Shooting turns fear into reality for UCSF Stanford health system

Metal detectors, armed guard wouldn’t have helped, officials say

It is every emergency department (ED) manager’s worst nightmare: Violence erupts in the setting designed to nurture and sustain life. That fear became reality in March on the Mount Zion campus of the University of California at San Francisco (UCSF) Stanford Healthcare. The sequence of events occurred as follows, according to news accounts and comments from ED personnel:

The parents of a 47-year-old man with a history of mental problems were bringing their son, who was experiencing stomach pain, to the Mount Zion ED. After arriving, father and son argued about where the car was parked. The son was armed. The argument apparently continued as the family approached the main hospital lobby, which is half a block from the ED entrance. As the mother asked directions at the security office, she turned to her son, who was out of the guard’s line of vision, and told him to put his gun away. The guard, who was not armed, also told him to put the weapon away and immediately called 911. While he was on the telephone, the man opened fire, fatally wounding his father and hitting an environmental services employee in the leg.

Hearing the gunshots, some ED nurses came out through the double doors and brought the father inside. When the son attempted to follow the gurney, one of the nurses told him he couldn’t go in, and he retreated down the hallway toward the hospital lobby. He was standing there, holding the gun pointed down, when police arrived and arrested him.

In the wake of the incident, UCSF Stanford’s safety committee was brainstorming to determine what, if any, changes should be made, says Marcia Robinson, RN, patient care manager.

Security measures were being re-examined, including the possibility of installing metal detectors in the ED, hospital officials said. They pointed out, however, that metal detectors would not have prevented the shooting because the family was not in the ED. The shooting occurred in the public hallway leading to the ED, which is protected by double doors that have to be opened with a code, using a keypad, notes Pete Balestreri, director of security services for UCSF Stanford Healthcare. The code is given to ED staff, security officers, and ambulance drivers, he says.

If the gunman had attempted to enter the ED, Balestreri points out, he would have made it only into the reception area, where admitting personnel are behind a plexiglass shield.

"This was a domestic situation that spilled into the area of the hospital," he says. "It could have happened anywhere." Still, he says, the health system’s safety committee is taking the opportunity to review its security measures. "We’re looking at what the unwritten industry standards are. We have some facts that we’re pulling together on Bay Area standards, on arming guards, and on metal detectors, and [we] will make recommendations."

The use of metal detectors is not always practical, he says, because of the high volume of traffic in and out of the hospital. Arming guards could lead to more situations that turn violent. He cited a survey in the February 1998 Journal of Healthcare Protection Management, which is published by the International Association of Healthcare Security and Safety, that showed more than 80% of hospitals reject the arming of guards.

"Bringing weapons into a health care environment could make it more dangerous," Balestreri says. "The gun could be taken from an officer or viewed as a potential confrontation."

Robinson says, "It’s to our advantage that the guard was not armed. [The son] had a gun, shot his dad, continued to hold the gun with a bullet in it, and had a reloader in his other hand. No one was confrontational."

It was probably fortunate, she adds, that the ED nurses "just went about their business" during the incident. At first they didn’t realize the gunman was still standing by his victim, she explains, and when they did see the gun, they ignored it because they already were committed to providing care. "When [the son] tried to go into the ED, one of the nurses put up her hand and said, Sorry. You’re not allowed in.’"

Help was provided almost immediately for ED employees on duty during the incident, Robinson points out. Staff who were not working were called in to relieve their colleagues, and psychological counseling was available that day from UCSF Stanford’s Family Staff Support counselors. That allowed employees to express their feelings right away if they had trouble dealing with the shooting.

"They met with counselors, we ordered them pizza, and they came back," she says. "It was good that they did it right away, got it over with instead of waiting for an appointment. People just dealt with it and moved on."

Screen well, limit visitors for safety

Balestreri offers some general advice for managers concerned with keeping the ED as secure as possible: "It pays to have good screening procedures for visitors, and to limit visitors to one person per patient."

It’s also a good idea, he advises, to educate staff on recognizing gang activity and being more cognizant of victims of violent crime. "There are lots of ways to recognize gangs — colors and bandannas, certain hand signs and signals," he explains. "With any gunshot wound or stabbing, there is the risk of someone wanting to finish the job," and the victims also might be armed.

California legislation requires hospitals to provide classes for their employees on defusing potentially violent situations, Balestreri says. UCSF Stanford contracts with a company called Healthcare Security Services of California, which provides training.