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Active Shooters in Hospital Environments: Time for Legal Prevention

posted on Wed, Jun 25 2014 2:15 pm by Layne Bettini, Kellie Nelson, and James G. Hodge, Jr.

Gun violence in hospital settings has become an alarming trend. From 2000–2011, over 150 hospital-related shootings across 40 states resulted in at least 235 victims. While reports of hospital shootings have garnered headlines nationally, two recent events stand out as notable examples. In September 2010, a gunman distraught about his mother’s medical condition entered the Johns Hopkins Hospital in Baltimore, where he shot his mother’s doctor before taking aim and killing his own mother, and then his own life. More recently, in January 2014, a shooter terrorized hospital staff and patients at Halifax Medical Center in Daytona Beach, Florida with a shotgun prior to committing suicide.

To counter threats from active shooters, hospitals have implemented various policies and practices, including trainings and procedures to assist staff in responding to dangerous situations. A New York City hospital now restricts access to many designated areas to staff with identification badges and patients and visitors with color-coded badges. Since implementing this restricted access program, violent crimes at the hospital dropped 65 percent over 18 months. Other hospitals have established emergency code policies (e.g., code black, code silver) to train and guide staff on procedures to follow during an active shooter situation, consistent with safety standards the Joint Commission assesses as part of hospital accreditation.

The federal Occupational Safety and Health Act of 1970 requires organizations to provide a workplace free from hazards that are likely to cause death or serious physical harm, including workplace violence. Although the Act was principally intended to address routine work-related injuries, it could apply to hospitals seeking to avoid gun violence. As noncompliance with these standards typically only results in minimal fines, hospitals may lack strong incentives to further ensure the safety of its premises.

The intention of the Act, however, is instructive. Prevention is a key component of many public health initiatives. Addressing hospital gun violence should appropriately begin from this cornerstone. Empirical evidence supports the role of prevention to decrease the chance of hospital gun violence. The Henry Ford Hospital in Detroit, for example, has significantly decreased its likelihood of workplace gun violence by voluntarily installing heightened security measures. These include metal detectors, which have been credited with preventing 33 handguns, over 1,300 knives, and numerous other weapons from entering the hospital over a 6 month period.

Laws may increasingly require hospitals to implement intense safety training for staff concerning active shooter events. Hospitals may consider heightened security measures at public entrances to mitigate the threat of gun violence. Given the high volume of traffic in hospital settings, putting these security measures into practice could be problematic, but the benefits of these initiatives far outweigh their logistical hurdles.

States might also consider implementing hospital gun-free zone laws, much like the laws relating to schools or airports. Of course, any time government seeks to restrict the carrying or use of guns, even if for public health purposes, Second Amendment rights may be raised, particularly concerning public hospitals. To the extent, however, that restrictions on carrying guns into courthouses, airports, sporting arenas, public schools, and federal buildings pass constitutional muster, so should limits on gun possession in hospitals and other health care settings. 

Minimizing the threat of active shooters inside hospitals is essential, but guarding hospital entrances may be insufficient. Up to 41 percent of hospital-related shootings occur on exterior grounds. To address this additional complication, implementing patient screening initiatives based on historical, diagnostic, and epidemiological indicators related to violence may help reduce risks of gun violence involving patients. Yet, this type of program may go too far by infringing patients’ privacy interests and possibly dissuading patients from seeking medical care. More data are needed to better assess the complex balance at stake in the protection of patients and staff from actionable violence contrasted with potential privacy invasions.

It is antithetical that in an environment designed to prolong patients’ lives and advance staff safety, active shooters may effortlessly or easily access facilities and engage in a killing rampage. These sorts of occurrences should be “never events.” Only through enhanced security, improved training, and access limitations undergirded by public health law may the rising trend of hospital-related gun violence be reversed.  

This blog post was prepared by Layne Bettini, J.D./M.D. candidate, Kellie Nelson, J.D. candidate, and James G. Hodge, Jr., J.D., LL.M., Director of the Network for Public Health Law – Western Region; Associate Dean & Lincoln Professor of Health Law and Ethics at the Sandra Day O’Connor College of Law, Arizona State University.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.

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