State health officials moved Friday to bolster security and reassess patients at Clifton T. Perkins Hospital Center, after the second patient slaying in a week at the state mental facility.
State police said the latest victim, Rogelio Mondragon, 40, was found dead in his room Thursday evening. Another patient, Andre Mayo, 46, was charged with first- and second-degree murder. An autopsy determined the death was caused by multiple blunt-force injuries to his face and neck. Police said video surveillance showed Mayo entering the victim's room twice within a half-hour.
The killing of Mondragon follows the death last Friday of David Rico-Noyola, a Perkins patient who police say was killed by his roommate, and is the third killing at the state's maximum-security mental hospital since 2010.
"The events at the Clifford T. Perkins Hospital over the last week are tragic and unacceptable," said Dr. Joshua M. Sharfstein, secretary of the state Department of Health and Mental Hygiene, which oversees the state-owned hospital. "Hospitals are places for healing, not violence. Perkins Hospital has taken many steps to strengthen the safety of its environment, but more needs to be done."
Some state legislative leaders called on officials to explain how they will prevent further violence at the Jessup hospital.
"It seems like something definitely needs to change," said Del. Peter A. Hammen, a Baltimore Democrat who chairs the House Health and Government Operations Committee. "We have an obligation to be sure everyone is safe."
Hammen had previously called on Mental Hygiene Administration officials to brief his committee on their investigation into last week's killing.
Nearly all patients at Perkins have faced serious criminal charges such as murder, rape and assault, and were ordered to the facility by courts for evaluation and treatment.
Mondragon was being held at Perkins after being found not competent to stand trial on charges that he and two others raped an 11-year-old girl in a Silver Spring apartment. State police said Mayo had been committed to Perkins on a second-degree rape charge, though that information could not be confirmed through court records.
There had not been a homicide at the 50-year-old facility until last year, and several deficiencies in the operation were uncovered in an ensuing investigation. But officials had since believed they had shored up the facility through better oversight and additional staff.
Officials from the Office of Health Care Quality, which licenses hospitals in Maryland, have begun evaluating the facility, as have outside consultants from the National Association of State Mental Health Program Directors in Alexandria.
Robert W. Glover, executive director of the association, said the three slayings since 2010 are unusual. "That's an unusually high number of incidents like that occurring in a single facility in that time frame."
Sharfstein acknowledged that Perkins may need to step up security — both of the patients killed within the past week had been in maximum-security units. Officials would not go into detail about what patients in those units were and were not allowed to do, or how those restrictions might change.
Because Perkins is a hospital, Sharfstein said, "There is not the level of security of a prison."
He outlined some immediate patient-safety measures. The hospital added one new monitor per shift beginning Friday, bringing the total to two.
Dr. Gayle Jordan-Randolph, medical director of the Mental Hygiene Administration, said that each patient with the potential for violence will be reassessed. That assessment helps staff determine to what unit the patient is assigned, from minimum to maximum security, and whether the patient has roommates and is allowed to move around freely on the ward.
Still, she acknowledged that "these are the most challenging patients to treat."
Mental health advocates and others have already called for better oversight and increased staffing. There are 248 beds in the facility and 496 staff, up from 493 in 2010 and 478 in 2009.
According to a report by the Department of Health and Mental Hygiene, there were 129 patient-on-patient assaults at Perkins in 2009, up from 100 in 2008. It rose again in 2010 to 150, according to the Maryland Operating Budget.
One lawmaker said funding has been an issue in running Perkins, leaving many patients housed three to a room, even in the maximum security units.
"Budget starts driving policy, instead of the other way around," said Del. James W. Hubbard, a Prince George's County lawmaker who sponsored legislation this year that now requires separate men's and women's bedrooms. The move was a response to last year's killing of Susan Sachs by El Soundani El-Wahhabi, a known sex offender.
This year, Gov. Martin O'Malley proposed to give the facility roughly $50 million; the General Assembly cut that to $48.5 million. Still, the final budget was slightly higher than either of the previous two years. Hubbard said the governor needs to "get personally involved" in being sure the facility is getting the resources it needs.
A spokeswoman for O'Malley said the governor has been in constant contact with officials since the killing.
"Our first priority is for the safety and security of the public, staff and patients," said Raquel Guillory, the spokeswoman. "Pending the outcome of the investigation of this latest incident, we will determine if change is needed."
The facility has already had its share of change at the top. There had been an interim head in place for the past year since the chief executive stepped down. And that interim leader left the post about two weeks ago. Dr. Muhammed Ajanah, clinical director at Perkins, then took over as interim director.
Sharfstein said a new permanent leader is expected to be named next week.
One patient says he was afraid to remain at the facility after the killing last week. Brandon Hart, who shared a ward with last week's victim, said he particularly feared the patient accused in the killing, Vitali Davydov, who was committed to Perkins after killing his psychiatrist five years ago. He was charged Oct. 21 in the death of roommate Rico-Noyola. He was deemed incompetent to stand trial in the death of his mother in 2008.
In a phone message left for The Baltimore Sun about two hours before the latest killing, Hart said Davydov had made verbal threats for a month before the attack, but staff didn't react. He also accused staff members of assaulting him and officials of ignoring his grievance about the incident. He threatened to hurt himself.
His mother, Lisa Hart, said her son has long been troubled, and his treatment at Perkins has made his condition worse. She said he has tried to take his own life twice, once with pills and once by hanging himself.
Yet, she said she was kept informed by her son and other patients, not by staff, who she says often don't return her calls.
"He called and said, 'I'm tired and I can't take it no more,' and I told the staff to keep an eye on him," she said. "I'm afraid I'm going to lose him."
Del. Samuel I. Rosenberg, the vice chairman of the House Ways and Means Committee, said he expects to hear from health officials about whether staffing and funding are adequate.
"The state's obligation here is glaringly apparent, and I think they are taking short-term and long-term steps to address the problem," Rosenberg said. "That doesn't bring anybody back to life. One hopes that these efforts will be followed through on, and we won't have another killing."