There must have been an awful commotion, although no one heard a thing. It was a busy county psychiatric hospital, after all, and the Unit C exam room door was closed. But inside, a terrible story was unfolding. During a routine afternoon checkup this past November, Dr. Erlinda Ursua was slain by one of her own patients, a severely mentally ill woman who had been brought to John George Psychiatric Pavilion that morning. The doctor was beaten savagely, according to sheriff's department records, her head and face smashed again and again into a solid object. She also was strangled, according to a not-yet-released autopsy report. Outside the door and just up the hall, nurses, mental health specialists, and doctors went about their work completely unaware of what was happening inside the room. Although the examination room had a panic button, the sixty-year-old MD, who stood only four-foot-eleven, couldn't get to it during the attack.
A hospital janitor made the ghastly discovery later that afternoon. Ricardo Simpson opened the exam room door so he could empty the trash and found the doctor's body on the floor. Her physician's coat was open and her shoes sat next to her feet. An earring, a piece of a jade bracelet, and paperwork were strewn around. No one else was in the room.
Alameda County Sheriff's Department detectives told Lorenzo Ursua that his wife probably didn't die during the beating. She lay there undiscovered for an hour and a half, they estimated, and was most likely alive for at least some of that time.
The suspected killer, 37-year-old Rene Pavon, whose hands were scratched and swollen when she was questioned by detectives later that day, said she became upset when the doctor tried to take her pulse. "I punched her in the neck and her blue wallet and keys went up in the air," she reportedly said. Then, according to a sheriff's department report, Pavon began to ramble unintelligibly.
While staffers at the 88-bed psychiatric hospital were deeply saddened by their colleague's murder, hardly anyone was shocked. For years, they have complained of assaults by patients, many of whom are severely mentally ill and are brought to the San Leandro facility against their will by the cops. Some are homeless; others are transferred from area jails. Many show up after going off their psychiatric medications and arrive in frightening states: They are brought in unkempt and reeking, covered in feces, barking like dogs, or dressed up in costumes. Patients also have been admitted with knives and other weapons stashed in their pockets.
"I've seen so many of my co-workers taken out on stretchers. It's terrible," says Cheryl Omeregie, a mental health specialist at John George who is out on stress leave after saving a colleague's life during a Christmas Day stabbing in 2002.
Stretchers for wounded staff members were all too common in the twelve months prior to Erlinda Ursua's death. One nurse was stabbed twice in the back. Another was punched in the face and had his nose broken. A staff member's head was slammed into a wall so hard she suffered a concussion, and another nearly lost an eye to a pencil-wielding patient. A doctor's jaw was dislocated, and one aide's knee was injured so severely that it required surgery and now has to be replaced. These, according to Dr. Harold Cottman, a hospital psychiatrist, are in addition to numerous less-serious assaults. In 2003 alone, at least six hospital employees went out on workers' compensation leave following patient attacks. But because of poor record-keeping, a top hospital administrator was unable to say just how many other employees went on leave in prior years. Only one thing was certain, the administrator said: "I can tell you there were others."
Despite the repeated attacks and a growing chorus of employee complaints, hospital administrators made few real improvements. By last April, safety had became such a concern at John George that five staffers approached the California division of Occupational Safety and Health, the state's workplace safety agency, to complain.
In June, following an investigation, Cal-OSHA cited the hospital and fined it $30,000 for failing to report two of the attacks as required by law. The state agency also issued a citation for the hospital's failure to maintain an adequate worker safety program. "On a regular basis," one of the citations reads, "employees are suffering injuries from violent patients who assault the employees."
Administrators at the financially strapped county hospital had heard much of it before, and not just from their employees. Cal-OSHA also had cited the hospital back in 1998 for an inadequate workplace safety program. This time around, the agency took the unusual step of making three recommendations that spelled out precisely what they believed needed to be done to protect hospital staff. But rather than implement any of the suggestions, county administrators appealed the citations and fashioned their own set of improvements -- which a number of staff members say were totally inadequate.
"There was no visible change in safety between Cal-OSHA and Dr. Ursua's murder," says nurse Stacey Johnson, who suffered a broken nose when he was attacked by a patient wearing a Spider-Man costume. Neither he nor the other staff members interviewed for this story were surprised by the hospital administrators' feeble response. It was what they'd come to expect. "We'd been complaining about safety for years, and we kept saying eventually somebody was going to get hurt really bad," he says. "They didn't listen. They didn't think there was a problem."
Five months after Cal-OSHA issued its citations, Dr. Erlinda Ursua was dead.
Dr. Ursua was not one of the complainers. The general practitioner loved her job and went about it cheerfully, despite the less-than-cheery workplace environment, her colleagues say. A native of the Philippines, she immigrated to the United States in 1975 with her husband and oldest daughter. Another daughter was born while Ursua pursued her California medical license. She took a job in Alameda County's public health system in 1977 and never left.
Colleagues describe Dr. Ursua as a devoted physician who treated her patients with great respect and patience. She didn't fit the doctor-with-an-ego stereotype; co-workers say she regularly ate her lunch with hospital housekeepers rather than with her medical colleagues. "They used to all share their lunches," recalls Soccoro Smith, a John George nurse for twelve years who has been on workers' compensation leave since 2001. Smith was attacked twice in one month by different patients who hit, kicked, and punched her in the head and neck. "Dr. Ursua comforted me and calmed me down. I was ready to walk off the job," she says.
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