The shooting, however, might draw attention to such clinics and others offering urgent care, surgery and other outpatient services that are expanding outside large hospital settings that tend to have more security.
“The violence in the clinic may be kind of surprising to the general public,” said Dr. Leigh Vinocur, an emergency room doctor, consultant and spokeswoman for the American College of Emergency Physicians. “When you hear about people being shot in a hospital or clinic you kind of think of Doctors Without Borders and think they are in a war-torn area.”
But, she said, the health care industry is recognizing that its workers are at risk for injury. Vinocur said the health care is listed by the federal Bureau of Labor Statistics as “one of the more dangerous professions.”
In fact, health care and social assistance topped the agency’s list of dangerous jobs in 2017 — the most recent data available — with 548,000 injuries of all kinds. That year, 189 health care workers died from on-the-job injuries of all types, including assault, up from 178 a decade before.
A survey by the college of emergency physicians last year found that close to half the doctors had been assaulted and 60 percent said it had been in the past year. That included such things as hitting, spitting and biting. About 70 percent of the doctors said the violence is increasing.
The organization called for more security, cameras, visitor screening and metal detectors in health care settings.
Vinocur said many hospitals already have taken those steps, particularly in their emergency departments as officials have recognized that they are places where people are often the most scared, angry and sometimes frustrated by lack of immediate information. Patients, their families, friends and others can lash out.
Outpatient clinics can be farther behind on security measures, she said.
In Maryland, there are no specific requirements for the security of health care facilities.
As a sign of the “less civil times,” Vinocur and others said, some health care workplaces now conduct active shooter drills and teach workers how to de-escalate tense situations. Such training could become more common with more mass shootings in workplaces.
A patient at the Man Alive treatment center in Charles North, where Monday’s shooting occurred, said her counselor did try to calm a man police alleged was the shooter. The man, they said, demanded methadone from workers before he was fatally shot.
Baltimore Police said a responding officer and a female worker were wounded. Another man found wounded inside the center later died.
The incident appeared to be a first for the center, the oldest such addiction treatment facility in the state. Officials from the state Department of Health reported that Man Alive had no history of safety concerns. It was last inspected in June.
The center has been held up as an example of innovative and helpful services such as art therapy and help with housing and jobs to support recovery, said Adrienne Breidenstine, spokeswoman for Behavioral Health System Baltimore, which oversees substance use and mental health treatment in the city.
He and other researchers found in their 2012 study that hospital shootings were relatively infrequent, despite some high-profile cases. The study identified 154 shootings at U.S. hospitals from 2000 to 2011.
More than 90 percent of those shootings were carried out by men, many of whom were motivated by a grudge against someone working at the hospital, by what they viewed as a mercy killing of a sick relative or by suicide. The shootings most commonly occurred in emergency departments.
He said nurses and doctors more often deal with other types of aggression, such as being hit, grabbed or scratched.
Like other facilities, Hopkins now offers active shooter drills and training on how to de-escalate potential violence.
Researchers did not study shootings in nonhospital health care settings, but Kelen believes outpatient clinics likely have a lower risk of violence than hospital settings such as emergency, intensive care or psychiatric departments.
Still, he said, “the public should not worry any more about being in a hospital, and maybe less, than going to the mall or a movie theater or church. Things happen, but it’s not a dangerous place for the average person.”