James Phillips was working as an emergency physician at Beth Israel Deaconess Medical Center in Boston in 2015 when a man walked into Brigham and Women’s Hospital across the street and shot and killed cardiovascular surgeon Michael Davidson.
Though Phillips was physically unharmed, the shooting served as a reminder of the several times he had been assaulted on the job.
There was one time when a patient spat blood, contaminated with hepatitis C, on him. And another when a patient threw an iPhone at his face.
“It started me on this pathway of looking back on my own early career and realizing that I’ve been the victim of violence several times,” recalled Phillips, now the chief of disaster medicine for the American College of Emergency Physicians, or ACEP, and chief of disaster and operational medicine at George Washington University.
Since the Boston shooting, attacks against healthcare workers have continued to rise.
Healthcare workers were five times more likely than those in other industries to be physically attacked while at work in 2018, according to the Bureau of Labor Statistics.
Some providers say the COVID-19 pandemic made violence worse.
In early 2023, the Massachusetts Health and Hospital Association issued a report and “call to action” on workplace violence at healthcare facilities in the state, based on an ongoing monthly survey of member hospitals. The organization saw an uptick in violence as the pandemic waned and hospital patient volume surged – a violent incident was reported every 38 minutes in 2022, up from every 57 minutes in 2020.
The American Hospital Association said healthcare workers experienced a “sharp increase” in violence after the pandemic, making it “more difficult for clinical staff to provide quality patient care.”
Phillips and ACEP now study violence against physicians. In ACEP’s annual membership poll this year, 91% of respondents said they or a colleague had been threatened or attacked in the previous year.
The data makes healthcare the “most violent non-law enforcement industry in America,” Phillips said.
Hospital groups, providers focus on guidelines
Healthcare workers are in a unique position because, particularly in emergency medicine, they have an obligation to treat people who might potentially put them in danger.
“I think it would be helpful to have some medical-legal guidelines that that allow us to know what our rights are once we’ve been attacked in the emergency department in terms of actions that can be taken against that person,” Phillips said. For example, would clinicians be held liable for abandoning the patient if they refuse to treat someone who is belligerent?
Seeking answers, physician and hospital organizations have created guidelines for preventing and managing violent interactions.
Other groups, like the MHA, have adopted codes of conduct for violence prevention.
MHA’s document calls for specialized training when appropriate — particularly for psychiatric and dementia patients — and post-incident debriefings by management, according to Patricia Noga, MHA’s vice president of clinical affairs.
“It was a template for, and guidelines for hospitals then to take and develop their own,” Noga explained.
In addition to the guidelines, hospitals should consider architectural redesigns, like rethinking the proximity of providers to room exits, and having at-risk staff wear duress alarms, Noga said.
Other strategies hospitals should consider include beefing up security, hardening entrances, providing escorts through the building or parking areas and adopting surveillance technology. However, there’s no good data on which strategies work better than others, she said.
A few states, notably California, have enacted policies requiring healthcare organizations to take concrete steps toward improving worker safety.
Provider groups have lobbied for federal legislation. One bill, introduced in April 2023, would have given healthcare workers the similar legal protections as commercial pilots and flight attendants. However, the legislation appears to have stalled after being referred to the House Judiciary Committee and again in the Senate Committee on the Judiciary.
Providers pivot to high-tech surveillance
Among the increasing violence, artificial intelligence companies have billed themselves as a new avenue for detecting violent actors.
One company called ZeroEyes, a Pennsylvania-based developer of “computer vision” software to detect brandished guns from images captured by security cameras, is seeing growth in the healthcare industry, according to Jonathan Norton, the firm’s vice president of commercial sales.
ZeroEyes taps into existing camera installations and, backed by an operations center staffed around the clock, determines if images flagged by the AI system are real threats. If appropriate, the company said it alerts clients and local police of potential danger in three to five seconds, then provides near-real-time updates on the potential assailant’s location and travel path.
Lane Dermatology, a four-physician group in Columbus, Georgia, signed on as a ZeroEyes customer this year. Though the independent practice has not experienced violence, founder Joshua Lane has been adjacent to it over the years, and said he would rather be prepared if it does ever happen.
Three people, including a nurse, were killed in 2008 at a hospital where Lane performs surgeries. In 2019, a gunman entered the clinic of a dermatology colleague of Lane’s in Gainesville, Georgia. Police shot and killed the suspect after a nurse was able to escape to a safe spot to call 911.
Lane, an Air Force flight surgeon with degrees in counterterrorism and homeland security who served in law enforcement for 15 years, presented at a national medical meeting this year on active shooters in healthcare settings.
Although his practice already had protocols for active shooters, he started looking into early-warning technology after the conference.
“Decrease the [response] time,” Lane advised. “The more that shooter is in your office, the more things can happen.”
In his lecture, Lane recommended keeping plans basic.
“The main thing is just to have a system and be aware of it. You don’t have to have an exact plan, but just know what to do if it happens,” he advised. “Have a panic button, have doors you can lock. Know your local sheriff and police department, talk to them.”
