Safety Net: With violence on the rise, otolaryngologists implement prevention strategies

The shooting of a doctor and two patients at Johns Hopkins Hospital in Baltimore in September sent a shudder of fear through all physicians, but for those who knew the late otolaryngologist John Kemink, MD, it was particularly saddening.

Dr. Kemink, a nationally acclaimed ear specialist who directed the Cochlear Implant Program at the University of Michigan Medical School, was shot to death by an angered, mentally ill patient in June 1992 during an examination at an otolaryngology clinic in Ann Arbor, Mich. Police said he was shot four times and died less than an hour later. His 70-year-old killer pleaded insanity but was found guilty.

Carol Bradford, MD, ACS, professor and chair of otolaryngology-head and neck surgery at the University of Michigan Health System, was in the hospital’s hallways that day, watching physicians, staff and patients fleeing from gunshots.

“If you ever go through anything like that, you will be changed for life,” Dr. Bradford said. “You’re never the same.”

Violence in the health care setting often draws the most attention in the wake of tragedies like the murder of Dr. Kemink or the shooting this fall at Johns Hopkins. But as a Joint Commission report from June notes, violence is always a reality in medical care. And while physicians once associated most violent acts with emergency departments situated in crime-filled urban pockets, the Joint Commission’s so-called “Sentinel Event Alert” points out that incident rates are rising, and that means all physicians need to take precautions.

“While the alert does not specifically mention otolaryngologists, the principles and guidelines can apply to caregivers across different care settings,” Kenneth Powers, a commission spokesman, wrote in an e-mail to ENT Today.

A Systemic Problem

Paul Schyve, MD, senior vice president of healthcare improvement at the Joint Commission, said the summer missive served to raise awareness of the potential dangers of violent incidents, whether they involve patients or staff. The commission’s Sentinel Event Database includes a combined category of assault, rape, and homicide with 256 reports since 1995, a number the organization suggests is under-reported. The report found that since 2004, hospitals have reported “significant increases in reports of assault, rape, and homicide.” According to the commission’s website, there were 6, 4, 24, 25 and 20 incidents each year in 2002, 2003, 2004, 2005 and 2006. In comparison, there were 36 reported incidents in 2007, 41 in 2008 and 33 in 2009.

Further, the report recommends that physicians learn techniques to identify potentially violent patients, implement violence de-escalation approaches and conduct violence audits to help determine safety protocols.