Reporting from San Francisco — When Napa State Hospital psychiatric technician Donna Gross was strangled last month on the hospital grounds, state officials lamented her death as a tragic and rare event, the first killing of a staffer in two decades.
They pledged to improve security by offering staff members shuttle rides to the parking lot, and they temporarily barred patients from going outside unaccompanied.
But a Times review suggests safety problems at the facility are neither rare nor so readily fixed.
Attacks on staff in the second quarter of 2010, the latest for which information was available, more than quadrupled to about 200 since early 2009 and patient assaults against one another have soared sevenfold to 692, data from the state Department of Mental Health show. Patients also have harmed themselves and threatened suicide at steeply rising rates since January of last year.
Even so, federal officials have declared the state hospital to be in "substantial compliance" with court-mandated changes to improve conditions and protect the civil rights of the hospital's 1,100 patients.
The reforms are the result of a 2006 lawsuit by the U.S. Department of Justice targeting Napa and three other state mental hospitals. They have cost California taxpayers tens of millions of dollars for, among other things, consultants, a federal court monitor, more staff and a computer system to better track treatment.
The efforts also have led to a reduction in close supervision, restraint and medication of potentially dangerous patients, most of whom have been committed because of crimes related to their mental illnesses, according to state data and interviews with staffers.
"Overall, it does more harm than good," Dr. David Brody, a former Napa State Hospital psychiatrist, said of the federal oversight. He said he left this fall because of ethical and safety concerns.
Although Napa's data on patient aggression in many ways reveals the most startling deterioration systemwide, the others under federal watch — Atascadero State Hospital on the Central Coast, Metropolitan State Hospital in Norwalk and Patton State Hospital in San Bernardino — have also experienced increased assaults on patients and staffers.
Stephen Mayberg, director of the state Department of Mental Health, said Monday that rising aggression rates are caused in part by the relatively recent practice of including such behavior as verbal assaults and throwing things, which often precede physical attacks. Napa is also getting more violent and unmedicated patients than it once did, he added.
He called Gross' death a "terrible, terrible situation" and said reducing violence "has to be one of the major markers for us as to whether or not what we're doing in our system works."
A U.S. Department of Justice spokeswoman said Tuesday that although it mostly abided by federal requirements, the Napa facility fell short in some areas. A monitor's report from a July visit, which she provided, suggested that the hospital was not adequately tracking aggression trends over time.
Central to the federal reforms was a requirement that patients attend 20 hours a week of groups — such as anger management and substance abuse recovery — conducted in a campus-style "treatment mall." One consequence was that patients had more freedom to wander among units and around the grounds, resulting in more assaults and exchanges of contraband, according to internal memos and reports to hospital and state administrators.
Jess Willard Massey, 37, the patient charged with murdering Gross, had a "grounds card" that permitted him to wander outdoors. He had been admitted to the hospital in 1997 after being declared not guilty of attempted murder by reason of insanity in connection with a brutal stabbing, according to media reports.
Gross' body was found on the grounds on the evening of Oct. 23 after she failed to return from a meal break.
Staff members said that it was bound to happen and that administrators had been on notice.
In June 2009, the hospital's social workers sent a report to their superiors, including Mayberg, that patients had been wandering unsupervised in hallways and stairwells; that patients who were supposed to be separated from one another had been assigned to groups on the same unit; and that those confined to locked units had been mingled with those from unlocked units.
The changes created "a chaotic and unsafe environment that has been incredibly stressful for staff but even more so" for patients, said the report, obtained by The Times. Staff members said they received no response.
The number of assaults grew. Patients are now locked out of their bedrooms during treatment hours in an attempt to compel them to go to groups, which many avoid. Memos indicate that staff members have continued to alert hospital administrators over the last year to security problems.