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Mass. General Stabbing Shows Difficulties in Preventing Violence

Scott Wallask, for HealthLeaders Media, October 29, 2009

Violence at Boston hospitals over the past eight days—including a fatal patient shooting—proves that healthcare security is an unpredictable business.

While it's hard to immediately learn lessons from this latest series of incidents, safety and security professionals at several medical centers offered steps they take to prevent and respond to workplace violence.

The following three incidents occurred recently at Boston medical facilities:

  • On Tuesday, an off-duty security guard shot and killed a patient who had allegedly stabbed a psychiatrist just moments earlier in a medical office building owned by Massachusetts General Hospital, according to the Boston Police Department. The security guard, who was legally carrying a weapon, didn't work for the facility and happened to be in the medical office building at the time. The psychiatrist was expected to recover from her injuries, the Boston Globe reported.
  • On Sunday, a man was stabbed in the waiting room at Boston Medical Center after a fight broke out between two groups of people, The Globe reported. The victim was expected to live, and police had not arrested any suspects as of Wednesday.
  • Last Thursday, a man was arrested for allegedly attempting to rape an employee at Mass. General, according to Boston police. The suspect, a convicted sex offender on release, allegedly grabbed the victim from behind in a women's restroom, slammed her head into the ground, and ripped her clothes before the victim was able to escape, The Globe said.

Tuesday's attack on the psychiatrist and subsequent shooting of the suspect at Mass. General garnered national media attention. However, Thomas Lynch, director of security for Baystate Health in Springfield, MA, warns that the circumstances surrounding that case make it hard to apply to other hospitals.

"I don't know how you plan for that [type of patient attack]," Lynch said. "And the response was out of left field, too, to have someone there [with a gun] … It's kind of amazing."

That said, as details emerge from the shooting it behooves other hospital officials to ask if they face similar risks at their behavioral facilities, says Steve MacArthur, safety consultant for The Greeley Company, a division of HCPro in Marblehead, MA.

Internal team can set protective measures
Cape Fear Valley Health System in Fayetteville, NC, established a security threat assessment team 10 years ago, says Steve Schultz, safety officer for Cape Fear. The team is made up of representatives from the human resources, safety, security, employee assistance, and risk management departments.

Any employee who feels threatened by someone else—be it a domestic partner, patient, or coworker—can request a meeting with the team. Supervisors who become aware of threats against their personnel can also request a meeting.

"The [team] can meet on 20 minutes' notice," Schulz says. "Our goal is to have an action plan developed within 60 minutes of the notification." The team offers recommendations on how to keep the threatened employee safe both in the hospital and outside of work.

"We've had issues with threatening patients and family members," he said. "For the past four years or so, it's been domestic situations" getting the most notice from the team.

Domestic incidents also concern Dick Lange, HEM, facilities manager at St. Joseph's Hospital in Marshfield, WI, part of Ministry Health Care.

"As the economy continues to tank, domestic [violence], as well as folks facing healthcare costs that they have no way of paying, all increase the chance of an explosive episode," Lange says. Downsized security forces at hospitals exacerbate the problem. St. Joseph's active shooter policy calls for an immediate lockdown of the building in the event someone brandishes a weapon. Hospital employees, including security officers, are not called upon to confront someone with a firearm, and in many cases, workers throughout the facility are encouraged to lock patients and themselves in rooms until the dangers has subsided. St. Joseph's security officers carry batons and pepper spray, but not guns.

Policies should spell out precautions for weapons
Employees directly involved in a violent situation involving a weapon face a dangerous set of circumstances. Summa Health System in Akron, OH, is about to roll out its new active shooter policy, says Howard Hunt, system safety officer.

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