The 25-year-old Hawaii State Hospital patient accused of fatally stabbing a 29-year-old nurse, was indicted Wednesday on one count of second-degree murder.

An Oahu grand jury indicted Tommy Kekoa Carvalho, who was a patient at a transitional group home on the campus of the State Hospital in Kaneohe.

The victim, Justin Bautista, was a nurse at the group home, and worked at the hospital for four years.

Circuit Judge Ronald Johnson ordered Carvalho to be held without bail, instead of the $1 million bail the grand jury had set. He is being held at the Oahu Community Correctional Center.

The court scheduled Carvalho’s arraignment and plea hearing for Monday. The case is being prosecuted by the Hawaii Department of the Attorney General.

There were no details available on what prompted Monday’s incident and what was used in the stabbing. Hospital Administrator Dr. Kenneth Luke called it an “unanticipated and unprovoked incident.”

However this was not Carvalho’s first attack. Carvalho pleaded guilty to assaulting an employee “at a state-operated or -contracted mental health facility” in May 2020.

He was also charged in 2016 of three counts of felony terroristic threatening on Kauai and acquitted due to mental incapacity in 2017, and sent to the State Hospital.

Court records also show that Carvalho was granted conditional release from the hospital, and recommitted on multiple occasions.

He was ordered to the State Hospital four times, and spent a year at the secure facility until August.

In response to questions about whether there were any concerns about Carvalho in light of the 2020 assault, state Department of Health officials said that information would have been considered when the decision was made to discharge him.

“It is public record that the patient pled guilty to assault in the third degree that was reported to have occurred on May 29, 2020, during a State Hospital admission,” department spokesperson Claudette Springer said in an email to the Associated Press Wednesday.

She added that such information, along with the patient’s hospitalization record, are “carefully reviewed and considered” when making a clinical assessment over whether to discharge a patient.

The hospital primarily houses patients with significant mental health issues who have committed crimes and have subsequently been ordered there by the courts. Courts may also order people to stay at the facility while they wait to be evaluated for their mental fitness to stand trial.

State Public Defender James Tabe said Wednesday that his office is expected to represent Carvalho at his initial appearance on the murder charge. Tabe declined to comment on the case.

Attorney Benjamin Ignacio represented Carvalho in the 2020 assault case. “Tommy was a mental health defendant and that always presents very difficult problems for both prosecuting and defending … so it’s very unfortunate,” he said Wednesday. “Mental health is a very difficult kind of legal problem.”

Bautista’s brother described him on a gofundme page as a “gentle and kind soul with the biggest heart.” He was the sole provider for his family, and leaves behind a fiancee and a 1-year-old daughter.

“If you personally knew him, you would always be drawn into his smile and positive energy,” Jester Bautista said of Justin, his only brother. “If you personally knew him, you would always be drawn into his smile and positive energy. He was naturally funny and loved to laugh.”

Justin Bautista was a hard worker and provider, managed a full-time job and worked six days a week, sometimes working double shifts, his brother said.

Bautista’s wish for his final resting place is on Kauai, he said.

The gofundme page was set up to cover funeral home and travel expenses to return Justin Bautista to his native Kauai. It has raised $12,065 of the $15,000 goal.

The Associated Press contributed to this report.