The Clifton T. Perkins Hospital is shown past a chain link perimeter fence in Jessup. Maryland State Police have charged a patient at the state mental hospital with killing another patient, the second such homicide in a week. (Patrick Semansky/AP)

Workers at Maryland’s maximum-security psychiatric hospital in Jessup, where two patients were slain recently, are calling on the state to address what they describe as problems in treatment and a pervasive climate of fear.

In the letter to state officials, they said some patients at the Clifton T. Perkins Hospital Center “are under-medicated and others are over-medicated.” Treatment teams do not get input from the direct-care staff, they added, so the teams “are often out-of-touch and therefore make dangerous clinical decisions regarding these very dangerous clients.”

The union representing many staffers said the fear — which some patients also complain about — even extends to doctors. “Staff have seen doctors showing serious fear of clients. . . . Doctors need to be trained to not show their fear of clients to either staff or clients,” said the letter, which called for improvements in staffing, among other areas.

Statistics provided by the state illustrate the dangers of working or living at Perkins. There were 267 assaults by patients against other patients or staff in fiscal 2011, up from 228 in 2010 and 225 in 2009, according to the state, although less than a dozen a year resulted in hospitalization.

About 150 of the assaults each year involved only patients.

During that three-year period, five staff members were fired for using excessive force against patients. Three staffers were criminally charged with assault after a 2010 incident at the hospital.

“Perkins is a dangerous place to work, because you have people there who have been committed there because they have committed violent acts,” said Patrick Moran, director of American Federation of State, County and Municipal Employees Maryland. “It is our opinion that the state should do everything they can to ratchet down people’s concerns at every angle.”

State officials say it is a delicate balancing act to maintain a secure environment at Perkins, which has about 250 patients, while helping such a challenging group recover.

The new chief executive recruited to Perkins last week from Spring Grove Hospital Center in Catonsville, another state psychiatric facility, said he is addressing the climate of fear.

“I’m not sure it’s possible to erase fear completely, but that would be the goal,” said David S. Helsel. “With the nature of the patient population, everyone has to exercise caution, and there will be some degree of people looking over their shoulder. The culture of fear can’t be erased until everyone feels safe.”

The complaints regarding Perkins raise questions about whether much has improved since El Soundani El-Wahhabi, a known sex offender, was charged in the death of Montgomery County resident Susan Sachs at the hospital in 2010.

A review pointed to workers sleeping on the job and other shortcomings. A state panel recommended keeping the halls well lit, walking rounds every 30 minutes and ensuring that an alarm sounded when a patient’s bedroom door opened.

The recent spate of violence began Oct. 21, when David Rico-Noyola, a former Anne Arundel County resident, was found dead; police charged roommate Vitali Davydov of North Potomac with murder.

Six days later, Rogelio Mondragon of the Langley Park area was found dead in his room in the same ward; patient Andre Mayo of Baltimore was charged with murder.

It’s not clear how Mayo was able to enter Mondragon’s room on the maximum-security ward, where there is one staff member for every three or four patients per shift.

Patients not only fear one another, but some say they also are scared of the staffers who control their privileges. Staff members, meanwhile, are on constant guard as they monitor patients whose mental illness has driven many of them to kill or commit other violent crimes.

There are many reasons for the fevered atmosphere, with patients and advocates saying there is inconsistent leadership at Perkins, which just named its third new head in a year; a lack of therapy for some patients; and shared rooms even among those with the most violent histories. Patients say staffers are inattentive, while union leaders say workers get little support from the top and are trained with antiquated methods.

The workers’ letter to state officials included recommendations for improving safety, including ensuring that patients are properly medicated and increasing evening activities for patients to prevent problems born of boredom.

They also wanted reevaluations of roommate pairings, more staff training and fewer employees working 16-hour days.

Sometimes the violence at Perkins extends beyond patient-on-patient attacks.

In addition to the five Perkins workers who were fired since 2009 for using excessive force, at least three workers have been criminally charged in the past year with violence against patients, court documents show.

Pledges of improved security have come from top state officials, including Brian Hepburn, director of the state Mental Hygiene Administration.

Every system is being reviewed, he said — from staff levels and training to oversight.

— Baltimore Sun