KEY POINTS:
It is the most unlikely setting for a love story.
The Mason Clinic houses Auckland's mentally ill. The Rata Unit holds 15 of its most dangerous patients: criminally insane killers and violent offenders.
They pose a "serious risk" to the public, to clinic staff and to themselves.
But there are no high fences and no razor wire: the state-of-the-art design means the security is in the architecture.
The ward has built-in "observation lines" so nothing too much can go on without being seen. There are no sharp edges or hanging points. Courtyards allow the patients to go outside to let off steam.
There are no security guards _ this is a hospital, not a prison. Instead, there is a heavy staff presence with psychiatrists and assorted health professionals accompanied by up to 10 nurses a shift.
The majority of nurses are male as this job requires "patient handling" and use of restraint techniques.
It is highly structured and has worked extremely well, with one escape the only blip on its record.
How the security could fail is hard to imagine. A double-lock system means you can't take somebody's keys on the inside and make your way out.
Everything must go through an airlock that is constantly manned. It keeps the patients in and contraband like cellphones, drugs and weapons out.
The Weekend Herald was not allowed inside the ward for this story. The Rata Unit has a low profile and the Mason Clinic wants to keep it that way.
That was, until a triple-killer who can be known only as X met the nurse known as Ms L.
Their inappropriate relationship in 2004 set off staff suspicions. Then came investigations, recriminations and finally, last month, a misconduct ruling against Ms L by the Health Practitioners Disciplinary Tribunal _ documenting a rare insight into life beyond the airlock.
X's potted biography is not that of your everyday eligible bachelor.
He was found not guilty of the three counts of murder on grounds of insanity _ a suppression order covers his name and the details of that offence.
X has since spent several years in high-security care at Auckland's Mason Clinic subject to a "special patient" order.
Aged in his 30s, X had previously done prison time for violence. He has a gang history and suffered serious abuse as a child. He is no stranger to psychiatric care.
X needs a lot of help. Officially, as described in tribunal documents, his condition is: Chronic, relapsing psychotic illness of the paranoid and grandiose type ... Personality disorder and early onset anti-sociality ... His illness episodes are treatment-responsive and are related to interpersonal stress and substance misuse ... [He has] a difficulty in engaging in trust.
Despite treatment, he still poses problems: a serious assault and other altercations are on his clinic history.
His staff management plan, given to the tribunal, says he has poor insight into his problems and poor anger management. He can create a "manipulating environment" around him. He uses "splitting techniques" with staff, employing "good nurse/bad nurse" strategies_ particularly with female and new staff.
The plan gives particular emphasis to making sure X does not push boundaries.
If allowed, this could pose a risk to other staff who do not allow pushing of boundaries.
Ms L did not heed this advice.
Now 38, she had been a nurse for only about two years when she struck up a bond with X in 2004.
What exactly happened between X and Ms L is as much he-says-she-says as any other relationship.
He told the tribunal it all began out by the volleyball court when she told him someone at the clinic had raped her.
It went from there: he felt sorry for her, a friendship developed, they started touching. Then came a cuddle, kissing and hugging in the storeroom.
They took day leave to see the movie Troy, but instead went to her house, with the invitation of a home-cooked "feed".
Their sexual relationship began.
He accused her of sneaking him away from the clinic to have sex either at her home or in toilets at the nearby Unitec polytechnic, Pt Chevalier library and McDonald's.
Ms L told the tribunal of a discussion at the volleyball court as well _ but in 2001 when she was a student nurse and how it was X who came to her, telling her how he believed he was under a makutu, or Maori curse.
The documents show Ms L was forthright about Maori issues and she claimed it was through this that she and X bonded.
She denied the sex took place, explaining there was just one visit to her home when she was escorting him on day leave and she started menstruating heavily. She argued she needed to change, as from a "Maori cultural perspective", it was not acceptable to continue her daily tasks without attending to her personal hygiene needs.
WHATEVER the truth of the two versions, the relationship between the two had come to the notice of other staff.
Anonymous phone calls finally led clinic management to search X's room, finding a cellphone with 42 messages from Ms L on it sent over a five-day period.
One message on it said: "I love u so much I fear I am going to lose you."
But Ms L was not alone. A female psychiatric assistant, known as Ms C, was also involved in "alleged misconduct" with X at the same time, forming a bizarre love triangle.
Ms C was investigated and also admitted giving X a cellphone. She left the clinic before she could be dismissed _ and because the position of psychiatric assistant is not registered within the tribunal's jurisdiction, she could not be called to further account.
X now claims to be in an ongoing relationship with a woman believed to be Ms C.
The web of personal relationships within the ward at the time was further complicated when a male worker giving defence evidence to the tribunal admitted to having been in a relationship with Ms L, which was against clinic policy.
And Ms L claimed that "malicious behaviour" towards her was driven by yet another worker whose advances she had rejected.
The tribunal heard of other apparent issues at the clinic: allegations of low morale, of tension between its Maori and Pakeha staff and of how other staff take patients home _ to mow the lawns.
These were not for the tribunal to judge.
In its decision the tribunal found Ms L not guilty of a charge of professional misconduct for the sexual relationship with X, saying that while it suspected the relationship, there was not enough proof.
She faces being struck off after being found guilty of the other charge of misconduct for providing the killer with a cellphone, taking him to her home and ignoring an escape bid X told her about involving another patient _ also with name suppression _ who, on his later release, became one of New Zealand's most notorious murderers.
Although unsuccessful, the escape bid sparked a "serious incident review" _ the results of which the clinic will not disclose.
In fact, the clinic will not disclose anything about the issues raised by X and Ms L or what it has done since.
Dr Sandy Simpson, who heads the clinic as clinical director of forensic psychiatry services for the Waitemata District Health Board, declined to comment on the case directly, saying he was constrained by having been a witness as there remains a possibility it may be appealed.
He would not comment when the Weekend Herald asked him about the serious incident review, the allegations of racial tensions or the "lawn-mowing" home visits.
Instead, Dr Simpson spoke of the success the clinic has had, with just the one successful escape from the maximum security ward since he became the clinic's director in 2001. He said the clinic, which opened in 1992, is doing its job _ particularly compared to its predecessors Oakley and Carrington Hospital that were on the same Mt Albert site.
Dr Simpson said the public had a right to ask questions about day leave _ but had nothing to fear. There were no incidents of the public being harmed by patients on day leave.
The rehabilitative results of day leave were such that they actually "enhance people's lives and improve community safety".
Pushed finally on the fallout from Ms L, Dr Simpson would only say: "We are a learning organisation, take from that what you will".
JUDGMENT VITAL IN `GREY AREA'
There are no hard-and-fast rules when it comes to nurses forming relationships with patients.
Tony O'Brien, a senior lecturer in psychiatric nursing at the University of Auckland, points to research that puts relationships between health professionals and patients "off limits in their entirety _ not just at the time but ever". O'Brien says this "total bar" protects the nurse. But he says that, realistically, relationships can and do emerge. Witness the mathematics professor and physicist Stephen Hawking, who suffers from motor neurone disease: he controversially married his nurse (and has since filed for divorce).
However, O'Brien says the vulnerability of a psychiatric patient puts relationships out of the question. Elsewhere, he advises, nurses should "think carefully".
The Health Practioners Disciplinary Tribunal has investigated four cases of inappropriate nurse-patient relationships since its inception in 2004. All are at the high-end of the scale: a prison nurse and a prisoner, a nurse and a vulnerable mental health patient, a nurse indulging in inappropriate on-the-job touching and breach of privacy and the X/Ms L case.
Jenny Carryer, Professor of Nursing at Massey University and executive director of the College of Nurses Aotearoa, agrees that at the lower end of the scale there is a "grey area". She says there is no written rule about nurse-patient relationships _ just professional judgment.
"If a patient with a cut hand subsequently makes contact with a nurse, I don't think any of us would consider that inappropriate _ and it happens.
"There is no manual for managing relationships. It is about professional judgment and doing no harm."
THE PLAYERS
THE PATIENT: X
Designated as a "special patient" after a triple-killing. All details suppressed except that he was found not guilty of murder on grounds of insanity.
THE NURSE: Ms L
Involved in an inappropriate relationship with X. Smuggled him a cellphone, took him to her home and ignored an escape bid by another patient. X says they had sex on numerous occasions; she denies this.
THE PSYCHIATRIC ASSISTANT: Ms B
Investigated for "misconduct" with X. Left the clinic but it is likely she would have been dismissed. Is said to still have a relationship of some kind with X.
THE WARD:
The Mason Clinic's Rata Unit is the most secure of its kind and holds mentally-ill killers and violent offenders of "serious risk to the public".
