ATASCADERO, CALIF. — When Lawrence Paul Rael was involuntarily committed to Atascadero State Hospital 10 years ago, his parents considered the placement appropriate.
Born prematurely and with a severe hearing loss, Rael had been in and out of mental health facilities from the time he was a child, with a tentative diagnosis of autism. At 18, he molested two boys and was sent to prison and then to Atascadero.
"We were comfortable with the fact that he was somewhere where he was watched," said Rael's father, Lorenzo, of Rancho Cucamonga. "He was supposedly in a hospital. We thought at least that he wouldn't get hurt."
But early Sunday morning, the slight 37-year-old man was found dead in his bed with a towel around his neck -- the victim of the first homicide in the Central Coast facility's 54-year history.
On Thursday, fellow patient Richard Earl McKee, 44, was arraigned in San Luis Obispo County Superior Court on one count of murder in Rael's death and one count of assault with a deadly weapon in connection with an attack on another patient.
The death of Rael, who was well-liked by patients and staff, has deeply shaken the hospital. For the last two years, Atascadero has struggled to transform its approach to patient care under a federal consent judgment that mandated sweeping changes. The judgment applies to four of the five state mental hospitals and requires them to address issues of patient safety, over-medication and excessive use of restraints. It also calls for changes aimed at more thoroughly involving patients in their own recovery.
In the midst of the transition, Atascadero -- like the state's other mental hospitals -- has had to contend with an exodus of experienced staff members to higher-paying prison jobs. An emergency move to raise salaries has eased recruiting woes in recent months but has brought an influx of staff members inexperienced with the criminal mentally ill who populate Atascadero.
The hospital treats a volatile mix of patients, with hardened predators often housed with more vulnerable residents.
Staff members have repeatedly complained that pressure from the U.S. Department of Justice to reduce the use of restraints and antipsychotic medications has contributed to an increase in assaults by patients.
"We can't even protect our patients and that's our job," one psychiatric technician said, adding that one resident greases his face to deflect punches and pads his body by dressing in several shirts and pairs of pants. "They can't exactly get well when they're constantly in fear."
Meanwhile, staff members contend that increased paperwork requirements have detracted from time spent building the kind of relationships with patients that can defuse violence.
The hospital's executive director, Jon DeMorales, called the death "devastating" and said the hospital is planning a "top to bottom analysis" to find ways to enhance patient safety.
He said the hospital is considering patient-operated bedroom door locks that could protect them from predators while they sleep, surveillance video cameras, enhanced training and supervision for novice staff, and night-vision goggles to aid in rounds.
"Our mission is evaluation, treatment and protection," DeMorales said, "and in that last regard we failed."
DeMorales acknowledged an increase in patient violence on the evening shift in recent months and said administrators were studying the causes. Though the transition to a system of more rigorous documentation has been hard on the staff, DeMorales said, he called it the best path to improved patient care and denied that it had detracted from relationship building.
Convicted of molesting two girls, McKee arrived from prison at Atascadero in 2005, categorized as a "mentally disordered offender," meaning he had a severe mental illness such as schizophrenia that contributed directly to his criminal behavior. Court records show that when he stopped his medication in prison he had become hostile.
Last year, a hospital spokesman said, his status was changed to "sexually violent predator." Patients said McKee developed a reputation for abusively threatening patients who he believed to be child molesters or homosexuals. He was bounced from unit to unit -- housed mostly with other sex offenders, who generally do not suffer from the types of severe mental illness that require intensive psychiatric care.
Last month, McKee lost a legal appeal challenging his confinement, records show. He became increasingly distraught, abusive and paranoid, patients said.
"A lot of guys had expressed concern about him," said Bill Langhorne, 51, a fellow patient with McKee and Rael on Atascadero's Unit 22. "He was talking to himself, making threats, pacing up and down, making lists."