Doctor Killed by Mental Patient

Dr. Erlinda Ursua, 60, was bludgeoned to death by a 37-year-old patient, Rene Pavonan, during an exam at John George Psychiatric Pavilion in San Leandro, California last Wednesday. Ursua was found on the floor of the exam room and died from blunt-force trauma, according to the autopsy.

No one on the unit was aware of the attack until a staff member noticed Pavon clutching a piece of medical paperwork that patients don't normally have access to and checked the exam room.

One of those unexpected, unfortunate, but unavoidable things? Not exactly. This had been forseen and efforts had been made to prevent it:

Cal/OSHA, the state's workplace safety agency, investigated John George in 1998 and earlier this year in response to violent workplace assaults and complaints about substandard measures to prevent workers from getting hurt.

The investigations resulted in five citations and $30,000 in proposed penalties for John George's not having an injury-prevention program in place and failing to report two nonfatal assaults on workers, one last December and the other in April.

In July, Cal/OSHA officials took the unusual step of suggesting measures the 80-bed inpatient facility could take to improve worker safety, including hiring trained peace officers as security guards and installing video cameras in exam rooms.

The union representing workers at John George was also involved in efforts to make the facility safer.

Linda Joseph, staff director for Service Employees International Union Local 616, said the union had been urging management to improve safety measures.

The assaults and state citations "are a direct result of misplaced priorities," she said. "They have financial difficulties. Instead of looking at misplaced programs to save money, they just cut staff, and with limited staff they aren't able to cover."

Tragically, before her death, Ursua had discussed being nervous about working at the facility

Shortly before Ursua was killed, she told her husband that after more than 25 years she was getting tired of the work and was feeling "uneasy" at the facility, a close family friend said Friday.

"She said the patients were becoming more difficult and she talked about the budget cuts," said Dr. Lene Martinez of Fremont, who knew Ursua both professionally and personally for more than 15 years.

Background: As mental health facilities closed in the 1980's and pscychiatric patients were deinstitutionalized, sent home or put into community facilities, the rate of violence against social workers began to rise, as did the number of violent attacks against workers in the remaining mental health facilities which had become increasingly understaffed at the same time their patient population was becoming increasingly violent.

I watched this happening to ASFCME members and we, along with SEIU, AFT and the nurses association, appealed to federal OSHA to consider workplace violence to be a workplace hazard under OSHA's jurisdiction. Until the Clinton administration, these appeals were ignored. "We deal with hazards coming from machinery and chemicals, not people. Anyway, there's nothing you can do to predict or prevent violence, except possibly increase staff, and that's out of our jurisdication. "

California, ahead of the curve as usual, took the lead in this area, coming out with innovative guidelines in 1993 that suggested practical measures to address workplace violence in mental health and social service workplaces. In 1997, Federal OSHA issued Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers and in 1999, Recommendations for Workplace Violence Prevention Programs in Late-Night Retail Establishments. OSHA handed down several General Duty Clause citations against health care facilities in the late 1990's, but has not actively pursued cases in several years because it is extremely difficult to win challenges to citations under the General Duty Clause.

OSHA has never seriously entertained the possibility of a workplace violence standard. Perhaps the time has come.