Keeping hospitals safe

The natural question after Dr. David Cohen was shot Thursday by the disgruntled son of patient was how the man was able to bring a handgun into the hospital in the first place. And the answer is something the thousands of people who work at Hopkins — and most any other big hospital — are all too aware of: There are no metal detectors, and the screening of patients and visitors is generally cursory at best. The head of Hopkins security said after the incident that metal detectors are extremely rare in hospitals and that installing them in a place like Hopkins, which has some 80 entrances, would be logistically difficult. Furthermore, hospitals have generally believed that metal detectors would change the atmosphere from open and welcoming to distrustful.

It may be time to rethink that, and not just because of Thursday's shooting. Reports of rape, assault and homicide in health care institutions are on the rise, though still relatively rare — just 33 in 2009, according to a national hospital accrediting organization. But doctors, nurses and other health care workers experience far more threatening behavior at work than people may realize.

It shouldn't come as a surprise. Patients and visitors to hospitals are sick, in pain and under tremendous stress. It is not at all uncommon for them to grow upset, hostile, even overtly threatening, over bad outcomes or a doctor's refusal to prescribe narcotics. In many cases, the health problems that land patients in hospitals are related to underlying — and untreated — mental health conditions. And health care workers often find themselves alone, in frightening situations, in offices or private rooms, out of the view of security guards.

Health care workers are faced with an impossible choice. Either they take the chance that the situation will not escalate and become dangerous, or they leave the room or call for security and risk irreparably damaging the therapeutic relationship with the patient.

Taking the steps that would truly be necessary to keep health care workers, patients visitors and others safe once an armed and belligerent person enters the hospital would be far more intrusive than stronger security procedures at the hospital door. We have long accepted metal detectors or other strong security measures at places where the potential for combustible interactions is lower than at hospitals, such as government office buildings and private companies. The notion espoused by City Council President Bernard C. "Jack" Young that victims of violence would actually be more afraid to go to a hospital if it were secured with metal detectors is ridiculous. As for the logistics of stricter security screenings, we've handled that at airports that have far more daily traffic than hospitals.

So before Hopkins decides that its existing security measures are good enough, it should do what it does best: research. The institution should bring the full rigor it would apply to any other public health problem to the question of whether its workers consistently feel safe, and to testing interventions to improve security while minimizing disruptions in the therapeutic relationship. Metal detectors may not be the answer, but Hopkins — and other hospitals — shouldn't jump so easily to that conclusion. There may be less disruptive but effective measures, such as the random screenings employed at train stations, that could discourage people from bringing weapons to hospitals.

But what is certain is that health care professionals need better safety training. Patients or visitors who turn violent don't necessarily need weapons to do great harm, and health care workers could benefit from learning to better spot the warning signs that a situation is getting out of hand. Most of all, they need to know they have the institutional support to err on the side of caution in their interactions with patients and visitors.

Given the size a hospital like Hopkins — practically a city unto itself — violence like that which took place Thursday is commendably rare, a testament to the size and effectiveness of the security force that's already there. But that doesn't mean the hospital is as safe as it should be. The Hopkins community should insist that the hospital's leadership take stock after the shooting of Dr. Cohen rather than treat the tragedy as an aberration.

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