Chapter 07: Workplace Violence

Medical Workplace Violence Issues

[The Growing Impact]

By Eugene Schmuckler

Man never made any material as resilient as the human spirit – Bern Williams

IntroductionMedical Red Cross

The impact of workplace violence became widely exposed on November 6, 2009 when 39 year old Army psychiatrist Maj. Nidal M. Hasan MD, a 1997 graduate of Virginia Tech University who received a medical doctorate in psychiatry from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and served as an intern, resident and fellow at the Walter Reed Army Medical Center in the District of Columbia, went on a savage 100 round shooting spree and rampage that killed 13 people and injured 31 others.

Yet, more than two decades before in Edmond, Oklahoma, Patrick Henry Sherrill, an employee of the US Postal Service, angered by perceived injustices against him by his employers, shot and killed fourteen people, wounded six and then killed himself in 1986. This shocking event added the term “going postal” to our lexicon.

Incidents of workplace violence have continued to spread. A veteran employee at the General Dynamics facility in San Diego, California, shot and killed his supervisor along with an industrial relations representative when he was fired after 25 years on the job. A fired Mount Pleasant, Michigan, sports editor used a pair of scissors to stab his boss in the head. A Tampa, Florida, man returned to his former workplace and shot three of his supervisors as they sat eating their lunches. He wounded two others before killing himself.

These incidents are not solely perpetrated by males. An upset female worker at a Bennington, Vermont, battery plant shot and killed the plant manager and wounded two others after trying to set the plant on fire. A woman in a Corona, California, opened fire with a .38 calibre handgun, wounding a nurse and spraying the infant nursery with bullets. Before she was arrested, she horrified hospital workers with her words, “Prepare to die.”

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12 thoughts on “Chapter 07: Workplace Violence

  1. BOULDER-CREST MEDICAL CENTER (BCMC)
    NEWS FLASH!

    The news report comes in: Two employees at the Boulder-Crest Medical Center have been killed in the workplace and two have been wounded. A witness has called 911 and the police as well as other emergency personnel are at the scene. The perpetrator (a former employee of the medical center) has been taken into custody, the victims are being treated, and the police are interviewing witnesses and gathering evidence.

    In this situation, the medical center’s crisis response plan called for the immediate involvement of an official from the public information office (PIO), in addition to the following BCMC employees:

    1. a top management representative;
    2. a security officer;
    3. a Human Resources (HR) specialist; and
    4. an Employee Assistance Program (EAP) counselor.

    Top management representative:

    The deputy hospital administrator coordinated the response effort because she was the senior person on duty at the time. In addition to acting as coordinator, she remained available to police throughout the afternoon to make sure there were no impediments to the investigation.

    She immediately called the families of the wounded and assigned two other senior managers to notify the families of the deceased. She also arranged for a friend of each of the deceased co-workers to accompany each of the managers. She took care of numerous administrative details, such as authorizing expenditures for additional resources, signing forms, and making decisions about such matters as granting leave to co-workers. It was necessary for the medical center to remain in operation and it was impossible to allow all of the employees to go home for the rest of the day.

    To ensure a coordinated response effort, she made sure that medical center personnel directly involved in the crisis had cell phones for internal communication while conducting their duties in various offices around the building.

    Security staff: The security staff assisted the police with numerous activities including locating witnesses and preserving the crime scene.

    HR representative: The HR specialist contacted the medical center’s corporate office and alerted them to the situation so that they could immediately begin to monitor any criminal and other legal proceedings. He made a detailed written record of the incident, but did not take statements from witnesses because to do so might have impeded the criminal investigation and possible subsequent prosecution of the case. He also helped the HR supervisor with internal documentation related to the incident.

    Employee Assistance Program (EAP) counselor: The medical center had only one EAP counselor available at the time of the incident. However, in prior planning for an emergency, the medical center had contracted with a local EAP provider to provide additional counselors on an “as needed” basis. The one EAP counselor on duty called the contractor and four additional counselors were at the medical center at the time. It was not possible to use the medical center’s social workers, as one of the victims was a social worker. The counselors remained available near the scene of the incident to reassure and comfort the staff. Since they were not medical center staff, they wore readily visible identification badges.

    Arrangements for post-incident traumatic stress debriefings were scheduled to begin in two days. The EAP counselor also arranged for two contract EAP counselors to be at the medical center for the next week to walk around the center inquiring how the staff members were doing and to consult with supervisors about how to help the staff in their recovery efforts.

    Public Information Officer: The PIO handled all aspects of press coverage. She maintained liaison with the media, provided an area for reporters to work, and maintained a schedule of frequent briefings.

    KEY ISSUES TO CONSIDER:

    The community, patients, press corps and employees of Boulder-Crest Medical Center realize there are no guarantees of personal safety and anti-terrorism in the modern era. But, BCMC was able to take lessons learned and boldly keep its commitment to safety and violence prevention in the medical workplace, and consider new solutions to the dilemma. Upon reviewing the situation at BCMC, consider the following questions:

    1) How would your healthcare facility or hospital have obtained the services of additional EAP counselors?
    2) How would or should employees be given information about this incident?
    3) Who would clean up the crime scene?
    4) Would you relocate employees who worked in the area of the crime scene?
    5) What approach would you take regarding the granting of excused absence on the day of the incident and requests for leave in the days/weeks following the incident?
    6) How would you advise BCMC management and administration to deal with work normally assigned to the victims?
    7) What support would your organization provide to supervisors to get the affected work group(s) back to functioning?
    8) What are the possible direct and indirect financial ramifications and recovery costs of the retroactive, crisis-prone approach to medical workplace violence, used at BCMC?
    9) What might have been the financial cost savings at BCMC, if a crisis-prepared approach to healthcare violence had been used?
    10) What might have been the financial costs of using a more pro-active, crisis-prepared approach to workplace violence at BCMC?

    Any thoughts on this sample case model after reading this chapter in the BMP 3.0?
    Gene

  2. Violent Women!

    I was saddened to learn of Amy Bishop PhD, the biology professor at the University of Alabama in Huntsville who is accused of shooting six and killing three of her colleagues during a faculty meeting in an apparent tenure dispute.

    She had also been a key suspect in an attempted bomb plot at Harvard University, and a doctor at Boston’s Children’s Hospital, in 1993.

    Christine

  3. Legislation Bills to Protect Nurses

    Two state bills are being proposed to impose stricter penalties on those that assault nurses on duty. The New York bill would make it a Class C or D Felony while the Ohio bill would “reclassify the crime as a fourth-degree felony, subject to fines of up to $5,000 and prison terms of between six and 18 months”.

    Article: http://polhudson.lohudblogs.com/2010/01/25/bill-would-make-assault-on-nurses-a-felony/
    Article: http://www.medcitynews.com/index.php/2009/12/ohio-lawmaker-to-propose-harsher-penalties-for-assault-of-nurses-in-workplace/

    Gene Schmuckler; PhD

  4. Violence in the medical workplace is indeed an emerging safety and health issue. Its most extreme form, homicide, is the fourth-leading cause of fatal occupational injury in the United States, according to the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI).

    Joshua

  5. The Johns Hopkins Shooting in my Home Town

    While the shootings last week at Johns Hopkins Hospital in Baltimore serve as a frightening reminder for healthcare facilities to revisit security and response plans, the tragedy also highlights the delicate nature of physician-patient interactions, especially when delivering difficult news, wrote Keith L. Martin in a Physician’s Practice Blog post.

    http://www.physicianspractice.com/blog/content/article/1462168/1667623

    Baltimore Sun: http://www.baltimoresun.com/health/bs-md-ci-shooting-hopkins-20100916,0,6535293.story

    And, of course, this textbook chapter by Dr. Eugene Schmuckler PhD.

    Dr. David E. Marcinko, MBA
    [Publisher-in-Chief]

    1. Stephen Harper should get out of the prnyiag business and leave that up to the Pope. Is it too much to ask that he actually do his job as an elected government official? At least he is being more realistic these days instead of wearing rose coloured glasses like he did during the election.

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