How Effective Is Hawaii’s Key Court-Sanctioned Drug Treatment Program?

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For a year, Andrey Lake stuck with the program at Sand Island Treatment Center, as ordered by a Honolulu judge in his second-degree burglary case.

Then, in late August 2018, he got a pass from the drug treatment facility to visit family. He got high and failed a urine test. Sand Island kicked him out.

A couple of weeks later, police said he was on the lam. He was featured on KHON’s “Hawaii’s Most Wanted.”

Eventually, he was sentenced to 10 years at Halawa Correctional Facility, where he’s now looking at a release date in late 2028.

“I was made to look like a savage beast and sentenced like one,” Lake wrote in a letter to Civil Beat. In prison, he said the opportunities for treatment of his meth addiction are extremely limited.

A variety of Hawaii state agencies, the federal government and the state’s Medicaid program all spend taxpayer dollars on drug and alcohol treatment for offenders such as Lake. The reasoning is simple — addiction is at the root of much criminal behavior. Cure the addiction and prevent crime, not to mention potentially saving or greatly improving the addict’s life.

Sand Island plays a pivotal role. The city of Honolulu last year spent $9 million to buy a new home for the rehab, and planned to charge only nominal rent, because its continued functioning was so key to treating criminal offenders with addictions.

Judges praise it as the “the highest level of treatment available” and the best program in the state. In the fiscal year ending last June, the courts referred 275 criminal defendants to Sand Island.

But how well does treatment work?

It depends on how you measure it.

State agencies that fund the program focus on the initial, intensive phase of treatment, when clients are living at the facility for one to three months. The Department of Health, for instance, requires the rehab to provide data on this initial phase, which it pays for.

In obtaining state contracts over the past decade, Sand Island itself has repeatedly cited a figure of 65% who “will complete residential treatment” or “remain in treatment until discharge” — but this number, too, covers only the initial phase of treatment paid for by public agencies.

Yet Sand Island is a two-year program. Judges who send offenders to the facility generally want to know if they’ve completed the full two years and gotten what’s known as a “clinical discharge.” That’s the question that matters, because it reveals whether the defendant has thrown off the addiction often at the root of criminal behavior.

To research this story, Civil Beat analyzed all Hawaii criminal cases in 2017 in which Sand Island was mentioned in the court minutes in the judiciary’s primary database. We chose that year because it was far enough in the past that clients would likely have had time to succeed or fail in treatment.

These cases included all defendants sent to Sand Island by the courts, not only those whose treatment was paid for by taxpayers through state contracts. Private insurance. MedQUEST — Hawaii’s Medicaid program — and others may also cover treatment expenses. It was impossible to connect the payers to individual cases. Sometimes, the clients themselves may not know who paid.

Also, not everyone at Sand Island was referred by a court. Some check in voluntarily, although insiders say the overwhelming majority of clients were sent there by a judge.

But the court system itself said it has no data on how many defendants referred to Sand Island or other drug treatment programs succeed.

Civil Beat did its own analysis of defendants sent to Sand Island in 2017 and found that about two of three don’t make it all the way through.

In response to questions from Civil Beat over several weeks, Sand Island acknowledged as much on Tuesday. In 2019, the rehab said, 32% completed the full two-year program, a number that would include criminal defendants, who make up the bulk of the facility’s clientele, as well as some who check in voluntarily.

Our analysis found no evidence that Sand Island’s success rate is subpar or that the treatment it offers is less than effective. Some of those who do make it through the full two-year program say it saved their lives.

But the disparate figures raise the question of how to measure success. Is it enough for an addict to make it through an intensive 30-day residential program? Or should success be measured for the full program or even five years after treatment ends?

For criminal defendants referred by courts to Sand Island, the difference between success and failure can be measured in years spent behind bars. Judges tend to go easy on defendants who make it through Sand Island. Those who don’t can feel the full brunt of the law.

One who made it through Sand Island said he was the exception.

Benjamin Zablan faced a number of charges for a robbery at City Mill in Kaimuki and other crimes. He made a deal with prosecutors — a lighter sentence if he got a clinical discharge from Sand Island. About three-quarters of the way through, he was discharged for his inability to follow the rules, he wrote in a letter to Civil Beat.

But staff members vouched for him and he got another chance. He finished, and was rewarded with a 10-year prison sentence with a two-year minimum, when he might have faced as much as 40 years.

Zablan has nothing but praise for the program.

“Attending Sand Island Treatment Center was by far the best opportunity I had, especially in my circumstances, towards a second chance at life,” he wrote. “Countless lives have been lost to the life of drugs, alcohol and crime but many lives are also being saved because of selfless and motivated individuals like the counselors at Sand Island.”

But Zablan himself pointed out that his case was rare.

“I am one of the very few who have completed the program,” he wrote.

In one of several written responses to questions from Civil Beat, Sand Island said it was “extremely proud” that 32% finished the two-year program in 2019.

“Given the clientele we serve, many of whom have crossed a sociological line that makes them more of a risk to other people and themselves and are the most challenging cases to treat, our success is considered the gold standard in Hawaii,” the facility wrote.

Defendants Can Wait Months For Treatment

The cases reviewed by Civil Beat revealed a disconnect between Sand Island’s promises in state contract bids and the reality for many criminal defendants.

Sand Island often states that three-quarters of clients are admitted within two weeks. While it was impossible to tell how the rehab performed for those covered by the contracts, court records show that criminal defendants, who make up much of Sand Island’s clientele, often wait for several months. The fact is so well-known in the court system that it has been cited in the case minutes by a probation officer, a defense attorney and a doctor.

It’s important to get addicts in when they say they want treatment, experts say, because the moment of opportunity can easily pass.

Even Sand Island, in a report to the Department of the Judiciary, acknowledged wait times of four months.

That’s a far cry from the rehab’s contract proposal for the judiciary, which stated that clients “deemed appropriate and eligible for treatment … are usually offered same-day admittance.”

The facility started in the early 1960s as a halfway house for alcoholics in a rundown chapel, tucked in amongst the heavy industrial landscape of Sand Island. Over time, the rehab started bidding for government contracts to treat addicts.

Today, much of Sand Island’s revenue comes from contracts with state departments, including judiciary, public safety and health, as well as federal agencies. Sand Island also gets payments from private insurers and MedQUEST.

The facility was the subject of a Civil Beat investigation in 2019 into extraordinarily high salaries for executive director Mason Henderson and his top staff members.

Hawaii judges know and rely on the Sand Island program, often looking to it as an alternative, or complement, to incarceration. Defendants may be ordered there prior to sentencing, or sometimes as part of a deal that includes prison time or probation.

Judges have praised the program as essential. Judge Henry Nakamoto called it the best program in the state, according to court minutes. In granting a defendant’s motion for reconsideration of his sentence so he could attend Sand Island, Judge Edward Kubo called the facility “the highest level of treatment available” and said the defendant was “deserving of this last chance.”

Sand Island is considered so crucial that the city of Honolulu in 2019 paid $9 million for a new home for the rehab in Kalihi. For more than five decades, Sand Island had been operating rent-free, without a lease, on state land. The new location had housed Hawaii’s only federal halfway house, Mahoney Hale.

The city was focused on the benefits of the program to addicts, according to Andrew Peirera, then the spokesman for Mayor Kirk Caldwell.

“If we did not find a new location, it would have cost the community much more,” he said, “not just in dollars, but the human equation.”

Success Rates Drop Off For Full Program

The facility itself places a premium on success.

“In our view relapse is not a normal part of the recovery process, but rather an indication, in many cases, of insufficient support during the critical stages of the recovery process,” Sand Island has stated repeatedly in its contract proposals.

But as shown in Civil Beat’s analysis and Sand Island’s own assessment, two of three don’t make it to clinical discharge, with those who fail relapsing, breaking the rules, simply walking away or sometimes because a judge is confident they’ll be OK without going through the two years.

“I can tell you that in the treatment industry as a whole, the whole success rate thing is so arbitrary.” — Jeff Nash, executive director of Habilitat, a Kanehoe treatment center.

One of those who didn’t was Jantzan Kanei-Mendes. He was arrested in 2016 for doing drugs in Auwaiolimu Park in Honolulu, after failing to show up for a court sentencing on a different charge earlier that month.

He went to Sand Island in early 2017 and made it through the residential portion. But a year-and-a-half later, he admitted to Sand Island that he had relapsed and tampered with a drug test. He got kicked out, and was sentenced to five years in prison and now resides at Saguaro Correctional Center in Arizona, awaiting a release date in April 2022.

Brandon Wages was sent to Sand Island in 2017 by the Big Island Veteran’s Treatment Court.

He said he was only two weeks from graduating when he left on a pass, got drunk and assaulted a man, earning a five-year sentence.

“There were many good things about the program,” Wages wrote in a letter to Civil Beat, “but overall, the atmosphere was very punitive, kind of like walking on eggshells everywhere you went.”

Civil Beat’s review found several instances in which criminal defendants such as Wages simply walked away from the Sand Island facility.

Kamaki Wilson-Makua disappeared for at least five months after he absconded from Sand Island in November 2017. Facing a car theft charge, he’d been sent to Sand Island by the Big Island Drug Court.

He ran into trouble a few months after starting the program when he admitted to buying a bag of Percocet while on a pass visiting the Big Island. He went back to Sand Island, but a month or so later, he walked away. Five months later, he still had not been arrested.

Eventually he was sentenced to five years.

In December, 34-year-old Dustin Spencer absconded from Sand Island and died in a shoot-out with police at a car dealership in Kalihi.

Spencer, on probation in a federal conviction for being a felon in possession of a firearm, had been sent to Sand Island by a federal judge in July.

It’s hard to compare the effectiveness of rehabs in Hawaii and nationally because of wildly varying definitions of what constitutes success.

“I can tell you that in the treatment industry as a whole, the whole success rate thing is so arbitrary,” said Jeff Nash, executive director of Habilitat, a long-term treatment facility in Kaneohe. “The problem is there’s no agreed upon definition of what is success.

“What happens is a lot of these 30-day programs — there’s a lot of them in the country — they will claim success if you finish the program. Well, for us that’s not success.”

Nash, who stressed that he had no knowledge of Sand Island’s success rate, said that only about 20% of clients make it through Habilitat’s 28-month program. He said that’s typical for similar programs around the U.S. About 63% of Habilitat’s graduates remain sober and successful five years later.

Readily Available Treatment Is Key

Another way of measuring a rehab’s performance is wait times. Experts say addicts should get treatment as soon as they are ready.

“Certainly waiting lists are a barrier to treatment,” Nash said. “The way that it works with someone who’s addicted — when they decide, okay, I want help, you have to strike while the iron is hot. And if you wait, they can end up dead or they change their mind.”

Nash said it sometimes takes time to get a criminal defendant a hearing or order to attend treatment at Habilitat. But he added, “We don’t have a waiting list. We will never have a waiting list, because it’s not good policy for treatment programs to line people up to get in.”

Sand Island acknowledges the importance of readily available treatment in its contract proposals, saying clients seeking help are at “considerable risk” of succumbing to the temptation to keep using.

“Our utmost efforts are employed to direct the prospective client into treatment at the time of request,” the rehab stated.

But the waits for defendants to get into Sand Island can easily stretch into months.

The rehab, in its bids for state contracts, has repeatedly stated that 75% of clients are admitted within two weeks, if not sooner. In its responses to Civil Beat, Sand Island said that figure is true for all of the facility’s clients, not just those whose way is paid by state contracts.

The facility uses a triage system, with those considered most vulnerable admitted first, including pregnant or abused women and those who in danger of harming themselves. Some of these clients may indeed be admitted quickly.

But court minutes paint a much different picture for criminal defendants, with many waiting five to six months or more.

Sand Island stated in its responses to Civil Beat that “the clock starts ticking” for these defendants only when a judge issues a formal referral, and that those who ask to go to Sand Island on their own, without such an order, are told that the wait can be long.

Yet Civil Beat found several cases in which defendants waited months after a judicial order. In many others, the judge and other court officers knew the defendant had been accepted at Sand Island and approved the move, but didn’t issue an official order until a bed became available.

It seems to be common knowledge in the courts that the typical wait would be months. In one case, a defense attorney noted that the defendant had been granted supervised release to Sand Island but that he was on the waitlist, “which is usually a six month wait,” according to court minutes.

In another, a probation officer told the judge “the wait list for a bed space at Sand Island is between 6 and 9 months.”

Among the state’s 562 beds for drug and alcohol treatment, the Department of Health says wait times can range from a day to 30 days or longer.

Sand Island itself has given conflicting information about its wait times.

In reports to the judiciary department — one of the state entities that contracts with Sand Island — the rehab stated that no judiciary clients were on the waitlist. It gave the same response the following year.

In the 2019 fiscal year, however, Sand Island stated in a report to the department that 30 judiciary clients were on the waitlist and that the average wait was four months. Even so, during that same fiscal year, the rehab bid for and won a new contract, promising once again that “individuals deemed appropriate for treatment are usually offered same day admission.”

The state of Hawaii hopes to get a better handle on issues such as wait times and success rates at all treatment facilities through a new program called Hawaii CARES.

The school of social work at the University of Hawaii Manoa won a contract from the state health department to run the CARES program. It will streamline the admissions process at treatment facilities and to hold them accountable for the quality of care and outcomes.

CARES is expected to look at data from individual treatment centers, and eventually offer consumers information about their track records. The program will coordinate with the judiciary on what’s needed to treat clients who are criminal defendants.