Cal/OSHA fines hospital in death of physician

Psych hospital failed to protect HCWs

John George Psychiatric Pavilion in San Leandro, CA, has been fined $54,000 for failing to take adequate precautions to prevent violent assaults against its staff.

The California Division of Occupational Safety and Health (Cal/OSHA) issued four citations against the locked, inpatient facility after a physician was beaten and strangled to death in an isolated exam room.

The patient of internist Erlinda Ursua, MD, has been charged with her murder.

The hospital, which cares for patients in acute crisis and is a part of Alameda County Medical Center, already faced $30,000 in fines for failing to report previous assaults on two nurses and failing to implement an injury/illness prevention program to protect workers from assaults.

After Ursua’s death, John George Psychiatric took immediate steps to prevent such violent assaults and already has corrected the situations that led to the citations, says Alameda County Medical Center spokesman Jeff Raleigh. For example, Alameda County sheriff’s deputies are now on-site 24/7, he says.

"There’s a new administration there," he says. "I think that will be a fairly significant change."

The incident occurred Nov. 2, 2003, when Ursua took a patient into a private exam room and began conducting a medical history and physical.

Later, staff became concerned when they saw the patient wandering around with a partially completed medical form. Soon after, Ursua was found dead; she had been beaten in the head and strangled.

The hospital had not taken precautions to protect health care workers, says Cal/OSHA spokesman Dean Fryer. "One [citation] was issued for using an isolated exam room and not inspecting for hazards when using that room," he says.

John George Psychiatric also failed to follow its own policy not to allow staff to be alone with a potentially violent patient, he says.

Cal/OSHA also cited the hospital for failing to enforce its dress code that prohibited scarves and jewelry, and for having an ineffective alarm system. "They did have an alarm system [in the exam room], but it was in a position that was not reachable," Fryer points out.

After Ursua’s death, the hospital closed all isolated exam rooms and created and enforced a written policy that two staff members must be in the room during patient evaluations, Raleigh says. The dress code has been posted and is enforced, he says.

"Now all employees carry a personal alarm with them while they’re in the facility," he says. "I’d like to emphasize that all of the actions were taken by John George before the citations were issued."

The hospital has not decided whether to appeal the citations, Raleigh says. An appeal of the previous citations still is pending.

Fryer notes that Cal/OSHA representatives met with hospital officials before the November death and made recommendations on how to correct the violations, "a step we very rarely take with employers.

"Our suggestions were not implemented, nor were there apparently any other measures implemented that would have prevented this attack in November," he says. "It’s highly likely that we will do a follow-up inspection to ensure these measures are taken to protect employees from attack."