State health officials are still investigating the second killing of a patient at the Clifton T. Perkins Hospital Center in just over a year.
Noyola's death comes thirteen months after Susan Sachs was killed at the hospital by a fellow patient and known sex offender in September 2010. The hospital retrained staff and tightened security measures after an investigation found employees slept on the job and didn't regularly check rooms.
"Both of these incidents are very concerning, perhaps in different ways," Sharfstein said. "So, we need to understand them and learn from them and recognize our goal is always to prevent instances like that."
But mental health advocates and the union that represents the hospital's workers said the previous changes were little more than a temporary fix and the latest killing is proof that not enough has been done.
They are calling for broad-based policy changes at the 50-year-old mental health facility.
"Violence prevention is more than how many staff you have and alarms and cameras," said Laura Cain, managing attorney of the adult mental health unit for the Maryland Disability Law Center, an advocacy group. "The hospital needs to create a culture of nonviolence."
Cain said the hospital needs to reassess policies such as how they decide what patients share rooms and what kinds of treatment patients are receiving beyond medication. She also questioned whether the staff was using the most effective methods to look for signs a patient is about to become violent.
A representative with the Maryland office of the American Federation of State, County and Municipal Employees said Perkins is still understaffed despite the state adding some employees. The state says the hospital added one person per shift after Sachs died, though the facility did this in part by reassigning current employees.
A health department spokeswoman said current and former staffing figures were not immediately available.
"We think there are some very common sense things that can be done to make places like Perkins safer," said Sue Esty, assistant director of AFSCME Maryland.
The union at Perkins has formed a joint committee with hospital staff to come up with safety measures, Esty said. She said the hospital should look at everything from making sure employee hand-held radios work to better tracking violent incidents.
"I think policies and procedures go along with things such as infrastructure and equipment, and they all need to be reviewed," Esty said.
A void in leadership at Perkins is not helping stabilize the facility, critics said. Sheila A. Davenport, the chief executive when Sachs was killed, stepped down in February, saying her resignation had nothing to do with the case. She was replaced by interim head Susan Steinberg, who left Perkins recently to take another job within state government. Dr. Muhammed Ajanah, clinical director at Perkins, took over as interim director.
Perkins houses 241 patients, many of whom are under evaluation for their competency to stand trial or who have committed felonies and would otherwise be sentenced to prison if not for their mental illness.
W. Lawrence Fitch, director of forensic services for the Maryland Department of Health and Mental Hygiene, said a killing of a patient is unusual. Rico-Noyola's death was the second killing at Perkins in its 50-year history, according to the state.
"These are extremely rare incidents," Fitch said, "even though these are people who come with violent pasts and extreme mental illness."
Davydov, the Montgomery County man who killed his psychiatrist in 2006, was returned to Perkins after being charged Friday.