Concerns Over Security Voiced Before Slaying at Hospital

Special to The Times

Alameda County public hospital officials rejected two proposals earlier this year to use sheriff's deputies to provide 24-hour security at a psychiatric hospital here, where a physician allegedly was killed by a patient last week.

Dr. Erlinda Ursua, 60, the senior lead internal medicine physician at the John George Psychiatric Pavilion, died Nov. 19 of blunt force trauma to her head and strangulation. The patient, Rene Pavon, 37, was arraigned on a murder charge Tuesday but did not enter a plea.

Medical center officials were so concerned about the potential for violence at the hospital that they twice asked the Alameda County Sheriff's Department for proposals to increase security, according to Sheriff's Capt. Gary Schellenberg.

But officials never went ahead with those proposals. Efton Hall, interim chief executive officer of the medical center, said that the decision to reject the sheriff's security proposals wasn't based on cost, but that the medical center wanted to consider other options, including bids by outside security agencies.

"The leadership at that time advised we needed to put out the [offer for other proposals] rather than simply respond to the sole proposal," Hall said. "We wanted to have the benefit that other respondents would offer."

Cal/OSHA earlier this year imposed $30,000 in fines against the Alameda County Medical Center, which runs the 80-bed psychiatric hospital, for injuries to two nurses by patients and for inadequate injury prevention measures. The medical center is appealing the decision.

Meanwhile, the Sheriff's Department first proposed that the hospital have two deputies and two sheriff's aides per shift at a cost of $2.1 million per year, Schellenberg said. Several months later, after pressing medical center officials, he was told they weren't going forward with the plan.

The Sheriff's Department then proposed having one deputy and two sheriff's aides at the center at a cost of $1.3 million a year. But Schellenberg said the medical center wanted the deputies to help restrain violent patients so they could be treated, essentially performing orderly duties they are not trained for, and which the Sheriff's Department rejected.

Since Sunday, the department has posted two deputies on overtime pay at the psychiatric hospital full time.

Now Schellenberg said he has been asked to develop a proposal for permanent staffing by the Sheriff's Department for the facility -- a recommendation he plans to make by Dec. 14.

But Schellenberg said that even if deputies had been at the facility, he doubts they would have been able to prevent the killing. Because it occurred in an exam room, he said, the only way deputies might have averted the homicide would have been if their presence had been a deterrent.

In the past few months, Hall said, the medical center has increased safety measures at the psychiatric hospital by increasing the cost of the contract and boosting it to three full-time security guards instead of two.

In addition, all patients and visitors entering the facility now are subjected to screening with hand-held metal-detection wands, he said.

The medical center also began flagging patients' medical records if they pose potential threats because of violent behavior, Hall said. And since last week's killing, attendants have been accompanying physicians into exam rooms, he added.

He said the medical center is conducting its own internal review to see if there was any relationship between the death of the doctor and its own security efforts, and whether any corrective steps are required.

The physician was discovered lying in the exam room after the patient was found wandering the hospital with a confidential medical record. Sheriff's investigators believe the doctor's head was hit against the wall or floor or both. Attempts to revive her at the facility failed.

Pavon, who had not been seen at the psychiatric hospital before and had no known criminal record, had been brought in by San Leandro police Nov. 18 after her sister and sister's boyfriend said "she'd been acting strangely," said Sheriff's Lt. Michael Hart.

The California Division of Occupational Safety and Health and the state Department of Health Services also are investigating the physician's death.

Cal/OSHA already has fined the hospital over safety issues. The first violation, which carries a $25,000 fine, says the hospital has inadequate injury prevention programs. "On a regular basis, employees are suffering injuries from violent patients who assault the employees," the citation said.

The second violation, which includes a $5,000 fine, alleges that medical center officials failed to notify the agency that a nurse suffered a broken nose at the facility in April and that another nurse was stabbed in the back last December.

"We started getting formal complaints by employees in April," said Dean Fryer, spokesman for Cal/OSHA in San Francisco. "They were expressing concern for their safety in regard to violent patients."

After the agency sent a letter to the medical center in April asking what safety measures were being taken, Fryer said the medical center failed to respond by the required 15-day deadline.

Finally, Cal/OSHA began its own investigation, and that's when it discovered the two previous assaults on the nurses that hadn't been reported. State law requires such injuries to be reported within eight hours, or no longer than 24 hours if "exigent circumstances" can be shown.

He said Cal/OSHA took the unusual step of recommending safety measures, including placing surveillance cameras in the exam rooms and other areas of the hospital, never leaving a staff member alone with a patient, and hiring police officers to handle security.

In the investigation of the physician's death, Fryer said, the medical center is facing a maximum $25,000 fine per violation and up to $70,000 for "willful neglect."

In 1998, Cal/OSHA issued three citations to the psychiatric facility alleging that it lacked an injury prevention plan, staff training and procedures for handling injuries.

Hall said he is awaiting a report from his staff about the latest Cal/OSHA complaints, noting that he wasn't in charge of the medical center when they were made.

The state Department of Health Services, which licenses the psychiatric facility, also began a probe, said Robert Miller, spokesman for the department.

At the time of the homicide, he said, the department had ongoing investigations involving the psychiatric facility, but he declined to provide specifics.

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