State officials tapped a veteran psychiatric hospital administrator Wednesday to take over leadership of Clifton T. Perkins Hospital Center, where two recent killings have sparked questions about the safety and therapy provided at Maryland's maximum-security mental facility.
Dr. David S. Helsel, 57, who has run Spring Grove Hospital Center in Catonsville since 2004, said he plans to immediately join the examination of "all systems" at Perkins, including those related to staff, patients and resources.
"The most important thing to do is go in with an open mind," he said. "It's hard not to draw any conclusions on what may have gone wrong."
Public officials and those in the mental health field gave a mixed review of Helsel's past performance. But some who blamed turmoil at Perkins on a lack of leadership stability were relieved that the position is now filled.
"They had been trying to recruit someone for some time, and Dr. Helsel has been doing this a long time and will put the focus on security, which we think is the most important thing right now," said Lynn Albizo, a public policy consultant for NAMI Maryland, an advocacy group. "I think it's a good decision given the choices at this point.
"There needs to be someone at the helm because there really has not been a full-time leader for a long time, and that's obviously a problem. There have been major issues."
The chief executive officer's position has turned over three times since the death of patient Susan Sachs, who was killed by another patient in September 2010. Sheila A. Davenport stepped down about four months after that killing, and the interim head, Susan Steinberg, left recently for another state position. Dr. Muhammed Ajanah, clinical director at Perkins, then took over as interim director at the Jessup facility.
After Sach's death, an oversight panel found serious lapses in security, including staffers who were sleeping on the job. Officials said they have since added more security and oversight of staff. But within a recent one-week period there were two more patient deaths, with two patients accused of the killings.
That has brought calls from lawmakers and mental health advocates for reviews, and for improved staff training and oversight. Patients and their relatives have reported their fears, and their concerns that little had changed in the past year to provide protection from other patients — many of whom have extremely violent pasts.
"We're glad [Helsel] is willing to do a really tough job," said Gov. Martin O'Malley.
Helsel said state officials asked him to apply for the job between the two most recent killings. He said he complied out of a sense of loyalty to the system and to leaders he's long worked for. He also said he's equipped to run the facility in the long term and to assess what went wrong more immediately.
Helsel said every security system would need to be reviewed, from staffing levels and training to management oversight and surveillance. On the patient side, the patients' psychiatric evaluations, freedoms and room assignments would need to be reconsidered. Medications and counseling for patients also would be reassessed, he said.
In addition to the deaths, Perkins reported 232 assaults on patients and staff by other patients in 2011, up from 207 in 2010 and 208 in 2009.
For now, Helsel said, the Perkins staff's near lockdown of the facility is appropriate, even if it causes some stress on workers and patients. Once problems are identified, there can be a more balanced approach to security and therapy.
Helsel, who has worked at Spring Grove since 1984, confronted at least one death under his watch. In 2006, staff member Lee McDuffie was sent to the hospital after breaking up a fight among patients and died later that night, although it's unclear if an official cause was determined.
Helsel said that after the death, he brought in outside grief counselors and reassessed staffing levels and training. "I decided we could have trained staff better in how to handle … patients being aggressive, and we added new kinds of practice sessions and the frequency of them."
But workers still complained that they were not equipped to handle the increasing number of patients sent involuntarily by the courts. Many patients had committed serious crimes, though generally not as serious as those committed by patients sent to Perkins.
Union leaders and health advocates said Wednesday they wonder if real change will come at Perkins under Helsel's leadership.
The Maryland Disability Law Center, an advocacy group, gets most of its patient complaints from Perkins and Spring Grove.
"It would appear that it's a bit of shuffling people around as a solution and that would not be in our opinion the best long-term solution for a troubled facility," said Laura Cain, managing attorney of the adult mental health unit for the center.
Cain said Helsel wasn't always responsive to the organization's concerns. "There are other facility directors who welcome our observations and our concerns and what we hear from patients, and we have not had that relationship with Dr. Helsel," she said.
Representatives from the American Federation of State, County and Municipal Employees union said they hope Helsel will talk with the workers at Perkins. But they, too, said they had little direct contact with Helsel at Spring Grove. His staff was less than responsive, said Patrick Moran, director of AFSCME Maryland.
"I have not seen much engagement from this individual, if any, in the past," said Moran. "His underlings have not shown a willingness to work with the employees. It's been quite the obstacle at times."
Moran said the union has pushed Spring Grove and other hospitals to improve employee training and to help create a safer work environment. "The best advice we have for [Helsel] is that he is going to need to talk to the people who do the front line work — the people who are out there dealing with the clients on a minute-by-minute, hour-by-hour basis," he said.
Cain also said she was concerned that the salary for the new position wasn't enough to attract candidates, particularly given the troubles at Perkins. Helsel will earn $194,792 at Perkins, the same salary he got at Spring Grove.
Others said he'll bring valuable assets to the Perkins post.
"Dr. Helsel is one of the most experienced and accomplished administrators and psychiatrists in our state," said Dr. Joshua M. Sharfstein, Secretary of the state Department of Health and Mental Hygiene, who had asked Helsel to apply for the job, along with Dr. Brian Hepburn, executive director of the Mental Hygiene Administration. "His steady hand will help guide Perkins through this difficult time.
Dr. William T. Carpenter, director of the Maryland Psychiatric Research Center at the University of Maryland School of Medicine, called Helsel "remarkably devoted to Spring Grove and its patients."
Carpenter, whose research and treatment facility shares a campus with Spring Grove and often relies on the hospital for space and resources, said he saw Helsel deftly handle the evolving demands of a large state psychiatric institution.
"These hospitals are very, very old, and it's very hard to get them to meet accreditation standards," Carpenter said of the national certification required by the federal government for payments and by states for licensure.
"And now these places are flooded with [court-referred] cases. These are extremely challenging jobs — any hospital with 300 beds will have … a propensity for violence and suicides within. … You almost never hear bad stories, and these places are almost designed for bad stories."
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