 A. There are Federal requirements. We use it
14 significantly for the training around the care
15 coordinator activities, for the coordinated service
16 plans, for those children who have very intensive needs.
17 We develop coordinated service plans that details their
18 mental health needs, and if needed, their out of home
19 placement, gives them the knowledge and the training to
20 participate in better team based decisions.
21 Q. Were any of these care coordinators trained or
22 used in the continuum project?
23 A. Not to my knowledge.
24 Q. How would you be able to tell me yes or no
25 without the qualifier not to your knowledge?
Page 105
1 A. Actually, I do believe that one care
2 coordinator resigned her position and accepted a position
3 as an MST therapist. I can give you the background of
4 those individuals who accepted the MST positions, and
5 that would show prior employment as a Child and
6 Adolescent Mental Health care coordinator.
7 Q. So what you're saying is because they resigned
8 from the position existing, that they did not have any of
9 this training, is that what you're saying? I'm trying to
10 link the Title 4E funds, which you're saying is to be
11 basically used for training. My question was any of the
12 people using or being trained under Title 4E were somehow
13 trained for the MST program, and you said not to your
14 knowledge?
15 A. Right. And I -- and I understand your question
16 better now, and I do not believe that anyone -- there's
17 specific training for MST, and I apologize, but I do not
18 know if it qualifies under Title 4E.
19 Q. Well, you know that Title 4E funds was
20 basically for Felix monitoring project purposes.
21 Correct? You know that's what you told us as part of the
22 law?
23 A. You're now associating it with Ivor Groves'
24 office. I'm not sure I understand. When you say Felix
25 monitoring project, that is Dr. Groves' office.
Page 106
1 Q. Well, let me read it do you.
2 A. Okay.
3 Q. This is what I assume comes from your
4 department, what you're asking for is these funds
5 necessary for fiscal year 2000 to 2001, so this is of
6 course an emergency appropriation to be used in support
7 of training costs of staffed employed by or contracted to
8 the Department of Health or contracted or deployed by the
9 Felix monitoring project for the purpose of improving
10 services provided to certain emotionally disturbed
11 children and adolescents. Does that refresh your
12 recollection in any way as to what these Title 4E funds
13 were supposed to be used for?
14 A. It's possible that an MST therapist could have
15 attended training that was paid with Federal funds out of
16 the special fund. The appropriation we were -- we were
17 asking to expend out of the special fund.
18 Q. Okay. My time is up.
19 CO-CHAIR SENATOR HANABUSA: Let's go
20 back to see if there's any follow up questions.
21 Mr. Kawashima?
22 SPECIAL COUNSEL KAWASHIMA: Madam
23 Chair, just one area.
24 BY SPECIAL COUNSEL KAWASHIMA:
25 Q. Miss Swanson, I believe you testified earlier
Page 107
1 based on questions I asked you and others, that the IEP
2 is the basis for what kind of care, level of care that is
3 provided to a child?
4 A. Yes.
5 Q. And so they go through this process and with
6 the personnel involved in the process come up with a
7 recommendation that comes to, among others, to the
8 Department of Health to approve or to question, am I
9 correct so far?
10 A. It does not come to us for approval.
11 Q. All right. It comes for review and perhaps
12 questioning?
13 A. It comes for authorization of service and
14 monitoring of the child's progress as it relates to
15 mental health services. There are many other issues
16 addressed in an IEP --
17 Q. I understand that.
18 A. -- that are educationally --
19 Q. But the type of care that relate to mental
20 health services, for example, we've talked about respite
21 care, flex care, those types of items, we've talked about
22 that.
23 A. Yes.
24 Q. Now, is it your testimony then that as far as
25 respite care, flex care, and I guess regular type of
Page 108
1 therapeutic care, all of that must be set forth in and
2 ordered by the IEP before that type of care can receive a
3 service authorization?
4 A. Respite care may not necessarily be a team
5 based decision because they may not know at the time of
6 the IEP meeting that respite care would be needed.
7 Respite care is something that can be authorized by the
8 care coordinator as they're managing the child's mental
9 health services.
10 Q. So the care coordinator has the absolute
11 authority to order respite care without anybody reviewing
12 that decision?
13 A. There's a review process through the family
14 guidance center and division.
15 Q. So that it does -- respite care doesn't come
16 under an IEP then?
17 A. It can or it may not. The continuation of
18 respite care may be provided in an IEP. If a call comes
19 in to a care coordinator that due to a severe illness of
20 one or the other parent, and an escalation of the child's
21 behavior related to that, that -- and the mother is
22 experiencing significant anxiety, the care coordinator
23 may authorize respite. If that's on an ongoing basis,
24 that is more likely to be something that's discussed and
25 included in the IEP.
Page 109
1 Q. But according to your testimony, it may not
2 necessarily be an ongoing thing, it may not necessarily
3 be an extension of something, the care coordinator has
4 the authority to authorize respite care even though there
5 is no mention of it in a particular IEP?
6 A. Right.
7 Q. Is that a fair statement?
8 A. And they would do that in accordance with the
9 CAMHD policy and procedure related to respite care.
10 Q. Is there anything else that doesn't come under
11 an IEP then that is authorized somehow by a person of the
12 level of the care coordinator or a similar position?
13 A. Not to my knowledge.
14 Q. What about flex care?
15 A. No.
16 Q. That has to come under an IEP?
17 A. Yes.
18 Q. And if it's not under the -- if it's not
19 ordered or recommended, whatever the term is, in an IEP
20 for a particular student, then flex care cannot be
21 ordered, cannot be given?
22 A. Again, I don't use the terminology flex care.
23 Flex is our way of paying for services that are required
24 to meet the needs of or were identified in the IEP where
25 we don't have a contracted provider, so by the nature it
Page 110
1 would almost be very -- it would be very difficult for
2 the care coordinator to authorize something that didn't
3 come out of the IEP.
4 Q. Okay. So do we agree that --
5 A. Yes.
6 Q. -- there cannot be a situation, the giving of a
7 care coordinator authorizing what we consider flex
8 services, that would not be spelled out in a particular
9 specific IEP. That should not happen?
10 A. That's correct.
11 Q. Thank you. That's all I have.
12 CO-CHAIR REPRESENTATIVE SAIKI: Thank
13 you. Members, any other follow up questions? Senator
14 Sakamoto followed by Vice-Chair Kokubun.
15 SENATOR SAKAMOTO: Thank you, Chair.
16 BY SENATOR SAKAMOTO:
17 Q. The last testifier, Ms. Donkervoet, talked
18 about 33 positions that funding was asked for in the
19 emergency funding and at least from my recollection, she
20 seemed to imply that the legislature didn't understand
21 the request in that these positions were still needed,
22 and it seemed to me that she said and we're going to keep
23 these people on anyway and request emergency funding. Is
24 that your -- is that what you feel is the case?
25 A. I could add some additional detail to that. We
Page 111
1 did not request any additional positions. Due to
2 miscommunications with the transfer of school based
3 services, it was interpreted -- interpreted by the
4 finance committees that we were also transferring the
5 care coordination for the children with less intensive
6 needs as children who would receive the school based
7 services to the Department of Education. So it was
8 proposed as an adjustment, and again, I forget the exact
9 terminology, but a reduction in our budget, and they were
10 proposing to give those 33 care coordinators to the
11 Department of Health and we said time out. Look back
12 last session. Last session we presented to you with a
13 workload analysis that demonstrated that we needed an
14 additional 73 positions to get our case loads to one to
15 15, one to 30. And we needed -- and at that point in
16 time the Department of Education had requested the
17 student services coordinators. The care coordination
18 issue was dealt with the prior session. Now we were just
19 dealing with transferring the budget, the money and the
20 accountability for the school based services. We'd
21 already dealt with the care coordination part of it, but
22 because of that misunderstanding, the committee stayed
23 firm and said that we didn't need the 33 positions. We
24 felt very strongly about that. We went, discussed it
25 with budget and finance, discussed it with the governor,
Page 112
1 and they understood our predicament of if we cut those 33
2 positions, we'd go way back and it was very regressive.
3 Q. I'm sorry. You're using all the time in a long
4 answer, and my question really wasn't justifying why that
5 was the case, my question was is it the intention or is
6 it the fact that you're keeping these positions and
7 therefore going to come and request emergency
8 appropriation, whatever the reason?
9 A. Yes.
10 Q. Why can't the department reprioritize and find
11 the money somewhere else?
12 A. There are no additional monies in the
13 Department of Health.
14 Q. The Department of Health has a humongous
15 budget.
16 A. We've looked.
17 Q. Well, I guess my question would be -- and they
18 gave me my time, but my question would be how do we
19 manage or how do you manage in your position as
20 management and not clinician, when items such as budget
21 come up and things don't go how the department sees fit,
22 how do you manage when respite care numbers go from here
23 to here to here or other numbers, how do you use the
24 progression of numbers to track how we can improve or
25 then address we don't need any emergency appropriation if
Page 113
1 we correctly budget? How do you use those numbers and
2 tools to help manage?
3 A. If there has ever been a moving target, it's
4 trying to understand what's happening at the team based
5 level and extrapolate that to a 100 million dollar
6 budget. Had we been -- had we been funded for what we
7 requested last year, we wouldn't be here with an
8 emergency appropriation. It's a very difficult
9 management job to try to manage with 33 positions less.
10 I didn't ask for the 33 so it wasn't at a stagnant point,
11 33 were taken away. So I can't very well go back and
12 tell those families --
13 Q. I've gone beyond the 33. It's not about --
14 it's about any -- any amount of money in any budget item.
15 How do you use those numbers to manage since we have
16 years of experience?
17 A. We take the years of experience, we use the
18 best knowledge and we keep increasing that knowledge for
19 the people who are at the team level. And we --
20 Q. Well, that's what you said before, but anyway,
21 thank you, Chair.
22 CO-CHAIR REPRESENTATIVE SAIKI: Thank
23 you. Vice-Chair Kokubun followed by Vice-Chair Oshiro.
24 VICE-CHAIR SENATOR KOKUBUN: Thank you,
25 Co-Chair Saiki.
Page 114
1 BY VICE-CHAIR SENATOR KOKUBUN:
2 Q. I wanted to follow up on Mr. Kawashima's
3 questions about the IEP, and is it my -- a correct
4 understanding on my part that the Department of Health
5 will provide mental health services only if they're
6 required in the IEP other than for high end?
7 A. Other than for what?
8 Q. High end?
9 A. No. All services -- the Department of Health
10 funds, and prior to the school based transition all
11 related mental health services for all children, and
12 after the school based transition, we're funding those
13 services other than outpatient or school based for Felix
14 eligible children. The services all originate in an IEP.
15 Q. In the IEP. So if an IEP is an educationally
16 based plan, isn't it, individualized --
17 A. Yes.
18 Q. So if you have a student who for instance is
19 not being negatively impacted in an educational --
20 A. Right.
21 Q. -- manner, how would they receive mental health
22 services if they needed it, and let me give you an
23 example. If you have a student who is exceptionally
24 gifted in academics yet they are either suffering eating
25 disorder or are a juvenile sex offender, how would they
Page 115
1 get treatment, if that's not in fact required by the IEP?
2 A. Currently there's -- there are no funds for us
3 to provide those services and it is clearly a gap group
4 in the State of Hawaii.
5 Q. Do you have any idea how many we're talking
6 about, what kind of number here?
7 A. I don't. There's a significant -- and I always
8 think of the qualifications after I answer the absolute.
9 We do have about 400,000, I believe, and I can check and
10 someone on the staff may be able to correct me very
11 quickly, of Federal funds that we use for homeless
12 children because they're not in school. But we use our
13 Federal block grant funds for that purpose.
14 Q. So --
15 A. But I do -- I cannot quantify you -- quantify
16 for you right now how many other children may have a need
17 for services.
18 Q. But does the department have the resources to
19 address this need?
20 A. No. We do not. Not within behavioral health.
21 Q. Well, I'm concerned about, you know, these
22 students falling through the cracks?
23 A. Uh huh.
24 Q. We need to take a look at that. Thank you.
25 CO-CHAIR REPRESENTATIVE SAIKI: Thank
Page 116
1 you. Vice-Chair Oshiro.
2 VICE-CHAIR REPRESENTATIVE OSHIRO:
3 Thank you.
4 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
5 Q. I just wanted to get some clarification. When
6 I think Senator Hanabusa was asking you a question on the
7 difference between home based and the continuum for MST.
8 A. Uh huh.
9 Q. In terms of the population make up, I thought I
10 had heard you say that the home based was mostly the
11 conduct disorder whereas the continuum was mostly bipolar
12 and schizophrenic, is that true?
13 A. Those would be the clinical terms. They're the
14 severely emotionally disturbed children, yes. They have
15 greater psychiatric needs.
16 Q. Those are in the continuum?
17 A. Correct.
18 Q. Okay.
19 A. Were.
20 Q. Excuse me, were in the continuum. Okay.
21 Because as I understand it, the benchmark in the
22 stipulation number 50 states that the research has
23 demonstrated MST as effective for children with conduct
24 disorders and other complex emotional conditions. So
25 being that that's the one that seemed to fit in the home
Page 117
1 based, I don't quite understand why we were doing the
2 continuum with these bipolar schizophrenic clinically
3 diagnosed children.
4 A. Okay. You're referring to the benchmarks of
5 August 2000, and that benchmark goes on to read -- I
6 don't know the benchmarks by heart, but it goes on to
7 read that we will have 56 children in the continuum. The
8 court monitor in drafting that benchmark, I can only
9 guess, is saying because there is research to support the
10 home based oppositional conduct, sex offenders, the
11 substance abusing children, we'd like to use that
12 methodology, again, what Senator Hanabusa was saying,
13 that format, and try it on another very challenging, very
14 costly population. So I would -- he's prefacing in those
15 sentences, but you were entirely correct. They have
16 different presenting conditions but we use the same
17 model.
18 Q. Because I mean conceptually anyway, I
19 understand why -- for the conduct disorder children or
20 juvenile delinquents, we want MST because what we're
21 trying to say is we need to address the family, it's
22 environmental, we need to make sure we cover it on all
23 ends, but at the same time when you bring up more --
24 other conditions such as bipolar or schizophrenic, to me
25 that -- that really infers additional kind of diagnosis
Page 118
1 and conditions that are a lot more complex than just
2 really environmental, and therefore, I'm not really sure
3 why I understand why MST, the continuum was being
4 utilized.
5 A. You're absolutely right. The alternative for
6 those children was a very restrictive hospital level of
7 care because we didn't have anything else, and we weren't
8 getting results. So we were using the research on a very
9 similar challenging -- I mean from the challenging
10 standpoint population in saying if we add the
11 psychiatrist, will we get better results than we were
12 getting in the residential environment and it would be in
13 the child's home and in their home community. But
14 children's mental health, there's not a lot of research
15 to show what works for some of the very challenging
16 conditions. And we were using research that is when the
17 most researched models, MST, and saying is there a way to
18 adapt it and we were -- we were going to research. I
19 mean not we, us, Annie Casey Foundation wanted to
20 research and see how that would work.
21 Q. Okay, thank you. Thank you.
22 CO-CHAIR REPRESENTATIVE SAIKI: Thank
23 you. Members, any other follow up questions? Co-Chair
24 Hanabusa.
25 BY CO-CHAIR SENATOR HANABUSA:
Page 119
1 Q. Yes. Miss Swanson, I believe Miss Donkervoet
2 testified that it was her decision to terminate the MST
3 continuum or she was agreeing with her husband's
4 statement that he believed she made the decision. You
5 just testified that it was a decision made by you in
6 consultation with Dr. Anderson. Is that correct? Who
7 made that decision to terminate the MST continuum?
8 A. She -- I would have -- I'm not going to speak
9 for her --
10 Q. Right.
11 A. I heard her bring a recommendation to me.
12 Q. Okay.
13 A. Which I then discussed with Dr. Anderson.
14 Q. Do you remember when that recommendation was
15 brought?
16 A. Early July, late June.
17 Q. Were you here when Margaret -- I think her name
18 was Pereira testified, and she said that around March or
19 so, the ending of March, there was already a movement and
20 they were told that the MST continuum will be sort of
21 like eliminated or done away with? Were you here when
22 she testified to that effect?
23 A. I was here when she testified. I heard her
24 testimony to say in the spring that -- again, I heard her
25 testimony to say in the spring that we weren't getting
Page 120
1 results. I had no knowledge of that, but that's what I
2 heard her testimony say, not that it was going away. I
3 am fairly confident there were no discussions prior to
4 the summer when I was pulled into a discussion.
5 Q. So it could be that you were just not pulled
6 into these discussions?
7 A. It's very possible.
8 Q. Until the summer?
9 A. That's correct.
10 Q. So up to that point you had no knowledge that
11 there were concerns over the MST continuum project?
12 A. Now you have changed it to concerns.
13 Q. Okay.
14 A. As contrasted with that we were shutting it
15 down.
16 Q. Okay, so let's make it clear. So that you had
17 no conversations about shutting it down prior to summer.
18 Now let's go to concerns. You had heard about concerns
19 of the MST continuum project prior to that time?
20 A. Yes.
21 Q. And when was that time?
22 A. Probably about two months before we started the
23 project, the summer before. We started addressing
24 concerns and challenges of being able to recruit the
25 staff in training them, in supervising them, in
Page 121
1 recruiting families and in responding to kids' needs.
2 Q. But you decided or it was a decision was
3 because it was part of the consent decree or part of the
4 benchmarks that it would proceed?
5 A. No. We proceeded because we thought it was the
6 best alternative to providing the care for children.
7 Q. Okay. Let me -- my time is up, but let me
8 quickly run through these. What was done to inform the
9 monitor, if anything, or the court that the MST continuum
10 project would be shut down?
11 A. We drafted a letter first informing -- he was
12 first verbally informed that we could not meet the number
13 of children in the project and that we were reevaluating
14 the project. And I was hopeful at that point in time
15 that we could potentially propose to him fewer children,
16 and as we continued our evaluation, we informed him that
17 we could not meet the benchmark and that we were going to
18 terminate the research side, and I believe that letter
19 was signed by Dr. Anderson and I believe that was late
20 June, early July. I'd be happy to provide the committee
21 with the letter.
22 Q. That's fine. And by the way, what happened to
23 the children that were being served under the continuum?
24 Have they gone into institutional residential care?
25 A. As of November 5, I know that one of the
Page 122
1 children is in a hospital level of care, and I believe
2 that we had -- I now have an analysis of all 29 children
3 and the services that they're currently receiving, which
4 is a range of therapeutic foster homes to outpatient
5 services. Some of them were very close to being
6 discharged stable and another population, significant
7 number were picked up by the home based teams.
8 Q. Okay.
9 A. They're all being followed with additional
10 psychiatric services.
11 Q. Okay. Thank you.
12 CO-CHAIR REPRESENTATIVE SAIKI: Thank
13 you. Representative Marumoto.
14 BY REPRESENTATIVE MARUMOTO:
15 Q. You know, I'm wondering how the department
16 could justify the encouraging families to go into the MST
17 program sort of like, you know, playing it up, telling
18 them how great it was, selling it, drumming up business
19 for it and then pulling the rug out from under them if
20 they were not selected to go into this, this program.
21 How could you justify that? It seems to be -- I don't
22 know, it might set back some students.
23 A. The children who -- and families, more
24 importantly, who are presented with children that are
25 severely emotionally disturbed and are looking for any
Page 123
1 new promising treatments, therapies that will provide a
2 more stable home environment, that will allow their
3 children to go to school, and if they're an older child
4 they have struggled with this for years. I'm not sure
5 that I could come to the conclusion that we built it up
6 and built it up and then pulled the rug from under them.
7 I think -- and I did not participate, did not hear any of
8 those discussions, but that it was done in a professional
9 way to lay out to them that we were researching this
10 model, there was an opportunity to participate in the
11 research, and if you chose not to participate in the
12 research we were still going to provide the services, and
13 it was going to be provided as we had previously. These
14 children didn't come to us not receiving anything. These
15 were children who were currently in our system, receiving
16 intensive in home, had been in hospital based residential
17 care, some of them had been on the mainland, and when
18 they next presented in an emergent situation at an
19 emergency room or they were ready to be admitted, we had
20 a discussion with the family and the child, if
21 appropriate, about the two options.
22 Q. My understanding is that it was presented as a
23 less desirable alternative and that it would be better to
24 get the new MST therapy even though it was experimental,
25 so it just was disappointing to hear that it was sold in
Page 124
1 this manner. It seems a little unethical, and it's
2 disappointing also to hear that the program was just
3 stopped abruptly for people who were using that therapy.
4 Anyway, thank you.
5 CO-CHAIR REPRESENTATIVE SAIKI: Thank
6 you. Members, any other follow up questions?
7 BY CO-CHAIR REPRESENTATIVE SAIKI:
8 Q. If not, Ms. Swanson, I have a couple of
9 questions on the emergency funding request for
10 approximately 478,000, the Title 4E reimbursement. Those
11 funds were used either by the Department of Health or by
12 the Felix monitoring project for basically employing
13 staff or contracting staff to improve services for
14 certain types of disturbed children. Do you know what
15 amount of that $478,000, what amount went to the Felix
16 monitoring project, approximately?
17 A. I don't believe any of it went to the Felix
18 monitoring project.
19 Q. None of it went?
20 A. No. No. I need to understand this better.
21 But I believe we were asking for a ceiling increase in
22 order to expend, and I don't have the same information.
23 Can you tell by looking at that if that's --
24 Q. Well, it's an appropriation out of the
25 Behavioral Health Administration Title 4E reimbursement.
Page 125
1 It's an interdepartmental transfer fund, the sum of
2 $478,250 for fiscal year 2000 through 2001.
3 A. I apologize. I don't know the details. I can
4 get them for the committee this afternoon.
5 Q. Well, do you know -- do you know why -- why was
6 the FMP included in this language?
7 A. I believe the way you read it to me and I guess
8 I need to clarify, the Child and Adolescent Mental Health
9 Division has not made any payments to the Felix
10 monitoring project other than what was in the court
11 ordered budget and specific payments by court orders.
12 When it says and/or contractors of the Felix monitoring
13 project, is that we may have invited their service
14 testers to attend a training. The monitor's office has a
15 cadre of service testers, and this would have made the
16 service testing available.
17 Q. Well, do the health department contract staff
18 and deploy them to the FMP using these funds?
19 A. No. Did we contract our Department of Health
20 staff --
21 Q. Or any kind of private provider and deploy
22 them, because this language allows for the deployment of
23 individuals to the FMP as well. This is an emergency
24 funding request, so the funds would have already been
25 spent in part at the time that we had appropriated these
Page 126
1 dollars, so I'm not sure why the -- there are no details.
2 A. There are details, Representative Saiki. I
3 apologize, I do not have them with me and I can get them
4 for you with a telephone call. But I'm also concerned
5 about it shows a transfer between -- I did not bring the
6 emergency appropriation file with me and I'd be happy to
7 get that for you and explain it following Dr. Anderson's
8 testimony.
9 Q. Okay, thank you.
10 CO-CHAIR REPRESENTATIVE SAIKI:
11 Members, any other follow up question?
12 REPRESENTATIVE KAWAKAMI: Just one
13 question.
14 CO-CHAIR REPRESENTATIVE SAIKI:
15 Representative Kawakami.
16 REPRESENTATIVE KAWAKAMI: Thank you,
17 Chair Saiki.
18 BY REPRESENTATIVE KAWAKAMI:
19 Q. Just one question I wanted to ask you. The
20 benchmarks came in on August 2, 2000.
21 A. The 2nd, or I don't know if it's the 2nd or the
22 3rd.
23 Q. According to what we have here?
24 A. Okay. We had benchmarks prior to the summer of
25 2000 that were from the original consent decree and the
Page 127
1 implementation plan. There were 141 of those benchmarks.
2 Q. Okay. So that was the original 41?
3 A. 141.
4 Q. 141?
5 A. Yes.
6 Q. And they -- and on this, that total did not
7 stay the same, weren't there additions?
8 A. Yes.
9 Q. Or alterations, etc.? What did it end up
10 being?
11 A. I believe that there were an additional 60 or
12 62 benchmarks.
13 Q. Right.
14 A. So that would be a total of more than 200.
15 Q. You know, I was trying to figure out, and I
16 think that's why principals were saying it was changing,
17 you know, this target is moving because there were
18 additions coming in and alterations to those benchmarks.
19 Am I correct?
20 A. To my knowledge, the benchmark has -- actually
21 one of the only ones that have been altered have been --
22 are changes that were reflected to incorporate at the
23 State's request, the one related to the children in the
24 continuum, but it's my understanding that --
25 Q. Others were not?
Page 128
1 A. We started with 141, they added an additional
2 60 plus, and we now have 200.
3 Q. Okay. Maybe that was the confusing part in the
4 field because you added, you know, they thought this was
5 going to be it and then, you know, they had these coming
6 in periodically or, you know, throughout.
7 A. Okay. I'd just like to --
8 Q. Thank you very much.
9 A. If I could clarify one issue, and evidently I
10 wasn't watching the faces, we had -- I made the comment
11 that there were 1,200 clients that we paid for the flex
12 services. Those were not 1,200 horseback riding, sailing
13 lessons. In fact, my staff over the lunch hour still
14 could only identify one situation on Kauai which was IEP
15 driven, where there was a therapeutic horseback riding,
16 but I also expect, Co-Chairs, to have that complete
17 report of all of our expenditures and flex and respite
18 delivered to the committee, if not by close of business
19 today, but early tomorrow. And I will also look at the
20 vendor names and try to figure it out.
21 CO-CHAIR REPRESENTATIVE SAIKI: Okay,
22 thank you. We have one more follow up question from
23 Senator Sakamoto.
24 SENATOR SAKAMOTO: Thank you, Chair.
25 BY SENATOR SAKAMOTO:
Page 129
1 Q. I was going to ask Dr. Anderson, but he'll
2 probably say he doesn't know, so I think I need to ask
3 you.
4 A. Well, you don't think I know.
5 Q. You know, or you should, because it's not
6 clinical. It's related to Federal reimbursement.
7 There's been some money that the department has
8 requested, and my understanding is at least the
9 preliminary request was rejected asking for either more
10 backup or too bad. What is the department doing to
11 maximize Federal reimbursement and as the ball has
12 transitioned to the Department of Education, how is the
13 department now working with them to maximize Federal
14 reimbursement for wherever we can get it?
15 A. The majority, or the most significant amount of
16 our Federal dollars comes from an agreement that we had
17 with the Department of Human Services whereby they
18 allocated seven and a half million dollars under the
19 budget neutrality for children's mental health services,
20 outpatient services. So while we were funding and
21 providing the accountability for those services, the
22 Department of Health for Felix eligible, and this is the
23 important part, and Quest eligible children, so you have
24 to be both, we were able to draw down against that seven
25 and a half million. I believe the last numbers I heard
Page 130
1 is that we had drawn down about five and a half while we
2 were still managing that budget. We submitted to the
3 Department of Human Services a revision to the State plan
4 which enables them to put additional services into and be
5 eligible for reimbursement more of our intensive
6 services, the residential programs, the intensive case
7 management, so that we could use some of the Federal
8 dollars that we're currently budgeted for, and again,
9 only for Quest eligible, Felix eligible children. That
10 was submitted, I believe September 30 to DHS and they've
11 submitted it to HICKVA, and once we get approval then
12 we'll be able to bill for those services.
13 Q. So --
14 A. To bill DHS for those.
15 Q. Are you going to help the Department of
16 Education continue to get maximized reimbursement?
17 A. We have offered to help the Department of
18 Education both with the school based transition and the
19 contracting and with the Federal maximization of the
20 outpatient services. Two things have to happen.
21 Q. Thank you.
22 A. One, we still have to be as a State under the
23 same level of budget neutrality. And I can appreciate,
24 having gone through the development stage where for the
25 Child and Adolescent Mental Health Division, the
Page 131
1 Department of Education cannot tackle both the
2 contracting for school based services and bringing up the
3 system to support billing for the outpatient services for
4 Quest eligible children at the same time. So we will
5 continue to offer to work with them and support them in
6 that process and we've made that offer very specific to
7 Miss Laurel Johnston.
8 Q. Thank you.
9 SENATOR SAKAMOTO: Thank you, Chair.
10 CO-CHAIR REPRESENTATIVE SAIKI: Thank
11 you, members. Any other follow up questions? Okay, if
12 not, we will take a five minute recess. Recess.
13 (Recess.)
14 CO-CHAIR REPRESENTATIVE SAIKI:
15 Members, we'd like to reconvene our hearing. We forgot
16 to thank Ms. Swanson earlier for her testimony. But we'd
17 like to now call on our next witness, Dr. Bruce Anderson.
18 We'll administer the oath at this time.
19 CO-CHAIR SENATOR HANABUSA:
20 Dr. Anderson, do you solemnly swear or affirm that the
21 testimony you're about to give will be the truth, the
22 whole truth and nothing but the truth?
23 DR. ANDERSON: I do.
24 CO-CHAIR SENATOR HANABUSA: Thank you
25 very much. Members, we'll follow our usual protocol.
Page 132
1 We'll begin with Mr. Kawashima.
2 SPECIAL COUNSEL KAWASHIMA: Thank you,
3 Madam Chair.
4 E X A M I N A T I O N
5 BY SPECIAL COUNSEL KAWASHIMA:
6 Q. Good afternoon, Dr. Anderson.
7 A. Good afternoon.
8 Q. For the record, state your name and business
9 address.
10 A. My name is Bruce Anderson. I am the director
11 of the State of Hawaii Department of Health. And my
12 office is located at -- on Punchbowl Street.
13 Q. All right. Dr. Anderson, will you very briefly
14 recount for us your formal education starting from the
15 higher education level?
16 A. I graduated with a Bachelor of Arts degree in
17 physics from the Colorado College, which is in Colorado
18 Springs, in 1974. Subsequently, I attended Yale
19 University, received my Masters in public health from
20 Yale in epidemiology, specializing in infectious disease
21 epidemiology but covered a wide variety of other topics,
22 of course. I graduated with a Ph.D. from University of
23 Hawaii School of Public Health in 1981 with a combined
24 degree in epidemiology and biostatistics, another public
25 health degree.
Page 133
1 Q. Thank you. Dr. Anderson, I notice that you
2 have been here from time to time during the various
3 hearings we've had here. I assume you've been briefed as
4 to what's been happening generally throughout the
5 hearings that affected the Department of Health?
6 A. I read, I have not been able to attend the vast
7 majority of the hearings you've had, but my staff had
8 briefed me on the hearings that have involved the health
9 department. I have not been briefed on many of the
10 questions that have been addressed to the DOE.
11 Q. Now, Dr. Anderson, in the past, you have -- you
12 and/or your personnel have come before the legislature
13 and asked for appropriations for your department and its
14 programs, have you not?
15 A. That's correct. In my introduction, let me
16 make it very clear to the committee, if you will, when I
17 became director of health so that you get some sense of
18 my perspective on the issues. I've been director of
19 health since January 1 of 1999. That's two years, eleven
20 months and seven days. Prior to that I worked for twelve
21 years in the Department of Health as the deputy for
22 environmental health and I want to emphasize that only
23 because in that capacity I had no dealings whatsoever
24 with Felix. It was another name to me, it was a large
25 part of our budget, I knew, but I had no dealings with
Page 134
1 the issues prior to January 1 of 1999. Since then, I've
2 been responsible for that program as well as every other
3 though.
4 Q. Right. But I'm sure to the extent that you've
5 been able to do it, you familiarized yourself with the
6 consent decree and as much as is possible and necessary
7 for you to be able to make decisions relating to the
8 decree?
9 A. Yes. One of the first things I did is read the
10 consent decree, IDEA and many of the other legal
11 documents associated with the situation.
12 Q. All right. Well, based on information you've
13 received from other personnel at the Department of Health
14 prior to January 1, 1999 with relation to the consent
15 decree, and what you have learned subsequent to January
16 1, 1999 in this area of appropriations, the department
17 has come before the legislature in years past, and since
18 you have been appointed director, do you believe as far
19 as that, those requests for appropriations is concerned
20 that the Department of Health has received adequate
21 funding from the legislature?
22 A. Since I've been director of health, the
23 legislature has appropriated the funds that were
24 requested by the administration to implement the Felix
25 Consent Decree. I don't recall a single instance where,
Page 135
1 with the exception of last year, I might add, the budget
2 was less than what we asked for through the executive
3 budget request. Last year we had 12.8 million dollars
4 less than what we asked for.
5 Q. That wasn't the emergency request, was it?
6 A. That was 12.8 million dollars less than what we
7 asked for in our executive budget request.
8 Q. All right. Now, are you able to say though,
9 Dr. Anderson, that the department has not been able to
10 comply with the consent decree because there has been
11 inadequate funding? I'm not suggesting you're saying
12 that, I'm just asking you whether or not that is a
13 position that the department is taking.
14 A. No. I think that the legislature has supported
15 the fiscal needs of the department with perhaps the
16 exception of last year, but I should have added in
17 addition to the executive budget request, we have come in
18 for emergency appropriation requests, I think just about
19 every year that I've been director, and I believe after
20 some adjustments those were also funded.
21 Q. All right. And as far as the executive budget
22 requests though, is it your position that the Department
23 of Health will not be able to comply with the decree
24 because of that funding not provided?
25 A. The Department of Health, as Miss Swanson said,
Page 136
1 has complied with virtually every benchmark that we have
2 before us. I'm speaking strictly about the Department of
3 Health. Insofar as the administration has set aside the
4 12.8 million dollars that we were short last year, I
5 don't see funding as being an obstacle to meeting the
6 requirements of the consent decree from the Department of
7 Health standpoint.
8 CO-CHAIR SENATOR HANABUSA:
9 Dr. Anderson, will you please move your mike a little way
10 away from you?
11 A. Sure.
12 CO-CHAIR SENATOR HANABUSA: We've got
13 the opposite problem of Miss Swanson. Thank you.
14 Q. Thank you. All right. I appreciate that, and
15 again, not that you or anyone in your department has
16 suggested it, but as far as this committee's
17 investigation that is ongoing at the present time, you do
18 not believe that this investigation has interfered with
19 the Department of Health's ongoing efforts to comply with
20 the consent decree, do you?
21 A. We have made every effort to continue with our
22 efforts to comply with the consent decree. I have to say
23 that the time spent here has perhaps taken away from time
24 that could have been spent in other areas, however, we
25 have committed to supporting the committee and your
Page 137
1 investigation. I made that very clear at the outset and
2 I've directed my staff to be cooperating and to fully
3 participate in the proceedings here, so the short answer
4 is no, we are continuing to the best of our ability to
5 meet the deadlines set forth by the court.
6 Q. Now, in terms of your instructing your
7 personnel to cooperate in every way possible, there were
8 some questions, I must say, with some of the department
9 employees who were concerned about coming before the
10 committee and testifying because of possible retaliation
11 against them. Are you aware of that, that reluctance?
12 A. I am not aware of any situation of that nature,
13 and I certainly would take action should I be aware of a
14 situation where any employee was not encouraged to be
15 forthcoming to this committee.
16 Q. All right. I'm not sure -- you see, I'm not
17 sure you received a copy of this, but early on when we
18 were attempting to obtain witnesses to testify in these
19 areas, there was an E-mail that was circulated to a
20 number of people, it appears all of which are at least
21 within the Department of Health, if not elsewhere,
22 regarding -- meetings with the auditor's office is the
23 subject of the E-mail from Ms. Donkervoet dated February
24 24 -- Friday, August 24, 2001, and it is directing --
25 giving advice to members of your department, and to
Page 138
1 Ms. Donkervoet's credit, there is a statement that in
2 terms of them talking with the members or the people from
3 the auditor's office, she says there's no problem with
4 talking to them, they just need to realize their work
5 capacity, their work capacity meaning the people in your
6 department, but what I'm focusing on though is a
7 paragraph that reads if anyone is contacted and chooses
8 to meet with the auditor's office, they need to
9 understand that it is in capacity as a CAMHD employee.
10 The meeting should take place during work hours and in a
11 place of work. It is also strongly suggested that the
12 AG, meaning the Attorney General, be present. Please
13 have staff call the AG for representation, if needed, and
14 they give a name of someone who should be called. Now,
15 were you aware that this E-mail was circulated?
16 A. I don't recall the specifics of the E-mail. I
17 was aware that there was an E-mail circulated to the
18 staff to this effect.
19 Q. And well, I guess the reason -- what I would
20 ask, sir, is why would an E-mail like this be circulated
21 suggesting that the meeting should take place during work
22 hours, first of all, and second, any place of work, why
23 is that of any necessity? Why would that be of any
24 necessity?
25 A. I don't know what the circumstances were that
Page 139
1 precipitated that E-mail. It may have been that staff
2 are reluctant to work -- to talk to anyone during work
3 hours about this issue. And I would interpret that memo
4 to be reinforcing the fact that this is work related, and
5 as such, it's perfectly appropriate to discuss with the
6 auditor any issues or concerns they may have during work
7 hours. As it relates to the AG's involvement, I think
8 that if necessary, the clause is appropriate. I know
9 many of my staff were apprehensive about the questioning
10 of the committee and probably would want to have the
11 option to talk to an AG. Candidly, I don't know if
12 anyone ever took advantage of that, I simply don't know
13 whether that was a significant problem or not.
14 Q. Okay.
15 A. I'm sure that Miss Donkervoet meant well in
16 this regard and certainly I didn't read anything in there
17 to suggest that they not be forthcoming with information.
18 Q. All right. Well, I believe though, doctor,
19 that this E-mail came in a certain context and the
20 context it came in was a person from the Diamond Head
21 Family Guidance Center coming to speak with the auditors,
22 people at the auditor's office, at the auditor's office
23 on that person's own time. What the person I think
24 appropriately did was took leave to come to this
25 interview, that person's own leave, and then that person
Page 140
1 was questioned about it by -- by his supervisor
2 subsequent to that. That's the context in which it
3 occurred, you see, that's why I believe the statement as
4 to the meeting should take place during work hours and in
5 a place of work being relevant to us, anyway. It was
6 suggesting that a meeting at the auditor's office ought
7 not to take place and it ought not to be on the person's
8 own time, I guess, probably because the person could do
9 it whenever they wished. But nonetheless, were you aware
10 that, for example, David Drews questioned Mr. Stewart
11 about his coming to the auditor's office to give an
12 interview? Are you aware of that taking place?
13 A. No, I was not aware of there being any concern
14 on his part, and let me emphasize whether or not it's on
15 work hours, during work hours or other times I would be
16 encouraging staff to be honest and forthcoming with
17 whatever information they may have.
18 Q. All right. And regarding the Attorney General
19 matter, you are aware that the Attorney General when
20 conferred, directed the employees to come and speak
21 honestly and forthrightly and completely before this
22 committee pursuant to the Attorney General's advice and
23 also the governor's advice?
24 A. I wouldn't be surprised if they were enforcing
25 that point as well.
Page 141
1 Q. Now, let me ask you, sir, you may not get
2 involved at this level but there have been questions
3 asked about billings, for example, by service providers,
4 certain ones billing for more hours than there are in the
5 day and the costs of services being higher than it
6 appears that they should be, things of that nature. Do
7 you get involved with that?
8 A. No. You're correct. I don't normally get
9 involved with contracting issues. However, if there was
10 a specific problem that developed and it was brought to
11 my attention, of course I would deal with it. But as it
12 relates to individual contracts and specifics around
13 billing, so forth, I would not be involved in those
14 issues unless a problem was brought to my attention.
15 There is a external audit done, I believe, of the
16 contracted service providers looking at the use of
17 Federal funds at least, and whether or not the billings
18 are consistent with the services actually provided. And
19 of course, our own staff monitor the contract terms
20 regularly.
21 Q. All right. How about matters such as potential
22 or perceived conflicts of interest, and I'm sure you
23 heard about the testimony given in these hearings about
24 David Drews, branch chief David Drews at his organization
25 called Central Pacific University and its relationship
Page 142
1 with Loveland Academy, one of the service providers for
2 patients of -- I should say clients of the Department of
3 Health. Have you heard testimony or heard about
4 testimony given in that area?
5 A. I heard the testimony this morning related to
6 the issue when Miss Swanson was testifying. I have not
7 heard any other testimony concerning the issue.
8 Q. Well, let me ask it this way. Do you consider
9 it a problem when you have a branch chief who has the
10 authority to pass on a service provider's statements, in
11 fact is asked to and in fact does pass on -- pass on a
12 few of these where there were disputes between the care
13 coordinator and the service provider, would that person
14 also having an arrangement where he was getting free rent
15 from that service provider?
16 A. I'm not aware of the specifics as it relates to
17 Mr. Drews' association with Loveland Academy. I know
18 Mr. Drews, I -- he's one of the first care coordinators I
19 ran into when I actually attended an IEP meeting. I did
20 ask Miss Swanson to give me her opinion on the issue and
21 based on what she told me, which was that she didn't see
22 or know of any evidence of any conflict of interest, I
23 did not investigate the matter further at the time.
24 Q. The situation as I just posed it to you does
25 not create in your mind a conflict?
Page 143
1 A. That he would --
2 Q. If you would accept --
3 A. I'm accepting your --
4 Q. Proposed as being truth and the fact, or being
5 fact, you don't see a problem there?
6 A. I would say I would need to look into the
7 circumstances more carefully before I could come to a
8 conclusion there was a conflict of interest.
9 Q. Assuming he was getting free rent now, he
10 wasn't paying anything for the use of two rooms at
11 Loveland Academy, in fact, in addition he was able to put
12 his sign, Central Pacific University up in one of the
13 buildings and then utilize that in a web site for Central
14 Pacific suggesting, and I believe in a misrepresentative
15 way, that Loveland Academy was in fact the premises or
16 the place where Central Pacific held its classes, in
17 context of that, and then getting free rent, also, for
18 use of two rooms at Loveland and then of course having
19 the oversight responsibility over Loveland's payments,
20 you don't see that as being a problem?
21 A. I'm not quite sure how I see that being a
22 problem insofar as Mr. Drews did not favor Loveland
23 Academy in any dealings as it relates to the provision of
24 services. If there was some evidence that you presented
25 that suggested that he was giving them a break in any
Page 144
1 way, then I would say there may be evidence of a conflict
2 of interest, but if was treating Loveland Academy the
3 same way he treats all his service providers, I'm not
4 sure how that is relevant to the issue.
5 Q. Well, it might be relevant though,
6 Dr. Anderson, if in fact issues of that nature don't
7 normally get to the level of the branch chief, for
8 example, however, someone at Loveland picked up the phone
9 and called Dr. Drews directly, discussed it with that
10 person and then approved the request for payment or
11 request that a service authorization be issued, for
12 example. In that situation as I just described, that
13 might be different from what you described though,
14 wouldn't it?
15 A. Again, I would need to know the circumstances
16 before I could come to judgment on whether or not there
17 was a conflict of interest and to know if there was any
18 favoritism provided to Loveland Academy.
19 Q. Not necessarily favoritism but the care
20 coordinator or that level of person feeling that the
21 payment should not be made and Dr. Drews overriding that
22 position and authorizing payment or authorizing a service
23 authorization to be issued, for example?
24 A. Again, with all due respect, I would want to
25 look into the issue more thoroughly. I do not know the
Page 145
1 circumstances around this case and I would hesitate to
2 speculate or come to judgment on a case without knowing
3 the circumstances fully.
4 Q. But you would not necessarily accept what David
5 Drews said as to whether or not he was being -- whether
6 he was exercising favoritism or not though, that wouldn't
7 be the test, would it?
8 A. Of course not, nor would I take anything else
9 that anyone else said without carefully considering that
10 statement.
11 Q. Do you know if someone has looked into that?
12 A. I believe the division did look into the issue
13 subsequent to my inquiry. And again, the report I got
14 back was that there was no favoritism provided to
15 Loveland Academy based on the evidence that we had. That
16 was a statement of fact, and I don't know what the
17 evidence was to substantiate that statement.
18 Q. Was a report generated as a result of that
19 investigation?
20 A. Not to my knowledge.
21 Q. If there is such a report, would you mind
22 providing it to the committee, if there is such a report?
23 A. I'll certainly ask if there is such a report,
24 and you'll certainly you will get a copy if we have such
25 a report.
Page 146
1 Q. Thank you. Now, Dr. Anderson, we've spoken
2 about this issue of super powers, in essence, just a
3 vernacular term, broad term that describes powers or the
4 power to waive requirements. That was given by the
5 Federal Court by order, I believe, of July 21, 2000 --
6 July 21, 2000, which order was then subsequently modified
7 and expanded somewhat. You know what I'm talking about,
8 don't you?
9 A. Yes.
10 Q. Was that something that the Department of
11 Health sought to have happen, to be given these powers to
12 include, among other things, waiving the requirements of
13 103F?
14 A. I don't recall we ever asked for any of those
15 special powers. I do recall there were discussions
16 around the difficulty in complying with the stipulations
17 in the benchmarks, particularly the requirement that we
18 provide services within 30 days and given the procurement
19 steps that have to be followed that we would have
20 difficulty complying with that provision, but beyond
21 that, I don't recall any specific requests that those
22 special authorities be conferred on either by the
23 Department of Health or the Department of Education, for
24 that matter.
25 Q. In terms of the time requirements that you just
Page 147
1 enumerated, the 30 days to comply with the new
2 benchmarks, do you feel that the department's interests,
3 Department of Health interest was properly set forth and
4 debated before the Federal Court before the judge issued
5 the order requiring these benchmarks to be met?
6 A. The monitor had been in discussion with the
7 department about many of the issues for some time, and I
8 believe in the course of that discussion was fully aware
9 of our concerns related to implementation of the consent
10 decree. I don't recall us ever having a chance to
11 formally comment on any proposed benchmarks. In effect,
12 those were dictated to the department and we didn't have
13 any choice but to accept them as they were. I should say
14 though that in preparing those we have had discussion
15 with the monitor, these weren't benchmarks that came out
16 of the blue, but there was no formal process where we had
17 a chance to appeal and so forth.
18 Q. I see. Well, let me ask you about that, about
19 the court monitor. You are aware that the court monitor
20 came to Hawaii as a advocate of one of the parties'
21 position, are you not?
22 A. I beg your pardon?
23 Q. Let me restate that. That's probably not a
24 good question. Are you aware that Ivor Groves, the court
25 monitor, came to Hawaii initially having been retained as
Page 148
1 a expert witness for the plaintiffs' attorneys in the
2 class action? Were you aware that's how he came to
3 Hawaii?
4 A. I'm not familiar with his background. I came
5 to know Ivor Groves as the court monitor and have met
6 with him a number of times in that capacity. I didn't
7 know him before that time.
8 Q. I see.
9 A. Nor am I familiar with his history.
10 Q. Nor would you be familiar with his background
11 in special education or mental health issues?
12 A. Very generally I know he's been involved with
13 these issues for an extended period of time, but I'm not
14 familiar with his history here in Hawaii.
15 Q. All right. How about that issue though, if in
16 fact he came to Hawaii as a representative of the
17 plaintiffs and their attorneys as an expert witness for
18 them and then is named court monitor, had you been aware
19 of that, might you have objected to his being retained or
20 appointed as court monitor?
21 A. Again, with all due respect, I would have to
22 know the circumstances before I could come to an opinion
23 on that. I wouldn't know in what capacity he was being
24 retained as an expert witness. If you could explain that
25 in detail, perhaps I could make some judgment on that,
Page 149
1 but I'm called as an expert in many situations, and I'm
2 not -- in other areas, of course, but --
3 Q. But that is in your capacity though as director
4 though, is it not?
5 A. Not necessarily, but it often has been as a
6 State official.
7 Q. Sure.
8 A. But without belaboring the point, let me just
9 say that I would hesitate to speculate on any potential
10 bias or conflict of interest he might have in this
11 regard.
12 Q. I understand. I understand your position,
13 Dr. Anderson. All I would say is though is that there's
14 not really much, much to -- much more to give you,
15 frankly, except to say that he was retained as an expert
16 witness, clearly someone retained and paid for at least
17 at that point in time by the plaintiffs' attorneys to
18 represent the interests of the plaintiffs, no one else,
19 the plaintiffs in the class action, you see. That's how
20 his -- he came to Hawaii, that position he occupied until
21 some point he was named court monitor, and I'm not sure
22 if the Department of Health had any ability to object to
23 that or not, and first of all, did you have the ability
24 to object to that or not?
25 A. I think a party to a case like this is entitled
Page 150
1 to bring whatever witness they want. I'm not sure
2 there's an objection to --
3 Q. No, to be then named court monitor though and
4 to have the powers that he has over the Department of
5 Health and the Department of Education, where previously
6 he was in opposition to your interests?
7 A. I am not familiar with the position the State
8 took. They may have indeed done that, I really don't
9 know if they objected to his participation as an expert.
10 I would think of him as an expert on some aspects of
11 special education, but that wouldn't surprise me that he
12 would be called as an expert by perhaps either side, but
13 having said that, I'm again not familiar with his
14 background or why he was called as an expert.
15 Q. Doctor, is the Deputy Attorney General assigned
16 to you for the Felix Consent Decree the same Deputy
17 Attorney General that represents the Department of
18 Education or not?
19 A. Russell Suzuki and Holly have been principal
20 attorneys representing the State for some time, including
21 both the Department of Education and the Department of
22 Health.
23 Q. All right. So they are the only ones who have
24 been advising you in this area thus far, they meaning
25 Miss Shikata and Mr. Suzuki?
Page 151
1 A. They're the ones I remember and there may have
2 been others who were involved from time to time, but as
3 of late at least, they are the ones who have been
4 advising us principally.
5 Q. Thank you. Is it -- well, strike that. As far
6 as the super powers are concerned, Dr. Anderson, or your
7 ability to waive certain procurement requirements, you
8 have utilized that, have you not?
9 A. Yes.
10 Q. Is it your intention to request at some point
11 that the court remove this authorization that was given
12 at least to the Department of Health?
13 A. Today we have required the use of those special
14 authorities in at least a couple of dozen, maybe 30, 40
15 occasions to enable us to provide services in a timely
16 manner. I believe that as time goes on we are going to
17 be leading -- needing those special services less and
18 less. As we develop a full array of services, build out
19 the supports that are needed, and those then continue on
20 an ongoing basis, we won't need those authorities as we
21 have -- as we have over the last year building the
22 programs. I can't tell you when that might be, but I can
23 say this without any hesitation, and that is without
24 those special authorities we would not be where we are
25 today.
Page 152
1 Q. With the benchmarks that had to be met?
2 A. With the time frames and the benchmarks that
3 were directed by the court.
4 Q. My understanding is based on testimony given by
5 Ms. Swanson earlier today, that the waiver authorities
6 you have notwithstanding, that the department, the
7 Department of Health has in fact complied with all of the
8 requirements that would come under, for example, 103F
9 except for time requirements, because of the shortness of
10 time you have to meet those benchmarks. Is that a
11 correct statement as far as you're concerned?
12 A. That's correct. Insofar as possible, we have
13 tried to comply with every step of the process normally.
14 As previously identified, we have the contract request
15 for services reviewed through our administrative services
16 office, it does go through the Attorney General, so we do
17 get an AG's review. We simply don't have the three
18 months it requires to go through an RFP process to get
19 those services in place, and that's where we have found
20 these authorities to be helpful, but again, insofar as
21 we've been able to, we've been trying to comply with
22 every other step that's normally required through the
23 procurement process.
24 Q. Thank you. I have no questions at this time.
25 CO-CHAIR SENATOR HANABUSA: Thank you.
Page 153
1 Members, we'll begin our questioning, beginning first
2 with Vice-Chair Kokubun followed by Vice-Chair Oshiro.
3 VICE-CHAIR SENATOR KOKUBUN: Thank you,
4 Madam Co-Chair Hanabusa.
5 BY VICE-CHAIR SENATOR KOKUBUN:
6 Q. I wanted to follow up on the waiving of 103F,
7 and how were those initiated, how were those actions
8 initiated? Is that something that you did or --
9 A. No.
10 Q. -- brought to your attention?
11 A. What would typically happens would be that
12 there would be a need identified by the division. The
13 division would request a waiver of 103. The -- Miss
14 Swanson would review the request, pass it on to our
15 administrative services office, who in turn would review
16 the request, look at the justification, and finally,
17 after that review process, it would come to me for
18 signature. That is the justification along with an
19 approval. I will sign off on it if I feel it's
20 appropriate to do so. But again, it's generated from the
21 division. They will find, for example, that there is a
22 need for a service to be provided in less than say three
23 or four months which it normally takes, and start the
24 paperwork right away such that I would then be able to
25 get authorization for the service in place in the time
Page 154
1 frame required, the 30 day time frame.
2 Q. Okay. So typically this process, once
3 initiated by CAMHD, that's a division?
4 A. Yes. I'm sorry, yes. Child and Adolescent
5 Mental Health Division, which Tina Donkervoet is the
6 chief of that, would initiate the request, and in all
7 circumstances that I'm aware of that's been the case.
8 Q. About 30 days to execute from initiation
9 execution?
10 A. The benchmark requires that we provide services
11 within 30 days. That's the driver on this, this process.
12 Q. I see.
13 A. So that if they don't have the service in place
14 already, they then need to get that new service in place
15 within 30 days or we're going to be in contempt, if you
16 will, or out of compliance, so they will then initiate
17 the request and we will process that request. And so far
18 we've been very successful in meeting the 30 day
19 stipulation.
20 Q. Okay.
21 A. But it's only because of those authorities that
22 we're able to do that. In every case we would have been
23 at least three or four months out without that.
24 Q. Miss Swanson mentioned that it was maybe
25 exercised or invoked 30 to 40 times. Is that your
Page 155
1 recollection?
2 A. Probably closer to 40 than 30, but yes,
3 something in that ball park.
4 Q. What kind of scale are we talking about in
5 terms of the contract, what kind of quantifiable scale?
6 A. I'm going to guess, and I shouldn't do that.
7 Probably in this context, about a third maybe of the
8 contracts that we've issued have been issued under this
9 authority as of late.
10 Q. Okay.
11 A. The others are going through the normal
12 process. Let me say also, because I don't want to miss
13 this, where we can, we go through the normal RFP process.
14 That's the default presumption. We are going to go
15 through that process wherever time allows. There is a
16 blanket RFP that is issued. I think 1999 we issued one,
17 as I recall we're late in getting the other one out, for
18 a wide variety of services, so when we need these
19 authorities it's usually to fill gaps and pukas where we
20 haven't services in place and they're typically for small
21 contracts, for filling those gaps, so as to meet some
22 specialized service need in a short time frame.
23 Q. I'm sorry, I wasn't real clear. My question
24 really had to do with the amount of the contracts. Can
25 you give me a rough idea what the top end, low end range?
Page 156
1 A. I really hesitate to guess because I'm probably
2 going to be held to it. I'm thinking it's about
3 one-third of the contracts we have issued, but I think
4 they're generally the very small contracts. Given our
5 budget being approximately 100 million dollars, maybe you
6 can get some sense of what that might be.
7 Q. Okay.
8 A. It's less than a third because generally the
9 smaller contracts, but I really hesitate to give you a
10 number without a better basis for that.
11 Q. But you'd be able to provide that information?
12 A. Oh, certainly.
13 Q. Yes?
14 A. Yeah.
15 Q. You know, there was also -- previously I asked
16 Miss Swanson about this gap group that was kind of
17 perhaps falling through the cracks in terms of not being
18 able to specifically provide services for students that
19 were not necessarily impacted negatively in the education
20 area, but still would require some kind of mental health
21 services, and an example was -- were you here for that?
22 A. I was, I heard the question.
23 Q. I won't go through that whole example then
24 about who they are.
25 A. Your example is very good, and to get the
Page 157
1 answer, I agree with Miss Swanson. There are undoubtedly
2 many situations where we have bright kids who have say an
3 eating disorder or other perhaps even more serious mental
4 health problems, but because it is not directly affecting
5 their education, that they're doing well in school,
6 they're not getting the help they need.
7 Q. Okay.
8 A. I have to say that much of the resource -- in
9 fact, we've had to direct almost all the resources that
10 we have in our department toward meeting the Felix
11 Consent Decree requirements, and unfortunately, that's
12 left others underserved, but that's been the situation
13 now for several years. The fact of the matter is that
14 the Federal lawsuit drives much of what we do.
15 Q. Okay. But given the statutory responsibilities
16 now for the department, is that something that the
17 department would accept as a responsibility?
18 A. There is no obligation for us to provide
19 services to everyone who needs those services. Morally
20 and otherwise we would like to be able to provide more
21 services to more kids who need them, but the fact of the
22 matter is that compliance with this consent decree and
23 focusing on those kids who -- whose -- who need services
24 to benefit from their education has been of such
25 magnitude that it's been -- that resources have been
Page 158
1 channeled into meeting those needs, possibly at the
2 exclusion of many other needs in the department. Let me
3 add, there are many other programs that are underfunded
4 in the health department after, you know, nine, ten years
5 of budget cuts and so forth, so it's not just that group
6 that's a potential problem.
7 Q. Well, I guess my concern is, you know, in
8 looking at the statutes, particularly 321171 its talks
9 about the department's responsibilities regarding
10 children's mental health services. It appears to me that
11 this is something that the department would have to
12 assume the responsibility for. And I guess my concern is
13 are we -- are we vulnerable to criticism and/or legal
14 action if in fact this group does fall through the
15 cracks?
16 A. I don't know that we're vulnerable to legal
17 action, but certainly we would like to be able to provide
18 services to those kinds of kids, kids who need mental
19 health services. There's, as far as I know, no Federal
20 obligation to do so, and for that reason I don't require
21 and know that there's any legal action threatened at the
22 Federal level at least, but if we had resources, I think
23 it would be helpful to be able to direct some of those to
24 meeting those needs.
25 Q. Yeah. I'm not -- my time is up, Bruce, but I'm
Page 159
1 not saying that there's any kind of action pending or
2 being contemplated, but it just seems to me that if we
3 are able to identify these groups that are not getting
4 the services we should think about providing some level
5 of response to that group.
6 A. I agree.
7 Q. Just to eliminate our vulnerability. Thank
8 you.
9 A. Thank you.
10 CO-CHAIR SENATOR HANABUSA: Thank you.
11 Vice-Chair Oshiro followed by Senator Slom.
12 VICE-CHAIR REPRESENTATIVE OSHIRO:
13 Thank you, Co-Chair Hanabusa.
14 BY VICE-CHAIR REPRESENTATIVE OSHIRO:
15 Q. I just have one question. Earlier, some the
16 testifiers came in and they were talking about I guess
17 the budgetary amounts that go directly to CAMHD. And
18 according to Valerie Ako, she had stated that back in
19 1995 the initial general funding, general funds amount
20 was about 32 million. In 2001, it's now at about 133.8
21 million. And she said it's just been steadily increasing
22 from 1995 through 2001, so seeing as that's about a four
23 times increase, I was just wondering in this -- in that
24 six year period, I mean, do you see us moving in any
25 direction where we're going to be able to start
Page 160
1 controlling this cost, is it going to start tapering off,
2 is there any way we're going to be able to start
3 decreasing it, because it's a pretty substantial amount.
4 A. Let me just speak for the Department of Health
5 and say this, that I believe we have the staff in place
6 now and the resources we need to continue to provide
7 mental health services to those with intensive needs to
8 support the Department of Education without a significant
9 increase in funding. We have a relatively mature
10 program, we're fine tuning it now, but our array of
11 services is largely complete. I think we're in a good
12 position as it relates to staffing, we have staff ratios
13 now that are reasonable, that one to 15, one to 30 she
14 mentioned is something that is a standard for other
15 states. I don't anticipate a lot more Felix kids to be
16 identified. That period from 1994 to 1999 or 2000 was a
17 period of very rapid growth of the program. I'm trying
18 to remember the numbers, but I think back then we had
19 about 1,200 kids that we were providing services to.
20 It's been a situation where over the years we've
21 identified more and more kids as we've become more
22 sophisticated in identifying those kids, and our budget
23 has increased accordingly. Incidentally, it would be
24 interesting to look at what the cost per child is now
25 compared to then. I'd be willing to bet that we're
Page 161
1 actually spending less per child now than we were back in
2 1994 and we're providing much better services for those
3 kids.
4 Q. Yeah, I think I agree with you and I think my
5 concern is just that given what you stated in terms of
6 improvements that are made and that we already seem to
7 have the infrastructure in place, do you anticipate any --
8 I mean I don't know if this is possible, but do you see
9 whether it would be any further need for emergency
10 funding to come in and continually have to request
11 additional emergency funding?
12 A. I see only insofar as I can see, we are
13 projecting a cost this year that is close to what we
14 projected last year for this year. I know that when you
15 spoke with Miss Swanson, you spoke about the request last
16 year and the actions taken by the legislature. The
17 amount that was reduced from our budget, the 12.8 million
18 dollars is very close to what I think we're going to be
19 needing this year. In other words, I think we projected
20 fairly closely last year what we would need this year. I
21 don't think that's been the case in the past. I think
22 because of circumstances outside of our control,
23 specifically the fact that referrals are coming from DOE
24 and our difficulty in projecting what those might be, we
25 have generally under budgeted for a variety of reasons,
Page 162
1 projecting out perhaps best case scenarios and those not
2 becoming realized, but having said that, looking into
3 this year, as far as I know we're right on target with
4 regard to what we requested and looking out over the next
5 year or two, I don't anticipate a significant increase
6 given that we have those services in place, and again,
7 let me -- I'm speaking about the Department of Health. I
8 don't want to speculate what the Department of
9 Education's situation might be in that regard.
10 Q. Okay. Thank you very much. Thank you.
11 CO-CHAIR SENATOR HANABUSA: Senator
12 Slom followed by Representative Kawashima.
13 SENATOR SLOM: Thank you, Co-Chair.
14 BY SENATOR SLOM:
15 Q. Dr. Anderson, you mentioned that you didn't
16 request the super powers, or as Ms. Swanson referred to
17 them, as Dr. Anderson's waiver authority. You didn't
18 request them, but you did utilize them and you didn't ask
19 that they -- they be ended. Do you know when they were
20 supposed to end?
21 A. I presume they continued so long as the Federal
22 Court has oversight, but I don't recall there's any
23 statement in the order saying when those powers would
24 sunset. You'd have to ask the lawyers technically how
25 that happens.
Page 163
1 Q. You mentioned at the very outset, and you were
2 very specific to let us know that you only became
3 director of the Department of Health January 1, 1999.
4 But are you saying that you had no direct involvement or
5 any involvement at all with Felix related matters prior
6 to that time?
7 A. In short, yes. I was deputy overseeing the
8 environmental protection programs and environmental
9 health services programs. There was no association
10 between those programs and anything that's involved with
11 Felix. The programs that I oversaw were clean air, clean
12 water, safe drinking water, solid and hazardous waste,
13 sanitation, vector control, food and drug, noise and
14 radiation, those more traditional public health programs.
15 I was not involved with the mental health programs at
16 all.
17 Q. Obviously you did have a full plate as you do
18 now, but you never attended any informational briefings
19 at the legislature regarding Felix?
20 A. No. I may have been present during hearings
21 when Felix issues were discussed, for example, during
22 budget hearings and so forth, but candidly, I had my
23 hands full with what I was doing and I was not involved
24 with any of the decisions on Felix.
25 Q. Since that time, since January '99, did any
Page 164
1 criticism of contracts or qualifications of providers
2 reach you directly?
3 A. No specific problems that I can recall with
4 regard to qualifications of service providers, keeping in
5 mind that as we develop these services and look for
6 service providers to provide those services, that there
7 is a learning curve associated with that. I'm not aware
8 of any problems or I can't recall any problems that came
9 to my attention as regards to misappropriation of funds,
10 mismanaging contracts or other problems of that nature.
11 They were undoubtedly issues there, and the division
12 dealt with them as best they could, often trying to work
13 with a contracted service provider to correct the
14 problems rather than terminate the contract. I think
15 this has been said, but under the circumstances, we were
16 having trouble just finding people out there who would
17 provide those services. We didn't have the luxury of
18 cancelling a contract if someone didn't meet the terms of
19 the condition. We'd leave dozens of kids or more without
20 any services. So the philosophy of the department has
21 been to as much as possible work with the service
22 providers to try to upgrade their ability to provide
23 services to be more accountable and to improve
24 performance. You would have to ask the division if there
25 were any contracts cancelled because of contract
Page 165
1 irregularities, but again, let me say I am not aware of
2 those particular problems.
3 Q. Okay. Were there any problems associated with
4 the transition between Department of Education and
5 Department of Health?
6 A. Well, I can say there were many problems that
7 came up in the course of that transition. I think from a
8 policy standpoint, one of the -- in fact, the largest
9 policy decision that Dr. LeMahieu and I made together was
10 the transition to school based services. I think it was
11 probably done late, later than it should have been, but I
12 think it was the right decision to make, but the
13 consequence of that was that we had to essentially
14 rebuild the system around a school based model. I think
15 it was the right thing to do, but it required them
16 developing the resources within the DOE to provide
17 supports in the school for the low end kids that weren't
18 there and a transition often from services that we, the
19 health department, provided off campus to services on
20 campus. In that process we had service providers who
21 were previously providing services off campus who were
22 upset because we were moving to a school based model.
23 Basically, many of them were going to be out of a job
24 unless they could redesign their services as providing
25 those in a school based manner. And there were many,
Page 166
1 many other issues that were associated with that
2 transition. I don't know where -- if you have anything
3 specific in mind, but certainly there were lots of issues
4 and problems associated with --
5 Q. I did have some, but my time is up. I have one
6 final question for you, and that is there was a
7 controversy earlier that developed with the proposed
8 closing and relocation of the Diamond Head Mental Health
9 Clinic, and there was a lot of community concern about
10 the availability of services for children and so forth.
11 What is your clarification on that issue?
12 A. I'm going to need a little help with your
13 understanding of the issue. I think we did propose to
14 transfer the adult mental health services at Diamond Head
15 to another location, consolidate those adult mental
16 health services, and that actually was to in part
17 accommodate some of the expanding needs of the Children
18 and Adolescent Mental Health Division. They were
19 growing, they needed more space, so our objective was to
20 relocate the adult mental health staff and one other
21 program that we had there, I'm trying to remember the
22 name of the program. It was a day program similar to our
23 clubhouse programs, which were also located with the
24 adult mental health program, but we haven't, as far as I
25 know, closed any children's programs at Diamond Head.
Page 167
1 Diamond Head Health Center is the administrative home of
2 the Children's and Adolescent Mental Health Division.
3 They do have a family guidance center there, but that has
4 never been closed nor are we proposed closing it. That
5 continues today. Again, that was the adult mental health
6 program that we had a problem with. That was the
7 controversy, and what we did with that is ultimately left
8 the adult program in place, the community mental health
9 center is what I think it's called, and this day program
10 I mentioned, and have been since then trying to
11 accommodate as best we can the expanding needs of the
12 children at also the health administration division
13 office.
14 Q. Thank you, Dr. Anderson.
15 SENATOR SLOM: Thank you, Co-Chair.
16 CO-CHAIR SENATOR HANABUSA: Thank you.
17 Representative Kawakami followed by Senator Sakamoto.
18 BY REPRESENTATIVE KAWAKAMI:
19 Q. Just a couple of questions, Dr. Anderson. How
20 many high end students now that you have in your shop?
21 A. I believe --
22 Q. When you split out, you know, with DOE?
23 A. I know shortly after the transition we had
24 approximately 4,000 of the 11,000 kids that we were
25 serving, 4,000 more or less. That changes of course from
Page 168
1 time to time, but that's I think a rough number of kids
2 that we're serving.
3 Q. Are there still some going out of state?
4 A. Yes.
5 Q. How many?
6 A. I think last count was about 40.
7 Q. About 40?
8 A. Excuse me. I need to look over my shoulder
9 here. I know we had 70 at one point. How many do we
10 have now?
11 MS. SWANSON: 19.
12 A. We're doing better than I thought we were.
13 We're down to 19.
14 Q. That's great.
15 A. Yeah, it is. That's one of the great successes
16 of our efforts, I think, has been to bring some of these
17 kids back home.
18 Q. So we have enough personnel now to be able to
19 take care of those in Hawaii?
20 A. We have, I believe, largely adequate staffing
21 for the Department of Health in terms of supporting the
22 system. We are continually working on assuring that we
23 have adequate services in place in the community and I
24 think that's going to be an ongoing process, but by and
25 large, I think the resources that we have available to us
Page 169
1 are sufficient to enable us to contract for the services
2 that are necessary. We have -- we don't have the full
3 array of services we would desire in their entirety, but
4 we have gotten a long way there to the point where I
5 believe that any -- that we're close enough for me to say
6 we've got most of those services in place that we need.
7 Q. Okay. So we've come a long way?
8 A. We have. We have come a long, long way.
9 Q. Thank you very much.
10 REPRESENTATIVE KAWAKAMI: Thank you,
11 Chair Hanabusa.
12 CO-CHAIR SENATOR HANABUSA: Thank You.
13 Senator Sakamoto followed by Representative Leong.
14 SENATOR SAKAMOTO: Thank you, Chair.
15 BY SENATOR SAKAMOTO:
16 Q. Dr. Anderson, I guess in looking at the
17 directory, you know, health department, so you have four
18 deputies. About how many people work under each of the
19 four, and I realize there's contracts and other things,
20 not just people, but to get a sort of feel?
21 A. Well, there's 3,200 people in the health
22 department. I've never broken down the numbers, and I
23 hesitate to do that. Of that 3,200, I'm trying to
24 remember how many are in the Behavioral Health
25 Administration, maybe Anita can help me with that.
Page 170
1 MS. SWANSON: About 1,100.
2 A. About 1,100. It's one of the largest portions
3 of the department. About a third of the department staff
4 are there. I'm going to guess at another third or so, so
5 I'm going to say another thousand in total, maybe a
6 slightly higher number being part of the environmental --
7 I'm sorry, the health resources administration. You all
8 know Dr. Presler, she oversees that area. Actually, the
9 environmental health administration is one of the
10 smallest of the administrations. I think there are
11 somewhere in the neighborhood of 600, 700 in that
12 particular administration, and I have a deputy director
13 position which oversees the State laboratory and other
14 miscellaneous offices, and the balance of that would be
15 in those program areas. So that might help.
16 Q. So putting that into that perspective, how do
17 you with your deputies sort of get benchmarks for your
18 department outcome measures that can help guide policy
19 makers, help guide yourself in what areas are we making
20 progress in and value for the dollars spent?
21 A. Let me say focusing first on the Behavioral
22 Health Administration, we have the consent decree and we
23 have the implementation plan and we have the benchmarks
24 which frankly dictate all of what we do in that program.
25 Those are clear guidelines on how we operate in that
Page 171
1 area. The adult mental health program also has a four
2 year plan. I think you may have -- remember our
3 presenting that last year to you, but they have a four
4 year strategic plan with benchmarks and other milestones
5 in it that is helpful in guiding them, that includes the
6 State hospital. In fact, as we speak we are developing a
7 plan to address the remaining issues at the State
8 hospital. That includes also very specific proposals
9 which will eventually be translated into the form of
10 court stipulated orders and benchmarks to deal with the
11 issues of the State hospital. In other areas, the
12 environmental programs have a strategic plan that lays
13 out benchmarks that we're following with strategies and
14 indicators associated with those. For most of the
15 programs we have strategic plans in place which guide the
16 programs in their direction.
17 Q. Okay, let me ask a follow up question. Like
18 zero to three is not in the same -- under the same deputy
19 as CAMHD.
20 A. That's true.
21 Q. However, in many people's impression, early
22 identification, early intervention is a key to keeping
23 costs down once children get to a greater age, so I'm
24 wondering why they aren't together, even though some
25 issues are not mental health, some are others, but
Page 172
1 children's issues, for example, why they aren't all under
2 the same sphere so we can use the money and resources
3 more efficiently?
4 A. Well, I think you hit on it really as to why
5 historically this hasn't been under mental health and
6 that is that the early intervention program, the zero to
7 three program focuses on a wide variety of issues besides
8 just mental health issues, and in fact what happens is if
9 they identify a child at risk, as they go through the
10 screening and assessments, that child would be supported
11 by those programs, but would be referred then to the
12 Child and Adolescent Mental Health Division for services
13 early on, which often prevent more serious consequences
14 down the line. This has been an area that's been
15 neglected for a long time. And thanks to the funding
16 that you all provided last year, we are going to be able
17 to do a lot more in identifying kids early in the
18 process, and hopefully making interventions that will
19 reduce the burdens, financially and otherwise on CAMHD.
20 Q. So I hope you're writing your services are
21 spread out, we've identified basically the basic
22 population, so has somebody come up with a plan in
23 increasing early identification and early intervention
24 for mental health as well as any other disabilities so
25 that globally we as a state can reduce the treatment
Page 173
1 costs, reduce some of the prevention costs, but increase
2 intervention costs?
3 A. I couldn't agree with you more. That's a
4 critical area, we do have a renewed focus on that area.
5 Now we have funding to help to assure that we're doing
6 universal screening of kids, that we're doing the
7 assessments, we're doing follow ups in the family,
8 identifying people who need physical therapy,
9 occupational therapy and so forth to assure that kids are
10 helped early in the process, but there is an elaborate
11 plan for implementation there, too.
12 Q. Well, I don't want the elaborate plan, I think
13 some of us want the simple plan.
14 A. Okay.
15 Q. So are you going to come up with a simple plan?
16 A. I could provide you the plan that has been
17 developed for that program if you'd like to see it.
18 Q. Yeah, please. Thank you.
19 SENATOR SAKAMOTO: Thank you, Chair.
20 CO-CHAIR SENATOR HANABUSA: Thank you.
21 Representative Leong followed by Representative Marumoto.
22 REPRESENTATIVE LEONG: Thank you, Chair
23 Hanabusa.
24 BY REPRESENTATIVE LEONG:
25 Q. Dr. Anderson, as you speak about some of these
Page 174
1 40 contracts that you've provided your waiver over, could
2 you just name a couple of them that there were emergency
3 waivers?
4 A. By name? Are there any specific ones you're
5 interested in --
6 Q. No, no, I just want to --
7 A. -- you might be able to pique my memory on?
8 Q. No, I just want to know what causes you to use
9 your -- this waiver? I mean I know they must be
10 important, but what are they?
11 A. These are contracts for various services, for
12 service providers to provide services to the health
13 department. And they range across the board depending on
14 the specific services. Some provide therapy services as
15 outpatient services, there are other contractors that we
16 hired to provide residential treatment services, we
17 actually hire people to take care of kids overnight and
18 they're provided therapy in homes. There are some
19 contracts that we have to provide much more intensive
20 services. They really range the full gamut of different
21 kinds of services. Some are very short term. There is
22 one contract that was in place for just one kid.
23 Q. I see.
24 A. A specialized service for that one child. But
25 we had to contract for a service provider to provide that
Page 175
1 service simply because it wasn't any other one, anyone
2 else to provide that service. But there's typically
3 services being provided to meet the requirements of the
4 IEP and assure that we have that support in place.
5 Q. Thank you. And I suppose there must be a
6 sunset on each of these contracts or --
7 A. Oh, they're all time limited.
8 Q. All right. And I just had another brief
9 question on that. In the Department of Education we have
10 Dr. LeMahieu, who had been the department superintendent
11 to look over the DOE. I suppose we have you to look over
12 the Department of Health with mental health services,
13 etc. Is that correct?
14 A. Yes.
15 Q. And if there is any kind -- is there anybody
16 else that works as a liaison between the two of you? I
17 know you've got a lot of people but I've often wondered
18 about this question.
19 A. To be honest with you, most of the discussion
20 between our departments goes on at levels below me and
21 Dr. LeMahieu. Miss Swanson I think testified earlier
22 today to the contact she has with Pat Hamamoto as she was
23 then deputy, and they're in touch several times a week.
24 Our staff are in touch much, much more frequently, and in
25 fact, on each of our care coordinators is in touch with
Page 176
1 DOE staff on a daily basis as it relates to the services
2 for individual kids. I think as you move up the ranks,
3 you probably find less and less contact, but generally if
4 you move down, you find more and more. I met with
5 Dr. LeMahieu probably on the average once every couple of
6 weeks and sometimes more frequently depending on the
7 issues, but I'd say on an average that amount of time and
8 probably no less than once a month on a variety of
9 issues, but again, let me emphasize there is regular
10 contact as it is, which is the way it should be.
11 Q. Right.
12 A. Between the two departments. We are joined at
13 the hip with the DOE.
14 Q. Well, that's good to know that. I was just
15 concerned about the overlooking of this whole process,
16 you know, but I think I understand that. I just wanted
17 to clarify. Thank you, Dr. Anderson.
18 REPRESENTATIVE LEONG: Thank you,
19 Chair.
20 CO-CHAIR SENATOR HANABUSA: Members, we
21 just noticed that we've been going for over an hour.
22 We'd like to give the court reporter a break, so we will
23 take a five minute recess. At that time we'll pick up
24 with Representative Marumoto's questions.
25 (Recess.)
Page 177
1 CO-CHAIR REPRESENTATIVE SAIKI:
2 Members, we'd like to reconvene the hearing and we'll
3 continue with questioning by --
4 CO-CHAIR SENATOR HANABUSA:
5 Representative Marumoto.
6 REPRESENTATIVE MARUMOTO: Thank you.
7 BY REPRESENTATIVE MARUMOTO:
8 Q. Do you feel like Superman now that you have
9 super powers, Dr. Anderson?
10 A. I feel tired.
11 Q. Tired? You're not supposed to be tired. I
12 really don't have a question, but I just want to bring a
13 contract to your attention. And I don't know whether it
14 was executed while you were director or before or after
15 you got your super powers, but it was given to Loveland
16 Academy or whatever for autistic children, and I believe
17 it was a sole source contract by CAMHD. And let's see.
18 We were disappointed to hear that this particular
19 facility was headed by a person who probably didn't have
20 the proper credentials, or academic credentials, but
21 subsequently did get them through a diploma mill, and
22 that they might not have a speech pathologist that is
23 licensed in Hawaii. And it was billed as the only
24 facility to handle autistic children in the State, and
25 one of the contract people who was here said that that
Page 178
1 was the only place that they were able to send autistic
2 children, yet in talking to another vendor, subsequently
3 this person said that they would have bid on the contract
4 or submitted a proposal had they had the opportunity, so
5 you know, we apparently gave the contract to a
6 questionable provider in our haste or for some reason to
7 award the contract, and so you know, we're under the gun,
8 so I think sometimes we don't always make the best
9 decisions and so I would just caution you to use your
10 super powers a little more carefully.
11 A. I appreciate that. Let me say, as I have been
12 director now for almost three years, I can't recall any
13 service providers coming to me with a complaint along
14 that line. They may have had a complaint, yes, and I
15 don't say that hasn't happened and I appreciate that we
16 would need to be careful, but I think the staff have done
17 as good a job as they can of trying to identify who's out
18 there even before issuing any contract with these waiver
19 provisions, and of course our continuing to hold whoever
20 is selected to the same terms as we would under any RFP,
21 including payment schedules and so forth, so if there's
22 others out there who feel that they didn't get a fair
23 crack at the contract, I can see why that might happen
24 from time to time, but it's remarkable to me how few
25 times it has happened considering all the contracts we've
Page 179
1 issued, I just want to make that point. And if you could
2 tell me who it might be, I can certainly be sure that
3 next time we're out there we can, you know, contact them.
4 Thank you.
5 Q. The bottom line is we want to be able to have
6 the best service possible for the children that need it.
7 A. Okay.
8 Q. Thank you very much.
9 A. Thank you.
10 CO-CHAIR SENATOR HANABUSA: Thank you.
11 Vice-Chair Saiki.
12 CO-CHAIR REPRESENTATIVE SAIKI: Thank
13 you.
14 BY CO-CHAIR REPRESENTATIVE SAIKI:
15 Q. My first question is more of a macro type
16 question. When there were situations where the
17 Department of Health and the Department of Education had
18 a conflict in terms of an implementation plan or
19 developing plans under the consent decree, how were those
20 conflicts resolved?
21 A. Well, ultimately, Dr. LeMahieu and I would make
22 a decision. I can't recall anywhere we couldn't make a
23 decision. Most often, any problems were resolved at a
24 lower level, and I mentioned earlier that our staff
25 worked together every day, Pat Hamamoto, Anita and others
Page 180
1 are in regular contact trying to solve problems, but I've
2 been impressed that the departments have been able to
3 work together and work out problems. That wasn't always
4 the case. But I think under this current administration,
5 Department of Health, Department of Education have been
6 working well together. That has not been a major barrier
7 as it might have been in the past.
8 Q. Is there a single person on the State level
9 who's in charge of Felix, who's ultimately accountable
10 for Felix within the State administration?
11 A. I believe when the auditor was asked that
12 question she pointed to the governor. If I could say if
13 there's an agency that is responsible, it's the
14 Department of Education without any doubt in my mind.
15 IDEA is an education act, we provide support services to
16 the Department of Education, but again, I suppose you
17 could point a finger at the governor if you really wanted
18 to have a single point of accountability as he's
19 responsible for everything that happens in the State.
20 Q. Well, in your mind who is ultimately
21 accountable for Felix on a statewide level within the
22 State administration?
23 A. I would say the Department of Education first
24 and foremost is responsible under the Federal law for
25 providing these services with others assisting in that
Page 181
1 regard, but the buck stops there in my view. That's not
2 to say we're not feeling responsibility as it relates to
3 provision of services. I feel very committed to
4 continuing this and I don't think the Department of
5 Education is in a position to provide the services we
6 provide to them. But again, let me emphasize that
7 ultimately it's the Department of Education who in my
8 mind is responsible for assuring that students get the
9 support and services they need to benefit from their
10 education, which is what IDEA is all about.
11 Q. Okay. I had a question -- I asked Miss Swanson
12 this question a few minutes ago, and after she finished
13 testifying I was looking at my documents and I found the
14 Department of Health's contempt order response plan which
15 is dated June 14, and we provided a copy to you during
16 the break. Is one of the questions that I -- basically
17 are you familiar with this document?
18 A. I had to ask my staff during the break what it
19 was. And I was reminded at that time that this was
20 submitted as a planning document shortly after we were
21 found to be in contempt.
22 Q. Who drafted this, or what department drafted
23 this?
24 A. I believe that our Department of Health staff
25 were involved in preparing this document. I wouldn't be
Page 182
1 surprised if the AG's office had a hand in it as well,
2 but it was probably a joint effort to identify some of
3 the issues that needed to be resolved following the
4 finding of contempt.
5 Q. Did the monitor assist in drafting this
6 response plan dated June 14, which is a draft? I only
7 have the draft copy.
8 A. I'm not aware of exactly who was involved. The
9 explanation I got for this document was that this was an
10 attempt to pull out of existing plans. We had a service
11 capacity plan, we had a training plan and other plans.
12 The key elements in those plans which were already in
13 place which were important in our view as it related to
14 our continuing to strive to be in compliance, and it was
15 simply a document that tried to identify what elements of
16 those plans were in our view important for consideration.
17 Q. So these -- this plan was basically submitted
18 to the court monitor and included in their recommended
19 benchmarks?
20 A. Yes. Recommended benchmarks as it relates to
21 implementing say the service capacity development plan
22 and so forth. I don't know what the monitor did with
23 this document, candidly he may have just torn it up and
24 thrown it away, but the department attempted through this
25 process to identify what we thought were key issues
Page 183
1 related to at least those two plans I mentioned, the
2 service capacity development plan and our training plan,
3 which we had developed previously as internal planning
4 documents. Essentially we said this is where we're going
5 and let's be sure that the court is aware of what our
6 plans are so that they can craft an order appropriately.
7 Q. One of the issues that we've been focusing on
8 is MST and its inclusion as a benchmark. Was MST -- MST
9 continuum, the MST continuum is an experimental program,
10 it has never really been used on the class of children as
11 it was used in Hawaii. It is a product from a --
12 emanating from the -- either a for profit or nonprofit
13 entity on the east coast that can stand to benefit
14 financially from this program if it's proven successful,
15 so one of the issues that we've been focusing on is why
16 it was included as a benchmark, and the testimony that we
17 heard today earlier, I'm sorry, I didn't catch this
18 earlier, but was that the embassy benchmark was included
19 unilaterally by the court monitor and that the health
20 department did not request that it be included as a
21 benchmark. The court monitor obtained the MST
22 recommendation or the MST data from the CAMHD needs
23 assessment survey, but yet in this document on page --
24 well, there's no page numbers, but on the fourth page
25 right on number three, there is a specific recommendation
Page 184
1 for an MST benchmark, 56 youth by July 2001. So it
2 appears here that the health department did in fact
3 request that MST be included as a benchmark. Is that --
4 do you have any idea why?
5 A. Again, let me emphasize that as far as I know,
6 the document here simply identifies those elements of
7 existing plans which probably included multi-systemic
8 therapy as an element. I'm not familiar with why that
9 was identified as a -- or highlighted as a benchmark. I
10 see the same thing you do and that is it's listed as one
11 of the possible benchmarks for consideration.
12 Q. Well, do you know -- do you know whether or not
13 the individuals who owned MST from the east coast were
14 here in Hawaii to lobby the health department to include
15 MST as a benchmark, to lobby either the health department
16 or the court monitor? I know they lobby in the
17 legislature, but did they lobby anybody else from the
18 department level or from the court monitor's office?
19 A. They never lobbied me. I don't know who else
20 they may have spoken to.
21 Q. Okay, thank you.
22 CO-CHAIR SENATOR HANABUSA: Are you
23 done?
24 CO-CHAIR REPRESENTATIVE SAIKI: Yeah.
25 BY CO-CHAIR SENATOR HANABUSA:
Page 185
1 Q. Dr. Anderson, you can imagine this committee is
2 very sensitive when people say things about us that can
3 be misconstrued. I want to clarify something that you
4 said earlier. Did anyone on this committee or the
5 committee itself ask that you personally or Miss Swanson
6 or Miss Donkervoet or any of your staff sit throughout
7 these hearings which may have taken you away from other
8 matters, including complying with the Felix Consent
9 Decree? Did we ask you to be here on a -- when you're
10 not testifying?
11 A. No. Certainly not. My staff have attended as
12 time allows, but there was no directive for anyone to
13 attend these meetings. I think we're very interested in
14 what you find, candidly I think the activities of the
15 committee are of interest, and if there are problems or
16 issues that you identify as a result of your
17 deliberations we'd like to know those and correct them if
18 we can.
19 Q. Thank you. Because I don't want anyone to be
20 left with the impression that it's somehow because of
21 this committee that both -- well, Miss Swanson definitely
22 and Miss Donkervoet have really been here for a lot of
23 the hearings and I don't want people to believe that we --
24 or be left with the impression that the committee is the
25 one that's taken them away from their work. The second
Page 186
1 point is you were kind enough to send to Representative
2 Saiki and myself a response to the subpoena, and I was
3 just kind of curious about how this happened. According
4 to this Exhibit A, Miss Swanson as the deputy director of
5 behavioral health to whom Miss Donkervoet reports earns
6 $6,323 a month, where Miss Donkervoet earns $8,195 a
7 month, and I think your salary is statutorily set and she
8 also earns more money than you. Isn't that correct?
9 A. And probably 100 other employees in the health
10 department that are in the same boat.
11 Q. So how is it that that came about?
12 A. Well, if you want to raise my salary I'd be
13 very happy to oblige, but it happens that the directors
14 and deputies have not had a raise in salary for over ten
15 years. Our salaries are not keeping up with I think
16 what's appropriate, but that's a legislative decision on
17 the governor's part. I think we are paying a competitive
18 salary for the professionals that we're recruiting.
19 Q. And that's Miss Donkervoet, for example. Do
20 you by any chance know how much her husband was making as
21 a clinical director?
22 A. No, I don't, but I can tell you that the
23 physicians in our department are often making 130,
24 $140,000 a year, something in that range.
25 Q. And someone in his position would be -- he
Page 187
1 could possibly qualify for that income range?
2 A. I think he's a psychologist, typically they're
3 not paid as much, but I don't know what he's being paid.
4 Q. But someone with his credentials would possibly
5 be making what, less than 130, 40, maybe 100 to 120,000?
6 A. I really don't know what the class pays. The
7 positions that we have a hard time filling now are the IT
8 positions, often the specialist positions and people have
9 tried to hire psychiatrists don't realize how difficult
10 they are to find at any price. There are not a lot of
11 people with specialized experience in this area.
12 Q. Well, you can provide the committee with how
13 much he was making, I know he resigned recently, with how
14 much John Donkervoet was making?
15 A. Oh, certainly I can tell you how much he was
16 being paid.
17 Q. Okay. The other question I have is I think you
18 made a statement that the Department of Health has met
19 its benchmarks, is that correct? Did I hear you
20 correctly?
21 A. Correct. As far as I know, we -- we, again,
22 the health department has been able to meet the
23 benchmarks that were stipulated, even that one benchmark
24 as it related to the MST continuum we talked about where
25 we had to have I think it was 56 people enrolled.
Page 188
1 Q. Right.
2 A. That as I understand it was withdrawn, so I'd
3 say technically we're meeting all the benchmarks now that
4 that's been withdrawn, but everything else we've been
5 able to comply with.
6 Q. Do you know how that was withdrawn?
7 A. Well, when we made a decision to discontinue
8 the program it was obvious that it would ridiculous to
9 keep a benchmark in there related to the program.
10 Q. So did you write a letter as represented
11 earlier to the monitor and say that we can't fill this
12 number and withdraw it?
13 A. Yes.
14 Q. Do you remember when you wrote that letter?
15 A. I think it was in the August time frame but I
16 would have to check on that. We can provide you a copy
17 of that letter.
18 Q. That's fine. Do you remember when you first
19 became aware that there's some kind of problems with the
20 benchmarks themselves? I mean -- sorry, with the
21 benchmark on MST, that the MST continuum program may have
22 to be terminated?
23 A. I was aware as we've tracked their benchmarks
24 that we were not approaching the benchmark for the last
25 six months, or I should say almost a year now, that we're
Page 189
1 having trouble recruiting into the program. We have been
2 monitoring our progress there. When Miss Donkervoet
3 brought to me the situation and described the problem, it
4 was a very easy decision for me to say let's terminate
5 the program. We weren't going to be able to recruit into
6 the program and I wasn't about to put people in a program
7 who didn't belong there. It was an easy decision to make
8 at that point in time.
9 Q. And is it your recollection that as to the time
10 frame when she first brought it to you?
11 A. I believe she brought to me a recommendation in
12 the July time frame and it was shortly after that, after
13 I made a few inquiries that we made a final decision to
14 terminate the program.
15 Q. Dr. Anderson, the $800,000 that we appropriated
16 for you, what happened to the rest of that money?
17 A. You know, I'm not sure that was -- I'll have to
18 check on what the disposition of those funds was. I
19 don't know that it was a separate account. As I recall,
20 there were funds backed out of our budget as a result of
21 the last review, obviously those monies would be applied
22 to other services. We're about twelve million dollars
23 short, as I testified earlier, so those monies would be
24 applied to meeting some of the needs in other program
25 areas.
Page 190
1 Q. Isn't that 12.8 million dollars that you
2 referred to earlier, wasn't that because of the 33
3 positions?
4 A. There were other funds attached to those, there
5 were other funds involved. The 33 positions specifically
6 were care coordinator positions.
7 Q. Right.
8 A. And there was funding associated with those,
9 but there was also service dollars in there. I would
10 have to get back to you exactly on what -- what that
11 involved but --
12 Q. My recollection is that the bulk of that money
13 was for those 33 positions?
14 A. It's probable that a large portion of that was.
15 Q. Yeah. You can give me the breakdown later,
16 because I recall a specific conversation with you about
17 the 800,000, and you had said that that was absolutely
18 necessary because it was required under the Felix Consent
19 Decree and that's the benchmark issue?
20 A. Yeah. At that time that's correct.
21 Q. Now, my time is up, so let me first open it up
22 to anyone else with any follow up questions.
23 SPECIAL COUNSEL KAWASHIMA: I have
24 none.
25 CO-CHAIR SENATOR HANABUSA: None? Any
Page 191
1 more this way? Any more follow up questions? Why don't
2 you ask it?
3 BY CO-CHAIR REPRESENTATIVE SAIKI:
4 Q. I have a follow up question, Dr. Anderson, also
5 referring back to the June 14 document. There is a
6 request there, actually it's right under the MST
7 benchmark, where the health department is requesting
8 super powers, although somewhat limited here, to raise
9 the small purchase amount from $25,000 to $250,000 under
10 Chapter 103F. It's on the fourth page.
11 A. I'm sorry, one, two, three, four. And I'm
12 sorry, let me find the spot again. One, two --
13 Q. It's on the fourth page in the middle.
14 A. Middle of the page?
15 Q. It says possible court language if needed?
16 A. Okay. I see it, yeah. Excuse me. I'm looking
17 right at it. Yeah.
18 Q. It's a request for super powers to increase the
19 small purchase -- it's a request to increase the small
20 purchase amount from 25,000 to 250,000. It's a
21 procurement related request.
22 A. Yeah. Again, I think -- I think you should
23 take into consideration the context in which this
24 document was developed. This was not a final document of
25 any sort and there were some ongoing discussions between
Page 192
1 the Department of Health, the AG's office, the court
2 monitor at this time. It's very likely that there was
3 some discussion around the need for some special
4 provisions if we were going to meet the time frames
5 identified of this nature. As I say, I don't recall ever
6 requesting anyone that we have super powers. I think it
7 was determined to be necessary to be able to meet the
8 time frames that were being discussed at the time.
9 Q. Well, the super powers is kind of a significant
10 issue in the scheme of things, and do you recall who
11 first broached that issue, that matter?
12 A. The first time I heard it discussed was by our
13 Attorney General or Attorney General representatives as a
14 possible part of the order. I know there was some
15 discussion at the staff level about the difficulty we
16 have in procuring services in a timely manner. There may
17 have been other discussions at that level about how we
18 might go about assuring that those services could be
19 provided. Again, I don't recall anyone from the
20 Department of Health requesting of the court or anyone
21 else that we have these super powers. I think it was
22 determined largely by the court to be necessary in order
23 for us to proceed. It's no secret that we have a long,
24 protracted procurement process, and that that has been a
25 barrier to some people's mind in aggressively and quickly
Page 193
1 putting services in place, so I think it's probably a
2 solution that was identified by the court as being
3 appropriate to address that particular issue.
4 Q. Okay. My time is up. Thank you very much.
5 CO-CHAIR SENATOR HANABUSA: I have a
6 follow up, Dr. Anderson.
7 BY CO-CHAIR SENATOR HANABUSA:
8 Q. What was produced to us from the Department of
9 Education is a Felix Monitoring Project, Inc. and these
10 are quarterly reports, and I notice that you were also
11 CC'd on these. Do you recall receiving them? They're
12 basically from Dr. Groves giving you what's happened,
13 what the monies are spent for. Do you remember receiving
14 those reports?
15 A. I do get a copy of all the quarterly reports.
16 Q. Okay.
17 A. And I try to read them.
18 Q. Okay. Let me ask you this then. In one of the
19 quarterly reports there's some reference to an
20 individualized education plan development. Do you recall
21 any discussions on what that is? Doesn't ring a bell,
22 huh?
23 A. Doesn't ring a bell. Obviously, the individual
24 education plans are discussed all the time but I don't
25 know about any --
Page 194
1 Q. This looks like it's a development of an
2 individual education plan of some sort. You don't recall
3 anything like that?
4 A. The only context in which I know of individual
5 education plans being developed are around specific
6 cases.
7 Q. This is -- this is to initiate one, so it must
8 be that it's some new plan, but if you don't know about
9 it I'll see if the Department of Education person does.
10 How about Title 4E monies, isn't that only through the
11 Department of Health? Title 4E monies, that's the
12 training monies? I don't see it in the DOE.
13 A. Yeah.
14 Q. I've seen it in reference to you like we
15 discussed earlier with Miss Swanson on the emergency
16 request. Isn't that basically a Department of Health
17 funds?
18 A. I can say we do have Title 4E funds, and let me
19 emphasize those are Federal funds, and incidentally, I
20 did ask Anita to look into this issue as to what happened
21 with regard to the funding last year. And the best
22 information I've been able to get so far is that what we
23 requested last year was a increase in the ceiling for
24 expending these Federal funds of $478,852. Our ceiling
25 at the time was 1.17 million dollars. That would raise
Page 195
1 the ceiling then to 2.25 million dollars. That funding
2 is used to support training for care coordinators and
3 other professionals in our staff. None of that money
4 went to the Felix monitor's office for training, as far
5 as we know.
6 Q. Do you know whether the monitoring -- the Felix
7 monitoring project itself makes claims for reimbursement
8 directly to the Federal government for Title 4E type
9 monies? Are you aware of that?
10 A. I'm not aware of any claims they may have made.
11 They bill us as the court approves for services and we
12 pay them.
13 Q. But isn't it also true that all that Department
14 of Health basically reports having spent for the monitor,
15 the Felix monitoring project are the flat amounts that
16 they ask for, I mean the lump sum payments, which is
17 about 600,000 and they asked for an additional 150.
18 Isn't that true?
19 A. That's true. We pay them what the court tells
20 us to pay them.
21 Q. The reason I ask is because as part of these
22 reports that the monitor has sent to you, they said
23 submitted 4E claims of $81,676.86 for reimbursable
24 training activities. Reimbursement claim to date is
25 $110,465.41, so it looks like in the first quarter they
Page 196
1 got 110,000, in the second quarter they're asking for
2 81,000, and it's a Title 4E claim. So did that ever
3 catch your eye and wonder what that was about?
4 A. No, it did not catch my eye, and I don't know
5 what it was all about.
6 Q. So I'm kind of curious as to how and what
7 happened to, one, that money, that reimbursement, and
8 two, where it comes from. Is there any other agency
9 within the State that you're aware of that has anything
10 to do with Title 4E monies besides yourself?
11 A. I have to profess some ignorance in how Title
12 4E works. I don't know what agencies might have access
13 to those funds. I know we do have access to those funds
14 and we are accountable for the funds we spend and I think
15 I mentioned to you how we spend those funds from our
16 department.
17 Q. Okay. My time is up.
18 CO-CHAIR SENATOR HANABUSA: Members,
19 any other follow up questions? Senator Sakamoto.
20 SENATOR SAKAMOTO: Thank you, Chair.
21 BY SENATOR SAKAMOTO:
22 Q. Dr. Anderson, in the monitor's status report,
23 the one that was till November 2002, one item, benchmarks
24 42, 45, 51 and 54 relate to the complex as a complete and
25 accurate service gap analysis and report. And in it it
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1 mentions both Department of Health, CAMHD and the DOE.
2 Is it -- is the DOH portion still being completed as well
3 or I guess in previous testimony seemed to indicate that
4 DOH was done with their share and the remaining portion
5 remains to be Department of Education? I just wanted to
6 clarify on that particular item, is your part done or
7 your part still ongoing, just as DOE's part is?
8 A. I need to see the document. Let me -- actually
9 I have a copy of it. I have a copy. This is ongoing. I
10 don't think that takes away from my statement that we're
11 on track with regard to meeting the benchmarks, and I
12 fully anticipate that come March 31, the Department of
13 Health at least will be compliant.
14 Q. With at least this one related to service gaps
15 which --
16 A. Yes.
17 Q. -- which complexes can get what services?
18 A. We will have billed out the full array of
19 services that are necessary at that time in my
20 estimation.
21 Q. We pray you'll be there as well as the DOE, but
22 I just wanted to clarify, because on one hand we don't
23 want to go with the representation that DOH is done and
24 the rest of the work is DOE work.
25 A. I don't want to say that we're done either, and
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1 I think we've got a lot of work ahead of us. We're going
2 to continue to fine tune those services. I do want to
3 say we've come a long way and I do appreciate all the
4 support that you all have given us for the years. I mean
5 we have a very dedicated staff in our department, we're
6 committed to making these services work for the State.
7 Q. Okay, thank you.
8 SENATOR SAKAMOTO: Thank you, Chairman.
9 CO-CHAIR SENATOR HANABUSA: Thank you.
10 Any other follow up? If not, members, thank you very
11 much. Dr. Anderson, thank you very much. And we will be
12 in recess and we'll reconvene Friday at one o'clock in
13 this room. Thank you.
14 (Hearing concluded at 4:19 p.m.)
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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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