California state psychiatric workers call for greater safety

Two weeks ago, Dr. Alex Sahba, a psychiatrist at Metropolitan State Hospital, was attacked by a patient who rammed the legs of a metal chair into his body, leaving him bruised, bloody and limping. But that was a minor incident compared to one a year and a half earlier.

Sahba was talking to a psychiatric patient when another came up from behind, choked him and chomped hard on his ear. When he struggled free, blood flowing, he saw a dozen patients in a circle staring at something on the floor. It was a piece of his ear. Sahba has had five surgeries to reconstruct it.

The psychiatrist was one of about 120 employees who protested Wednesday outside the Norwalk hospital to call on the state Department of Mental Health to improve safety.


“It’s kind of eerie, never knowing whether you’re going home at night when you go to work,” he said.

Since a psychiatric technician was strangled by a patient at Napa State Hospital in October, the rising violence at the state’s mental hospitals has come under increased scrutiny. Unions that represent workers formed a statewide coalition to press for major improvements. But the employees who slipped on union T-shirts, hoisted posters and chanted demands say little has happened.

The workers said Metropolitan needs more staff, hospital police officers stationed full time on the units, high-security housing for the most dangerous patients and an improved alarm system. They said employees are frequently less alert from working double shifts, pulled from patient care for paperwork and assigned to units where they are unfamiliar with the patients.

Dr. Michael Barsom, the medical director, said the hospital administration is concerned about increased aggression. “We have tried to take every measure that we can,” he said.

He said administrators have worked to increase staff-to-patient ratios on more violent units. And he said police officers now rove through the units and half a dozen new officers should be hired soon.

Barsom also acknowledged that the alarms carried by the staff malfunction. He said a new system is being tested at Napa and may be installed at Metropolitan. “I’ll be pushing for that,” he said.

The rally came as a handful of bills addressing state mental hospital safety wend their way through the Legislature. They would speed up the process of involuntarily medicating certain violent patients, criminally penalize those who bring contraband into the facilities and require thorough patient risk assessments upon admission that take criminal background into account.

A new Assembly Select Committee on Hospital Safety will convene next month to explore solutions to the violence. Among its seven members is Tony Mendoza (D-Artesia), whose district includes Metropolitan. He called hospital conditions “unacceptable” and said he wants to protect workers whose “physical well-being is threatened every day.”

On June 30, a nurse at Metropolitan was taken to a local hospital with bruises and a bump on her head. She was punched and kicked by a patient who forced her way into the medication room and locked the door.

Willie Cottens, a psychiatric technician, said he was the only employee who saw the patient enter the room. “Luckily, I was in the hallway,” said Cottens, who noted that the patient had previously attacked others. “How many people did she have to hit before they did anything?” he asked.

Although Napa has received the most attention, attacks occur at a higher rate at Metropolitan. Last year, there were 2,438 assaults on patients and 1,324 on staff members.

In May, Metropolitan was cited by the California Division of Occupational Safety and Health for failing to adequately address “hazards posed to hospital employees by patients with assaultive behavior.” The $9,560 citation noted that, in the first three months of the year, there were 42 assaults on staff resulting in “contusions, lacerations, bites, fractures and other injuries.”

Since 2006, four state psychiatric hospitals, including Napa and Metropolitan, have operated under a reform plan imposed by the U.S. Department of Justice in a court settlement. But assaults by patients have increased. A spokeswoman said the Justice Department had no comment.

Union leaders met with hospital administrators last month. But Denise Nicks, a rehabilitation therapist and chief steward for one of the unions, said the department’s response to safety concerns has been the same for years. “They keep saying they’re going to look into it,” she said.

Many protesters offered their own stories of attacks that they believe could have been prevented.

Eddie Barrios, a psychiatric technician, said one of his fingers was slammed in a drawer and broken by a patient. Dr. Raymond Flores, a physician, was slugged in the back of the head. “I saw stars, of course,” he said.

And Nicky Sonteya, a psychiatric technician, said he was bitten so deeply on his forearm that it left a dark scar. The patient who assaulted him has tested positive for hepatitis C. “It’s just like I’m going to a war zone,” he said. “I am not sure if I will be coming home to my family or coming home in a body bag.”