Their recommendations for improving safety at the state's maximum security psychiatric facility included hiring 28 more workers, improving communications among labor and management, and increasing training and security-related technology.
"We can't guarantee absolute safety," Helsel told the House Health and Government Operations Committee and others. "But what we can do is continuously improve safety."
Helsel and the consultants agreed on major steps that started with improving staff morale. He said they needed higher pay commensurate with private-sector jobs, as well as the training and ability to communicate with leadership. "A happy and committed staff will provide the services we need to provide," he said.
In a report after one of the killings, state regulators had said some staff members had been sleeping on the job, among other problems.
The hospital has fired three employees, created an all-female ward, begun random monitoring and started to clinically reassess patients.
Most of the patients at Perkins have been ordered there by a court for evaluation or treatment. The bulk of them have violent histories, which clinicians say make them the most difficult psychiatric cases to treat.
Dr. Kenneth Appelbaum of the University of Massachusetts said he and fellow consultant, Dr. Joel Dvoskin of the University of Arizona, had open access to Perkins and found the staff mostly dedicated and talented. They were also eager for training and other changes, he said.
"It's not uncommon for staff to be defensive," Appelbaum said. "But that's not what I found at Perkins."
The staff has been working mandatory overtime to cover more shifts deemed necessary to keep the facility safe. Helsel said 17 new workers were being trained and more are being hired. Committees also are being set up so information can be shared among staff.
But this and many of the 73 total recommendations will take time and resources, Appelbaum said.
There is no accounting of costs or timetables, but Dr. Joshua M. Sharfstein, secretary of the Department of Health and Mental Hygiene, which oversees state hospitals, said that would be forthcoming.
For now, extra funding for new staff was coming out of the budget for mental health, Sharfstein said. Additional funds will likely be sought through the state budgeting process.
But beyond the costs, lawmakers wanted to know what leadership has already done to ensure no one else would be harmed.
"I'm not hearing 'never again,'" said Del. Shawn Tarrant, a Baltimore City Democrat.
Helsel pointed to the new staff and changes in procedures that include stepped-up monitoring and electronic surveillance, as well as the reassessments of all the patients and staff. He said he and others in leadership were walking the halls themselves.
But he added, "No hospital is absolutely safe."