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Digital Issues

Hospital Shooting Puts Workplace Safety in the Spotlight

Police have charged Richard Plotts, the psychiatric patient who last week killed his caseworker and exchanged gunfire with his psychiatrist at Mercy Fitzgerald Hospital in Darby, Pa., with first-degree murder.

According to news reports, Mr. Plotts pulled a loaded .32-caliber semi-automatic handgun during a scheduled appointment and shot Theresa Hunt in the head at close range, killing the caseworker. Lee Silverman, MD, ducked behind a chair, drew his own handgun and shot Mr. Plotts 3 times before co-workers burst into the room to wrestle the armed patient to the ground. The psychiatrist suffered graze wounds on his temple and thumb, but Delaware County (Pa.) District Attorney Jack Whelan lauded his actions.

"I believe that if the doctor did not have a firearm, (and) the doctor did not utilize the firearm, he'd be dead today, and I believe that other people in that facility would also be dead," Mr. Whelan told reporters.

Dr. Silverman possessed a permit to carry the weapon, but carried it in violation of hospital policy, according to reports. Mercy Health System spokeswoman Bernice Ho says patients and visitors are required to check firearms with hospital officials during their stays.

"After a tragic event such as this, we certainly will review our policies and procedures to ensure we do all we can to protect our patients," she says, adding that Dr. Silverman remains a full member of Mercy Health's medical team.

The incident was another stark reminder of the dangers that healthcare workers face from acts of violence.

  • In 2010 at Johns Hopkins Hospital in Baltimore, a distraught man shot the orthopedic surgeon who delivered bad news about his mother's surgery.
  • In November 2013, another stabbed a nurse to death at a Texas ASC.
  • A month later, a gunman opened fire in a Reno, Nev., urology office, killing a physician and wounding 2 others.

In light of this violence that put healthcare workers in the crosshairs, as well as the 2013 incident in which a man opened fire at a Washington Navy Yard office complex, the staff at Parkway Surgery Center in Hagerstown, Md., approached Administrator Jennifer Collins, CMOM, CASC, about developing a plan of action for facing similar terror.

"It's a very stressful topic," says Ms. Collins. "The psychology of gunmen is that they want to do as much damage as they can in the shortest amount of time possible."

Local police instructed her to watch the video "Run, Hide, Fight", issued by the Federal Bureau of Investigation, which offers tips for surviving an active shooter event. The images are disturbing and the topic is tough to discuss, but the lessons are vitally important, says Ms. Collins.

The police emphasized that you can't predict anyone's behavior, including your own, when faced with an actual life-or-death death situation, she noted. The best you can do is to put policies in place to protect staff and patients when an armed intruder threatens their safety. But after talking with administrators from across the country at a recent conference, Ms. Collins was surprised at how few facilities have such plans in place.

Daniel Cook

What Nursing Shortage?

Do you remember hearing dire predictions of an oncoming nursing shortage about a decade ago? Well, never mind. New research says it never came to pass.

Nationwide, the nursing workforce has spiked higher than government estimates projected it would back at the turn of the century, which observers attribute to the economic downturn of recent years and an increase in new nurses.

A total of 2.7 million registered nurses were at work in the U.S. in 2012, half a million more than labor analysts anticipated from the standpoint of the year 2000. While they'd predicted a shortage as the baby boom generation's nurses retired, those nurses have been postponing retirement in large numbers — a move seen in many career fields.

In addition, nursing programs have seen more than double the number of graduates since then. In 2002, there were 500,000 nurses under age 35, a number that increased to 750,000 by 2012.

While the combination of more grads and fewer retirements can crunch young nurses looking for work, policy researchers at the RAND Corporation — writing in the journal Health Affairsspeculate that the baby boomers' exits will begin within the next 5 years, and that the increased patient population and demand for services created by federal healthcare reform legislation will provide many opportunities for skilled nurses, particularly in ASCs, office-based practices and other non-hospital employers.

David Bernard

Could JAMA Study Lead to Power Morcellation Ban?

One out of every 370 women who underwent minimally invasive hysterectomies via power morcellation had uterine cancer, says a recent study published in JAMA, but the significance of that study is widely misunderstood, says an expert in the field.

In a controversial advisory, the FDA recently cautioned against the use of power morcellation in hysterectomies because it can spread cancer in patients who have undetected uterine sarcomas. The agency recently held hearings that could result in an outright ban on power morcellation.

In contrast, however, Elizabeth Pritts, MD, director of the Wisconsin Fertility Institute, argues that people are missing an important distinction in the JAMA study — that uterine sarcoma is a rare subset of uterine cancer, involving only 2% to 4% of all cases. Dr. Pritts, who testified at the FDA hearings, says that she and 6 colleagues will soon publish a paper based on 133 studies that shows the number of patients with undetected sarcomas — those who might unknowingly undergo morcellation and have perilous outcomes — is about 1 in 6,500.

She and other practitioners argue that banning the procedure would do more harm than good, because open surgery is associated with significantly higher rates of morbidity and mortality.

Jim Burger

InstaPoll: Should a Healthcare Worker Be Permitted to Carry a Gun in the Workplace?

Workplace violence is a risk that healthcare workers face daily. Still, most hospitals and surgery centers prohibit workers, including physicians, from carrying guns. Tell us in this week's InstaPoll if you think healthcare workers should be allowed to carry a gun in the workplace, then check back next week for the results.

Are nurses working beyond retirement age nowadays? Without question, according to the results of last week's poll. Of the 819 who responded, 96% said baby-boomer RNs are working beyond retirement age. The results:

Are RNs working longer and delaying retirement?

  • yes 96%
  • no 2%
  • unsure 2%

Dan O'Connor

News & Notes

  • Tamper-resistant narcotic approved The FDA has approved a new, extended-release, long-acting opioid analgesic designed to deter oxycodone abuse. Targiniq ER, manufactured by Purdue Pharma, contains naloxone, which blocks the euphoric effects gained by abusers who crush and snort the drug or who dissolve and inject it.
  • Say no to triclosan soaps Soaps that contain triclosan aren't any more effective than other antimicrobial hand preparations, and actually kill a narrower spectrum of bacteria, which risks resistance and contamination, according to the leading infection prevention organizations, which have updated their recommendations for hand hygiene in the August issue of the journal Infection Control and Hospital Epidemiology.
  • Robots don't benefit bladders Sixty patients who underwent robotic-assisted radical cystectomies experienced similar rates of complications and lengths of hospital stays to the 58 patients who underwent open surgery, according to a study in the New England Journal of Medicine. The researchers concede experienced surgeons at a single high-volume center performed the procedures, but say the findings show the importance of weighing the benefits and risks of new surgical technology before implementing it.