A report on the Hawaii State Hospital adopted by a Senate investigative committee Wednesday described numerous problems at the state’s only public mental health hospital, including poor management, the appearance of nepotism and abuse of overtime.

The report came after 14 witnesses testified during 10 hearings before the committee, which looked into misconduct and worker safety at the Kaneohe facility.

Some issues in the report:

» The top six overtime earners received a total of about $200,000 in overtime in fiscal year 2013, which was about 6.7 percent of the hospital’s $3 million overtime budget.

» The hospital spent $530,000 in 2011 to create a psychiatric intensive care unit that was closed within months after a patient attacked an employee and has been used only a few times since for low-risk patients.

» The associate chief nurse has six relatives and the director of nursing has five relatives working at the hospital.

» Only one person monitors 140 security cameras.

» The hospital lacks procedures to alert the public of escapes.

The report said the State Hospital has a longstanding problem with keeping a safe work environment for workers and if the problem is not addressed, a fatality will occur at the hospital.

"There are very significant problems at the Hawaii State Hospital, all of which can be fixed," said Sen. Josh Green, co-chairman of the committee. "But it’s going to take a change in the culture."

The Senate committee began hearings in March after hospital workers raised concerns about working conditions last November. More than 600 people work at the hospital, which has about 170 patient beds, but averages close to 200 patients.

The committee’s report includes more than 20 recommendations to improve conditions for patients and staff and to protect the community.

The recommendations include sending high-risk or violent patients to the mainland for treatment and consider fencing the campus perimeter to prevent escapes.

Sen. Clayton Hee, committee co-chairman, said the Department of Health recently implemented a policy to send the most dangerous patients to the mainland and since 2010, two have been sent to South Carolina.

According to the report, only about 5 percent — or 10 patients — are so violent they create a greater danger at the hospital and sending them to the mainland would create a safer environment and save the state about $350 a day. It costs $657.97 a day to care for one patient at the hospital.

The report will be given to senators Thursday during a special session convened for judicial nominations.

Green said improvements won’t be accomplished overnight, but he vowed to work on implementing the recommendations as long as he’s chairman of the Health Committee.

Janice Okubo, DOH spokeswoman, said the department is encouraged by the report and hopes it leads to more state funding.

She said the hospital needs money to replace the Goddard Building, a ward no longer being used, with a building that can house more patients.

Kalford Keanu Jr., 37, a psychiatric technician who said employees fear retaliation from management and need better training for handling violent patients, liked the recommendations in the report.

Keanu was injured last October while trying to stop a patient-on-patient attack and plans to return to work in January.

"I like helping out the patients," he said. "It’s a lot easier to care for the patients when you don’t have to worry about the leadership targeting you."

Hee said there already have been changes at the hospital. He said policies are being implemented for more transparent hiring procedures and a new administrator was hired.

"There’s a cultural shift because now people know," he said.