A patient who was angry about back pain entered a Tulsa medical office building on June 1, determined to kill his surgeon and, officers later said, “anyone who got in his way,” a mindset that ultimately killed four people.
Ten days later, the implications of the incident continue to reverberate across medicine, at a time when tensions are already running high due to the coronavirus pandemic. For more than a year now, health care workers have reported friction with patients who have sometimes refused to wear masks, reacted violently to positive test results and protested outside hospitals over government vaccination mandates.
Local health providers said this week that they are reinforcing previous active shooter training among their employees and medical staffs.
Sharp HealthCare is reminding its employees of special duress alarms installed on its office computers which allow anyone to notify security that a situation is underway by discreetly hitting a series of keystrokes and checking the exterior doors of its buildings to make sure they lock properly. Additional reminders have to do with a special function of company-issued security badges which, if used in a certain way, allow quick activation of facilities’ emergency alert systems.
Kaiser Permanente San Diego, Paradise Valley Hospital, Alvarado Hospital and others across the region said in their own statements that they are prioritizing active-shooter response techniques in reaction to the recent spate of shootings with Scripps Health adding that it intends to pilot “some new security screening procedures,” though the exact nature of those changes is not being released to the public.
Few in health care have more experience with health care security than Chris Van Gorder, chief executive officer of Scripps Health. A sworn police officer injured in the line of duty, Van Gorder’s first health care job was director of security at the hospital where he recuperated from the injury that ended his law enforcement career.
In an email this week, he noted that health care facilities are limited in the extent that they can practice for such attacks. In hospitals especially, it is difficult to bring the kind of realism that makes threats and responses feel real.
“Real drills with actors as shooters and dozens of police officers, deputies and SWAT team members is intense and even frightening to staff participating, as I’ve been told by many employees,” Van Gorder said. “That’s why I am not in favor of drills with real patients who might have behavioral health issues or might be medicated and not realize this is just a drill.”
That appears to be the standard, at least locally. Drills are generally “tabletop” exercises where workers talk through how they would respond to a given situation — say, a person entering their building with a gun — rather than going through acted scenarios.
There has been much talk in the wake of shootings in New York, Texas and Oklahoma that those who find themselves targeted should themselves take aim. The argument is generally that a workplace with armed occupants will be less likely to be the location of an attack.
So far, there does not seem to be any such movement underway in San Diego.
Dr. Toluwalase “Lase” Ajayi, recently inaugurated as the 152nd president of the San Diego County Medical Society, said this week that she has not detected any move toward physicians arming themselves in reaction to the Tulsa shooting.
Doctors, she said, tend to be focused on treating causes rather than symptoms, and those she has spoken to tend to favor stiffer gun regulation rather than bringing firearms to work.
But there has been plenty of worry.
“To think that you could be attacked for doing your job, trying to do your best, and not just you but your team, it’s extremely scary,” she said.
The pandemic, she added, has clearly increased the number of tense situations unfolding in many health care settings. Some of her colleagues, she said, recently told her of being spit upon by a patient who did not appreciate receiving the results of a positive coronavirus test.
“Just in general we’re seeing this increase in aggression toward the medical professions, and it speaks to a larger societal burden,” Ajayi said.
How to respond to violence, especially gun violence, largely comes down to regulation as far as organized medicine is concerned. The powerful American Medical Association renewed its call for a ban on “military-style” weapons and high-capacity magazines Friday, supporting bi-partisan talks in the Senate after Congress passed a new gun-regulation bill Wednesday.
Of course, there remains a call to harden targets and to arm those who find themselves working in places that come under assault.
Ajayi said the local perspective of doctors, at least those she has spoken to, tends toward skepticism that increasing layers of defense or increasing the presence of firearms in the hands of trained defenders will do much good against truly-determined patients. Turning health care locations into bunkers, she said, is not likely to get support from medical professionals trained to increase access to care.
“Militarization of health care, that bunker mentality, would absolutely do harm because it decreases access to care, takes away patient autonomy,” she said. “At the end of the day, it’s the marginalized patients who suffer the most.”
It is not clear just how often violence, especially gun violence, against medical workers occurs. Google searches turn up plenty of anecdotal reports of similar incidents from an orthopedic surgeon killed at a shooting in a medical plaza in Rancho Mirage in 2020 to a disgruntled medical employee shooting his colleagues at a New York hospital in 2017.
San Diego’s highest-profile situation of similar danger to a local doctor occurred in 1994 when a patient angry over the outcome of a prostate procedure shot Dr. George P. Szollar, a urologist, in the groin. The physician survived, and his 62-year-old assailant served prison time after fleeing to Mexico.