On a typical, hectic day at Massachusetts General Hospital, as many as 60,000 people stream into the main building near the Charles River. Figuring out how to protect such a teeming mass of doctors and nurses, patients, and their families from random acts of violence is enough to keep even a seasoned security chief up at night.
For starters, there are too many entrances and exits to station metal detectors, and even those aren’t foolproof, said Bonnie Michelman, director of Mass. General’s police, security, and outside services. And a locked-down fortress is not the welcoming image a hospital wants to project to visitors.
A day after a cardiovascular surgeon at Brigham and Women’s Hospital was fatally shot, administrators of big city hospitals and doctors in small suburban offices were revisiting how they can keep harm out of the exam room.
The challenge is formidable, given the stew of emotions in medical offices, with its continual news of life and death.
“It’s a high-stress environment, and you mix that with the number of people, and people who are not able to care for themselves or their emotions — that creates some interesting complexities,” Michelman said.
At the New England Quality Care Alliance, a doctors group affiliated with Tufts Medical Center, administrators Wednesday were considering whether to issue safety guidelines to the group’s 1,850 doctors, many of whom work in the suburbs.
“Of course, now we’re thinking about this and trying to figure out how to advise on security, but it has to be in the context of what’s best for the patient,” said Dr. Michael Cantor, chief medical officer of the doctors network.
More broadly, the group’s doctors are focused on supporting patients and identifying, when possible, if someone is angry and prone to violence, Cantor said. “It’s become an increasing focus of ours as we realize that patients do not get what they feel they need. This is an extreme example,” he said of the Brigham case.
Patients or their families sometimes make threats but stop short of carrying them out. Dr. Richard Pieters, president of the Massachusetts Medical Society and a cancer specialist in Worcester, said a patient’s father once threatened to “take out my kneecaps.” But that was 25 years ago, and it hasn’t happened since.
“The only real way we can protect ourselves is to communicate, communicate, communicate, and develop a human connection with patients and their families,” Pieters said. “That’s really the best protection we have.”
The shooting of the Brigham surgeon — investigators blamed a man who they said was upset about the death of his mother, who had been treated at the hospital — shocked thousands of health care workers who toil in the Longwood neighborhood every day, and the broader medical community.
“Many of us are still processing what it means for us,” said Dr. Bradley H. Crotty, an internist who treats patients at Beth Israel Deaconess Medical Center, around the corner from the Brigham. “We go into the job to make people better and to heal. We will continue to do that.”
While hospital shootings are rare, other violent crimes and assaults at US hospitals are rising, according to a 2014 survey from the International Healthcare Security and Safety Foundation, and data from the Bureau of Labor Statistics.
Health care workers are kicked, punched, beaten, and even sexually assaulted by patients and others, said David Schildmeier, spokesman for the Massachusetts Nurses Association. The union is pushing for legislation that strengthens policies that aim to prevent violence in hospitals and other medical settings.
“It appears that in this case the Brigham did everything right in responding to the situation,” Schildmeier said. “The issue is this incident shines a light on a dramatic increase in workplace violence throughout health care. . . . It’s prevalent, especially in emergency departments. Assaults are very common.”
The association gives nurses tips on how to stay safe, including being aware of their surroundings and learning self-defense moves.
Hospitals use technology — security cameras and alarm systems — to monitor and try to thwart problems, but also are increasingly training staff on how to defuse volatile situations.
“Verbal judo” is the way Connie Packard, executive director of support services at Boston Medical Center, describes the hospital’s training, teaching staff to look for warning signs and know when to call for help.
Packard said staff members are taught to observe certain details: How close is someone standing to them? Are they raising their voice? Clenching their fist?
“Sometimes, people are awfully quiet and that could be a sign in and of itself,” she said.
A 2010 fatal shooting at Johns Hopkins Hospital in Baltimore underscored the need to be prepared, said Dr. Eric Goralnick, the Brigham’s medical director of emergency preparedness for the hospital’s 17,000 staffers.
“We cannot prevent these types of incidents,” Goralnick said, “but we can do our best.”