From a distance, the campus looks like a small suburban office park. Buildings are fringed by a wide lawn, but on the perimeter is a tall metal fence, topped by barbed wire. This is Napa State Hospital, a psychiatric hospital managed by California’s Department of State Hospitals.

Here, anyone who enters the secure area, workers and visitors alike, passes through multiple doors, metal detectors and locked gates.

While most people with mental illness are not violent, more than 80 percent of Napa’s patients are referred here by the criminal justice system. Some of them committed horrific crimes but were found not guilty by reason of insanity or incompetent to stand trial but ordered to a psychiatric hospital.

Many of these patients can still be dangerous. Last year alone, the hospital says they committed more than 1,800 physical assaults.

For staff here, this week marks a somber anniversary. It was here, on October 23, 2010, that psychiatric technician Donna Gross was murdered by a patient — grabbed, dragged and strangled to death.

“Everyone who was here the day that Donna died on these grounds has PTSD, and we will never be able to address it. We just carry it. It’s there,” says  Michael Jarschke. He has worked as a psychiatric technician at Napa State Hospital for 32 years.

A poster in the union hall at Napa State Hospital invites workers to a memorial service for their murdered co-worker Donna Gross.
A poster in the union hall at Napa State Hospital invites workers to a memorial service for their murdered co-worker, Donna Gross. (Scott Shafer/KQED)

At the time of Donna Gross’s murder, staff members all carried alarms to call for help. But Jarschke says that back then the alarm worked only inside the buildings — not outside, where Gross was murdered.

“When you think about it today, that’s almost ludicrous that we would do this,” Jarschke said. “We always look back five years [later] and say, ‘Wow, we were really dumb back then.’ ”

As president of the union representing psychiatric technicians, Jarschke helped form the “Safety Now Coalition,” employees who organized — and demanded — change.

Hospital Executive Director Dolly Matteucci says there have been changes, like limiting the ability of potentially dangerous patients to walk around freely.

“At this point in time, we have a much more stringent and informed and comprehensive grounds access policy,” Matteucci said.

Matteucci describes the most important change at Napa — a new personal alarm system with GPS to help hospital police respond more quickly to emergencies anywhere on the grounds. She has one hanging around her neck and explains that by pulling it, it sends an “immediate notification to dispatch and to all hospital police.”

When I asked how frequently staff members are pulling the alarm, I was astonished by her response.

“The tag gets pulled from 11 to 17 times in a day,” she told me. “Staff might see a patient escalating and say, ‘That’s looking a little precarious. I want a little help before I engage that patient.’ ”

She says that the heavy use of the alarm system illustrates how difficult it can be to serve such a challenging population “in a very complex, active environment that was not built for a forensic patient population.”

Napa State Hospital opened in 1875. Until 20 years ago, most of its patients were civil commitments. Today, the vast majority have criminal backgrounds, including gangs. In fact Napa patients include members of the Crips, Bloods, Aryan Brotherhood — they’re all there.

Michael Jarschke leads the Napa Chapter of the California Association of Psychiatric Technicians. He pushed to create a new alarm system with GPS to protect staff members.
Michael Jarschke leads the Napa Chapter of the California Association of Psychiatric Technicians. He pushed to create a new alarm system with GPS to protect staff members. (Scott Shafer/KQED)

To address that, Matteucci says, Napa has added more hospital police. But the hospital remains a dangerous place for staff.

At a hearing of the state Senate Health Committee last year, psychiatric technician Stephanie Diaz gave tearful, halting testimony, recounting her recent experience with one patient. As she was escorting him up a stairwell, she said he tripped her, pinned her to the floor and attempted to rape her.

“I started screaming at the top of my lungs,” she told the committee, “praying that someone would hear me. I wasn’t sure if I (had) pulled my alarm completely, and after a slight delay I heard the alarm sound and help arrived. It felt like an eternity. And I feared for my life.”

Diaz was testifying on behalf of legislation that would allow California’s five state mental hospitals to isolate the most dangerous patients and give them more intensive treatment. The bill, AB 1340, passed and was signed by Gov. Jerry Brown last year, but it will take time to implement.

Napa psychiatrist Steve Seager is a vocal critic of hospital administration. He says much more needs to be done to protect both patients and staff.

“Violence is part of our life every day,” he said. “It’s just a constant thing. It’s not like violence happens now and again. Violence is part of the daily life at Napa.”

It begs the question: Why would anyone want to work here?

“One of my nurses said, ‘This is a Jesus job.’ The patients need treatment. They’re criminals.They’ve committed crimes. I never forget that. But they deserve to be treated with dignity, which we try and do,” Seager said.

Despite the violence, despite their criminal records, the clients at Napa are patients, not prisoners. Hospital director Matteucci reminds us that as patients, they have certain rights.

“They have the right and ability to be out and about in their treatment environment, treatment in groups. Exercising as a group. So it’s just a demonstration of the complexity of our system,” she said.

5 Years After Brutal Murder, Napa Hospital Seeks to Balance Treatment With Security 26 October,2015Scott Shafer

  • June Forbes

    Labeling the patients criminals doesn’t tell the story. Patients in the “secure treatment area” at Napa State Hospital may or may not have committed the crimes they were accused of. Many have not had trials or made plea bargains; they’re waiting until their symptoms of mental illness are lessened enough to deal with the court process. Others were intimidated into pleading “not guilty by reason of insanity” to exaggerated charges prompted by fear and stigma.

    The State’s miserly budget for State Hospitals doesn’t fund best practices. It funds locking people up on wings of a hospital with little to do – a recipe for the trouble boredom in close quarters breeds. Qualifying for conditional release isn’t just a matter of time, it’s a matter of authorities’ subjective judgement, so It’s common for patients to be hospitalized far longer than they would have been incarcerated if they’d just pled guilty to their charges.

    • Jim Reilley

      So, that makes it ok to murder the staff? Whether they are legally “criminal” or not, they are dangerous and need to be properly restrained during treatment. The focus should be on the safety of staff first and most.

    • Robert Sommer

      Not all the patients are criminals, present or former. Many are there on “mercy bookings,” a subterfuge used by counties to save money. If a person in the community shows signs of a major psychiatric disorder such as bipolar disorder or schizophrenia, and causes a disturbance like shouting at passing cars or at people on the sidewalk, If a police person brings them to Napa State Hospital (NPS) and they accept him as a patient, the county would be charged over $450 per day of hospitalization. To avoid this, there is a charade in which the individual is arrested on a charge of loitering or disturbing the peace, and brought to court where the judge quickly finds them “Unable to stand trial” due to insanity (presumably unable to assist in their own defense) and sends them to NSH for 30 days after which they are returned to where they were arrested. These are classified as criminal commitemnts. There are other subterfuges used as well to save counties money under the terms of the Lanterman-Petris-Short Act.

  • Kathleen

    Some of the most dangerous patients are not in NSH due to the criminal justice system; they’re in the other part of the hospital, not in the forensic section of the hospital. They are dangerous because they’re very very sick. Their treatment may never work, sometimes is does. Enhanced staffing, more staff on the floor, all day, every day, is the only thing that can help keep the patients and staff safe. If Mattucci thinks the new alarms are the best thing they’ve done, she needs to look again. An alarm? Really? For Pete’s sake, ongoing, 1800 assaults every year, really and I don’t think that has changed much in the past several years. The hospital needs assault prevention efforts, like an officer on the units before an assault happens, not just after the fact. Patients who are too frightened of other patients that they won’t come out of their rooms, how is that helping anyone? The hospital has been understaffed for years, no matter what the legal staffing guidelines tell you. Governor Brown, you should be ashamed. This is your state hospital.

  • Steve

    Napa State Hospital was devastated 5 years ago at the loss of one of our own colleagues. We all know going in to this environment each and every day that there are risks to getting injured or hurt in the midst of potentially calming a violent event but this murder pushed everything over the top and revealed obvious limitations and holes in our system. Dolly Matteuci, Executive Director, and the other administrators under the guidance of DSH in Sacramento implemented a number of added safeguards including the GPS alarm system and additional Hospital Police officers. It has improved the safety for both patients and staff alike short of ever completely eliminating the risks involved in this line of work; similar to risks police and firefighters face daily. It’s also true that an Assembly Bill passed that will allow for the segregation and closer monitoring of the most dangerous, preying patients that are within the Secured Treatment Area however an even more important bill has failed twice and this is of greater impact. The other bill would have addressed the staffing resource deficits that effect the daily care and treatment of all patients. This bill would have reduced the staffing of nurses, psychiatrists, psychologists, clinical social workers, and rehabilitation therapists BACK to the manageable ratios they were at for decades UNTIL lean financial times caused the DSH Administrators to arbitrarily increase these caseloads. The end result is less attention and less treatment across the board. Staff are more stretched and stressed. They are less capable of providing ethical, timely, and effective treatment and observation of the patients and the environment. Morale drops.
    There are approximately 800 patients inside the Secured Treatment Area and about 200 who reside outside of these formidable locked gates and are conservatees (unable to provide food, clothing, and shelter for themselves in the community). It is true; the patients outside of the STA are actually more likely to assault staff and peers than those who have been committed for having engaged in a violent crime and either pled Not Guilty by Reason of Insanity, or those who are awaiting this trial and were committed as Incompetent to Stand Trial until otherwise decided by a court. The conservatees are less predictable as their respective medications have not resolved the extent of their mental difficulties and their behaviors are less predictable. Many still struggle with internal preoccupation and stimuli such as auditory and visual hallucinations, delusional beliefs, and disorganized thought processing.
    We are at a time in which overall, there are better psychiatric medications and various treatments which DO EXIST to assist severely mentally ill patients in significant ways, however these resources need to be in place for this to occur!! Most staff at NSH really DO wish to provide more than adequate care and come there daily for all the right reasons.

Author

Scott Shafer

Scott Shafer migrated to KQED in 1998 after extended stints in politics and government to host The California  Report. Now he covers those things and more as senior editor for KQED’s Politics and Government Desk. When he’s not asking questions you’ll often find him in a pool playing water polo. Find him on Twitter @scottshafer

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