Last Wednesday, an aggrieved Oklahoma man bought an AR-15-style assault rifle. He paired the weapon with a semiautomatic pistol he had purchased from a pawn shop three days before and drove to Saint Francis Hospital, in Tulsa, where he killed Dr. Preston Phillips, a spine surgeon who had operated on him two weeks earlier. He also killed Dr. Stephanie Husen, a sports medicine physician; Amanda Glenn, a receptionist; and William Love, a former Army sergeant who was shot while holding the door to an exam room closed, trying to shield his wife from the killer.
For many of us who work in health care, the tragedy adds to a gnawing, visceral pain that grows with each news cycle detailing another mass shooting in America. Many of us see firsthand the effect of high-velocity rounds on the human body on a regular basis, and very often we’re powerless to reverse the scale of injuries that the weapons have wrought. As a surgical resident three years into training in Philadelphia, I’ve seen bullets shred blood vessels, spleens, lungs, and nearly every other part of the body and helped recover organs for transplant from those killed by guns, both from self-inflicted wounds and those caused by others.
But the Tulsa shooting was poignant for another reason: It was a reminder of our own vulnerability and the profound violence plaguing U.S. hospitals. Data shows rates of assault against health care workers have doubled the last decade, and increased even more rapidly in the last few years amid the Covid pandemic. Roughly 40 percent of those working in hospitals have been victims of physical violence within the previous year; when including threats and verbal abuse, these figures climb to nearly 100 percent. In emergency departments, nurses are four times more likely to be assaulted compared to those working in other parts of a hospital—and close to 90 percent of assaults on health care workers go unreported in formal tracking systems.
For many in U.S. health care, it’s rare to work a shift without witnessing or suffering some type of abuse. During my training, I have been punched, kicked, and verbally assaulted by patients, as have many of my co-residents. Outside of our emergency department last year, a resident from another department was bludgeoned with a metal pipe by a chronically homeless man with a long record of abusing emergency room staff. And in the fall of last year, a nursing assistant was gunned down in a patient ward of our hospital, killed by another hospital employee. At a hospital just several blocks away, a psychiatry resident came under sustained, brutal attack last year, suffering multiple stab wounds to the head and face.
And while my institution’s leadership has admirably stepped forward to hire more police on staff and has taken steps to improve safety in the vicinity of the hospital, much more is needed, both here and in health care more broadly.
What does that action look like? Above all, we need stronger federal gun laws. Federal legislation should designate all medical clinics and hospitals as gun-free zones. America remains armed to the teeth, with close to 400 million guns in circulation and as many as 20 million new guns purchased each year. There is no solution to the gun violence epidemic beyond the difficult, politically charged steps that we all know are needed: The manufacture, purchase, ownership, and carrying of firearms must be heavily regulated, and incentives for the buyback or destruction of existing firearms are critical. But we also need to stop looking past the issue of violence toward caregivers. Those of us in health care must speak up and advocate for systemic change.
There are numerous proposed laws aimed at protecting health care workers stalled in state legislatures around the country. Many outline fines and sentences for the physical assault of health care workers, akin to protections afforded police officers and flight attendants. More than these policies, though, those who work in health care need their employers to take action.
Every hospital employee should have a silent alarm with them and know that help is quickly accessible if they need it. Every patient and visitor must be thoroughly searched for weapons at medical facility entrances. In a single year, the Cleveland clinic confiscated nearly 30,000 potential weapons from patients and visitors after implementing this type of policy, including guns, knives, box cutters, and pepper-spray canisters. These weapons have no place in health care settings. Finally, reporting systems for violence must be made frictionless, recognizing that the ones in place today are too time consuming and onerous for thinly stretched staff to take seriously. And this data must be acted upon. Facilities and units with high incidences of violence against nurses, techs, and physicians must in turn be staffed appropriately with police, both uniformed and in plain clothes, and mental health workers trained in de-escalation.
Finally, we need to start taking our nation’s mental health crisis seriously. Since the deinstitutionalization of psychiatric hospitals by Ronald Reagan in 1967, we’ve lacked a coherent national strategy to manage mental illness. Much, though nowhere near all, of the violence we face in hospitals is perpetrated by those with mental illness, be it untreated, undertreated, or undiagnosed. As anyone who has sought mental health care in the United States has found, it is nearly impossible to access, and when accessible, it is nearly impossible to afford, even for those with insurance. Today, those in acute mental health crisis typically wait multiple days in an emergency room before a psychiatric hospital bed becomes available, typically boarding in overcrowded units or on hallway stretchers. We must prioritize mental health by mandating generous coverage by insurers for outpatient mental health services and substantially increasing the revenue hospitals and care organizations can make through effectively managing those with mental health disorders.
Careers in health care are some of the most rewarding one can find; they should not also be among the most dangerous. The physical and emotional costs of caring for others is already extremely high, and the added threat of physical violence has driven many from the field. The federal government, state governments, and hospital administrators must all do more to safeguard our medical facilities, both for patients and those who serve them. America’s health care workers deserve better.
