First, there were three killings in the span of 13 months, with three psychiatric patients charged with murder in the deaths of three of their fellow patients at Clifton T. Perkins Hospital Center, in Jessup.
Then came a 38-page consultation report loaded with 73 new safety recommendations for Perkins, the state's only maximum-security psychiatric facility.
Now, Gov.Martin O'Malleyhas proposed spending $4.4 million to add 93 new staff positions and other safety improvements at Perkins as part of his 2013 budget.
O'Malley's move is in line with the report's recommendations, which were released to the public earlier this month, said Dr. Joshua Sharfstein, the state's health secretary, who first called for consultants to be brought in to conduct the report.
"We basically decided we needed more people on some of the key units," Sharfstein said.
The facility has been heavily scrutinized, and the safety of its patients questioned, ever since the killings, which began with the death of a female patient in September 2010 and culminated with the deaths of two male patients in the span of a week in October.
The three killings came after Perkins had "enjoyed half a century of existence without even one such event," according to the report.
State health officials are now hoping O'Malley's proposal and the report's recommendations will give the hospital the boost it needs not only to respond to the scrutiny, but to better care for its patients.
"Unfortunately, it sometimes takes tragedies to create the mix that results in a very positive outcome," said Brian Hepburn, executive director of the Maryland Hygiene Administration, which oversees the state's public mental health system.
The hospital center is already moving in the right direction, Hepburn said, implementing recommendations from the report and addressing concerns that have been raised.
"The goal is to try to make sure there's leadership on each unit, there's good communication between staff, that the direct care staff have connections with the treatment team and the leadership so that the overall treatment for individuals at Perkins is very positive and is done in a way that matches best practices for programs around the country," he said.
Among other recommendations, the report calls for a "staffing needs assessment" that looks at the "changing nature of the hospital's population" and the "appropriate number and kinds of supervisory staff" needed there.
It also recommends the hospital create a new, specific position of ward director, with "overall responsibility for the unit and authority to provide supervision to all ward staff either directly or indirectly through shift managers when the ward director is off-site."
Specifics on how the governor's requested funding will be used vis-à-vis the recommendations were not available.
But, moving more employees to the facility will help ensure its preparedness, Hepburn said, at a time when Perkins' role in the state's overall mental health system is becoming increasingly important.
Although a long trend of deinstitutionalization has led the state to dramatically decrease its institutional capacity for most psychiatric patients in favor of community placements, home-based services and treatment at community hospitals, forensic patients like those at Perkins, who come out of the court or penal systems, aren't part of the shift.
While civil admissions at state hospitals dropped from 2,306 in 2002 to just 209 in 2011, accounting for the drop in institutional capacity needs, admissions involving the court system actually bumped up during the same time period, from 862 in 2002 to 895 in 2011, Hepburn said.
"At the time that other hospitals perhaps will be downsizing, (Perkins) will not be," Hepburn said.
Part of the staff increases at Perkins will be offset by cuts — to the tune of $3.8 million — elsewhere in the state's mental health system.
Hearings on the Department of Health and Mental Hygiene's budget are scheduled in the Senate on Feb. 10 and in the House on Feb. 13.