Theyre breathing bridgehead to viewers may find offensive. [applause] think youre much. Originally it took three years to write. It is only 250 pages that we thought we would hide the name of law hospital because i wanted something this listener with the first publicity packet then i said that was ridiculous so we changed it so it is like a stain that is out there i cannot get out of. I work at napa state to the book is about napa state. This is the first time anyone has been inside the napa state to tell the story on the outside. There is some newspaper stuff if you want to know what goes on inside it is the largest foreign said hospital and whole reason i rode it i did not know what went on i showed up nobody told me they dont discuss that. And there was a brawl. A man was hit on top of the head with the chair who later died. They believe it to 3,000 assaults per year. These are bleeding, broken bones, it kicks in in the head may be as high as 10,000 it could be higher. I thought my patients are the ones getting the crap beat out of them my women my staff mostly women half her out on disability they dont have a voice for i am well paid i could leave tomorrow. But the patients cannot. 3,000 beatings for your quick math that is 10 a day that i will read you some stuff. I want to do a far point and i really should have done that but the violent to personalize those 3,000 assaults i have been on npr talking about the book people are overwhelmed thinking it cannot be true. But literally 4 miles summer is getting the hell beat out of them and it goes on all day long. We have had staff killed killed, patients killed, it is episodic we in the newspaper but 7 miles from French Laundry in the middle of the food capital of the world and then 10 people are beaten up every day and no one knows about it. It is about the head and my family but the true heroes i wanted to read from the book first then i will tell you some facts about Napa State Hospital said he thinks i am not making it up and people always think that. Anyway this is a preface ill just read for five minutes. All the patients have been changed to read and answer actually vince it is not the attempt to halt the patients it is unusual time for me and my staff. Every when we are faced with an epidemic of violence. So this is how the book begins. I sat at opposite ends of the rickety table this was of a stake. This single window looks out to a whole way. There was musty in july. I slid my chair for word. Good afternoon i said. I am dr. Stephen. He did not reply. I felt sixth in the gays. I tried again. The eye is did not waver of wonder how long they could go without blinking. A psychiatrist i had recently been run hired to run a new patient unit it was said dangerous place made familiar by silence of the lambs after one week of training he is the first patient i had talked to a long and was rushing to get home. How are you feeling . Another pause. You are a bloodsucker are you . He smiled but his voice was smooth as glass. He steadied me in his eyes narrowed. A forensic Mental Hospital is not a regular Mental Hospital theyre not just psychotic the criminals is the School Shooters hand of Jeffrey Dahmers of the world. And in every the accelerating. You and them are fucking in this together. We will suck the blood and kill the corpse. Working in management burbank and San Francisco then became ill. One month after the termination he killed his boss and coworkers with a shotgun. I will strangle that faggot da or you. I became acutely aware of this seeking ever. Panicked i stood. His hands pushed the table for her and pinned my size to though wall. To look frantically to the small window and saw nothing i reached for the alarm bieber issued and remembered it was still in my office. Sweat rolled off his head. Dont move you son of a bitch if your every cornered by a patient and keep talking. Tell me about your crime. His eyes widened the table that the bone in my head to the press and his head dropped and the stairs of thinned. He sat down and put a hand on his forehead. He looked mortal. I killed my closest friend he said. What kind of person does that . A person with an illness i said. Sliding to the jury reached around to grab the door handle that is why you are here not in prison for you are sick for opening the door cassava vendors and text to hustle toward me my legs were trembling by turn back. Will you be okay . The staff will help you back to your room. They escorted him back down the hall. Dark hair, thirties we were toe to toe. For the second time i was backed against the wall. She glared up at me bring you in there alone . Yes. Didnt they tell you not to do that . Yes. He could have killed you i know. I was really frightened. Did you learn anything from that terrible first day . I attach the stitches on the back of my head. I did know what to say she said we need you. Please get smarter. I sent to the floor. I was on the way to get someone else killed. Was called into the hallway. Walking to dinner with the rest of the patients he said thanks. True story. The names have been changed but that is a true story. Then is sort of an introduction of what i write to the first chapter about the of brawl going on how i got the stitches. To get a little bit of sense of history about napa, the most common thing i get is they say it isnt that where foster kids go when they turn 18 . No. Is that where demented people go . No. To know who goes there . Most people dont and i bet people in this room really dont know. We have about 12 or 1300 patients inside, 940 inside their called the criminally insane natalie mentally ill but have committed a major crime. Just dial little bit of history patients and staff has been killed you may have read about that in 2010. I will tell you about another killing in 2001 right outside my office so they had to murders and the same place. But besides the occasional news story there is the culture of silence if you go on my Facebook Page everything is tagged with the culture of violence and that is the problem it is a silent but they have silenced everyone half of the nurses, you did on disability they dont say anything. Enough is enough. You need to know your friends and neighbors are getting the hell beat out of them and nothing is happening what you do with the deprivation i realize i cannot make anybody do anything but it is up to you. All little bit of history a site was lecter work began on the original style difficile pitchers it is from the addams family. [laughter] for stories and it is creepy the largest building ever built in napa county to this day. And has been torn down of course,. Due to the overcrowding of the stock to an asylum which is californias first State Hospitals it opened 1875 vendor admitted the first two patients. It was known as the castle. There were two periods of time. The of the floor of wine and after wine and. [laughter] this was definitely before wine. The acres exactly it is now. 182 acres was purchased 11,200,500 from the mexican land grab. Eventually it grew to over 2,000 acres from the turnofthecentury became completely selfsufficient that nobody cared what went on. They recently found mass graves of people who died in the hospital. There were hundreds there were plans to dig them up demoralized them an entire city out there nobody you knew nothing about it. But that population in 1960 there were 5,000 patients. Due to the introduction of medication in the institutional is asian of the 1980s there was a large facility without patients actually became a homeless mentally ill. The first 5,000 are now living on the streets is in sarah francisco. They decided to take forensic patients instead and said we will take the Court Ordered people people come there for a number of reasons that the two big reasons they committed major crimes and invoke the insanity defense the major one is incompetent to stand trial that means you killed him but you are nuts for trial. Or when you did it. That is the percent of the population there are smaller ones that made the people that have done the insanity defense. That information is extremely difficult it is for any State Hospital i cannot even get the number of beds which i write about in the book. Is either 1362 or 1206. Depending. I dont know. That gives you a piece of what this is like. And i worked at Napa State Hospital the staff is terrific it is the best i have ever worked with in my life the doctors are great the nurses are fabulous the patients are my patients. I like them. They get them shipped the shit me out of them when hiv and hepatitis b was a big deal in the hospitals what you do . You just go to work and said i will get hiv or hepatitis . It is violent and people said guess i would get the hell beat out of me so they made changes and precautions sell medical workers dont get hiv or hepatitis but we cannot seem to motivate anyone to do anything just to make simple changes are precautions. The hospital is great. Is still want to work there but when im at work every single step i take i look both ways i walk to my unit when they are at lunch i keep my office door locked i dont go anywhere i dont see patients alone. That is what you have to working as a physician and nurses are trapped. I require them. Admire them for they built the hospital the ground was done. Two sets of numbers 200 different were 1,000 species of trees on those grounds some of which are the only species in the United States or in california they used to have a fellowship just to study the ground. Once the defense has gone up is either 63 or 23. [laughter] he would think theyre just about to measure it. [laughter] but it is very tall and covered with gold were to wires which is an unsettling for a hospital. It looks like a prisoner of war camp outside the fence you can see we lost three buildings of those Beautiful Homes to the earthquake they are uninhabitable. But you can tell it was built in the 50s. The trees are cool. The buildings are cool. Inside the fence is not. There is 17 units. I am not alone there is either 75 or 82. Depending on what you look at. When they tore down the castle they did a remodel so they built like the Junior College every unit is separate like a 17 story hospital all spread out and somewhere peacocks showed up [laughter] there are dozens of peacocks ever wear. Their beautiful they have a weird cries that sells life the opening notes of rhapsody in blue from gershwin then they laugh. It is weird. People run around there bloody than eupepsia peacock. I ask when they come from . Though the seems to know i was eating lunch the other day and a big buck deer was chasing a female deer and scared us to death. Wills, a wildlife, it is quite a place. [laughter] inside the fence there are two kinds of assault. I will bore you too much but the simple assault and aggravated assault they will not arrest unless it is the aggravated assault that means broken bones or teeth knocked out for two days in the hospital. We have cuts and bruises and fractures and washoe you a picture of our chief of staff that did not qualify. So i think we have set tend to jail and they come right back. If you were in the State Hospital because you are incompetent then they will see what incompetent so they will beat the crap out of there roommate in my flight to San Francisco two days later they come back to the same room in the same bet and everybody shakes their head. Woody supposed to do with a roommate . One guy goes to the hospital then comes back and nothing ever happens. It is not the state the three assault some. You can assault anybody once disneys times as you want nothing will happen. I am happy to answer questions. There are 60 beds with forcing ballrooms reshuffle people all the time but the person who beat the crap out of the whiz down bohol. But the way it is configured the front door is locked. Nothing else. I with with 60 people who committed murder or rape and just walking around. Id bump knuckles i have mass murders that i liken and mass murders they do not like. Is crazy. We talk. You go to lunch but people are surprised there is no guards. For filipino nurses, a social worker and a psychologist. Data is it. If all hell breaks loose i guess we jump in or something. But the alarm system by raised the question the primary prevention and secondary if you were getting a salted the police will arrive between three and five minutes maybe two minutes but you can get a lot of hell kicked out of you into minutes that weve learned a couple weeks ago when one of governors is what is pulled down the hallway in all 33 were kicked out and she was saved with another patient intervene to have to be in a hallway with other patients when you are attacked. We rely on the goodwill of the psychotic patients. So in this room if there were 1,000 the odds in one year of any of us getting assaulted is 6. Two when you walk into the fence your chances is 62point to. 10 times more likely if it is 10 years you were guaranteed. My psychologist has been assaulted 14 times it goes up astronomically you think it would get somebodys attention but it doesnt. I will read you something here is a disconnect that you know, betrayed what happens and what the Administration Says happens i am not picking on the administration they are stuck but somebody has to pick on somebody everybody blames somebody else. There is a problem everybody gets the hell kicked out of them it is their fault. This is what they put out. From the napa state website. The mission is to provide hope for the adults with serious Mental Illness and support each patient for personal recovery. That is true. That is a good plan. Items like to criticize that. The values our recovery, hope, dignity, res pect. Accountability and safety. Under safety knowing full well there is 3,000 incidents per year they say we commit to an environment free from harm or injury. Under principles quality, a care, leadership care, leadership, partnershi p, and diversity, safety and security we promote a safe and secure Violence Free environment for patients or staff and community. As a community. That is the mission. That it is Violence Free. The treatment philosophy is fine it is the recovery model thats i not know if you are aware but the patients are encouraged to take risks. Make decisions and experienced the results in a safe and supportive environment. My guess is theyre making bad decisions. This is how the administration views what is going on. I thought that is not how works. It is mayhem. The hospital looks like a college campus. What i want to do is read a little bit from the newspapers. I will do this briefly. Just in case you think i am making this up. For randomly reasons i am not sure for every email for every assault was not supposed to get this but i did. This is what happened inside the hospital in three days in march. Allegations of punching in the face while sleeping. Without provocation and got up from his bet and rushed at the staff with a closed fist. A fight broke out of a sustained bloody nose and a chipped front tooth. Someone had a seizure. Okay. Someone cannot of the restroom with the left forearm dripping with blood walking to the nurses station. At 7 30 p. M. The patient was assaulting the roommate punching him with a fast. He went to the nursing station to say help he punched me in the face by one was in the bathroom. The patient was making loud noises with the radio and punch the staff with a fist but was prevented by a their staff. A patient got out of bet the dead and they could counteract to jelly in physically we direct to the bet. [laughter] i am just reading what is on here. Hitting on the left cheek and was very angry to bang on the door then attempted to assault the nurse the patient turned in a piece of broken glass found in the courtyard. And they argued theyre not listening the favorite punching each other in the face then they get quiet with detail oriented aggressive to staff or self aggressive back to another individual to another individual. And other individual. Story that was published in the New York Times came out that it was strangled inside of the hospitals treatment center. She said every unit is contaminated with the culture of violence. The psychiatrist at the hospital said so every single unit is contaminated with this. The New York Times said the mentally ill would get victimized by the manipulating individuals from the prison mentality. We dont really have any way to protect them. He is gaped and fought back and it mentioned that someone who killed the patient in the hospital is transferred to another. And then the director of the hospital said, quote, i found nothing more than our staff to be safe. Now the valley register. They reported at the State Hospital this was may 24 of this year they were caught in the stairwell. Homicide coverage, la times for safety Mental Hospitals, documented patients against staff in the Second Quarter of 2010 double the total in the Previous Year recording increased six fold in the same yearoveryear comparison. Against the staff and other patients doubled at the metropolitan State Hospital. [inaudible] i will than just a second. Let me get through these. Have a valley register they were in the intensive care unit where he was flown in for the surgery and the hospitals remain vital and. The Napa State Hospital has around 3,000 against the patients staff in 2012 and that is concerned Hospital Police in the violent nature. Im going to show you two pictures. What i want to do is put a face on these assaults. They are actual people not far from our office. Im not going to get into it because they didnt publish it in the paper. A real person, mother. I want to show you another picture, too. This is the chief of staff. He did have as you can see black eyes, stitches and got his wrist fractured. Can we user picture and he said yes. So this is what the physicians go through at napa. I has to for the first call for change, california medical the. I wont go on because i sense people would like to ask questions, but i would like to kind of end of my prepared remarks with a