The number of assaults resulting in injury to staff at Atascadero State Hospital has more than doubled in the past seven years, new figures show.

While such assaults have increased from 61 acts in 2005 to 137 acts last year, overall aggressive incidents — physical violence or threats against staff that did or could cause injury — have held steady, according to state data.

Violence is not uncommon at ASH, which has the highest level of security among California’s five state hospitals that treat mentally ill violent offenders.

The goal is to stabilize them through medication, therapy and daily programs so offenders can return to trial or prison within an average of six months.

Overall, the number of aggressive acts on staff hasn’t fluctuated excessively in recent years, ranging from 405 incidents in 2005 to 409 incidents in 2011, according to data requested by The Tribune through the Public Records Act. A recent high of 450 incidents was recorded in 2008, while a low of 365 was posted in 2006.

Within the overall aggressive incidents, the number of events that resulted in physical injury is significantly lower. For example, of last year’s 409 aggressive acts, 151 incidents resulted in injury.

Disordered offenders

One issue is that aggression tends to increase as the facility’s population shifts toward a type of patient ASH calls the mentally disordered offender — those who are so sick that they serve their parole there or remain institutionalized after their parole has expired if they’re deemed too dangerous to leave.

ASH, licensed for 1,275 beds, had 1,035 patients last week. Of those, about 46 percent — or 475 patients — were deemed mentally disordered offenders.

“We have taken a number of steps to reduce aggression since our population has shifted,” Acting ASH Executive Director Linda Persons said in a statement.

To help, management has assigned more structured activities, expanded staff training and returned employees to “direct patient care instead of doing unnecessary documentation,” the statement says. The data ASH provided The Tribune break down how those physical-injury incidents to staff occurred: either by sudden outright assaults or when a patient is being contained.

Of the 151 aggressive incidents that resulted in injury last year, for example, 137 stemmed from assaults, and 14 occurred during containment situations.

Assaults occur when patients become agitated and behave violently toward staff in the course of a day. Such an incident might occur when a staffer and a patient are in the same room.

Containment incidents occur when patients become violent and resist staff members who are trying to calm them. Staff tries to contain patients by administering medication, physically restraining them or secluding them in a room, according to the hospital.

ASH also defines aggressive acts to include instances in which patients use body parts or substances such as spit or urine as weapons.

On rare occasions — four times last year — patients threw something or converted a pen into a shank. Three of those incidents occurred when a patient tried to stab an employee with a shank; the other involved an object being thrown, according to the data.

Focus on safety

Safety, officials say, is a priority for the roughly 2,100 employees at ASH. The unions representing doctors, nurses, psychiatric technicians and others, as well as state Sen. Sam Blakeslee, R-San Luis Obispo, are also striving to keep ASH safe.

But despite those efforts, Cal/OSHA fined ASH more than $38,000 last week for failing since 1994 to correct workplace hazards — such as having too few alarms and a lack of security personnel — that the agency says have led to patient assaults on employees.

“A lot of members were complaining and getting hurt,” said Paul Hannula, president of the California Association of Psychiatric Technicians’ ASH chapter.

He hears concerns from his members and says many remain shaken from the 2010 slaying of Donna Gross, the psychiatric technician strangled by a patient at Napa State Hospital.

“We’re trying to prevent staff members being killed at ASH,” he said.

The California Department of Mental Health has met with Cal/OSHA regularly on the issue and is working to develop new policies, DMH Chief Deputy Director Kathryn Gaither said in a statement. “We remain committed to upgrading safety for a secure working environment.”

Blakeslee says outside oversight on behalf of staff is positive.

“The pressure from outside parties has almost exclusively been to uphold patients’ rights and patient safety,” he said. “I think it’s important that the DMH know not to tip the balance in putting patients before their staff and the safety of the people in our community. It’s just not acceptable.”

Oversight lifted

In November, a federal court relinquished its temporary oversight that focused on patients’ civil rights at some state hospitals, including ASH.

The rules had limited the use of seclusion and medication since 2006, which many said contributed to increased rates of violent behavior in patients.

Lifting that oversight is part of the solution, Blakeslee said.

He has also been working on laws to protect staff at ASH and the four other state hospitals.

One bill he introduced last week would help make court referrals more accurate to cut down on misdiagnoses of violent offenders, such as not referring those patients to ASH who have a temporary substance-abuse problem. The bill would require an offender’s substance-abuse history to be included in the process and add a procedure to observe and assess a newly referred patient for 30 days before a court referral is permanent.

A second bill, with help from the San Luis Obispo County District Attorney’s Office, would make it a felony for mentally disordered offenders to assault ASH employees.