The Hawaii State Hospital, the only publicly funded, state psychiatric hospital in the islands, just fired three top-level managers as it struggles with patient overcrowding and an ongoing shortage in staff exacerbated by the COVID-19 pandemic.

On Thursday the hospital’s Chief of Nursing Lani Tsuneishi and Associate Administrators Dr. Bim Strausser and Tony Fraiola were reportedly escorted off the premises after they were fired with no explanation.

Tsuneishi, who has worked at the hospital since 1992, said Saturday that she was still shocked by her termination. She called it a “slap in the face” when a state Attorney General officer presented her with a termination letter and escorted her from the hospital.

“I said, ‘I’ve been here 30 years, so what’s this all about? Did something go wrong, what happened?” Tsuneishi said. “(They said), ‘As an at-will employee, we don’t have to give you a reason. We can just let you go.’”

The hospital’s acting administrator, Kenneth Luke, in an email dated Thursday to the hospital staff, announced the firing of the hospital’s three senior managers and said leadership will be restructured.

“Other leaders will be asked to take on new roles to help our organization to move forward,” Luke said in the email.

The letter didn’t provide a reason for the terminations or its decision to restructure, although it suggested that a growing number of patients at the hospital was front of mind when it made its decisions.

“Hawaii State Hospital is being challenged with maintaining quality care in a safe and therapeutic environment, while having to manage an ever-increasing demand for our services,” Luke said in the letter. “I am confident that, by functioning as one team, we can meet this challenge.”

At the time of her termination, it did not appear that Tsuneishi was in poor standing at the hospital.

“I was at work and we were getting ready for an executive meeting so we can go over the issues of staffing, the issues of overtime,” she said. “It’s so funny because (Luke asked), ‘Why don’t you take the administrator job?”

The state Department of Health did not immediately reply to an inquiry from the Honolulu Star-Advertiser.

The staffing shortage, addressed by overtime, and patient overcrowding were described as top issues at the state hospital, which provides psychiatric treatment for patients from Hawaii’s court system.

A number of factors contributed to those issues, Tsuneishi said, although the pandemic appeared to be the catalyst for the hospital’s current situation.

One impact it had at the hospital, the state and the country was burnout of medical staff.

“We have a really good young staff, but the more experienced staff, they were done, they were burned out. A lot of them left,” Tsuneishi said. “Overtime budgets are through the roof. It’s not just our hospitals — every hospital can tell you that.”

The pandemic, according to the hospital’s annual report for Fiscal Year 2021, did contribute to a drop in admissions: It had 229 admissions that year, down from 331 and 364 admissions respectively during the previous two fiscal years.

They’re back on the rise, as suggested by Luke’s letter and Tsuneishi’s descriptions of the state of the hospital.

That’s certainly been the case over the last few weeks, as admissions have about doubled. Tsuneishi said she’s not entirely sure what caused the most recent surge, but it’s contributed to what appears to be a dire situation.

“We would get one admission every two or three days. The other day we got seven admissions in one day,” she said. “Where are we going to put these patients? They ended up in seclusion rooms, they ended up in activity rooms. Poor patients weren’t getting activities or programming because we were using (those areas) for bed space.”

Tsuneishi also said patients are directed toward the state hospital, even if it doesn’t have any space for them.

In 2020 the state Legislature passed Act 26 to aid in the decriminalization of mental illness by quickly diverting those convicted of nonviolent petty misdemeanors from the criminal justice system, instead encouraging rehabilitation, which the state hospital can provide.

The hospital also has no authority on who can or cannot be admitted if they’re sent from the court system, Tsuneishi said.

“(Other hospitals) have the luxury of closing and saying no to admissions. We don’t,” she said. “We can’t say, ‘No we can’t take this person because we don’t have a bed.’ We have to make a bed, we have to find a bed.’”

While these have been issues the ousted leaders of the hospital were trying to address, Tsuneishi, now on the outside looking in, said it still needs attention.

“At this point, somebody’s got to talk about what’s happening there. I just feel so bad that the patients suffer, that the staff suffer,” she said. “I would guarantee you that the staff is there because we want to provide good care. We do — I did. It just hurts me beyond belief to be walked, to be escorted off like that.”