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We reported earlier this month on the dramatic increase in violence at state psychiatric hospitals here in California. Now there's been another death at a hospital in Napa, the second one there in less than six months. Napa State Hospital was also just fined for violating basic workplace safety laws. NPR's Ina Jaffe has this update.

INA JAFFE: Last October, it was a Napa State Hospital staff member who was murdered by a patient. Last week, it was a patient who died. His name was William Roebling. He'd attacked a fellow patient.

But as staff members tried to subdue him, Roebling stopped breathing. The coroner's preliminary report says that he died of natural causes, including coronary disease, not because of the staff intervention.

State Senator NOREEN EVANS (Democrat, California): I can only imagine how the staff that works there feels. They're not only frustrated, they are scared.

JAFFE: State Senator Noreen Evans represents the Napa area. After Roebling's death, she and another lawmaker wrote to Governor Jerry Brown demanding that something be done about the dangerous conditions at Napa State Hospital.

Senator EVANS: I was willing to give the new administration some opportunity to try to address the problems. But it hasn't happened. And now we've seen a second death. In the meantime, we've had a number of attacks on staff and patient-on-patient attacks. It's just not acceptable.

JAFFE: But it will take some time to fix, says Diana Dooley, California's secretary of Health and Human Services.

Secretary DIANA DOOLEY (Department of Health and Human Services, California): The conditions didn't occur overnight, and they're not going to be resolved overnight.

JAFFE: It's taken years, she says, for Napa's patient population to change to the point where now more than 80 percent of them are committed through the criminal justice system. They're not guilty by reason of insanity or incompetent to stand trial, for example. And the hospital just wasn't designed to handle such patients. So late last week, Dooley lifted a hiring freeze to add more clinical and security staff.

Sec. DOOLEY: It is a small down payment, but I hope it illustrates that I am committed to working with all of the stakeholders to see that we create a safe environment for the staff as well as the patients.

JAFFE: She also met face to face with those stakeholders, including representatives from the Napa staff - like Brad Leggs, a psychiatric technician and union rep. He says there was a fair amount of consensus on making changes that the staff has wanted for a long time.

Mr. BRAD LEGGS (Psychiatric technician): Having a decent alarm system in place, having good staffing ratios, and probably the creation of a unit that would house some of the individuals who are a little bit more difficult to handle.

JAFFE: One of those difficult to handle individuals is accused of murdering a Napa staffer last fall. Last week, California's Occupational Safety and Health Agency cited the hospital's failure to deal with that patient and other safety defects as violations of state labor law. The agency fined Napa $100,000 and gave the hospital just a few weeks to fix the problems.

But Cliff Allenby, acting director of the state Department of Mental Health, says those citations will be appealed.

Mr. CLIFF ALLENBY (Interim Director, Department Of Mental Health, California): Because we believe they're not appropriate and they're not right.

JAFFE: Though Allenby wouldn't say what was wrong with them. But he cautioned that the appeal shouldn't be mistaken for a lack of commitment to improve safety at the hospital.

Mr. ALLENBY: We need to have protection for our employees and for the other folks that are in our system.

JAFFE: But that's mostly still in the planning stages just like it was before there was a second death at Napa State Hospital.

Ina Jaffe, NPR News.

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