Safety concerns raised after back-to-back patient killings at Perkins

After two patients were killed in the span of a week by fellow patients at the state's maximum-security mental hospital, mental health advocates say safety must be improved — but one warned against a clampdown.

"It sounds counterintuitive, but sometimes you actually have to relax things a little bit," said Laura Cain, managing attorney of the adult mental health unit at the Maryland Disability Law Center, an advocacy group.

Another advocate for people with mental illness says the recent patient killings, along with another last year, are a sign of serious gaps in security for patients and staff at the Clifton T. Perkins Hospital Center in Jessup.

"Whatever they're doing now is not enough because it's not working," said Lynn Albizo, a consultant to the National Alliance on Mental Illness of Maryland. "You need to examine the safety issues involved."

Cain said she sees the three killings at Perkins as "evidence of pretty severe dysfunction at this hospital." Still, she said she hopes hospital and state health officials resist the temptation to lock down the units that house its approximately 250 patients.

"That doesn't mean you don't pay attention to safety — you do," she said. "But it can be done in a way that's giving back some of the responsibility to the patients and allowing them to feel safe."

The approach is called "trauma-informed care," based on an understanding that the patients have experienced trauma in their lives. And it's an approach that Cain applauds Perkins for moving toward since Susan Sachs was killed in September 2010 by a fellow patient who was a known sex offender.

Sachs was the first patient in the 50-year history of Perkins to die at another patient's hand, authorities said. Then came the two recent killings in quick succession.

On Oct. 21, hospital staff found David Rico-Noyola on the floor of his room, bleeding and suffering from trauma to his body and head. Vitali Davydov, who killed his psychiatrist five years ago, was charged with killing Rico-Noyola, his roommate. On Thursday evening, 40-year-old Rogelio Mondragon was found dead in his room, police said. Andre Mayo, 46, is charged with first- and second-degree murder.

Patients at Perkins suffer from a range of serious psychiatric disorders such as schizophrenia and psychosis. Most have faced serious criminal charges such as murder, rape and assault, and were sent to the hospital by court order for evaluation and treatment.

"Any time you have a client with mental health issues who's declared incompetent to stand trial, you expect the facility he's in to be a safe environment," said Jonathan Fellner, a Rockville attorney who was representing Mondragon on rape charges. "I was shocked and surprised when I found out that he was killed. He wasn't safe there, and I'm sure they're going to investigate why this happened."

Cain agrees that an investigation is needed. But she said the culture at Perkins needs to change. For example, she says, the orientation for new employees overemphasizes the risk of violence.

"When you have staff who are terrified of the patients, you're setting up a bad scenario," she said. "They're not going to be able to do their job."

Her organization also advocates changes in patient policies that "reduce coercion, which actually increases safety in the long run as people feel more respected, have a little bit more control." As Cain put it: "When people have no control, the only thing they can do is hurt themselves or hurt someone else."

Albizo, the consultant to the state chapter of the National Alliance on Mental Illness, said, "I think trauma-informed care is one piece, but there's also a need to look at the different likelihood of violence among different populations."

Attorney Debra Saltz, who represents the man charged with killing Sachs, is a former Howard County prosecutor who for two years handled cases that came out of Perkins. There were "tons of incidents, but most of them minor," she said.

Last year there were 150 patient-on-patient assaults, according to the state.

In reviewing the case against El Soudani El-Wahhabi, who allegedly strangled Sachs in her room, Saltz said she came to believe that security at Perkins was "extremely lax."

"People sleeping on the job, security measures in place that nobody was following. Security doors that were supposed to be locked [were] left open freely so that people could come and go. It was ridiculous," Saltz said.

She said county jails, with their tighter security, "have the ability to handle some of these people."

Mubarak Taylor, El-Wahhabi's brother, said in a telephone interview that he didn't fault Perkins for failing to prevent what happened to Sachs. "I've been there several times. And when I was there, it was like any other facility where people are incarcerated — they seemed to take the appropriate measures," he said.

"These things do happen, at other institutions as well," he said. As for his brother, Taylor said: "We just take it day by day and hope that someday he'll get better."

After Sachs' death, the hospital retrained staff and tightened security measures after an investigation found that employees slept on the job and did not regularly check rooms.

Last week, a union official said the hospital should look at everything from making sure that employees' hand-held radios work to better tracking of violent incidents.

The goal is to avoid violent altercations such as the one that claimed Rico-Noyola's life this month.

Well before he got to Perkins, Rico-Noyola had been acting out, and when the 20-year-old's parents found drug paraphernalia in his room, they took him for a psychiatric evaluation, according to a 2008 article in The Annapolis Capital. But they were told that he was fine, so he returned home.

In December 2008, Rico-Noyola's mother was found dead in their home. Police charged the son with the crime. His father, David Rico, spoke out afterward.

"I want this to be a lesson to doctors, parents and psychiatrists that when their kids are on drugs and alcohol and have serious symptoms, I want them to be taken seriously," Rico told The Capital through an interpreter. "It's dangerous when people don't take these things seriously."

In the weeks after the killing, his lawyer wrote in court papers, Rico-Noyola was "actively psychotic and suicidal," and suffering from hallucinations. "We have not told the defendant what he is charged with and who the victim is for fear of how he will react to it," attorney Karl Gordon wrote.

Baltimore Sun reporters Andrea F. Siegel and Alison Knezevich contributed to this article.

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