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Ted Talks: Health Care Violence

Dr. Ted Rosen

Ted Rosen, MD, FAAD
Editor-in-Chief

I hate doctors. They’ll do anything—anything to keep you coming to them. They’ll sell their souls! What’s worse, they’ll sell yours, and you never know it until you find yourself in hell.”  

– Eugene O’Neill

It was December 18, 1982. An unidentified man walked into the MD Anderson Hospital office of the Vice President for Patient Care, Dr. Fred Conrad, and opened fire. Six gunshots, at close range, and the well-known and highly respected oncologist was dead. The case was never solved. 

Fast forward to July 20, 2018, when Dr. Mark Hausknecht, a Houston cardiologist, was shot to death while riding a bicycle to work at the Texas Medical Center. The killer was the son of a woman who died while under the doctor’s care some twenty years earlier. 

Two physicians, along with a receptionist and a bystander, were shot to death on the Tulsa campus of St. Francis Hospital just a few months ago (June 2022) by a disgruntled patient with persistent pain following back surgery. 

We hear a lot about gun violence in schools, especially when a mass murder occurs. What we don’t hear much about is gun violence in the health care setting. Only about 5% to 7% of all injuries and fatalities related to deliberate firearm use occur in health care facilities. Still, this phenomenon does happen and remains one of the many risks we all accept when we go to work daily. 

Can we do anything about it? Should we?

Think about the times we live in! In this litigious society, it’s more a question of when rather than if one will be embroiled in medical malpractice. COVID is not fading away, and has brought greater office expense, more red tape, more outside intervention, and frustrated patients whose procedures have been delayed or cancelled. There are rampant staff shortages and record inflation affecting the price of office supplies and the delivery of care. Doctors are working longer hours, sometimes for lower remuneration, and are generally more stressed and fatigued. And then—on top of all that—you have to worry about an unhappy patient walking into the office and killing you?

There are options, of course. Medical buildings, like many educational facilities, could become more “hardened” targets: armed guards at entryways and on the periphery, metal detectors, keypad or card key staff entrances, abundant security cameras, physical barriers, automatically locking doors at office entry points, brightly lit and patrolled parking lots and garages, and the like. 

Needless to say, this might be a bit challenging in high flow buildings which need to accommodate disabled or frail patients. It might also be a good idea to—as many schools do now—draw up and periodically practice a detailed “active shooter” (or “active threatening person”) plan of action. That plan should include well-trained security personnel who are available in a nearly immediate manner.

You might be forced to “size up” patients for their potential to become sufficiently distraught to commit violent acts. What about a patient who is demanding opiate narcotics following skin surgery or in association with herpes zoster or related to severe eczema? Can you tell which patient denied no longer justified “pain pills” could become a violent threat? How about the patient whose long overdue bill is tuned over to a collection agency and is now mad at the harassing phone calls and emails? Or the patient who is angry about a missed or delayed diagnosis of skin cancer? Someone who might have simply complained to the state medical board or filed a malpractice lawsuit in years past might, instead, decide that violent means of extracting retribution are more immediate or perhaps even more satisfying. 

Alas, I, for one, am not a good enough mental health professional to rely on myself to make that call! How good are you at picking up key warning signs in your own patients?

None of the suggestions above is foolproof, and the person dedicated to gun (and other forms of) violence will often find a way to circumvent any and all reasonable precautions. 

Remember the universal recommendation in an active threat situation: RUN, whenever possible; HIDE, if you can’t flee; FIGHT, only as a last resort. 

Let’s consider the worst possible scenario: In order to protect yourself, your staff, and your patients, you use a scalpel to disable or even to kill a menacing patient.  What is your professional and even legal liability having injured someone for whom, paradoxically, you are bound ethically to render care? Could a case be made by a grieving family or an enterprising district attorney that, as a health care provider, you should have had the skill to “talk down” the threatening individual? 

In this situation, a lot would depend upon state laws and a state medical board’s interpretation of the incident. Bottom line, despite the intense trauma of such an event, speak to nobody except an attorney—not even to seemingly sympathetic police or administrators. Even spousal communications may not be protected in a potential homicide case.

All of the foregoing discussion is pretty terrifying. Nonetheless, we can no longer pretend that we live in the bygone era of “Marcus Welby, MD” when health care providers were admired and trusted, and violence directed against them (or their staff) was essentially unheard of. 

According to U.S. Bureau of Labor statistics, injuries (including fatalities) caused by violent attacks against medical professionals grew by 67% from 2011 to 2018. During the COVID-19 pandemic, things only got worse. Violent assaults in hospitals rose 23% in 2020, alone. 

I urge you all to remain ever vigilant! Remember, there are individuals lurking in the shadows who agree with Russian playwright Anton Chekov who wrote: “Doctors are the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you too.”

This is Ted’s take. What’s yours? Ted.rosen@thedermdigest.com

News References:

  1. December 1982 shooting at MD Anderson Hospital:
  • “Hospital Violence: A Silent Epidemic.” American Medical News, December 20, 1982.
  1. July 2018 shooting of Dr. Mark Hausknecht:
  1. June 2022 shooting at St. Francis Hospital:
  1. Statistics on gun violence in healthcare settings:
  • “Hospital Violence: A Silent Epidemic.” American Medical News, December 20, 1982.
  1. “Active shooter” plans:
  1. Warning signs for potential patient violence:
  1. Universal recommendation for responding to active threats:
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