Lawmakers took Hawaii State Hospital officials to task over reports that escaped patient and admitted killer Randall Saito had a half-dozen sexual relationships while in the psychiatric facility’s care — including with hospital employees, who legislators believe may have helped him escape in November.

Members of the House Health and Human Services Committee considered a bill Friday that would provide the hospital with millions of dollars for increased security at the Kaneohe campus, including for electric ankle monitors and a perimeter security fence that is estimated to cost at least $17.4 million.

Some lawmakers said they are skeptical of investing in security measures when internal controls appear to be lacking.

“We want to do all we can to protect our communities and keep the State Hospital secure,” said House Health and Human Services Chairman John Mizuno. “However, we can build the Great Wall of China around the State Hospital, but if you’ve got a ward of the state walking through the front gate, it doesn’t really matter, does it?”

Mizuno said an evaluation of Saito in 2010 by psychiatrist Dr. Gene Altman revealed Saito had six “significant relationships” since being committed to the State Hospital in 1981, according to an assessment filed in court records. Three of those relationships, he said, were reportedly with hospital employees, and the others were with women who visited the facility.

Saito, 59, was committed to the hospital in 1981 after he was acquitted by reason of insanity in the shooting and stabbing death of Sandra Yamashiro at Ala Moana Center two years before. He was diagnosed with sexual sadism and necrophilia.

“The concern that this committee has is that when we have a person who is a ward of the state, he or she is in the State Hospital, our duty is to protect them and help them rehabilitate,” said Mizuno (D, Kamehameha Heights-Kalihi Valley). “There seems to be significant evidence that the person in question had sexual relations with at least three staffers.”

He added, “That’s part of the reason how Randall Saito probably got his privileges and was able to escape. He got a lot of contraband, and this is a major concern.”

Saito escaped from the hospital grounds Nov. 12, hailed a taxi, flew a chartered flight to Maui and then flew to California before being captured three days later. Surveillance video footage would later show him taping the locks of doors in the facility, retrieving a bag with clothes and other items from a locked cabinet and walking off the campus after opening a combination-locked gate. He has since been extradited and charged with felony escape.

Beyond safety concerns, lawmakers Friday also cited criminal liability on the part of the employees accused of engaging in sexual relations with Saito. It’s unclear whether any were prosecuted.

Sexual contact between correctional employees and anyone imprisoned or detained by the state is a crime under the state’s sexual assault laws. The offense of third-degree sexual assault also prohibits anyone from knowingly subjecting to sexual contact another person who is “mentally defective, mentally incapacitated or physically helpless.”

Hospital officials would not directly confirm whether the encounters occurred and were unsure whether any written policies exist that explicitly prohibit sexual contact between staff and patients.

“There is an understanding; we do training on appropriate boundaries between patients and the employees,” Hawaii State Hospital Administrator William May told lawmakers. “The sexual, the situations happened many, many, many years ago. The gentleman was a patient at the hospital for close to 40 years.”

Mizuno said that’s not an excuse: “Whether it happened 10 years, 15 years, 20 years ago … this can always come up again in present day.”

May said he didn’t know whether any employees were terminated, but emphasized that the employees who have been placed on leave as part of the investigation into Saito’s escape “had nothing to do with those circumstances.”

“I think it’s important to realize that back in the early ’90s some of the things may or may not have happened, but the staff members who were put off duty relevant to this escape, there was nothing mentioned in regards to that at all,” May said.

Mizuno said more escapes could happen if employees are allowed to have close relationships with patients. “Our concern going forward is that … if this type of behavior continues, nothing precludes the gate from being opened for another patient,” he said.

House Majority Leader Della Au Belatti (D, Moiliili-Makiki-Tantalus) said the hospital — the state’s only publicly funded psychiatric facility for criminal patients — needs to revisit its policies.

“You folks are a unique hospital situation, and I think it behooves the administration to look at what are some of the administrative policies in other criminal settings where there are explicit policies: ‘There shall be no sexual contact between patients and staff,’” she said. “That should be grounds for immediate termination.”

Belatti added, “The $17 million wall is not going to stop the person who has a way to get out because they have the assistance of people either inside or external of the institution, and that’s what we have to be focused on as well.”

Mark Fridovich, adult mental health administrator for the state Health Department, said the hospital is not designed to be a prison setting.

“It’s a hospital. The functions are rehabilitative. People are entrusted to the custody and care of the director of health for rehabilitation, and some of that means testing their opportunity for safe functioning in increasingly normative environments,” Fridovich said. “So risk will never go to zero. We are quite pleased with the progress that’s been made in reducing a very high rate in the early 2000s of escapes to a very low rate today. It’s not zero, so more work needs to be done.”

May said that since 2001, when there were 28 escapes in that year alone, the rate of so-called elopements has dropped to an average of fewer than two per year.