Wednesday, December 22, 2004

Epilogue on the Death of Erlinda Ursua

I wrote over a year ago about the tragic death of Dr. Erlinda Ursua who was beaten to death by a mental health patient at John George Psychiatric Pavilion in California.

I just ran across an excellent article by Susan Goldsmith in the East Bay Express, written last February, about conditions at John George and the futile attempts of John George employees and CalOSHA to convince management to implement measures to make their workplace safer.
There must have been an awful commotion, although no one heard a thing. It was a busy county psychiatric hospital, after all, and the Unit C exam room door was closed. But inside, a terrible story was unfolding. During a routine afternoon checkup this past November, Dr. Erlinda Ursua was slain by one of her own patients, a severely mentally ill woman who had been brought to John George Psychiatric Pavilion that morning. The doctor was beaten savagely, according to sheriff's department records, her head and face smashed again and again into a solid object. She also was strangled, according to a not-yet-released autopsy report. Outside the door and just up the hall, nurses, mental health specialists, and doctors went about their work completely unaware of what was happening inside the room. Although the examination room had a panic button, the sixty-year-old MD, who stood only four-foot-eleven, couldn't get to it during the attack.

A hospital janitor made the ghastly discovery later that afternoon. Ricardo Simpson opened the exam room door so he could empty the trash and found the doctor's body on the floor. Her physician's coat was open and her shoes sat next to her feet. An earring, a piece of a jade bracelet, and paperwork were strewn around. No one else was in the room.

Alameda County Sheriff's Department detectives told Lorenzo Ursua that his wife probably didn't die during the beating. She lay there undiscovered for an hour and a half, they estimated, and was most likely alive for at least some of that time.
Ursua's death was only the latest incident in a long line of assaults that had brought several CalOSHA citations.
While staffers at the 88-bed psychiatric hospital were deeply saddened by their colleague's murder, hardly anyone was shocked. For years, they have complained of assaults by patients, many of whom are severely mentally ill and are brought to the San Leandro facility against their will by the cops. Some are homeless; others are transferred from area jails. Many show up after going off their psychiatric medications and arrive in frightening states: They are brought in unkempt and reeking, covered in feces, barking like dogs, or dressed up in costumes. Patients also have been admitted with knives and other weapons stashed in their pockets.

"I've seen so many of my co-workers taken out on stretchers. It's terrible," says Cheryl Omeregie, a mental health specialist at John George who is out on stress leave after saving a colleague's life during a Christmas Day stabbing in 2002.

Stretchers for wounded staff members were all too common in the twelve months prior to Erlinda Ursua's death. One nurse was stabbed twice in the back. Another was punched in the face and had his nose broken. A staff member's head was slammed into a wall so hard she suffered a concussion, and another nearly lost an eye to a pencil-wielding patient. A doctor's jaw was dislocated, and one aide's knee was injured so severely that it required surgery and now has to be replaced. These, according to Dr. Harold Cottman, a hospital psychiatrist, are in addition to numerous less-serious assaults. In 2003 alone, at least six hospital employees went out on workers' compensation leave following patient attacks. But because of poor record-keeping, a top hospital administrator was unable to say just how many other employees went on leave in prior years. Only one thing was certain, the administrator said: "I can tell you there were others."
And the situation at John George was hardly unique:
In fact, the statistics are staggering. The federal Occupational Safety and Health Administration reported last year that mental health workers were five times more likely to be the victims of nonfatal violent crime on the job than workers in any other occupation. In a 1998 report, Cal-OSHA warned that psychiatric workers "may be at a higher risk for injuries from assaults than the risk for injuries from all causes in the country's most hazardous industry."
So what or who was to blame? Unresponsive administrators, laws passed to protect the civil rights of patients which make it more difficult for employees to medicate or restrain violent residents and dwindling funding for outpatient mental health services that increase emergency admissions at psychiatric hospitals which are also having their budgets cut.

All of the above, and more. As I wrote a year ago, the root cause of the horrific situation in this country's mental health institutions may lie even deeper.
The question is who will pay for the things that society demands to make life in this country civilized and livable? If those who already have more than enough money are to pay, then their taxes need to be raised. The other option is budget cuts and increases regressive sales taxes and “user fees,” in which case the poor and struggling middle class end up forking out the dollars, while those who don’t have the means to help themselves -- unemployed, the disabled, the mentally ill -- end up "paying" in the form of fewer services.

In the meantime, workers are paying the price with their health and their lives. California, and a handful of other states that run their own OSHA programs, like Minnesota, Oregon and Washington occasionally cite employers for exposing workers to the threat of workplace violence. Federal OSHA, although it issued guidelines for health care, social services and retail workers, has not handed down a workplace violence citation since 1995...Maybe it's time for OSHA to start working seriously on a workplace violence standard.
The chances of that don't seem too likely, however. Departing OSHA director John Henshaw doesn't even think that workplace violence is a legitimate workplace hazard that OSHA can do anything to prevent.

But with drastic budget cuts coming down the line in the wake of massive federal budget deficits, it will become more and more important for OSHA to pressure the administrators of health care institutions to ensure the safety of their employees. Let's hope that the new Assistant Secretary is more sensitive to the dangerous and important work of dedicated employees like Erlinda Ursua.

The general practitioner loved her job and went about it cheerfully, despite the less-than-cheery workplace environment, her colleagues say. A native of the Philippines, she immigrated to the United States in 1975 with her husband and oldest daughter. Another daughter was born while Ursua pursued her California medical license. She took a job in Alameda County's public health system in 1977 and never left.

Colleagues describe Dr. Ursua as a devoted physician who treated her patients with great respect and patience. She didn't fit the doctor-with-an-ego stereotype; co-workers say she regularly ate her lunch with hospital housekeepers rather than with her medical colleagues. "They used to all share their lunches," recalls Soccoro Smith, a John George nurse for twelve years who has been on workers' compensation leave since 2001. Smith was attacked twice in one month by different patients who hit, kicked, and punched her in the head and neck. "Dr. Ursua comforted me and calmed me down. I was ready to walk off the job," she says.