"This hospital is still in crisis and security is the most important issue," Dr. Gail Jordan-Randolph, medical director of the state Mental Hygiene Administration, told the members of the Finance and Budget and Taxation Committees.
But Randolph and other high-ranking officials said that the state's maximum-security mental hospital has also made several changes to improve safety measures and employee confidence, and is working to identify systematic problems that may have led to the killings.
Among the changes, the hospital has fired three employees, created an all-female ward, started random monitoring and started a clinical reassessment of all Perkins patients. A committee of rank-and-file workers and management will also meet monthly to discuss safety concerns.
David Helsel, who started as chief executive officer of Perkins two weeks ago, said he is beginning to identify other changes that could be made at the hospital as well.
"These are very hard jobs, and people are demoralized," Helsel said. "I'm working hard to make sure people understand that even though terrible things happen, we have to pull together."
He said employees are working too much overtime, and that patients feel as if "they have nothing to look forward to." He also said clinical services for patients should be enhanced.
"I am trying to come up with ways so that there are more intense treatment practices than are currently in place," he said.
The state has hired two experts in forensic psychology and psychiatry to perform an extensive audit of the facility. Dr. Joel Dvoskin of the University of Arizona and Dr. Kenneth Appelbaum of the University of Massachusetts will present preliminary observations to state officials in January and a more extensive report in February.
Appelbaum told the senators the pair would do an analysis of treatment programs, policy and procedures, security, patient grievances and oversight of the facility by the Maryland Department of Health and Mental Hygiene. He said they would gather evidence from documents and medical records and through interviews with patients, families, staff and other stakeholders.
Committee members questioned health officials about whether workers were getting adequate grief and trauma counseling since the killings.
Sen. Thomas M. Middleton, chair of the finance committee, said advocacy groups have said the hospital had complained that outside counselors were not brought in to treat workers.
Jordan-Randolph said that crisis teams and other counseling were on hand for workers and patients. Helsel said staff members who want to meet with counselors have been doing so.
But Middleton wondered if staff might not feel comfortable complaining.
"You don't think patients have a mistrust of you?" asked Middleton.
"I haven't picked up on that," Helsel responded.
One woman who works at the facility said there is no time to for workers to take advantage of the counseling. Majeeeda Halfeezar, who attended the briefing, also said employees at the facility are still uneasy and scared at times, something the local union has brought to the attention of management.
"You don't want to say too much because you don't want to lose your job," she said.
But Halfeezar said after the meeting that she was glad the state seemed to be ready to look into some of the issues at Perkins, such as overtime.