The murder of high-profile forensic psychiatrist Steven Pitt, DO, was widely reported earlier this month after he was shot dead outside his office by a suspect who was allegedly disgruntled over his contentious divorce and custody battle. Dr. Pitt had previously conducted a court-ordered mental health evaluation on the suspect.
While coverage of Dr. Pitt’s death made national news due to the high-profile murder investigations he was known for working on, violence against physicians and other health care workers happens regularly, often under the radar, and has been a continuing concern for the profession.
“Violence can be due to changes in health care laws and prescribing policies that are getting patients very upset,” says Robert Piccinini, DO, a board-certified psychiatrist and AOA Trustee who has presented on the subject of violence in the workplace. “Physicians become the focus of their anger and angst.”
A 2012 study in the Annals of Emergency Medicine tallied more than 150 shootings in health care facilities between 2000 and 2011. “The ED [emergency department] environs were the most common site (29%), followed by the parking lot (23%) and patient rooms (19%),” the study authors wrote. “Most events involved a determined shooter with a strong motive as defined by grudge (27%), suicide (21%), ‘euthanizing’ an ill relative (14%), and prisoner escape (11%).”
According to 2013 data from the Bureau of Labor Statistics, approximately 75% of the nearly 25,000 workplace assaults reported each year occur in health care and social service settings. Employees in health care settings are four times more likely to be victimized than those in private industry.
The opioid factor
New prescribing guidelines for opioids in some states add more limits for prescribing physicians, says Dr. Piccinini, which in turn angers patients. “A majority of [opioid] patients aren’t doing anything wrong, but they’re branded as drug-seeking,” he says. “Doctors become the face of that, and that puts us at greater risk.”
The opioid epidemic has absolutely heightened the risk of violence against physicians, says Charles J. Sophy, DO, a psychiatrist in Beverly Hills, California. “Now that there is increased oversight and scrutiny [regarding opioid prescriptions], physicians may be less inclined to refill scripts out of fear of losing their license,” Dr. Sophy says. “If a patient is drug-seeking or going through withdrawal, they might use violence to get what they want. Those same risks apply to mental health specialists who work with people who have addictions.”
In 2015, the AOA House Of Delegates passed a resolution calling for “uniformity in laws in every state that would upgrade physical assault and verbal threat laws from misdemeanor to felony charges where applicable” when it comes to violence against health care staff.
That same year, the American Medical Association passed policy to support a new study on methods to prevent violence against physicians and other health care professionals in their workplaces after a Boston cardiac surgeon was fatally shot by a man suspected of having a grudge.
The Health Care Workplace Violence Prevention Act, H.R. 5223, was introduced in March 2018 by Rep. Ro Khanna of California. The bill would mandate that the federal Occupational Safety and Health Administration develop a national standard on workplace violence prevention that would require health care employers to adopt a comprehensive violence prevention plan.
Averting violence in health care settings
There’s no way to protect yourself against violence 100 percent of the time, says Dr. Piccinini, but physicians can take steps to make themselves and their employees less vulnerable. While hospitals and mental health clinics often have safety protocols in place, independent practices can be more at risk, especially if staff assume that an attack is unlikely to happen.
Dr. Piccinini suggests the following safety practices:
- Avoid looking at your phone as you walk out of the office.
- Pay close attention to the cars parked around you as you’re coming and leaving the office.
- Lock your car doors as soon as you get into your car.
Independent practices should consider policies they have in place for keeping doors between waiting areas and exam rooms locked or shut, and offer separate entrances for staff and patients if possible.
“It all comes back to just being more aware of your surroundings and what you’re doing, and communicating with your staff about that,” Dr. Piccinini says.
Charlie Ransford, director of science and policy at Cure Violence, an organization that offers training on implementing violence prevention methods in schools, prisons and other environments, says a hospital’s violence-prevention program could include training employees on the following:
- common instigators of violence so these can be avoided,
- when/how to remove themselves from risky situations,
- how to approach a high-risk situation, and
- how to de-escalate it.
A higher-level violence prevention program might include hiring workers whose job it is to actually respond to dangerous situations that arise. “Ideally you would hire someone who is credible to the perpetrators, looks like them, has a similar background,” Ransford says. “They would be trained in de-escalation and detection, as well as other skills.”
If your hospital or workplace is interested in more information on violence prevention, take a look at:
- The U.S. Department of Labor Occupational Safety guidelines for preventing workplace violence in health care settings.
- The Security Industry Association’s manual on managing the risk of health care workplace violence.
- This alert from hospital accreditor the Joint Commission, which provides information on helping organizations recognize workplace violence directed against health care workers, preparing staff to handle violence, and addressing its aftermath.