They are the "frequent fliers" of the Maryland Shock Trauma Center: Patients who show up again and again -- stabbed, shot, beaten with baseball bats, even pushed out windows. Almost a quarter of the assault victims are emergency room veterans, their bodies bearing the scars of previous attacks.
In the first experiment of its kind, the hospital wants to see if it can prevent victims of violence from getting hurt again. In addition to medical treatment, many will receive help finding a job, getting off drugs, moving to safer neighborhoods -- and mainly, staying out of trouble.
"Patients like these are seen in emergency rooms across the country, and the thinking has always been, 'Let's patch them up and send them out again,' " said Dr. Carnell Cooper, a trauma surgeon who helped to design the experiment. "Let's see if we can do more than that."
Behind the program is a recognition that many of the repeat victims are not true innocents. A recent study at Shock Trauma found that 40 percent are on probation or parole; 80 percent have served jail terms; and three-quarters admit to current or past drug use.
"We have an incredible revolving door of violence, people perpetrating crime and being victims of crime," said Lt. Gov. Kathleen Kennedy Townsend, who made $168,000 in state funding available for the one-year study. "Rather than stopping the cycle, we've allowed it to continue."
The cycle is well-known to trauma specialists around the nation.
"When you've been at the trauma center for several years, you can see them come in with scars on their bellies, scars on their chests and you know they've been here before," said Cooper. "You hear the frustration in people's voices. You wonder, 'Couldn't we have done something before?' "
Five years ago, Shock Trauma set out to learn all it could about the patients who keep returning. Researchers studied 200 repeat victims and a slightly larger number who were admitted with injuries stemming from car, motorcycle and other accidents.
Most of the repeaters had been treated for violent injuries once, twice or three times in the past -- but several had longer histories, including one who had been treated 16 times after assaults. That patient was far from typical, a mentally disturbed man who allowed "friends" to engage him in sadistic games.
The new program, which began last month, serves patients on probation or parole who have been treated at least once before for violent injuries. Twenty will be paired with an officer from the state Department of Probation and Parole who works in a hospital office. They will also see a psychiatrist, social worker and, if needed, a drug abuse counselor who will help steer them to services in the community.
The probation officer will have the authority to investigate whether patients have been living up to the terms of their release, such as staying off drugs, obeying curfews or performing community service. Those who haven't can be placed under stricter supervision, or taken to court on alleged violations.
Another 20 patients will receive the usual help -- which, beyond medicine and surgery, often amounts to little more than a list of drug treatment programs. Researchers will track both groups to see if the intervention made any difference.
Many of the findings did not surprise the researchers greatly: Most of the repeat patients were unemployed, lived in poverty, served jail terms and abused drugs or alcohol. Half completed high school. Three-quarters admitted to having beaten someone in the past; half said they had done so in the previous year.
Eighty-three percent were African-Americans; 90 percent were males; the median age was 31.
They were injured in all manner of assaults: 46 percent were shot, 20 percent stabbed, and 25 percent beaten with baseball bats, crowbars or fists. Included in a group that defied category were people pushed out of windows and off roofs, and others deliberately struck by cars.
None of this surprised the trauma researchers: They had seen the swollen faces, the fractured skulls, the exit and entry wounds many times before. What surprised them was a common theme voiced by 80 percent of the "frequent fliers" -- their most recent injury, they said, arose from simple acts of disrespect.
"To me the surprise was the number who said that 'dissing' had to do with the incident," said Dr. Paul Stolley, chief epidemiologist at the University of Maryland Medical Center. "I would have thought it was much lower than that."
One patient was stabbed after a man accused him of eyeing his girlfriend in a nightclub, according to research assistant Dawn Eslinger. Another was beaten after he accidentally scratched someone else's car. A third was shot in the back after he confronted a man who had jumped his father.
The grant money comes from the Governor's Office of Crime Control and Prevention, which Townsend runs.
"We'll take a 65-year-old man who smokes and drinks and give him a heart transplant," said Cooper. "Why not the young man who has years and years of potential? Everybody wants to write them off."
Pub Date: 2/10/99