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Imagine working in a place where there are more than 1,800 physical assaults in a single year. This is what happens at Napa State Hospital in California. And this weekend will mark five years since an employee there was brutally murdered by a psychiatric patient. We're going to hear what's changed since then and what hasn't. And a warning - this report includes some graphic descriptions. Here's Scott Shafer of member station KQED.
SCOTT SHAFER, BYLINE: Napa State is not your typical hospital.
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STEPHANIE DIAZ: I was escorting a patient up a stairwell when he tripped me and he pinned me to the floor, attempted to rape me.
SHAFER: At a hearing of the state Senate Health Committee last year, psych tech Stephanie Diaz gave tearful, halting testimony, recounting her recent experience with one patient.
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DIAZ: I started screaming at the top of my lungs, praying that someone would hear me. I wasn't sure if I 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.
SHAFER: Diaz was testifying on behalf of legislation that would allow California to isolate the most dangerous patients and give them more intensive treatment. The bill passed, but it'll take time to implement. The tall metal fence surrounding Napa State Hospital is topped by barbed wire. Workers, visitors, they all pass through multiple doors, metal detectors and locked gates.
More than 80 percent of Napa's patients are referred here by the criminal justice system, found not guilty by reason of insanity or incompetent to stand trial. Most are not violent but a small number of patients commit physical assaults on other patients and staff. It was here on October 23, 2010, that psychiatric technician Donna Gross was murdered by a patient - grabbed, dragged and strangled to death.
MICHAEL JARSCHKE: 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.
SHAFER: Michael Jarschke has worked as a psych tech at Napa State Hospital for 32 years. At the time of Donna Gross's murder, all staff carried personal alarms to call for help. Back then, it only worked inside buildings, not outside where Gross was murdered. Sitting at a long table in an office building at Napa, hospital director Dolly Matteucci describes the new improved alarm with GPS. It's hanging around her neck.
DOLLY MATTEUCCI: You pull down on the tag and it releases from this top joint here. And when it does that, that sends the immediate notification to dispatch and to all hospital police.
SHAFER: How often does somebody pull that?
MATTEUCCI: A typical tag pull is about 11 to 17 in a day.
SHAFER: Eleven to 17 times a day - that's kind of shocking. So what does that tell you?
MATTEUCCI: Our staff are serving incredibly ill, complicated patients that have criminal histories in a very complex, active environment.
SHAFER: When the hospital opened in 1875, it wasn't meant for patients like these. Until 20 years ago, most were civil commitments. To address the more dangerous population, Napa has beefed up security, but it's still a very dangerous place.
STEVE SEAGER: It's not like violence happens every now and then. Violence is part of the daily life at Napa.
SHAFER: Napa psychiatrist Steve Seager is a vocal critic of hospital administration.
SEAGER: Every time I leave the unit or go on the unit, it's like a little military exercise where I decide where I'm going to go. I watch every step. I look under my door before I open it. I go directly where I'm going. I don't make eye contact. You really have to be extremely careful every minute of the day.
SHAFER: Seager says hearing all this might make you wonder why would anyone want to work here?
SEAGER: One of my nurses said this is like a Jesus job. The patients need treatment. They're criminals. I know that. They've committed crimes. I never forgotten that. But they deserve to be treated with dignity, which we try and do.
SHAFER: But when it comes to balancing safety and treatment, Napa's executive director, Dolly Matteucci, says there is more to be done.
MATTEUCCI: We have made tremendous progress in safety improvements and in mitigating violence at the hospital. But sadly it continues to be a part of our environment and our shared experience as patient and employees. And it is unacceptable.
SHAFER: Keeping hospital staff safe is a top priority. For NPR News, I'm Scott Shafer in Napa, Calif.
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