HLM 2015: State gun rules vary for health systems

https://www.healthleadersmedia.com/content/QUA-318003/Gun-Laws-in-Health-Systems-Vary-by-

Hospitals aren’t havens from mass shootings

By Tinker Ready

For the staff at the Brigham and Women’s Hospital in Boston, the fuzzy security photo of a young man entering the Charleston church where he shot nine people had to be disturbingly familiar. A hospital camera recorded similar scenes in January, when a man walked into the main entrance of the hospital, made his way to a cardiology clinic and fatally shot his late mother’s doctor.   

The death of Michael Davidson, a well-liked, well-respected cardiac surgeon shook the hospital and its entire staff. The man was reportedly unhappy with his mother’s care. Dr. Jo Shapiro is a physician and director of the hospital’s Center for Professionalism and Peer Support.

“I don’t know a single person who ever thought we would have to pay with our lives for someone else’s perception of our care,” she says.  “That reality…shattered a sense of security that I think I’ve always had.” 

But, hospital shootings occur regularly. Just a few weeks before Davidson was killed, a man entered a New Hampshire hospital, shot his wife – who was on life support – then killed himself.

Hospital staff train to handle all kinds of mass casualties and trauma. But when someone enters the hospital with a gun, providers, employees and patients turn into potential victims. Or not, depending on how you see it. Last summer, a patient shot a psychiatrist and a caseworker at Mercy Fitzgerald Hospital in Philadelphia. The doctors survived, pulled his own handgun and fatally shot the patient.  

So far this year, news of hospital gunplay has been steady. A nurse was wounded in January at a Los Angeles hospital. A doctor was fatally shot by a man who then shot himself at a Texas Veterans Affairs hospital. In April, a man was charged with fatally shooting a woman in the parking lot of a Houston hospitalAn elderly couple died in another apparent murder-suicide at a Texas hospital earlier in June. Also in June, a woman reportedly shot herself in the bathroom of a Seattle hospital.    

While a federal law bar guns from schools, state rules regarding guns in hospitals vary.  In some states — including Texas — hospitals are designated gun-free zones.

But some, like Texas State Representative Drew Springer, don’t think banning guns will stop criminals from shooting in health care settings. He introduced a bill in the past legislative session that would have allowed staff and family to bring firearms into hospitals for self-defense. The bill expired with the session, but he plans to keep pushing the issue.

“The gun-free zones do not stop the crazies who are going to commit these actions,” Springer says, noting that they only prevent people at the hospitals from defending themselves. He says his district includes some rural hospitals that have limited security staff. Also, several nurses have told him that want to take their guns to work for protection.  

Linda Quick, president of the Southern Florida Hospital Association, agrees that the safety zones can’t keep all armed criminals out. Still, members of her group think guns in general add an unnecessary risk to an already high-risk setting.

 “We have enough hazards,” she says. “We have floors people can fall on. We have infections people can catch. We certainly don’t need the added element of firearms on campus.”

After two Florida doctors were shot in the late 1990s, her group tried to get hospitals added to list of areas — like schools and courtrooms – where guns were prohibited in the state. They are still trying, she says. Legislation proposing the ban – which is opposed by the Florida members of the National Rifle Association — has failed to gain traction.

With the reality that even gun-free zones can’t keep firearms out of health care settings, staff sometimes need to deal with the aftermath of a shooting. At the Brigham and Women’s Hospital, the memories of the Boston Marathon bombings were still fresh when Dr. Davidson was shot. And while counselors could remind the shell-shocked staff of how many lives they saved after the 2013 tragedy, that wasn’t an option in January. The murder was especially harsh for members of the team who worked in the operating room to save their fellow surgeon.

“The idea that something devastating happens to your colleague (and) despite all of your efforts, you can’t save your colleague — it was a very shattering moment,” Shapiro says.

Shapiro’s team offered peer counseling and group sessions to staff. Many found it helpful to talk to a colleague who was feeling similar emotions. Her team also sought out those who had been impacted, but did not seek help.  They were encouraged to process their feelings about the shooting – a key step to recovery, but not always an easy one for health workers, Shapiro says. Doctors and other direct care staff are trained to tend to a patient’s emotions before their own. 

“A lot of us hold it in,” she says. “We’ve been trained to hold it in. Holding-it-in is highly valued.”

Even without gun violence, health care workers see a lot of suffering and often struggle with depression and burn-out. Programs like Schapiro’s are designed to identify and help troubled providers.

“If I’m burned out, the chance of me giving you the kind of care you deserve goes down,” she says. “We’re starting to pay attention to the wellness of clinicians as a service to patients and families.” 

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