Sounds like she's overworked. Has too much on her plate thus is negligent. 20 graduate students plus 10 patients that's 30 hours. 10 hours left over for lectures supervising and coffee breaks. Then there's overtime work.
Her patients and students should be reevaluated by someone else just to make sure they are not becoming batty and over medicated.
Sadly, a lot of our psychotic mass-murderers have been under treatment at the time or until fairly recently before their acts, especially the young ones.
I think the threshold for notification and action may be a little too high. In some cases, the families of the young men were even trying to get them committed to residential care because they knew something was about to break...but the psychiatrists would say, “oh, he’s just fantasizing,” and refuse.