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The shooting at Mercy Hospital & Medical Center, which left an emergency room doctor, a pharmacy resident and a police officer dead, serves as a chilling reminder for employers to update and test workplace violence prevention plans.

The attack started Monday around 3:30 p.m., following a domestic dispute between the gunman and a doctor, in the parking lot of Mercy Hospital at 2525 S. Michigan Ave. The gunman killed Dr. Tamara O’Neal before entering the hospital and killing Dayna Less, a first-year pharmacy resident, and Officer Samuel Jimenez, a first responder. The gunman also died.

“A hospital should be a safe place. Every shooting in America is a tragedy, and it is especially senseless when a shooting occurs in the healing space of a hospital,” Dr. Patrick Connor, Mercy’s director of emergency medicine, said during a news conference at the hospital Monday night.

Connor said that the hospital “regularly plans for emergencies” and conducted an active shooter drill last month. “Our primary job,” he added, “is to make sure patients are safe.”

Mercy’s chief medical officer, Dr. Michael Davenport, said during the news conference that the active shooter drill, which includes classroom and online learning, is meant for all hospital employees. However, one reporter noted during the news conference that several employees said they were not aware of the most recent drill.

Medicare and Medicaid participating providers and suppliers, which includes hospitals, are required by the Centers for Medicare and Medicaid Services to ensure adequate planning for natural and man-made disasters by performing a risk assessment, developing and implementing policies and procedures, creating a communication plan, and conducting training and testing.

The Illinois Health and Hospital Association conducted a virtual active shooter drill for 75 hospitals on Nov. 8, said Danny Chun, a spokesman for the organization. The association offers active shooter drills to provide hospitals with additional support, but many hospitals conduct their own drills on a regular basis, he said. Mercy’s recent drill was not related to the one the association conducted. 

Dick Sem, president of security and workplace violence consultant Sem Security Management in Burlington, Wisconsin, said about half the workplace violence prevention plans and policies he sees at hospitals aren’t comprehensive enough. Most of Sem’s work is in the health care industry, with hospital clients in 46 states, including Illinois. He does not work with Mercy.

Some of the first questions he asks clients include: “Are staff trained on how to recognize early signs of potential violence? Do they know how to deescalate, rather than escalate? . . . Do they know when they should remove themselves from a situation?”

“More often than not, I see very little training,” Sem said. “They might train high-risk staff, like emergency and security and behavioral health, but not all the staff.” Meanwhile, Sem said frontline staff, like receptionists and retail pharmacists, “often get the brunt of it if somebody comes in and is stressed or angry. That may be the first employee they encounter. Yet, probably 90% of the time, those employees get no training.”

Four days prior to the shooting, Rep. Joe Courtney, D-Conn., a member of the House Education and Workforce Committee, introduced H.R. 7141, which would require the U.S. Occupational Safety and Health Administration, or OSHA, to issue a standard requiring health care and social service employers to write and implement a workplace violence prevention plans.

While OSHA does not have an enforceable workplace violence standard, its general duty clause requires employers to provide workers with a place of employment “free from recognized hazards that are causing or are likely to cause death or serious physical harm,” according to the federal agency.

Acknowledging that the health care and social services industry is more likely to endure violence-related occupational injuries than other private-industry sectors, OSHA updated its workplace violence prevention guideline for the industry in 2015.

The guide details five components of effective workplace violence prevention programs: a written program should include management commitment and employee participation; a worksite analysis; hazard prevention and control; safety and health training; and recordkeeping and program evaluation.

Workplace violence consultant Sem said that, of the 16 hospitals and clinics he’s worked with following shootings or stabbings that resulted in lives lost, “maybe six of those were totally random acts of violence that nobody could have anticipated … but the other 10 or so showed some warning signs. There was some escalation. There were signs that this person is problematic or potentially problematic, but little or nothing was done until the gun or knife appears, and then it’s too late.”

The work shouldn’t end once a policy is written and tested, he added.

“You can’t spend or do too much to council and take care of your people (following a traumatic event),” Sem said. “I’ve been brought in a month or two later where it’s festering. … What you end up with is increased turnover, lower morale. Employees are actively looking for jobs elsewhere. Not because of what happened, but because of how the administration responded.”

In addition to adopting a violence prevention policy, the American Medical Association encourages health care facilities to “incorporate, within their security policies, specific provisions on the presence of firearms in the hospital setting,” according to a 2016 report by the group’s Council on Science and Public Health.

Meanwhile, the National Rifle Association tweeted earlier this month that “someone should tell self-important anti-gun doctors to stay in their lane.” The post led physicians and first responders to share heart-wrenching stories about treating victims of gun violence. Yesterday’s shooting reignited the conversation on social media. 

AMA President Dr. Barbara McAneny addressed gun violence at the group’s interim meeting last week: “Just in the last two weeks we have mourned still more senseless deaths from the mass shootings in Pittsburgh and in Thousand Oaks. … Thoughts and prayers just won’t cut it anymore.”

Following the shooting at Mercy, Illinois Health and Hospital Association President and CEO A.J. Wilhelmi said in a statement, “This was an unexplainable act that took the lives of three people who went to work every day to protect and save lives in their community. We owe it to them to find ways to stop the violence, and the hospital community remains dedicated to helping in that important endeavor.”

Mercy Hospital is part of Trinity Health, a nonprofit Catholic health system based in Livonia, Mich., which also owns Loyola Medicine and its three hospitals.

“Since its founding (in 1852), Mercy has become an integral part of the city, advancing our mission of providing access to compassionate care to our communities,” according to Trinity’s website.

A lack of behavioral health resources and the opioid crisis are two of the biggest trends in health care security violence management, Sem said, adding that the most prevalent form of violence is “assaultive behavior.” 

“I’ve been in (emergency rooms) where the nurses are saying every other week they’re getting slapped, poked or threatened,” Sem said. “They say, ‘It’s just part of the job.’ No it’s not part of the job. You shouldn’t have to put up with that.”

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