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Fear Is Making the Rounds at Atascadero State Hospital

A brutal attack on a technician sends a chill through the mental institution, which has seen a 66% increase in aggressive acts against staff the last two years.

January 08, 2006|Lee Romney | Times Staff Writer

ATASCADERO, Calif. — By the time most colleagues heard the emergency alert, Wahida Abdeen-Poncelot was unconscious, her blood pooling beneath her. Her head was gashed, a kneecap shattered.

The diminutive psychiatric technician had just worked a double shift at Atascadero State Hospital, a mental institution for patients funneled through the criminal justice system.

As she headed for the door of her unit that November night, a patient slammed her against a wall. After a co-worker grabbed the attacker, a second patient jumped Abdeen-Poncelot. She might have died had a third patient not intervened.

Raymond Albert Lopez, 34, later told hospital police that his alleged accomplice, 29-year-old Lynford Jay Perry, gave him "uppers" in a bathroom as they planned the attack. "He hit her and I finished her off," said Lopez, who with Perry is facing charges of attempted murder and conspiracy.

Brutal, premeditated attacks are rare, but this one sent tremors through the ranks at Atascadero, which has seen a 66% jump in hitting, kicking and other aggressive acts against staff in the last two years. There were 374 such assaults between July 2004 and June of last year, up from 225 two years prior.

The jump is not the worst in the state's five-hospital system; such incidents at Metropolitan State Hospital in Norwalk more than doubled. But psychiatrists, nurses and others at Atascadero say they face particular peril because the facility is taking on increasingly combative patients in already-crowded wards just as it contends with an unparalleled staffing shortage.

As it stands, the Central Coast facility houses the state's largest share of mental patients likely to be violent -- including criminal defendants acquitted by reason of insanity, mentally ill parolees and those who have completed parole but pose too much of a threat to be released.

Staffers fear that the danger grows with every shift.

"In 16 years here I've never felt unsafe," said Dr. William Walters, a psychiatrist and vice chief of the medical staff that covers 75 severely ill parolees in two units -- Abdeen-Poncelot's among them. "I now feel I'm just waiting to get hit."

The trend is a jarring setback for a facility that took a national lead more than 15 years ago in calling attention to violence as an occupational hazard. Through its Clinical Safety Project, the hospital dramatically reduced serious staff injuries, trained employees to manage aggressive patients and enlisted patients in counseling peers. But a recent analysis by Atascadero officials shows that the rate of assaults against staff members by patients considered the most volatile -- on parole or confined beyond their parole terms -- has tripled since January 2003.

Atascadero houses the largest proportion of such patients, called "mentally disordered offenders," and their numbers are growing. Staffers say a key factor in the upheaval at the hospital is court rulings in 2004 that granted the patients the right to refuse psychotropic medications.

Clinical Safety Project director Colleen Love stressed that the hospital has been successful over time in reducing serious injuries that curtail work duties or require more than first aid, but those recently have climbed as well -- from 69 in 2003 to 76 in 2004 and 81 last year.

The increased violence and injuries come as the state's mental hospitals face intensive scrutiny by the U.S. Department of Justice. That agency, however, has previously focused mainly on violations of patients' rights, including possible overmedication and excessive use of restraints, not staff security.

Indeed, federal investigators issued reports on Metropolitan and Napa State hospitals that were highly critical of staff members' failure to prevent patients from harming themselves or other patients. The agency only recently completed reviews of Atascadero and San Bernardino's Patton State Hospital -- which is reeling from two recent killings of patients by their peers.

Now Atascadero, like other hospitals in the system, is poised to shift to a new model of care that is less restrictive for patients, offering them more autonomy, interaction with peers and individualized treatment. Though many staff members support the concept of this "recovery model" -- pioneered at Metropolitan -- they fear that it requires far more manpower to be carried out safely.

As it stands, more than a quarter of Atascadero's budgeted positions for nurses, psychiatric technicians, psychiatrists and other caregivers were vacant last January -- compared with a 12% vacancy rate at Patton and 2% at Metropolitan and Napa, according to the most recent state data.

The shortages at Atascadero, which houses more than 1,300 patients and has more than 2,200 budgeted staff positions, are worse still when staff members who are on leave -- many due to assaults or stress -- are included. In one program that includes the hospital's high-stress admissions units and its medical unit, 10% were on extended leave as of Dec. 1.

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