Paul Warren Pardus did not have to evade security Thursday when he took a handgun to the eighth floor of the Nelson Building at Johns Hopkins Hospital.
There was nothing to stop him from carrying a gun into the hospital, no metal detector to set off an alarm.
While Hopkins has long focused on safety at its sprawling medical campus in crime-plagued East Baltimore, the hospital does not require patients or visitors to pass through metal detectors, as Americans must do now at airports, courthouses and many federal buildings.
With a weekly stream of 80,000 patients and visitors, imposing such security restrictions is "impossible," Hopkins officials say — and security experts agree. Even as violent incidents appear to be on the upswing at hospitals, they need to remain welcoming places, experts say.
The Nelson Building's entrance is not equipped with metal detectors, said Harry Koffenberger, vice president for corporate security at Hopkins. Neither are the dozens of other doors, loading docks and emergency exits at the mammoth hospital facility.
"To put in magnetometers at 80 doors, and the requisite armed force needed to staff them, would be impossible," he said at a news conference. "Not in a health care setting."
Hopkins does, however, conduct searches and magnetometer "wanding" in "high-risk situations" in the emergency department, where gunshot and stabbing victims are often treated.
Otherwise, guards verify the medical appointments of all arriving patients and visitors. The guards — part of a security force that numbers more than 400 — place wristbands on every one.
Few hospitals in the United States have metal detectors.
"There are only one or two institutions that I am aware of — hospitals — that have them, and they're not on the East Coast," Koffenberger said.
Even in the wake of Thursday's shootings — which left a doctor wounded and two people dead — hospital security experts echoed his view that metal detectors are not feasible or necessarily desirable.
"We're not Fort Knox; we have to serve the public," said Joseph Bellino, president of the International Association for Healthcare Security and Safety, a professional organization based in Illinois.
Bellino said hospitals try to strike a balance between protecting patients, visitors and staff and fostering a welcoming atmosphere.
"A hospital is considered a safe haven," Bellino said. "People come to us to cure them, help them, make them better. Overall, when you see incidents like this they're very rare."
This year, there have been only a handful of such incidents nationwide, he said. In March, an 85-year-old heart patient in Connecticut allegedly stashed a revolver in the folds of his hospital gown and shot a nursing supervisor who tried to grab the gun. The 35-year-old nurse was shot three times but survived.
Since 2004, there have been "significant increases in reports of assault, rape and homicide," at health care institutions across the country, according to the Joint Commission, a private accrediting body for hospitals. It reported that the greatest number of reports have been in the past three years, with 36 incidents in 2007, 41 in 2008 and 33 in 2009.
Kathleen McPhaul, a University of Maryland workplace violence researcher, said it's an "open question" whether hospitals need to deploy detectors.
"It's just unclear to me whether we have to go to the level of metal detectors, but I'm not sure there's really any other way to make sure someone is not bringing a weapon in," said McPhaul, an assistant professor at the School of Nursing. "People carry guns in this society."
McPhaul said that while the occasional shooting grabs headlines, hospitals are beset every day with low-level violence and verbal abuse directed by patients at caregivers.
"Hospitals are frustrating places," she said. "People are sick, patients are in pain. Visitors are worried about loved ones. There are delays in care."
Hopkins pharmacy technician Sharon Addo said the incident did not make her feel uncomfortable working at the hospital.
"I'm not afraid to come to work," Addo said. "It's just an unfortunate situation that happened at the best hospital in the country." She said the only potential security shortcoming could be the fact that all visitors aren't searched.
Thursday's incident is being assessed to determine what might be learned from it, Koffenberger said. He said Hopkins officials have talked about installing metal detectors in the past and could discuss it again.
Hopkins has more than 400 unarmed security officers on duty at the East Baltimore campus, "one of the largest, if not the largest health care security force in the country," he said. More than 150 armed, off-duty police officers are available to respond to hospital emergencies.
The institution recently teamed up with Baltimore police to share data from security cameras. Under the agreement, video from 136 cameras around the hospital campus would stream into the city's surveillance office. In exchange, Hopkins security staff could access video from six city-operated cameras in the area.
Hospital officials had prepared for an incident like Thursday's, and the emergency plan played out as designed, Koffenberger said. The plan was drawn up with the help of Baltimore police after a student gunman killed 32 people, then committed suicide, at Virginia Tech in 2007.
Emergency text messages were sent to all Hopkins staff within minutes of the first shooting and were followed up with e-mail messages. Hospital security personnel moved staff and patients from the Nelson Building's eighth floor and isolated the suspect until Baltimore police arrived. Everyone in the building from the seventh floor down was kept there. Visitors were escorted from other hospital buildings, blocks away.
"I think at the end of the day we're pleased with the way the plan was implemented," Koffenberger said.
Mayor Stephanie Rawlings-Blake said FBI officials praised the response by the city and Hopkins.
"The FBI remarked on how well we worked together and ... how quickly we responded," she said. "It was an orchestrated response. I'm very comfortable and confident with our response."
Rawlings-Blake called the shooting an "aberrant incident" and cautioned against a "knee-jerk response."
"Hopkins is the best medical institution in the world, and this incident, as tragic as it is, is not going to change that," she said.
City Council President Bernard C. "Jack" Young said the hospital's security is adequate and that metal detectors would create a hazardous situation for patients entering the building.
"Why would they want metal detectors going into the hospital?" Young said. "People go to the hospital because they got shot. People wouldn't go to the hospital because of the metal detectors. They would stay away and die rather go through metal detectors."
Young, who worked as a manager at Hopkins for decades, said, "These things happen. This could have happened anywhere."
Improving safety has been a Hopkins priority for decades. In 1992, the hospital overhauled and expanded its security force after a series of violent crimes, including the kidnapping of a professor and the abduction and rape of a 27-year-old medical student. The overhaul included hiring a new class of well-trained officers to supplement its staff of guards.
Other hospitals in Baltimore have had to deal with spasms of violence at their facilities. In September 2003, mayhem erupted outside the emergency room at the University of Maryland Medical Center.
Several women barged into the waiting room about 3:45 a.m. and began stomping and beating another woman awaiting treatment, according to a Baltimore Sun article. The victim and a companion had arrived with injuries reportedly suffered in a bottle-swinging brawl at a nightclub.
A University of Maryland campus police officer called for backup and attempted to break up the fight with her baton. But one of the women grabbed the baton and began to beat the patient. The officer backed away and told the woman to drop the nightstick. When she failed to comply, the officer fired, wounding the attacker and grazing the patient's arm.
Baltimore Sun reporter Erica Green contributed to this article.