Cal/OSHA has fined John George Psychiatric Pavilion $54,000 for four workplace safety violations in connection with a physician's slaying at the facility last November, according to an article in theAlameda Times-Star.

Dr. Erlinda Ursua, 60, was strangled and beaten to death at the facility. A female patient has been charged with the crime and has pleaded not guilty.

Ursua met the newly admitted bipolar patient alone in an examination room on an isolated hallway. A custodian found Ursua lying unconscious 90 minutes later when he entered the room to empty the trash. Attempts to revive her were unsuccessful.

Among Cal/OSHA's citations:

  • The isolated exam room behind locked doors wasn't effectively inspected or identified as an unsafe environment for physical examinations.

  • An unwritten policy of staff not being alone with patients was not formalized nor enforced.

  • Established safety policies weren't enforced. These included special precautions on aggressive patients. The patient had been brought to the hospital the night before on a "5150 hold," a 72-hour evaluation for those at risk of hurting themselves or others.

  • In addition, a hospital policy prohibiting staff from wearing scarves, necklaces or other jewelry wasn't enforced. Ursua was wearing a scarf that may have been used against her in the attack.

  • A "panic alarm" on the wall of the exam room where Ursua was attacked was not accessible.

    A spokesman for the Alameda County Medical Center, which operates John George, said corrective action was taken on all counts immediately after Ursua's death.

    These included issuing staff individual panic alarms, no longer using isolated rooms to examine patients and having written, enforced policies on patient escorts, as well as dress codes and precautions for aggressive patients.

    A Cal/OSHA official said the fines were high because of past violations. "They've been warned of these things before and taken no corrective action," he said.

    In June 2003, John George was fined$30,000 by Cal/OSHA for failing to report assaults on staff and implement a workplace safety program.

    At the time, Cal/OSHA took the unusual step of recommending a series of reforms, such as hiring more security, installing a video surveillance system and instituting a policy of not allowing staff to be alone with patients.

    The hospital did not adopt these measures before Ursua's death, though it was not required to do so by law.

    Ursua's family is pursuing legal action against the county and the medical center.