By Valerie Monson

HONOLULU (The Maui News, Dec. 13) - A report by the state auditor's office found that the Department of Health has "exercised poor management" of the Kalaupapa settlement, authorized excess payments to some staffers and failed to listen to the patients' concerns.

The two-page summary was especially critical of Kalaupapa administrator Michael McCarten, who was described by the patients as "abusive, rude and lacking in compassion."

Kalaupapa is home to fewer than 40 people who were once banished to the Molokai peninsula because they were diagnosed with leprosy, also known as Hansen's disease. State law says that, although cured, the patients may live at Kalaupapa for as long as they want with services provided for their well-being. The last patient was admitted to Kalaupapa in 1973 after the state's isolation laws were abolished four years earlier.

The audit was the result of action taken by the patients last winter. Gloria Marks, president of the Kalaupapa Patients Advisory Council, said she and others in the community had been frustrated by apparent abuses of the system taking place in Kalaupapa, far from the watchful eyes of Honolulu. Because the patients, most of them elderly, could get no one at the Health Department to listen to them, they went to the state Legislature and pleaded for an audit.

Many of their claims were validated by Auditor Marion Higa in her report issued Friday. Higa found that McCarten had authorized excess compensation to settlement staff for airplane travel and "trail pay" for those who use the Kalaupapa Trail to get to and from their homes on topside Molokai.

When reached at her job at the Kalaupapa Bookstore, Marks said she was pleased that the patients were vindicated, but she was sad the whole situation had to happen. The recent turmoil has been disruptive for everybody in the little community.

"It's way overdue, but it's too bad we had to go this far to make others understand what the patients were going through," said Marks. "If they would have only listened, instead of just going ahead and doing what they wanted. Maybe somebody's going to finally wake up."

Janice Okubo, Health Department communications officer, said corrective steps were already under way to make life better at Kalaupapa. While Okubo said that no "major changes in personnel" were expected, meaning that McCarten will be kept at his post, more staff training and improved communications were in the works.

McCarten, who has worked at Kalaupapa for more than 10 years, did not return a call Friday afternoon.

Since the patients went to the Legislature last session, the Health Department has been trying to address some of the concerns. More meetings have been taking place, a trend that will continue.

Okubo also said officials were pleased that Higa recognized that the department had been meeting the medical needs of the community.

"In some respects, the auditor has brought forth issues we definitely need to change," said Okubo. "We will meet the nonmedical concerns of the patients there."

While the patients chastised McCarten, Higa noted that he "received consistently high marks from his superiors." Higa also reported that McCarten "lacked the background and experience to work with the elderly and those with special needs" but was never given training in those fields.

In a written response to Higa, Health Director Dr. Chiyome Leinaala Fukino defended the positive evaluations of McCarten while acknowledging that efforts will be made to help him with his position in the community.

"The department will work with the administrator to improve the image the patients have of him," wrote Fukino. "We will provide opportunities for professional development including additional knowledge and skills in communication and issues pertinent to managing a community of aging adults."

Higa also found examples of possible misuse of state money.

She said that four employees were wrongly reimbursed for 75 round-trip airfares that totaled more than $6,500 beyond what collective bargaining allows. One staffer alone received more than $3,000 in excess air travel reimbursements.

Okubo said she did not know if those employees would be required to pay back the state.

In addition, the report questioned weekly purchases of food or other supplies from commercial markets outside of the settlement that were covered by the Health Department, but Fukino wrote that those expenses were justified because the Kalaupapa administrator hosts "numerous (many uninvited) dignitaries and other individuals visiting the settlement as part of his job duties." She said food credits to clergy at Kalaupapa, who also host many volunteer groups that perform valued services for the community, "might go as far back as Father Damien's time" when he served as administrator.

Higa said a failure to develop policies and procedures for nonmedical needs had contributed to the patients' "perceptions of abuse and unfair treatment" in some administrative practices.

"Finally, we found that the department's poor oversight extends to its inability to distinguish between patient and nonpatient costs," wrote Higa.

Marks said that's been at the crux of the matter.

"They've been using the patients as pawns," she said.

December 15, 2003

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