RALEIGH - A psychiatrist at a state mental hospital in Goldsboro is still on the job despite an internal investigation that concluded he hit a mentally ill teenager who has developmental disabilities.

Dr. Ralph Berg, 58, struck Ricky Luciano in the back during a tussle over a T-shirt at Cherry Hospital. The incident, which occurred April 28, was recorded on a hospital security camera.

Berg, reached at his home Friday, said he had been instructed not to comment about the case.

According to the hospital's internal investigative report, released at the behest of Luciano's family, Berg told hospital officials he was defending himself after Luciano, then 18, bit him on the forearm.

Even if Berg was attacked, a state law regarding the use of force in mental hospitals bars staff from retaliating with violence.

The assault was not reported to any law enforcement agency, including Cherry's internal police department.

A review of public files at the N.C. Medical Board gives no indication a complaint was filed against the doctor, who has been on the state payroll since 1999 and receives an annual salary of $187,681.

"He should have been fired," said Deborah Sargis, Luciano's mother. "I've been a nurse more than 20 years. Had I ever seen anything like that when I was working, I would have reported that doctor in a minute."

On the recording

The recording, which the state Department of Health and Human Services did not disclose until pressed by The News & Observer, shows Luciano standing in a hospital day room at 8:37 a.m. with his shirt off, snapping it at two staff members in front of a nurse's station.

Berg enters through a door and attempts to snatch the shirt from Luciano. The two tug at it, spinning around before Luciano appears to dip his head toward the doctor's hand. As the patient is bent over, Berg strikes him in the back, and Luciano collapses to the floor.

The doctor throws the shirt to the floor before grabbing it and leaving through the same door he entered. Luciano, who is schizophrenic and has an IQ of 58, is left sitting on the floor with his head bowed until the tape, as edited, ends.

The written report of the incident included in Luciano's medical file indicates he bit the doctor, who "pushed" the patient to make him release the bite.

A handwritten note that says "no injury to client" was crossed out and replaced with "Error. Reddened area L[eft] shoulder blade." The mark, which later darkened to purple, measured about 4 inches square.

Afterward, records indicate Luciano was given the maximum recommended dose of an anti-psychotic drug, along with anti-anxiety and mood-stabilizing drugs. When administered together, the drugs would have heavily sedated the patient.

An internal investigation was launched that day, after the incident was reported to one of the hospital's patient advocates. In an interview with Berg transcribed in the file, the doctor said he tried to grab the shirt only after Luciano snapped it at him.

"He locked his jaw into my arm," Berg is reported as saying. "As he was locked on me, I went to push him down, and he moved up a bit, and it wound up slapping him on the back. ... I feel badly that it went down like that, but I am going to stand by my guns that I didn't do anything wrong."

Nurses and lower-ranking employees at state hospitals are routinely fired if an abuse complaint is substantiated against them, and their names are placed on a blacklist that makes it difficult for them to find another job.

According to the investigative report, the Cherry officials who reviewed the complaint against Berg recommended that a supervisor "address how the intervention used was not appropriate and discuss how the situation could have been handled differently."

In a transcript in the investigative file, Berg complained to investigators he was treated poorly.

'Grossly unfair'

"I think this was grossly unfair, humiliating and embarrassing," Berg said. "This really, really, really hurt me worse than anything that has happened in my life. ... I am the victim, and I was bitten. I tried to stop it. I was the victim."

Sargis, her son's legal guardian, said she was told nothing about the assault until she received a two-sentence letter from the hospital about three weeks later.

"This letter is to inform you that an allegation of abuse made on 4/28/08 was investigated and was substantiated," the letter said. "If you have any questions about this, please do not hesitate to call the [patient] advocate."

When she tried to find out what happened, Sargis said, she was provided with little information. When she pressed for more, she said, the hospital's clinical director threatened to discharge Luciano and send him home.

Shown the video for the first time last week, Sargis said top hospital administrators, including Cherry Director Jack St. Clair, misled her.

"It was nothing like what they told us," Sargis said. "St. Clair said he wasn't hit, it was just a little tap. They said Ricky never hit the ground. It looked like they were fighting."

Luciano's medical file indicates that Cherry's staff struggled to control his behavior during his two-month stay at the hospital. He was frequently restrained and heavily medicated.

The file also indicates he suffered several injuries while there, though little explanation is sometimes provided and it appears his mother was often not informed.

Two days after the altercation with Berg, instructions for Luciano's care handwritten by a doctor whose initials are illegible instructed nurses: "Ice pack to R side of face 20 minutes. ... Do not call family."

No interviews

Requests to interview St. Clair or other Cherry administrators this week were declined by the department.

"The doctor remains on the staff and continues to practice," spokesman Tom Lawrence wrote in e-mail Friday. "No other information will be provided as anything else violates state personnel policy."

N&O stories earlier this year described the 2006 beating of a Cherry Hospital patient by three staff members and the death of another Cherry patient smothered by more than a dozen staff members restraining her.

The incidents were among 82 questionable deaths in state mental hospitals and 192 cases where the state determined its employees had abused or neglected patients.

The top medical official at Cherry, Dr. Robert C. Owens, was reassigned to a job at a state prison last year after it was revealed publicly that he had pleaded guilty to a felony in 1989 after performing oral sex on a sleeping 9-year-old girl.

As part of a pledge to improve transparency in the state hospital system, DHHS Secretary Dempsey Benton said in January all patient deaths or incidents involving injuries to patients or staff would be noted on the department's Web site. No entry was made about Luciano, however.

"There was no real injury," Lawrence said Friday. "I think it takes more than a red mark to qualify."

Luciano was transferred from Cherry in June to a state home for the developmentally disabled.

"The doctors there said he had been overmedicated at Cherry," Sargis said. "They took him off most of the drugs, and he is doing much better."

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